Mucosal Pattern Research Articles

A meta-analysis of narrow-band imaging for the diagnosis of primary nasopharyngeal carcinoma.

Background: Narrow band imaging (NBI), an endoscopic technique featuring an augmented definition of microvasculature and mucosal patterns. NBI is increasingly advocated as a tool to characterize neoplasia and intestinal metaplasia in endoscopic standards, such as for colorectal polyps and tumors. Recently NBI has also been studied in the detection of Nasopharyngeal Carcinoma (NPC). Here we aimed to assess the diagnostic utility of NBI for the diagnosis of NPC. Methods: A meta-analysis of studies comparing narrow-band imaging and white light endoscopy in the diagnosis of primary nasopharyngeal carcinoma was performed. The review process involved two independent investigators. The databases used were MEDLINE, PubMed, the Cochrane library, Embase, and the Web of Science. Statistical analysis was performed with OpenMetaAnalyst, MetaDiSc version 1.4, and Medcalc version 17.9.7. Results: Five studies including 2480 patients were included. The sensitivity and specificity for narrow-band imaging were 0.90 (0.73-0.97) and 0.95 (0.81-0.99) respectively. The positive likelihood ratio and negative likelihood ratio were 18.82 (0.31-82.1) and 0.08 (0.02-0.31). For white light endoscopy, the sensitivity and specificity were 0.77 (0.58-0.89) and 0.91 (0.79-0.96). The positive likelihood ratio was 7.61 (3.61-16.04), and the negative likelihood ratio was 0.21 (0.11-0.39). The odds ratio for detection rates between narrow-band imaging and white light endoscopy was 4.29 (0.56-33.03, p = 0.16). Area under the curve for narrow-band imaging was 0.98 (SE: 0.02), and for white light it was 0.93 (SE: 0.03). There was no significant difference in the receiver operating characteristic curves between the two modalities (p = 0.14). Conclusion: Narrow-band imaging showed a higher sensitivity and positive likelihood ratio for the diagnosis of nasopharyngeal carcinoma. However, there was no significant difference in detection rates compared to white light endoscopy. Further investigation with a uniform diagnostic criteria and terminology is needed for narrow-band imaging in the diagnosis of nasopharyngeal carcinoma.

Efficacy of Narrow Band Imaging in Detecting Lower Gi Lesions and Its Histologic Correlation

Background: To evaluate the efficacy of Narrow band imaging (NBI) in detecting lower GI lesions and differentiation on the basis of color, vascular pattern and surface pattern findings on NBI with histopathologic correlation. Material and Methods: 94 patients of both gender, with lower GI symptoms were subjected for lower GI endoscopy by conventional   white   light   endoscopy and CLV-190 HD colonoscope having Narrow-band imaging (NBI) as standard feature after obtaining an informed consent. Patients who did not give consent, patients with severe inflammatory bowel disease and who lost during follow up were excluded from the study. All NBI findings of suspected lesions were classified according to NICE (NBI International Colorectal Endoscopic) classification, into hyperplastic lesion, adenomatous and invasive carcinoma. Biopsies were taken and stained with Haematoxylin and Eosin as well as Periodic Acid Schiff stain. Statistical analysis was done to compare NBI diagnosis with the histopathological diagnosis. Results: Majority of the patients were in the third decade of life, with a mean age of 36.22 years. Diarrhea was the commonest clinical presentation, in 60 (63.8%) patients. NBI was suggestive of ulcerative colitis/Inflammatory bowel disease (IBD) in 59 (62.8%) patients, neoplastic polypoidal lesion in 24 patients (25.5%) and polypoidal non-neoplastic lesion in 11 (11.7%) patients. Out of 59 (62.8%) cases of Ulcerative colitis (UC), 35 (37.2%) were polypoidal, among which 24 (68.6%) were suggestive of neoplastic polypoidal lesion (NICE II-III) and 11(31.4%) were non-neoplastic polypoidal lesion (NICE I). Out of 59 cases of UC, clear mucosal vascular pattern (MVP) was found in 11 (18.6%) cases and obscure MVP in 48 (81.4%) cases. Conclusions: NBI provides a unique image with contrast enhancement and can emphasize the capillary pattern and surface architecture and plays a major role in the differentiation of neoplastic and non-neoplastic colorectal lesion, with high sensitivity and specificity.

