The impact of image-enhanced endoscopy for the detection of parasites in the gastrointestinal tract.

I read with great interest the article by Wong Becerra et al., presenting vivid images of Anisakis larvae captured using blue-laser imaging (BLI) and magnification. I would like to congratulate the authors on providing novel insights into the identification and extraction of parasites in the stomach. I would like to comment on the utility of image-enhanced endoscopy (IEE) in cases other than neoplasms. Conventional white light endoscopy can sometimes have difficulty distinguishing the larvae from white mucus threads, light reflections, and the inflamed or edematous background mucosa. Narrow-band imaging (NBI), a form of IEE, emphasizes the larvae by enhancing the contrast between their bodies and the surrounding mucosa, making them more visible. Wong Becerra and colleagues have suggested that BLI, which operates via a different mechanism to IEE, could be useful in improving the detection and facilitating treatment of gastric anisakiasis. While the typical symptoms of severe abdominal pain and a detailed patient history of consuming raw fish can lead to a diagnosis of anisakiasis and the decision to perform an endoscopy, a recent large-scale Japanese study revealed that 22.2% of the 212 cases of gastric anisakiasis were asymptomatic. Thus, IEE can help to prevent the penetrating Anisakis larvae from being overlooked, even in asymptomatic patients. In conclusion, Wong Becerra's excellent images highlight the importance of IEE in detecting parasites in the gastrointestinal tracts. Further studies are needed to evaluate the utility of IEE in this condition.