A systematic review of the role of non-magnified endoscopy for the assessment of infection.

There is growing interest in the endoscopic recognition of infection, and application to routine practice. We present a systematic review of the current literature regarding diagnosis of during standard (non-magnified) endoscopy, including adjuncts such as image enhancement and computer-aided diagnosis.  The Medline and Cochrane databases were searched for studies investigating performance of non-magnified optical diagnosis for , or those which characterized mucosal features associated with infection. Studies were preferred with a validated reference test as the comparator, although they were included if at least one validated reference test was used.  Twenty suitable studies were identified and included for analysis. In total, 4,703 patients underwent investigation including white light endoscopy, narrow band imaging, i-scan, blue-laser imaging, and computer-aided diagnostic techniques. The endoscopic features of infection observed using each modality are discussed and diagnostic accuracies reported. The regular arrangement of collecting venules (RAC) is an important predictor of the -naïve stomach. "Mosaic" and "mottled" patterns have a positive association with infection. The "cracked" pattern may be a predictor of an negative stomach following eradication.  This review summarizes current progress made in endoscopic diagnosis of infection. At present there is no single diagnostic approach that provides validated diagnostic accuracy. Further prospective studies are required, as is development of a validated classification system. Early studies in computer-aided diagnosis suggest potential for a high level of accuracy but real-time results are awaited.