ASSOCIATION BETWEEN ENTAMOEBA HISTOLYTICA/DISPAR AND HELICOBACTER PYLORI INFECTIONS IN PATIENTS WITH GASTROINTESTINAL COMPLAINTS

This research studied the prevalence of different intestinal parasitic infections amongst H. pylori infected patients and assessed the association impact in the pathogenesis of H. pylori infection at the Tropical Medicine and Gastroenterology outpatient clinic, South valley University Hospitals. A total of 80 stool samples were collected. H. pylori infection was diagnosed by detecting the H. pylori antigen in stool. Accordingly, patients were divided into 2 groups: H. pylori positive cases (group I) and was 50 cases (62.5%) and H. pylori negative cases (group II). H. pylori positive cases were subjectedto upper endoscopy. There was a significant association between parasitic infections and H. pylori in patients with gastrointestinal complaints (P≤0.005). Entamoeba histolytica/dispar (55.5%) was the commonest parasite detected in H. pylori positive cases. Upper gastrointestinal endoscopy of the stomach showed characteristic mucosal pattern (mosaic appearance with focal hyperemic area), indicated H. pylori infection.

Antigen Loading (e.g., Glutamic Acid Decarboxylase 65) of Tolerogenic DCs (tolDCs) Reduces Their Capacity to Prevent Diabetes in the Non-Obese Diabetes (NOD)-Severe Combined Immunodeficiency Model of Adoptive Cotransfer of Diabetes As Well As in NOD Mice.

Tolerogenic DCs (tolDCs) are being researched as a promising intervention strategy also in autoimmune diseases including type 1 diabetes (T1D). T1D is a T-cell-mediated, organ-specific disease with several well-defined and rather specific autoantigens, i.e., proinsulin, insulin, glutamic acid decarboxylase 65 (GAD65), that have been used in animal as well as human intervention trials in attempts to achieve a more efficient, specific immunotherapy. In this study, we have tested tolerogenic DCs for their effectiveness to prevent adoptive transfer of diabetes by diabetogenic splenocytes into non-obese diabetes (NOD)-severe combined immunodeficiency (NOD-SCID) recipients. While i.p. application of tolDCs prepared from bone marrow of prediabetic NOD mice by vitamin D2 and dexamethasone significantly reduced diabetes transfer into the NOD-SCID females, this effect was completely abolished when tolDCs were loaded with the mouse recombinant GAD65, but also with a control protein—ovalbumin (OVA). The effect was not dependent on the presence of serum in the tolDC culture. Similar results were observed in NOD mice. Removal of possible bystander antigen-presenting cells within the diabetogenic splenocytes by negative magnetic sorting of T cells did not alter this surprising effect. Tolerogenic DCs loaded with an immunodominant mouse GAD65 peptide also displayed diminished diabetes-preventive effect. Tolerogenic DCs were characterized by surface maturation markers (CD40, CD80, CD86, MHC II) and the lipopolysaccharide stability test. Data from alloreactive T cell proliferation and cytokine induction assays (IFN-γ) did not reveal the differences observed in the diabetes incidence. Migration of tolDCs, tolDCs-GAD65 and tolDCs-OVA to spleen, mesenteric- and pancreatic lymph nodes displayed similar, mucosal pattern with highest accumulation in pancreatic lymph nodes present up to 9 days after the i.p. application. These data document that mechanisms by which tolDCs operate in vivo require much better understanding for improving efficacy of this promising cell therapy, especially in the presence of an antigen, e.g., GAD65.

Correlation of Fecal Markers with Magnifying Endoscopic Stratification in Patients with Ulcerative Colitis Who Are in Clinical Remission

Background: Maintenance of mucosal healing is recommended during the treatment of ulcerative colitis (UC). However, symptoms of UC often do not reflect mucosal disease activity. Fecal markers such as calprotectin, lactoferrin, and hemoglobin have been reported to correlate well with the Mayo endoscopic subscore (MES) and are being considered alternative monitoring tools in endoscopy. Ulcerative Colitis Endoscopic Index of Severity (UCEIS) is a new and more detailed endoscopic scoring system compared to MES. Furthermore, magnifying endoscopic stratification (ME) based on alterations in the mucosal surface pit patterns is noted in UC. However, the association between fecal markers and UCIES and magnifying endoscopy is relatively unexplored. Summary: This study investigated the association between the aforementioned fecal markers and MES, UCEIS, and ME in patients with UC in clinical remission. This prospective study included 60 patients with UC in clinical remission who underwent colonoscopy at the Nagasaki University Hospital between June 2015 and November 2016. A significant correlation was observed between MES and all fecal markers. Notably, the fecal markers correlated well with UCEIS (calprotectin Spearman’s correlation coefficient [r] = 0.54, p < 0.0001; lactoferrin r = 0.56, p < 0.0001; and hemoglobin r = 0.43, p < 0.001). Furthermore, ME findings correlated significantly with calprotectin (r = 0.50, p = 0.0002) and lactoferrin (r = 0.46, p = 0.0006) levels and slightly with hemoglobin (r = 0.28, p = 0.043) levels. Moreover, each cutoff level of fecal calprotectin, lactoferrin, or hemoglobin had a high sensitivity and specificity for the detection of MES = 0, UCEIS = 0, ME = A, for predicting mucosa healing. Key Messages: Fecal markers correlated not only with MES but also with UCEIS and ME and should be useful for monitoring patients with UC in clinical remission.

A COMPARATIVE ULTRASTRUCTURAL STUDY OF THE LINGUAL EPITHELIUM IN TWO REPTILIAN SPECIES UROMASTYXA EGYPTIUS (FAMILY: AGAMIDAE) AND HEMIDACTYLUS TURCICUS (FAMILY: GEKKONIDAE)

The present study aimed to determine the histological structure, histochemical aspects and ultrastructure of the lingual mucosa of two reptilian species Uromastyx aegyptius and Hemidactylus turcicus (which differ in habitat and feeding) by using light, scanning and transmission electron microscopes. The dorsal surface of the tongue in the two species shows many types of lingual papillae (reticular papillae in U. aegyptius and cylindrical and filamentous papillae in H. turcicus). Microvilli and microridges are widely distributed over the surface of the papillae. In U. aegyptius, the branched alveolar glands and compound tubular glands are found, while the mucous glands appear in H. turcicus. Transmission electron microscope showed that the secretory granules in U. aegyptius have more electron-dense core and small electron-dense peripheral areas, while in H. turcicus a large number of spherical secretory granules have very electron-dense cores and more electron-dense peripheral regions. The tongues of the two species were positive for periodic acid-Schiff(PAS), PAS-Alcian blue and bromophenol blue stains with variable degrees of intensities. The main difference in the dorsal lingual mucosal pattern between the present two reptile's lies in some peculiarity of diet as the Uromastyx is herbivourous and the Hemidactylus is insectivorous species.

A Large Pedunculated Polyp With Surprising Pathology Results

We present a unique case of an inverted diverticulum mimicking a large adenomatous pedunculated polyp. Inverted colonic diverticulosis (ICD) is a rare finding described in 0.7% of colonoscopies.1 ICD is typically a few millimeters in size, located in the sigmoid colon and resembles a polyp. Our finding was unusual based on its size, location and appearance. An initial colonoscopy on a 50-year-old male found a pedunculated polyp in the transverse colon with a 2.0 cm stalk and 9 mm polypoid head. Believed to be an adenomatous polyp by inspection with a firm head, snare cautery was used to remove the polyp. The patient tolerated the procedure well without complication. Surprisingly, histology showed polypoid prolapsing mucosa fold consistent with a diverticular disease associated polyp. The differential diagnosis of a pedunculated colonic lesion is broad including an adenomatous pedunculated polyp, a mucosubmucosal elongated polyp, an inflammatory polyp, a filiform polyp associated with inflammatory bowel disease, autoamputation of a pedunculated polyp, ICD and rarely colonic intussusception of an adenoma. There can be significant overlap between inflammatory polyps and prolapse polyps, but the smooth muscle extending between glands is fairly iconic of prolapse polyps and not found in other entities. Our patient's histopathology was consistent with ICD (Figure 1b). Generally, ICD mucosal pattern on a lesion is similar to surrounding mucosa. In our case, the endoscopic appearance of the polyp head was not similar to the stalk one. Hypothetically, this could be due to vascular congestion, trauma of the polyp head, or the presence of inflammatory changes. Histologically, the latter seems to fit best as there is clear crypt architectural abnormalities seen on the head not seen on the stalk or base. ICD may appear polypoid and even present as pedunculated polyps. It is important for endoscopists to distinguish between ICD and adenomatous polyps to prevent complications that can arise with biopsy. In our patient, there was no evidence of perforation likely due to the cautery that sealed the mucosa closed. If there is suspicion of ICD after polyp removal, a resolution clip or over the scope clip could close the defect and prevent complications.Figure: Histopathology of lesion with lobulation and fibrous septa.Figure: focal epithelial denudation, hyperplastic crypt architecture with branching crypts, a lamina propria with prominent fibromuscular proliferation and smooth muscle projections between individual glands, a polymorphic inflammatory infiltrate, dilated capillaries, and hypertrophy and upward extension of the muscularis mucosae.Figure: High definition endoscopic image of transverse pedunculated polyp.

胃Ｘ線像における粘膜萎縮(粘膜ひだの領域, 粘膜ひだの形態, 粘膜面の性状)の12年間にわたる変化

胃Ｘ線像における粘膜萎縮(粘膜ひだの領域, 粘膜ひだの形態, 粘膜面の性状)の12年間にわたる変化

Role of toll-like receptor 10 gene polymorphism and gastric mucosal pattern in patients with chronic gastritis.

Helicobacter pylori stimulates the host's toll-like receptors (TLRs). Single-nucleotide polymorphism (SNP) of TLRs is related to the manipulation of regulatory cytokines and also implicated in the varied outcomes of the inflammatory response, including the development of precancerous lesions of gastric mucosa and disease progression. We hypothesized that TLR10 rs10004195 polymorphism is associated with gastric mucosal patterns. TLR10 rs10004195 polymorphisms were identified in a total of 400 gastritis patients using the TagMan SNP genotyping assay. Gastric mucosal patterns were classified by Conventional Narrow Band Imaging gastroscopy (C-NBI gastroscopy). Logistic regression was used to analyze the association. The gastritis patients was Type 1, 37.5% of Thai patients. The T/T homozygous genotype was exhibited by the highest percentage (46.5%) of patients, and the A/A homozygous and A/T heterozygous genotypes were exhibited by 20.25% and 33.25%, respectively, of patients. TLR10 rs10004195 was significantly associated with gastric mucosal patterns. After adjusting for confounding factors, patients with the A/A homozygous genotype showed a significantly increased risk of severe inflammation (OR=1.35, 95% CI=0.97-2.13, p=0.028). Patients with the A/T heterozygous and T/T homozygous genotypes showed a significantly increased risk of mild inflammation (OR=1.24, 95% CI=0.78-2.07, p=0.042 and OR=1.78, 95% CI=0.51-3.35, p=0.001, respectively). Our results indicate that the presence of TLR10 rs10004195, A/T heterozygous, and T/T homozygous genotypes is associated with type 1, 2, and 3 whereas that of the A/A homozygous genotype is associated with type 4 and 5 of gastric mucosal patterns. This suggests that the A/A homozygous genotype contributes to severe inflammation in H. pylori-associated gastritis in Thai patients.

Magnetic resonance enterography in pediatric celiac disease

ObjectiveTo assess if magnetic resonance enterography (MRE) is capable of showing evidence/extent of disease in pediatric patients with biopsy‐proven celiac disease (CD) by comparing with a control group, and to correlate the MRE findings with anti‐endomysial antibody (EMA) level, which is an indicator of gluten‐free dietary compliance. MethodsThirty‐one pediatric patients (mean age 11.7±3.1 years) with biopsy‐proven CD and 40 pediatric patients as a control group were recruited in the study. The MRE images of both patients with CD and those of the control group were evaluated by two pediatric radiologists in a blinded manner for the mucosal pattern, presence of wall thickening, luminal distention of the small bowel, and extra‐intestinal findings. Patient charts were reviewed to note clinical features and laboratory findings. The histopathologic review of the duodenal biopsies was re‐conducted. ResultsThe mean duration of the disease was 5.6±1.8 years (range: 3‐7.2 years). In 24 (77%) of the patients, EMA levels were elevated (mean 119.2±66.6 RU/mL). MRE revealed normal fold pattern in all the patients. Ten (32%) patients had enlarged mesenteric lymph nodes. ConclusionAlthough a majority of the patients had elevated EMA levels indicating poor dietary compliance, MRE did not show any mucosal abnormality associated with the inability of MRE to detect mild/early changes of CD in children. Therefore, it may not be useful for the follow‐up of pediatric CD.

Magnifying narrow-band imaging of gastric mucosal morphology predicts the H. pylori-related epigenetic field defect

DNA methylation is associated with “field defect” in the gastric mucosa. To characterize “field defect” morphologically, we examined DNA methylation of non-neoplastic gastric mucosa in relation to their morphology seen by narrow-band imaging (NBI) with magnifying endoscopy. Magnifying NBI of non-neoplastic gastric body was classified as follows: normal—small and round pits with uniform subepithelial capillary networks; type 1—a little enlarged round pits with indistinct subepithelial capillary networks; type 2—remarkably enlarged pits with irregular vessels; and type 3—clearly demarcated oval or tubulovillous pits with bulky coiled or wavy vessels. Methylation of nine candidate genes (MYOD1, SLC16A12, GDNF, IGF2, MIR 124A1, CDH1, PRDM5, RORA and MLF1) were determined by bisulfite pyrosequencing. Infinium HumanMethylation450 array was used to characterize the methylation of >450,000 CpG sites. Mean Z score methylation of nine genes positively correlated with the changes of mucosal patterns from normal to types 1, 2, and 3 (P < 0.0001). Genome-wide analysis showed that development of mucosal patterns correlated with methylation accumulation especially at CpG islands. Genes with promoter CpG islands that were gradually methylated with the development of mucosal patterns significantly enriched the genes involved in zinc-related pathways. The results indicates that gastric mucosal morphology predicts a “field defect” in this tissue type. Accumulation of DNA methylation is associated with “field defect” in the non-neoplastic gastric mucosa. Endoscopic identification of “field defect” has important implications for preventing gastric cancer. Our results suggest that magnifying NBI of gastric mucosal morphology predicts a “field defect” in the gastric mucosa.

Evaluation of Pyloroplasty repair by Single layer Simple Interrupted Extra Mucosal technique in Dogs

In this study a pyloroplasty technique was designed by using a single layer simple interrupted extra-mucosal suture pattern on pyloric region in dogs. Nine adult dogs were used to induce longitudinal surgical incision in the pyloric region under general anesthesia using a combination of 15mg/kg B.W. ketamine hydrochloride 5% and 5 mg/kg B.W Xylazine hydrochloride 2%. The incision was closed by pyloroplasty technique (longitudinal incision for whole layers with transverse suturing) using single layer simple interrupted extra mucosal technique. The examination achieved by daily clinical observation, radiological finding, at the end of 21st day post operation, macroscopical and histopathological examination at the period 3rd, 7th, and 21st days post operation. The results showed no significant clinical changes in body temperature and physiological activity. The radiological findings showed good patency of the pyloric canal after 21st days post operation. The macroscopic finding shows heavy amount of the omentum adhered around the site of incision. The microscopic finding showed good healing process by re-epithelization of the mucosal layer associated with granulation tissue proliferation, angiogenesis, and less infiltration of mononuclear inflammatory cells. The conclusion indicated that single layer simple interrupted extra mucosal suture pattern technique can be used successfully in repair the pyloric stenosis in dog.

Su1209 We Can Judge the Existence or Non-Existence of Present or Past H.Pylori Infection With Only One Endoscopic Cardiac Images (Whale Shark Sign: WSS)

Background and aim: Several H.pylori（HP）infection related gastric findings (mucosal atrophy, metaplastic change, diffuse redness, spotty redness and nodular change of the antrum etc.) are so important sign of HP infection on endoscopic examination. On the other hand, we have confused with various newly endoscopic findings (patchy redness and map-like redness etc.) were seen on the post-eradicated stomach. On this time, we have found out a new other ultimate useful finding showing HP infection related gastritis at gastric cardia (EG junction) including present and post HP infection. The endoscopic image of gastric cardia is the first gastric view through the esophagus on each endoscopic examination. Our aim of this study is to elucidate possibility of judgement with only this cardiac endoscopic view about presence or absence with HP infection. Methods: We have found out so useful and specific cardiac image (We call Whale Shark Sign: WSS) closely related to HP infection. We have examined the presence of WSS on 4, 268 cases that have been able to overviewed on their endoscopic profiles. We have judged the presence of HP infection with serum HP antibody titers on each case. The 3,233 cases their serum HP antibody titers were measured from Jan. 2012 to Oct. 2016. A total of 2,810 patients (HP positive) were enrolled. Fisher’s exact test was used in all statistical analyses. The judgement of HP present or past infection was done more than serum HP antibody 3 U/ml to avoid false negative results. Results: Mean age of patients was 52.4 years old. In case of WSS positive, all their serum HP antibody titers showed more than cut-off level (3 U/ml). This means that the presence of WSS closely related to HP related gastritis. The positive predictive value (PPV) of WSS was surprisingly high (98%). According to this high PPV, we can think WSS positive cases are high risk of gastric carcinoma. This WSS mean that the presence of irregular gastric mucosal surface pattern and the presence of lymphoid hyperplasia, that showing HP infectious stomach. Especially presence of lymphoid hyperplasia at gastric cardia is most important specific sign of HP related gastritis. This lymphoid hyperplasia at gastric cardia were recognized small round whitish nodules on white light endoscopy. And this was more emphasized with image-enhanced endoscopy (Narrow Band Imaging: NBI), it looks like Whale Shark. This WSS sign is very simple and easy for every gastroenterologist. It is so useful to know gastric cancer risk at gastric entrance (cardia) with the presence of very easy simple sign. Conclusion: We have been able to judge the presence of HP infection with only cardiac endoscopic images (WSS), we should take care of seeing the presence of WSS sign. Since this sign is very easy and simple, everyone will be able to judge the presence of HP infection and gastric cancer risk. View Large Image Figure Viewer Download Hi-res image

Tu1954 The Usefulness of Atrophic Mucosal Patterns on Blue Laser Imaging for H. Pylori Infection

Tu1954 The Usefulness of Atrophic Mucosal Patterns on Blue Laser Imaging for H. Pylori Infection

Magnetic resonance enterography in pediatric celiac disease

ObjectiveTo assess if magnetic resonance enterography is capable of showing evidence/extent of disease in pediatric patients with biopsy-proven celiac disease by comparing with a control group, and to correlate the magnetic resonance enterography findings with anti-endomysial antibody level, which is an indicator of gluten-free dietary compliance. MethodsThirty-one pediatric patients (mean age 11.7±3.1 years) with biopsy-proven celiac disease and 40 pediatric patients as a control group were recruited in the study. The magnetic resonance enterography images of both patients with celiac disease and those of the control group were evaluated by two pediatric radiologists in a blinded manner for the mucosal pattern, presence of wall thickening, luminal distention of the small bowel, and extra-intestinal findings. Patient charts were reviewed to note clinical features and laboratory findings. The histopathologic review of the duodenal biopsies was re-conducted. ResultsThe mean duration of the disease was 5.6±1.8 years (range: 3–7.2 years). In 24 (77%) of the patients, anti-endomysial antibody levels were elevated (mean 119.2±66.6RU/mL). Magnetic resonance enterography revealed normal fold pattern in all the patients. Ten (32%) patients had enlarged mesenteric lymph nodes. ConclusionAlthough a majority of the patients had elevated anti-endomysial antibody levels indicating poor dietary compliance, magnetic resonance enterography did not show any mucosal abnormality associated with the inability of magnetic resonance enterography to detect mild/early changes of celiac disease in children. Therefore, it may not be useful for the follow-up of pediatric celiac disease.

DOP068 The virtual electronic chromoendoscopy score in ulcerative colitis exhibits very good inter-rater agreement in scoring mucosal and vascular changes after computerised module training: a study across academic and community practice

