Image-enhanced endoscopy in upper GI tract: State-of-the-art review

Early and accurate identification of upper gastrointestinal (GI) malignancies remains a cornerstone for improving clinical outcomes. Conventional white light endoscopy, although the standard diagnostic modality, often fails to detect subtle premalignant and early neoplastic changes. Image-enhanced endoscopy (IEE) addresses these limitations by improving visualization of surface structures and vascular patterns. Despite its proven diagnostic value, IEE remains underutilized in resource-limited settings, largely due to lack of training and standardization. Adoption of structured training programs and digital learning tools could help bridge these gaps and enhance the detection of early GI neoplasms. This comprehensive review outlines the clinical utility of IEE in upper GI endoscopy, with a particular focus on narrow band imaging. Practical tips for usage are provided on equipment selection, procedural preparation and standardized examination techniques such as the Systematic Screening Protocol for the Stomach (SSS). Pre-medications, use of soft black hoods and anti-peristaltic agents are highlighted as critical adjuncts for optimizing visualization.