Magnifying Endoscopic Findings Research Articles

Usefulness of magnifying endoscopy for diagnosis of sessile serrated lesion with dysplasia or carcinoma: Large retrospective study.

Background and study aims Sessile serrated lesions (SSLs) are precursor lesions in the serrated neoplasia pathway that lead to invasive carcinoma from dysplasia arising from SSLs. This study aimed to elucidate the clinicopathological and endoscopic features of SSLs with and without dysplasia or carcinoma. Patients and methods We reviewed the clinicopathological and endoscopic data from all colorectal lesions pathologically diagnosed as SSLs at Juntendo University Hospital, Tokyo, Japan, between 2011 and 2022. In addition to conventional endoscopic findings, we retrospectively evaluated magnifying endoscopic findings with narrow-band imaging (NBI) or blue laser imaging (BLI) using the Japan NBI Expert Team system and analyzed pit patterns using magnified chromoendoscopic images. Results Of the 2,132 SSLs, 92.5%, 4.7%, 1.8%, and 0.9% had no dysplasia, low-grade dysplasia, high-grade dysplasia, and submucosal invasive carcinoma, respectively. Older age, the proximal colon, and larger lesions were more frequently associated with SSLs with dysplasia or carcinoma. However, 41.3% of the SSLs with dysplasia or carcinoma were ≤ 10 mm in size. Endoscopic findings, such as (semi)pedunculated morphology, double elevation, central depression, and reddishness, were frequently found in SSLs with dysplasia or carcinoma. Furthermore, magnifying endoscopy using NBI or BLI and magnifying chromoendoscopy showed high sensitivity, specificity, and accuracy for diagnosing dysplasia or carcinoma within SSLs. Conclusions SSLs with and without dysplasia or carcinoma exhibit distinct clinicopathological and endoscopic features. In an SSL series, conventional endoscopic characteristics in addition to use of magnifying endoscopy may be useful for accurately diagnosing advanced histology within an SSL.

Type B2 vessels and infiltrative growth patterns b and c are associated with lymphatic invasion in pT1a-lamina propria mucosa esophageal squamous cell carcinoma.

Tumor growth pattern correlates with outcomes in patients with esophageal squamous cell carcinoma (ESCC), however, the clinical significance of the tumor growth pattern in pT1a-lamina propria mucosa (LPM) type of ESCC was unclear. This study was conducted to clarify clinicopathological features of tumor growth patterns in pT1a-LPM type ESCC and the relationship between tumor growth patterns and magnifying endoscopic findings. Eighty-seven lesions diagnosed as pT1a-LPM ESCC were included. Clinicopathological findings including tumor growth pattern and narrow band imaging with magnifying endoscopy (NBI-ME) in the LPM area were investigated. Eighty-seven lesions were classified as infiltrative growth pattern-a (INF-a): expansive growth (n = 81), INF-b: intermediate growth (n = 4) and INF-c: infiltrative growth pattern (n = 2). Lymphatic invasion was shown in one INF-b and one INF-c lesion. NBI-ME and histopathological images were matched for 30 lesions. The microvascular pattern was classified into types B1 (n = 23) and B2 (n = 7) using the JES classification. All 23 type B1 lesions were classified as INF-a without lymphatic invasion. Type B2 lesions were classified as INF-a (n = 2), INF-b (n = 4) and INF-c (n = 1), and lymphatic invasion was present in two lesions (INF-b and INF-c). The rate of lymphatic invasion was significantly higher in type B2 than type B1 (p = 0.048). The tumor growth pattern of pT1a-LPM ESCC was mostly INF-a in type B1 patterns. Type B2 patterns are rarely present in pT1a-LPM ESCC, however lymphatic invasion with INF-b or INF-c was frequently observed. Careful observation before endoscopic resection with NBI-ME is important to identify B2 patterns to predict histopathology.

Linked Color Imaging and Blue Laser Imaging for the Diagnosis of Superficial Non-Ampullary Duodenal Epithelial Tumors

Background and Objective: This study aimed to evaluate endoscopic findings using linked color imaging (LCI) and blue laser imaging (BLI) and to determine a diagnostic predictor for duodenal adenocarcinomas. Methods: All consecutive patients who underwent endoscopic resection for superficial non-ampullary duodenal epithelial tumors (SNADETs) between October 2012 and June 2019 were enrolled in this study. Two highly experienced endoscopists investigated six morphological findings using both white light imaging and LCI and three magnifying endoscopic findings using magnifying BLI (M-BLI). Results: A total of 90 patients with 110 SNADETs, including 87 adenocarcinomas and 23 adenomas, were analyzed in this study. Among the non-magnifying endoscopic findings, the presence of reddish color, orange color on LCI (orange color sign), lobulation, depression, and marginally white opaque substance were found significantly more frequently in adenocarcinomas than in adenomas (p = 0.015, p < 0.001, p = 0.048, p < 0.001, and p = 0.007, respectively). Among the magnifying endoscopic findings, a mixed microsurface pattern (MSP), irregular MSP, and irregular microvascular pattern were found significantly more frequently in adenocarcinomas than in adenomas (p < 0.001, p < 0.001, and p = 0.002, respectively). In the multivariate analysis of all endoscopic findings associated with adenocarcinoma, orange color sign (odds ratio [OR] 10.46; 95% confidence interval [CI]: 1.42–77.08; p = 0.021), mixed MSP (OR 4.66; 95% CI: 1.02–21.40; p = 0.048), and irregular MSP (OR 13.11; 95% CI: 1.41–121.99; p = 0.024) were independent predictors of adenocarcinoma. Conclusions: The presence of orange color sign on LCI and mixed/irregular MSP on M-BLI were independent diagnostic predictors that were frequently observed in duodenal adenocarcinoma.

Gastric metaplasia of the duodenal mucosa in Crohn's disease: novel histological and endoscopic findings.

Background and study aims Upper gastrointestinal endoscopy and biopsy are useful for differential diagnosis of Crohn’s disease (CD) of the large intestine and ulcerative colitis (UC). We aimed to identify novel histopathological and endoscopic findings in the upper gastrointestinal tract in patients with CD who did not have Helicobacter pylori infection. Patients and methods Upper gastrointestinal endoscopy was performed on patients with CD and UC. Mucosal lesions detected were subsequently observed using magnifying endoscopy with narrow-band imaging (M-NBI), following which biopsy was performed. When no mucosal lesion was detected on conventional endoscopy, M-NBI and biopsy were performed on four sites: the gastric body, gastric antrum, duodenal bulb, and second portion of the duodenum. Results The prevalences of gastric metaplasia (GM) were 48 % (24/50) and 16 % (8/50) in the CD and UC groups, showing a significant difference ( P = 0.001). In 23 of 24 patients with histologically proven GM in the CD group, mucosal lesions were detected using conventional white-light imaging (C-WLI). In 22 of 24 patients with histologically proven GM in the CD group, disappearance of normal villous structure and the presence of curved marginal crypt epithelium were noted using magnifying endoscopic findings characteristic of GM (M-GM). A combination of C-WLI and M-NBI yielded a significantly increased specificity ( P = 0.004) and accuracy ( P = 0.039). Conclusions The prevalence of GM in the duodenal mucosa was significantly higher in patients with CD than in controls. The identified endoscopic findings may be useful as novel indicators for the histological diagnosis of GM in the duodenum.

Early-stage primary signet ring cell carcinoma of the colon with magnifying endoscopic findings

Early-stage primary signet ring cell carcinoma of the colon with magnifying endoscopic findings

Ex vivo magnifying endoscopic observation of bile duct mucosa using narrowband imaging.

Detailed endoscopic findings of the bile duct mucosa have not been fully established. This fundamental exvivo study assesses the relationship between magnified endoscopic findings and pathological findings of the bile duct mucosa. Forty-one surgically resected common bile duct mucosae were investigated. Each common bile duct wascut open longitudinally for exvivo endoscopic observation. A magnifying endoscope commonly used for the gastrointestinal tract was used, using both white light imaging and narrowband imaging. After pathological diagnosis, the association between the magnifying endoscopic findings and histopathology was evaluated. Totally, 39 non-neoplastic mucosae and 13 neoplastic mucosae were evaluated. In 13 non-neoplastic mucosae without inflammation, an oval-shaped depressed area and a fine, regular network of microvessels were observed. These findings were not clearly seen or not seen at all in the non-neoplastic mucosae with inflammation. Although vessels with loop-like structure were observed on all eight papillary tumors of 13 neoplastic mucosae, no characteristic vessels were seen on the other five. Ishida and colleagues assessed the association between magnifying endoscopic findings and histopathological findings of the bile duct mucosa ex vivo. Oval-shaped, depressed areas and a fine, regular network of microvessels are characteristic features of normal bile duct mucosa, while loop structures may be indicative of a type of tumor vessel.

Magnifying Endoscopy for Esophageal Ectopic Sebaceous Glands.

Ectopic sebaceous glands are found very rarely in the esophagus; heretofore, several cases have been reported. The sebaceous gland is originally a source of an endodermal origin; however, there have been controversies regarding whether the origin of the esophageal ectopic sebaceous gland is ectodermal or endodermal. Ectopic sebaceous glands of the esophagus usually do not cause symptoms; thus, they are often found incidentally on endoscopy for routine health screening. Endoscopic findings are characterized by single or multiple yellow patches or nodular lesions of various sizes, sometimes with small central openings. We report two cases of esophageal ectopic sebaceous glands found incidentally during endoscopy with magnifying endoscopic findings. The lesions were in the mid-esophagus and lower esophagus, respectively, and both endoscopic findings were similar as multiple yellowish patches or plaques. Magnifying endoscopy revealed the openings of the excretory ducts surrounded by circular microvessels in both cases.

Magnifying Endoscopic Findings Can Predict Clinical Outcome during Long-Term Follow-Up of More Than 12 Months in Patients with Ulcerative Colitis

Background and Aims. To explore the association of magnifying endoscopic (ME) findings with histopathology and relapse in ulcerative colitis (UC). Methods. Forty-six patients with UC underwent ME with narrow band imaging (NBI) and crystal violet staining and were followed for more than 12 months. ME findings with vital staining were classified into ME-A, regular arrangement of round to oval pits; ME-B, irregular arrangement with/without enlarged spaces between even pits; ME-C, irregular pits in size and shape with more irregular arrangement of pits; and ME-D, disrupted or disappeared pits. NBI-guided ME features of microvascular pattern (MVP) were divided into the MVP-regular and MVP-irregular type. Results. There were 5, 24, 10, and 7 cases of ME-A, ME-B, ME-C, and ME-D grade, respectively, while there were 21 and 25 of MVP-regular and MVP-irregular type, respectively. ME classifications were significantly associated with Matts endoscopic grade. ME classifications and MVP types were significantly associated with each pathognomonic microscopic feature of severe mucosal inflammation, crypt abscess, and goblet cell depletion. There were significant differences in the percentages of remission among ME classifications and between MVP types. Conclusion. ME findings can be predictive of relapse in UC and reliable for in vivo histopathological assessment.

Evaluation of magnifying endoscopy using narrow band imaging using ex vivo bile duct (with video)

Detailed endoscopic findings of the bile duct mucosa, even of the non-neoplastic mucosa, have not yet been established. The aim of the present study was to compare a currently used video cholangioscope (CCS) with a magnifying endoscope (ME) that is commonly used for the gastrointestinal tract, for visualization of the bile duct mucosa. Ten freshly resected common bile ducts were used in this study. We observed the non-neoplastic bile duct mucosa with CCS and ME, and carried out both conventional white light imaging and narrow band imaging. After histological diagnosis, the 10 specimens were classified into three categories according to the degree of histological inflammation: normal to mild, moderate, and severe. Then, we examined the relationship between the magnifying endoscopic findings and the histopathological findings. In eight of the 10 cases, the visualization obtained with CCS was inferior to that obtained by ME. Five specimens were classified as normal to mild inflammation, and many oval-shaped, depressed areas and a fine, regular network of the microvessels were observed by ME on the mucosal surfaces of these specimens. The remaining specimens were classified as moderate or severe inflammation, and the aforementioned findings could not be clearly visualized. CCS does not allow visualization of the bile duct mucosa with high sensitivity. Oval-shaped depressed areas and a fine, regular network of microvessels are characteristic endoscopic features of non-neoplastic bile duct mucosa without inflammation.

Examination of NBI magnifying endoscopic findings “irregularity vessel” and histologic type of gastric cancer

Examination of NBI magnifying endoscopic findings “irregularity vessel” and histologic type of gastric cancer

Magnifying Endoscopic Findings of Massively-Invasive Early Colorectal Neoplasm; Clinical Efficacy of “Type VI-High Grade” to Estimate the Depth of Cancer Invasion

Background: Recent advances of magnifying chromoendoscopy have enabled detailed observation of colorectal neoplasm. According to Kudo's pit pattern classification, we are able to estimate the histology of the lesion, with a high degree of accuracy, without taking biopsies from it. Type I and II are non-neoplastic patterns. Lesions with type IIIs, IIIL and IV are almost always benign adenomas. Type V is seen in cancers. Non-structural pit pattern is called type VN and it represents massively-invasive cancers, requiring surgical treatment. Type VI (I: irregular) reflects structural atypism of cancerous glands, corresponding to wide range of lesions from adenoma to massively-invasive submucosal cancer. Thus it is of great importance to find diagnostic characteristics of deep invasion. Aim: To clarify magnifying endoscopic findings which enable to predict the massive invasion of submucosal cancer exposing type VI pit pattern. Methods: A total of 9255 colonic lesions (including 378 submucosal cancers) were treated at Showa University Northern Yokohama Hospital from April 2001 to June 2008, and classified into seven pit patterns such as type I, II, IIIL, IIIs, IV, VI and VN according to our classification. Of these, 210 submucosal cancers presenting with VI pit pattern were studied. We defined the pit pattern with narrowed lumen, rough margin, unclear boundary, abnormal branching or dense distribution as “type VI-high grade” and evaluated if these findings were useful for predicting the depth of cancer. Endoscopic pictures were judged by endoscopists who were blinded to the final pathological diagnoses. The risk factors of type VI for massive invasion were analyzed according to multiple logistic regressions. Results: Among 210 submucosal cancers with VI pit pattern, 118 (88.7%) of 133 type VI-high grade lesions were massively invasive, whereas 48 (62.4%) of 77 type VI-low grade lesions were slightly invasive. Assuming that type VI-high grade is suggestive of massive invasion, the accuracy, sensitivity and specificity would be 79.1%, 80.3% and 76.2%, respectively. Concerning depressed type lesions, these would be 88.4%, 85.7% and 100%, respectively. Endoscopic findings with narrowed lumen and rough margins were significant risk factors for massive invasion. Conclusion: “Type VI-high grade” is a useful clinical diagnostic finding for determining the depth of invasion in colorectal lesions and their therapeutic selection. Especially in depressed type cancer, this will be an excellent accurate predictor of massive invasion. “Rough margin” and “narrowed lumen” are significant magnifying endoscopic indexes of massively-invasive submucosal cancers.

Differential Diagnostic Criteria for Neoplastic Lesion in the Stomach By a NBI-Enhanced Magnifyingendoscopy, “APC Score”

Background: Magnifying endoscopy has a potential to evaluate tissue character based upon tissue structural atypism. Recent development of NBI-enhanced technology enables to observe not only pit pattern changes but also vascular structural changes. The present authors advocate “APC score” as differential diagnostic criteria for gastric neoplastic lesions based upon NBI-enhanced magnifying endoscopic findings. Methods: 234 consecutive cases which were classified into A1 or A2 (196 cases of gastric neoplasm and 38 cases of gastritis) were included in this study.

4475 Clinical usefulness of magnifying endoscopic findings and il-7 mrna expression in remission mucosa for the prediction of recurrence of ulcerative colitis.

Background: We have demonstrated the dysregulation of mucosal interleukin-7 (IL-7) mediated immune responses in the colitis lesion of human ulcerative colitis (UC) by using endoscopically biopsied materials.To establish an effective method for the prediction of recurrence of UC, we assessed of magnifying endoscopic findings and IL-7 mRNA expression in remission mucosa of UC. Methods: 1) A magnifying electronic endoscopy Olympus EVIS colonoscopy CF-200HM and CF-240Z that could be used for observation at maximum 100-167 magnification on the monitor were used to assess minute lesions in the rectum mucosa. 2) Mucosal biopsied specimens was obtained from endoscopically normal remission mucosa of UC. IL-7 mRNA expression was assessed by semi-quantitative RT-PCR method. Results: 1) Normal architecture of pits of Liberkuhn glands was visualized in the colonic mucosa by the magnifying colonoscopy after 0.2% indigocarmine or 0.25% methylene blue spraying. 2) In remission UC mucosa, abnormalities of area colonicae were demonstrated by the magnifying colonoscopy, even in the mucosa with normal appearance by conventional colonoscopy. These included redness (81%), microerosions (69%), and irregularity (50%) decreased in number (56%), disordered arrangement (81%) of area colonicae. 3) IL-7 mRNA expression was significantly decreased in actively inflamed mucosa. In contrast, that in remission mucosa varied. In the colonic mucosa from three of ten patients IL-7 mRNA expression was slightly decreased, and not changed in the mucosa of other seven patients. 4) Even in remission UC mucosa with normal appearance by conventional colonoscopy, IL-7 mRNA was decreased in the cases with abnormalities of area colonicae by magnifying colonoscopy. Conclusions: These results indicate that magnifying endoscopic findings in combined with assessing of IL-7 mRNA expression in remission mucosa may be useful for the prediction of recurrence of UC.

Clinical course and magnifying endoscopic findings of fine lesions of the large intestinal mucosa in Crohn's disease.

"Worm-eaten" appearance (WEA) is a fine lesion of Crohn's disease observed in apparently normal rectal mucosa by magnifying endoscopy. Magnifying endoscopy has now been performed following application of methylene blue on 37 occasions in 27 patients with Crohn's disease, and the occurrence of WEA was reviewed in relation to the duration and extent of disease. The frequency of WEA was 75% in patients with a history of less than five years and 77% in those who had had the disease for more than five years. In the active stage, the frequency was 85% and 100% respectively, and the degree of WEA also increased. The detection rate of granulomata in regions of WEA was 53% when the clinical history was less than five years and 33% when five years or more. In active disease, granulomata were found in 70% and 67% respectively. The large intestine other than the rectum was reviewed in eight patients with ileitis. WEA and granulomata were observed throughout the large intestine including the cecum, especially when the ileal disease was active.