title: Gastric endoscopy in the 21st century: appropriate use of an invasive procedure in the era of non-invasive testing.
abstract: BACKGROUND
  The acceptance of the premise that Helicobacter pylori infection is aetiologically related to gastric cancer and peptic ulcer and that the risk of gastric cancer among Helicobacter pylori infected individuals is related to the extent, severity and duration of atrophic gastritis has led to major changes in medical and endoscopic practices. The development of non-invasive methods to detect Helicobacter pylori and to estimate the extent and severity of gastritis has reduced the need for diagnostic endoscopy in asymptomatic individuals.
  
  
  RESULTS
  Here we provide recommendations regarding deciding whether non-invasive and endoscopic assessment of the gastric mucosa is preferred. We also include specific recommendations and caveats regarding the preferred biopsy number and sites as well as the identification of specimens, to allow the pathologist to reliable stage the severity and extent of gastritis, and thus provide prognostic information needed for patient managements (e.g., whether endoscopic surveillance is recommended).
  
  
  CONCLUSIONS
  In summary, while there is clearly a role for gastric endoscopy and endoscopic biopsy in the Helicobacter pylori era, obtaining useful diagnostic and prognostic information is critically dependent upon attention to detail with regard to biopsy site and identification as to the location from where the specimen was taken.
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 77030, USA. dgraham@bcm.tmc.edu
authors.forename: D Y
authors.initials: DY
authors.lastname: Graham
authors.forename: M
authors.initials: M
authors.lastname: Kato
authors.forename: M
authors.initials: M
authors.lastname: Asaka
mesh_terms: D001706:Biopsy / Q000379:methods*; D005757:Gastritis, Atrophic / Q000175:diagnosis / Q000382:microbiology*; D005773:Gastroscopy / Q000379:methods*; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D010437:Peptic Ulcer / Q000175:diagnosis / Q000382:microbiology; D015995:Prevalence; D011379:Prognosis; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology