Narrow Band Imaging Endoscopy Research Articles

Microarchitectures of Barrett's esophagus associated with DNA methylation status.

Aim: DNA methylation is involved in esophageal adenocarcinoma (EAC) and Barrett's esophagus (BE). Microarchitectures of on-neoplastic BE associated with DNA methylation status were examined using magnifying narrow-band imaging (NBI) endoscopy. Patients and methods: Using biopsies from non-neoplastic BE without cancer (n=66; N group), with EAC (n=27; ADJ group) and EAC tissue (n=22; T group), methylation of N33, DPYS, SLC16A12, miR124a3 andmiR34bc genes were quantified. MagnifyingNBI features of non-neoplastic BE were classified according to their morphologies. Results: TheADJ and T groups presented higher DNA methylation compared with theN group. Magnifying NBI endoscopic features of non-neoplastic BE also correlated with DNA methylation as an independent factor. Conclusion: Microarchitectures of BE visualized by magnifying NBI endoscopy correlated with DNA methylation.

Endoscopic features of gastric neuroendocrine carcinoma.

The endoscopic features of gastric neuroendocrine carcinoma (G-NEC) have not been clarified; therefore, they were investigated in relation to clinicopathological findings. Consecutive patients with G-NECs who had undergone endoscopic or surgical resection at our institution between January 2005 and March 2022 were included in this retrospective study. The endoscopic and clinicopathological findings of the lesions were analyzed to provide information of diagnostic value. In addition, cases of gastric neuroendocrine tumor (G-NET) and common-type gastric adenocarcinoma treated in the same study period were identified to compare the endoscopic findings between each G-NEC versus G-NET, and G-NEC versus common-type gastric adenocarcinoma. Patients with common-type gastric adenocarcinoma were matched for age, sex, tumor size, and depth of tumor invasion in 1:3 ratio. Among 15 patients with 15 G-NECs, submucosal tumor-like marginal elevation (87%), adherent white coat (67%), and ulceration with a distinct border (60%) were characteristic endoscopic findings in white-light images. Magnifying narrow-band imaging endoscopy revealed an absent microsurface (MS) pattern plus disrupted irregular microvessel (MV) in five (71%) of seven cases with evaluable MS and MV patterns. The area with an absent MS pattern plus disrupted irregular MV corresponded to the histological finding of NEC component in all five cases. These endoscopic features were all significantly more frequent in G-NECs than G-NETs (n=22) or common-type gastric adenocarcinomas (n=45). These endoscopic features should be taken into consideration to increase the index of suspicion and to improve the accuracy of target biopsies for G-NEC.

Comparison of narrow-band imaging with autofluorescence imaging for endoscopic detection of squamous cell carcinoma of the tonsil

PurposeEarly detection of mucosal neoplastic lesions is crucial for a patient’s prognosis. This has led to the development of effective optical endoscopic diagnostic methods such as narrow band imaging (NBI) and autofluorescence (AFI). Independent of each other, both of these methods were proven useful in the detection of mucosal neoplasias. There are limited reported data comparing both methods for oropharyngeal cancer diagnostics. The aim of the study was to compare NBI and AFI endoscopic visualization of signs in identifying tonsillar squamous cell carcinoma (SCC) and assessing its extent and to determine whether the score was related to the evaluator’s experience.MethodsPatients with tonsillar SCC underwent endoscopic pharyngeal examination using NBI and AFI. Fiftyseven video sequences of examinations of lesions proven to be SCC were evaluated by three reviewers. The accuracy of determination of lesion extent and visualization of its endoscopic signs of malignancy were evaluated.ResultsEndoscopic visualization of tumour spread was significantly better using AFI than NBI (p = 0.0003). No significant difference was found between NBI and AFI in the visualization of endoscopic malignancy determining signs (p = 0.1405). No significant difference was found among the three reviewers in the visualization of tumour spread and for identifying malignancy-determining signs in NBI endoscopy or AFI endoscopy.ConclusionsThe results show that AFI obtained better results for assessing the extent of tonsillar cancers than NBI. Both methods were proven to be equal in the visualization of endoscopic malignancy-determining signs. Both are useful even for less experienced evaluators.

Gastrointestinal: Unusual pathology of an anorectal lesion mimicking a benign laterally spreading tumor.

A 70-year-old woman was referred to our institution for the diagnosis and treatment of an anorectal lesion detected on colonoscopy performed at a previous hospital for hematochezia. Colonoscopy revealed a 32-mm flat elevated lesion in the lower rectum with an anal component extending to the dentate line (Fig. 1a). Chromoendoscopy with indigo carmine spraying demonstrated a papillary surface (Fig. 1b). Magnifying endoscopy with narrowband imaging (NBI) displayed an irregular vessel resembling the intrapapillary capillary loop (IPCL) of the Japan Esophageal Society Classification Type B1 (Fig. 1c). Magnifying endoscopy with 0.05% crystal violet staining revealed the absence of discernible glandular ducts, hindering the evaluation of the pit pattern (Fig. 1d). The endoscopic appearance resembled a large adenoma or condyloma acuminatum; however, the absence of a pit pattern indicated that the lesion was covered with squamous epithelium and not columnar. Moreover, the irregular vessel pattern suggested a neoplastic lesion. Based on these observations, the lesion was diagnosed as a neoplasm originating from the squamous epithelium of the anal canal. Thus, we performed endoscopic submucosal dissection for complete elimination. Histological examination revealed a papillary growing squamous cell carcinoma (SCC) exhibiting low-grade and high-grade atypia and abundant dilated vessels (Fig. 2a). The tumor extended from the anal transitional zone (ATZ) to the rectum and entrapped the rectal crypts (Fig. 2b). Some tumor cells had a clear cytoplasm, indicative of koilocytosis (Fig. 2c), and positive p16 immunohistochemical staining suggested human papillomavirus (HPV) infection (Fig. 2d). The final diagnosis was HPV-associated SCC in situ originating from the ATZ with rectal extension. Anal canal cancer (ACC) is a rare disease that accounts for only 0.3% of all malignancies and is strongly associated with high-risk HPV (HPV-16 and HPV-18). This case was unusual because of the extensive infiltration of the columnar epithelium. Therefore, it might be misidentified as a rectal adenoma. Early ACC shows irregular vessel patterns reminiscent of esophageal SCC on magnified endoscopic NBI, which has been reported to be useful in diagnosing ACC. However, laterally spreading tumor (LST) can exhibit similar irregular capillary vessels. The difference in endoscopic appearance between ACC and LST can be explained by their different epithelial anatomies. ACC develops in the squamous cell epithelium and has no orifice or crypt. In contrast, LST originates from the columnar epithelium and has crypt openings. Condyloma acuminatum has a similar endoscopic appearance but with milder vascular dilatation and caliber changes. In conclusion, HPV-associated anal canal cancer can be suspected in papillary tumors with an irregular esophageal SCC-like vascular pattern and absence of glandular structures. Piecemeal endoscopic mucosal resection can be selected for large adenomas; conversely, en bloc resection is the preferred method for ACC to mitigate the risk of recurrence. To ensure the implementation of appropriate treatment, more attention should be paid to lesions extending along the anal canal to the rectum.

Diagnosis of nasopharyngeal carcinoma with convolutional neural network on narrowband imaging

Objective:To evaluate the diagnostic accuracy of the convolutional neural network（CNN） in diagnosing nasopharyngeal carcinoma using endoscopic narrowband imaging. Methods:A total of 834 cases with nasopharyngeal lesions were collected from the People's Hospital of Guangxi Zhuang Autonomous Region between 2014 and 2016. We trained the DenseNet201 model to classify the endoscopic images, evaluated its performance using the test dataset, and compared the results with those of two independent endoscopic experts. Results:The area under the ROC curve of the CNN in diagnosing nasopharyngeal carcinoma was 0.98. The sensitivity and specificity of the CNN were 91.90% and 94.69%, respectively. The sensitivity of the two expert-based assessment was 92.08% and 91.06%, respectively, and the specificity was 95.58% and 92.79%, respectively. There was no significant difference between the diagnostic accuracy of CNN and the expert-based assessment （P=0.282, P=0.085）. Moreover, there was no significant difference in the accuracy in discriminating early-stage and late-stage nasopharyngeal carcinoma（P=0.382）. The CNN model could rapidly distinguish nasopharyngeal carcinoma from benign lesions, with an image recognition time of 0.1 s/piece. Conclusion:The CNN model can quickly distinguish nasopharyngeal carcinoma from benign nasopharyngeal lesions, which can aid endoscopists in diagnosing nasopharyngeal lesions and reduce the rate of nasopharyngeal biopsy.

A comparison of the efficacy of narrow band imaging and contact endoscopy in an early diagnosis of squamous malignancies of the upper aerodigestive tract

BackgroundThis study aims to compare the efficacy of narrow band imaging (NBI) endoscopy and contact endoscopy in early diagnosis of squamous malignancies of upper aerodigestive tract. MethodsThis study was of 18 months duration, sample size 50, and carried out at tertiary care hospital. The patients were subjected initially to NBI endoscopy followed by contact endoscopy. Thereafter, the lesion was biopsied and subjected to histopathological examination as is done routinely. The images obtained were analyzed based on criteria proposed by earlier studies and compared with histopathological examination as gold standard. ResultsThe sensitivity, specificity, and negative predictive values of NBI in early diagnosis of squamous malignancies of upper aerodigestive tract were high and better than contact endoscopy. ConclusionEndoscopic NBI is a noninvasive and promising tool used for in vivo differentiation between malignant and nonmalignant lesions of upper aerodigestive tract by using morphology of mucosal capillaries and is more efficacious than contact endoscopy. It can be employed as part of routine ENT examination in outpatient departments; however, it has got a learning curve associated with it.

Accuracy of narrow-band imaging for diagnosing malignant transformation of vocal cord leukoplakia: A systematic review and meta-analysis.

To explore whether narrow-band imaging (NBI) endoscopy is accurate in the diagnosis of malignant transformation of vocal cord leukoplakia. The PubMed, Embase, Cochrane Library and Web of Science databases were searched to collect data on studies reporting the use of NBI endoscopy as a diagnostic test for diagnosing vocal cord leukoplakia from January 2015 to December 2021. Study design, analysis method, and extraction results were performed according to the PRISMA guidelines. The sensitivity, specificity, pooled positive likelihood ratio (PLR), negative likelihood ratio (NLR) and area under the curve (AUC) were used to summarize the performance metrics of the meta-analysis. Risk of bias data and the quality of the included studies was evaluated according to the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2). Nine studies were finally included in the analysis. The results of the meta-analysis showed that the pooled sensitivity and specificity of NBI endoscopy for diagnosing leukoplakia lesions were 0.76 (95% CI: 0.72-0.8) and 0.93 (95% CI: 0.91-0.95), respectively. The PLR and NLR were 10.09 (95% CI: 6.53-15.59) and 0.22 (95% CI: 0.13-0.38), respectively. The comprehensive diagnostic odds ratio (DOR) was 54.96 (95% CI: 24.32-124.17), and the area under the curve was 0.9584. The eight articles had a low risk of bias risk and one article was unclear. NBI likely has good accuracy for diagnosing malignant transformation of vocal cord leukoplakia. However, multicenter studies and large samples are still needed.

Narrow band imaging versus lugol chromoendoscopy in screening for esophageal squamous neoplasia: a randomized trial.

An optimal method for endoscopic detection of esophageal squamous cell neoplasia in high-risk individuals is not yet established. We aimed to compare the narrow-band imaging (NBI) and Lugol chromoendoscopy in screening for esophageal neoplasia among patients after treatment for head and neck squamous cell cancers (HNSCC). We randomly assigned 300 patients ≥1 year after curative treatment of HNSCC in a 2:1 ratio to NBI or Lugol endoscopy. Following white-light examination of the esophagus, one of the assigned imaging modality was performed and biopsies were taken from any suspicious lesion identified with NBI or Lugol chromoendoscopy. The primary endpoint was positive predictive value (PPV) of biopsied lesion for diagnosis of esophageal neoplasia (high-grade intraephitelial neoplasia (HG-IEN) and invasive squamous cell esophageal carcinoma, ESCC). The secondary endpoints included number of biopsied lesions, time of esophagus examination, and endoscopy tolerance. In 294 patients (204NBI: 90Lugol) 3 ESCC(1.02%) and 2 HG-IEN (0.68%) were diagnosed. The PPV of NBI and Lugol in per-lesion analysis were 7.69% (95% CI, 0.94%-25.1%) and 8.11% (95% CI, 1.70%-21.9%), respectively (P = 1.0). The NBI outperformed Lugol in the rate of patients requiring biopsy (12.75% vs. 41.11%, P = 0.003), esophagus examination time (3.50 min. vs. 5.15 min., P <0.001) and endoscopy tolerance (25.0 mm vs. 36.5mm, P = 0.002). With a comparable PPV, but lower number of biopsies required, shorter examination time and better patient tolerance, NBI could be considered primary screening method for ESCC in patients with HNSCC.

Diagnostic Value of Adding Magnifying Chromoendoscopy to Magnifying Narrow-Band Imaging Endoscopy for Colorectal Polyps

This study examined the additional value of magnifying chromoendoscopy (MCE) on magnifying narrow-band imaging endoscopy (M-NBI) in the optical diagnosis of colorectal polyps. A multicenter prospective study was conducted at 9 facilities in Japan and Germany. Patients with colorectal polyps scheduled for resection were included. Optical diagnosis was performed by M-NBI first, followed by MCE. Both diagnoses were made in real time. MCE was performed on all type 2B lesions classified according to the Japan NBI Expert Team classification and other lesions at the discretion of endoscopists. The diagnostic accuracy and confidence of M-NBI and MCE for colorectal cancer (CRC) with deep invasion (≥T1b) were compared on the basis of histologic findings after resection. In total, 1173 lesions were included between February 2018 and December 2020, with 654 (5 hyperplastic polyp/sessile serrated lesion, 162 low-grade dysplasia, 403 high-grade dysplasia, 97 T1 CRCs, and 32 ≥T2 CRCs) examined using MCE after M-NBI. In the diagnostic accuracy for predicting CRC with deep invasion, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for M-NBI were 63.1%, 94.2%, 61.6%, 94.5%, and 90.2%, respectively, and for MCE they were 77.4%, 93.2%, 62.5%, 96.5%, and 91.1%, respectively. The sensitivity was significantly higher in MCE (P < .001). However, these additional values were limited to lesions with low confidence in M-NBI or the ones diagnosed as ≥T1b CRC by M-NBI. In this multicenter prospective study, we demonstrated the additional value of MCE on M-NBI. We suggest that additional MCE be recommended for lesions with low confidence or the ones diagnosed as ≥T1b CRC. Trials registry number: UMIN000031129.

An Unusual Case of Significant Cervical Esophageal Stricture

Question: A 65-year-old man was referred to our facility for solid-food dysphagia without other disease history. He lived a happy and healthy life without abuse of alcohol or tobacco. The symptom started about 2 years before, without accompanying heartburn and regurgitation, and did not progress significantly. A stricture at the upper orifice of the esophagus was found (Figure A) and hampered the routine endoscopic examination (GIF-Q260; Olympus). Instead, an ultrathin endoscope (GIF-XP290N; Olympus) was used, which revealed a well demarcated translucent white scaly lesion with shaggy surface distributed in a two-thirds circumferential arrangement from 15 cm to 25 cm of the esophagus distal to the incisors (Figure B, Video A). Narrow-band imaging endoscopy showed a distinct white irregular map-like area (Figure C, Video A). Computer tomography (CT) did not show any neck mass or thickness of the cervical esophageal wall (Figure D). Multiple biopsies were obtained from the proximal esophagus. No malignancy was confirmed pathologically (Figure E).

Evaluating hypopharyngeal carcinoma using narrow band imaging and oxygen-injected laryngoscope: New technique

ObjectiveTo evaluate the diagnostic value of narrow band imaging (NBI) endoscopic classification for hypopharyngeal lesions and to lay the groundwork for practical applications of oxygen-injected laryngoscope for hypopharyngeal carcinoma (HC). MethodsA total of 140 subjects with suspected 146 hypopharyngeal lesions were selected for pathological examination. Subsequently, NBI and white light imaging (WLI) endoscopy were performed to observe and classify lesions into 7 types according to our modified NBI classification. Pathological results were used as the gold standard to assess the diagnostic value of the NBI classification. The value of oxygen-injected laryngoscope for accurate assessment of lesion extension was evaluated based on the exposure of hypopharyngeal lesions before and after use. ResultsThe accuracy, sensitivity, and negative predictive value of NBI endoscopy in diagnosing hypopharyngeal lesions were 95.9 %, 96.7 %, and 84.6 %, respectively, which were higher than those of WLI mode (p < 0.05). NBI endoscopy was more accurate than WLI in diagnosing malignant lesions (p < 0.05), especially for high-grade dysplasia (HGD) (p < 0.05). There was remarkable consistency between NBI classification and pathological results (Kappa = 0.855). Type Va and type Vb-c accounted for 72.7 % and 92.8 % of HGD and invasive carcinoma, respectively. Moreover, the oxygen-injected laryngoscope was found to provide a more accurate assessment of HC extension (P < 0.001). ConclusionWe propose a more appropriate NBI endoscopic classification for hypopharyngeal lesions, which can effectively improve diagnostic accuracy, especially for the early diagnosis of hypopharyngeal cancer. Moreover, the application of oxygen-injected laryngoscope is essential for the accurate assessment of HC and has a high clinical utility.

Endoscopic Grading of Gastric Intestinal Metaplasia Using Magnifying and Nonmagnifying Narrow-Band Imaging Endoscopy.

Several endoscopic findings obtained by magnifying image-enhanced endoscopy (IEE) are reportedly correlated with gastric intestinal metaplasia (IM); however, the differences between magnifying and nonmagnifying IEE for the diagnosis of gastric IM remain unknown. This study included 100 consecutive patients who underwent narrow-band imaging endoscopy. Four areas of the stomach were evaluated using nonmagnifying and magnifying IEE. Light-blue crest (LBC), white opaque substance (WOS), and endoscopic grading of the gastric IM (EGGIM) were assessed. The concordance rates between nonmagnifying and magnifying IEE were 80.5% for LBC and 93.3% for WOS. The strength of agreement between each observation technique showed good reproducibility, with a kappa value of 0.69 and 0.83 for LBC and WOS, respectively. The individual EGGIM score indicated a good correlation between nonmagnifying and magnifying IEE (concordance rate, 75%; kappa value, 0.67). The prevalence of a high EGGIM score in patients with and without gastric cancer (GC) showed a significant difference both with nonmagnifying IEE (odds ratio (OR), 3.3; 95% confidence interval (CI), 1.2-9.0), and magnifying IEE (OR, 3.1; 95% CI, 1.1-8.9). Nonmagnifying IEE has the potential to stratify the individual risk of GC, similar to magnifying IEE, warranting further investigation with histological assessment.

Intrabronchial haemorrhage – the bronchoscopist’s nightmare: A case of major haemoptysis due to pulmonary Dieulafoy’s disease

Massive haemoptysis is a term used to describe a large amount of expectorated blood or rapid rate of bleeding (&gt;100 ml blood in 24 h) and is associated with a serious risk of death. However, there is no clear consensus on its definition [1]. In the present we report the case of a 39-year-old male, investigated for haemoptysis, quickly turning bad during diagnostic flexible bronchoscopy due to a rare condition. The congenital abnormality with displaced right upper lobe segmental bronchus and lack of the apical segment bronchus of the right lower lobetogether with the endoscopic narrow-band imaging were the diagnostic clues for the presence of pulmonary Dieulafoy‘s disease and angiographic glue embolization (n-butyl-2-cyanoacrylate) the treatment of choice.

H. pylori-associated chronic gastritis: status update on the problem

Chronic gastritis is a group of chronic diseases that are morphologically characterized by persistent inflammatory infiltrate and impaired cellular turnover with the development of intestinal metaplasia, atrophy, and epithelial dysplasia in the gastric mucosa. Numerous studies have shown that Helicobacter pylori (H. pylori) infection is the absolutely dominant etiological factor of CG worldwide. Given this fact, the Expert Council of the latest Maastricht VI 2022 consensus recommended that H. pylori is to be treated as a pathogen, which always results in the development of CG. The prevalence of H. pylori-associated CG is about 44.3–48.5%, however 80–90% of cases are asymptomatic. In H. pylori­infected patients with dyspepsia and no other pathology of the gastroduodenal region, which has been confirmed endoscopically, clinical manifestations can be interpreted as part of H. pylori­associated CG if a long-lasting remission of symptoms has been achieved after successful eradication therapy. While patients with persistent dyspeptic symptoms can be considered as patients with functional dyspepsia, despite successful eradication therapy. Advanced endoscopic techniques (narrow band imaging (NBI) endoscopy, high resolution endoscopy, chromoendoscopy, laser confocal endomicroscopy) are precise and reproducible methods for diagnosing precancerous changes in the mucous membrane. However, the diagnosis of CG requires that inflammatory cells have been histologically detected in the lamina propria. The CG therapy aims to reach a persistent relief of dyspeptic symptoms of the disease (if any), as well as resolution of inflammatory processes and prevention of the progression of precancerous changes in the gastric mucosa. The achievement of these goals is primarily determined by the timely diagnosis of H. pylori infection and successful eradication therapy.

Narrow-band imaging Dual focus endoscopy capabilities in diff erential diagnosis of intestinal metaplasia types

Stomach cancer has an important place in medicine. Unfortunately, diagnosis of gastric cancer is being established in majority of cases at the IV stage. So, yt is necessary to detect tumors at the earliest stages of carcinogenesis and to evaluate and treat precancerous diseases, such as gastric atrophy and intestinal metaplasia. Aims : To estimate the value of Narrow-band imaging Dual focus (NBI Dual Focus) endoscopy capabilities in differential diagnosis of intestinal metaplasia types. We evaluated the data of Russian and foreign articles on this topic from 2011 to 2021. In our study 46 patients with suspected intestinal metaplasia admitted to Nizhny Novgorod Oncology Dispensary. We have performed multimodal endoscopy, including White light endoscopy (WLI), narrow-band imaging (NBI, WLI, BLI — 28) and Dual focus endoscopy (18). Sydney system based multifocal biopsy and targeted biopsy of IM foci were performed in all cases. Results : Verification of intestinal metaplasia, visualized with WLI, was confirmed in only 59% cases. However, intestinal metaplasia, observed with NBI, was confirmed by pathology in 100% cases. NBI Dual Focus endoscopy made possible to differentiate complete and incomplete intestinal metaplasia also in all patients. Conclusions : Intestinal metaplasia can be successfully diagnosed with NBI endoscopy. Differential diagnosis of types of intestinal metaplasia and other variants of gastric mucosa metaplasia is possible using narrow-spectrum endoscopy with dual focus (NBI Dual Focus).

Multidisciplinary treatment strategy for early colon cancer

Background: Treatment for early colon cancer has progressed rapidly with endoscopic resection and minimally invasive surgery. Selection of patients without risk of lymph node metastasis is necessary before deciding on endoscopic resection for early colon cancer treatment. We aimed to review the optimal multidisciplinary treatment strategies for early colon cancer, including endoscopy and surgery.Current Concepts: Pathological risk factors include histologic grade of cancer cell differentiation, lymphovascular invasion, perineural invasion, tumor budding, and deep submucosal invasion. These risk factors for predicting lymph node metastasis are crucial for determining the treatment strategy of endoscopic excision and radical resection for early colon cancer. Prediction of the depth of invasion in early colon cancer using endoscopic optical assessments is vital to determine the appropriate treatment method for endoscopic or surgical resection. Furthermore, optical assessment of pit and vascular patterns is useful for estimating the depth of submucosal invasion using magnifying chromoendoscopy and narrow-band imaging endoscopy. Performing an endoscopic and pathologic evaluation of the risk factors for lymph node metastasis is imperative when selecting endoscopic or surgical resection. Endoscopic treatments include cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection. In addition, appropriate surgical treatment should be recommended for patients with early colon cancer with a high risk of lymph node metastasis.Discussion and Conclusion: A multidisciplinary approach should be recommended to establish an optimized treatment strategy, minimize the risk of complications, and obtain excellent oncologic outcomes via patienttailored treatment in patients with early colon cancer.

Diagnostic Value of Endoscopic Narrow-Band Imaging Technique in Early Gastric Cancer and Precancerous Lesions.

Objective To investigate the diagnostic value of endoscopic narrow-band imaging technique in early gastric cancer and precancerous lesions. Methods A total of 100 patients with recurrent upper gastrointestinal symptoms in our hospital from January 2017 to January 2022 were selected and divided into group A and group B according to the random number table method, with 50 cases in each group. Group A received white light endoscopy, and group B received narrow-band imaging technology combined with endoscopy. Narrow-band imaging combined with magnifying endoscopy was used to stain the area with suspicious mucosal lesions with indigo carmine and magnified observation. Results The endoscopic image clarity of group B was significantly better than that of group A in terms of lesion outline, gastric pit, and microvascular morphology (P < 0.05). There were 10 cases of early gastric cancer, 18 cases of benign lesions, and 9 cases of gastric cancer (nonearly stage); 17 cases of precancerous lesions, 12 cases of early gastric cancer, 13 cases of benign lesions, and 6 cases of gastric cancer (nonearly stage) were diagnosed by ordinary white light endoscopy. Pathological results confirmed that among the 50 patients in group B, there were 15 cases of precancerous lesions, 11 cases of early gastric cancer, 17 cases of benign lesions, and 7 cases of gastric cancer (nonearly stage). Among the 50 patients in group A, 16 were precancerous lesions, 11 were early gastric cancer, 15 were benign lesions, and 8 were gastric cancer (non early stage). In the diagnosis of precancerous lesions and early gastric cancer, the diagnostic consistency, sensitivity, and specificity of group B were better than those of group A (P < 0.05); NBI combined with endoscopy in the diagnosis of precancerous lesions and early gastric cancer (kappa = 0.860, kappa = 0.883) was more consistent with pathological diagnosis than common white light endoscopy (kappa = 0.433, kappa = 0.535). Conclusion The value of narrow-band imaging technology combined with endoscopy in the diagnosis of precancerous lesions and early gastric cancer is better than that of ordinary white light endoscopy, and it can be widely used in clinical practice.

Submucosal Clustered Brownish Microvessels Based on NBI Endoscopy: A Characteristic of LPR.

This study aimed to analyze the characteristics of laryngopharyngeal reflux (LPR) by using narrow band imaging (NBI) endoscopy. A prospective study. A large-volume practice with tertiary care providers. A total of 67 patients with suspected LPR who underwent 24-hour multichannel intraluminal impedance-pH monitoring were included from June 2020 to March 2022. Manifestations of NBI endoscopy included submucosal clustered brownish microvessels (CBMs), spotted brownish microvessels, and no special microvessels; the latter 2 formed the non-CBM group. The manifestations of all patients and their changes were observed after 8 weeks of proton pump inhibitor and symptomatic treatment for patients with LPR, and symptomatic treatment for patients without LPR. According to the results of 24-hour multichannel intraluminal impedance-pH monitoring, the incidence of submucosal CBMs was significantly higher in patients with LPR (30 cases) than in those without LPR (37 cases, P < .001), particularly in the posterior cricoid area (P < .001). Besides Reflux Finding Score, the incidence of signs such as subglottic edema and vocal fold edema was significantly higher in the CBM group than the non-CBM group (P < .05). Finally, 22 patients with LPR (91.7%) and only 2 patients without LPR (28.6%) underwent a transformation from CBMs to spotted brownish microvessels after continuous medication for 8 weeks in the CBM group (χ2 = 15.916, P < .001), while no significant change was observed in patients with or without LPR in the non-CBM group (P > .05). Submucosal CBMs in the posterior cricoid area under NBI endoscopy may be a characteristic of LPR.

Predicting Histological Healing and Recurrence in Ulcerative Colitis by Assessing Mucosal Vascular Pattern Under Narrow-Band Imaging Endoscopy.

This study investigated the predictive value of narrow-band imaging (NBI) endoscopic staging of different mucosal vascular patterns (MVPs) in patients with ulcerative colitis (UC) for histological healing or clinical recurrence of patients with UC. A total of 124 patients with UC in clinical remission attending the First Affiliated Hospital of Weifang Medical College were included in the study and underwent NBI colonoscopy. Inflammatory activity was assessed in the intestine using the Mayo endoscopic score (MES) and the MVP. Mucosal inflammation was histologically graded using the Nancy index (NI). The colons of 124 patients with UC were staged according to NBI endoscopic MVP staging criteria. The differences between NBI colonoscopy MVP typing and white light endoscopic MES in assessing histological healing (HH) were statistically significant (p < 0.001), and there was a moderate correlation between MES and the degree of HH (r = 0.471, p < 0.001). In addition, there was a significant correlation between the severity of mucosal activity determined by white light endoscopy (WLE) and MVP staging (r = 0.811, p < 0.001). The differences between NBI endoscopic MVP staging and white light endoscopic MES in assessing UC recurrence were statistically significant (p < 0.001). Spearman's correlation analysis showed a moderate correlation between NBI endoscopic MVP staging and clinical recurrence. NBI endoscopic MVP staging can predict HH and clinical recurrence status better than WLE.

Endoscopic Screening for Second Primary Tumors of the Esophagus Among Head and Neck Cancer Patients.

Malignancies of the head and neck (HN) region and esophagus are among the most common cancers worldwide. Due to exposure to common carcinogens and the theory of field cancerization, HN cancer patients have a high risk of developing second primary tumors (SPTs). In our review of 28 studies with 51,454 HN cancer patients, the prevalence of SPTs was 12%. The HN area is the most common site of SPTs, followed by the lungs and esophagus, and 13% of HN cancer patients have been reported to have esophageal high-grade dysplasia or invasive carcinoma. The prognosis of HN cancer patients with concomitant esophageal SPTs is poor, and therefore identifying esophageal SPTs as early as possible is of paramount importance for risk stratification and to guide the treatment strategy. Image-enhanced endoscopy, especially using narrow-band imaging endoscopy and Lugol’s chromoendoscopy, has been shown to improve the diagnostic performance in detecting esophageal neoplasms at an early stage. Moreover, the early detection and minimally invasive endoscopic treatment of early esophageal neoplasm has been shown to improve the prognosis. Well-designed prospective studies are warranted to establish appropriate treatment and surveillance programs for HN cancer patients with esophageal SPTs.