Background: Mucosal healing is the desired therapeutic endpoint for clinical trials in ulcerative colitis (UC). However, conventional white light endoscopy may fall short of capturing the full spectrum of inflammatory change; and virtual electronic chromoendoscopy (VEC) can show ongoing disease activity even when Mayo scores suggest healing (Iacucci et al. Endoscopy 2015). Applicability of VEC scoring requires determination outside the expert setting; thus, our aim was to provide external validation among trainees, consultant gastroenterologists and colorectal surgeons, practicing across six general and specialist centres. Methods: 15 participants reviewed a computerised training module outlining HD and i-Scan modes. Anchor points for the VEC score indicated mucosal changes (crypt distortion, 0 [A–C]; microerosions, I [1–3]; erosions, II [1–3]; and ulceration, III [1–3]) and vascular alterations (non-dilated vessels, 0 [A–C]; dilated/crowded vessels, I [1–3]; mucosal bleeding, II [1–3]; and intraluminal bleeding, III [1–3]). Performance accuracy was tested using a video library pre-/post-training (n=30). Agreement between raters was tested for the Mayo score, UCEIS and VEC score, and results correlated with histology (New York Mount Sinai system; Harpaz et al.). Results: The inter-rater agreement was very good for the Mayo score, UCEIS scoring erosions/ulcers and overall, and for VEC scoring mucosal patterns in both modules (Table 1). For the vascular components of UCEIS agreement was only moderate, and did not improve post-training; unlike the agreement for VEC vascular patterns which improved significantly to very good. Correlation between histology and VEC score was highly significant for mucosal and vascular scoring (Spearman's ρ: 0.910, p<0.001; and 0.907, p<0.001; respectively, Figure 1). This was superior to the Mayo score (0.876, p<0.001) and UCEIS (0.887, p<0.001). Table 1. ICCs are from a two-way random model with absolute agreement, and are for single measures. All values are significant at a p<0.001. Figure 1. Correlation between the EVC score and histology in ulcerative colitis. Average score per video per participant for each category are presented (post-training). Conclusions: The VEC score demonstrates very good inter-observer agreement across all levels of experience and provides excellent correlation with histology. Unlike UCEIS, the VEC score does not have subjective elements (e.g. mucosal erythema, incidental/contact friability) and may better delineate vascular changes due to filter technology. Given the ability to define subtle endoscopic features, VEC may be applied to further stratify treatment paradigms for patients with UC.

A Case of Brunner Gland Adenoma, which Exhibited Dramatic Macroscopic Metamorphosis in 2 Years without Canceration

A 68-year-old Japanese male was shown to have a spherical semipedunculated duodenal submucosal tumor (SMT) with a small central depression. He was followed up under the tentative diagnosis of Brunner gland (BG) hyperplasia (BGH) by biopsy. The tumor was found to have turned inverted dome-shaped with a central depression occupying almost all the top of it 2 years later. The disrupted surface was uneven, more reddened and lobulated by groove-like excavations, in and around which the mucosal pattern was obscured and abnormal vessels were observed. The biopsied specimen was interpreted as BG adenoma (BGA). The tumor was endoscopically resected because of a risk of complicating malignancy, judged to be completely excised, and definitely diagnosed as BGA containing no malignancy by the intensive examinations. Though explicitly proves that, contrary to the reports so far, dramatic macroscopic metamorphosis of BGA does not necessarily herald malignant degeneration within but is apparently due to disequilibrated blood supply, the present case implicitly omens, rather than completely excludes, the future possibility of canceration in the lesion on the grounds of the neoplastic findings.

Role of Narrow Band Imaging in Relation to Stroboscopy and White Light Laryngoscopy in Diagnosis of Benign Nonvascular Glottic Lesions

ABSTRACT Objective To evaluate the role of narrow band imaging (NBI) in detecting benign nonvascular glottic lesions. Materials and methods Our study is a retrospective and prospective analysis of 247 patients with suspected benign glottic lesions who presented to our voice clinic over a 6-month duration. Patients were diagnosed on stroboscopy (by the first author) and divided into three groups consisting of leukoplakia, sulci, and cysts. A white light (WL) laryngoscopy and NBI examination was performed by an independent laryngologist (not an author) followed by a comparative analysis. The final gold standard for diagnosis was microlaryngoscopy with or without histopathology. Sensitivity of each modality for diagnosis of the three groups was calculated. Results The NBI is more sensitive for diagnosing leukoplakia. Stroboscopy is more sensitive for diagnosing sulcus. Conclusion Small vocal fold lesions may be missed on WL laryngoscopy. Stroboscopy helps in the diagnosis of structural glottic lesions affecting mucosal wave pattern. Many studies have shown that NBI light highlights the vasculature in superficial mucosal and subepithelial layers. This study is an analysis of the value of NBI in detecting relatively avascular glottic lesions, such as leukoplakia, sulci, and cysts. How to cite this article Nerurkar NK, Shedge AE, Gupta HK, Arya AA. Role of Narrow Band Imaging in Relation to Stroboscopy and White Light Laryngoscopy in Diagnosis of Benign Nonvascular Glottic Lesions. Int J Phonosurg Laryngol 2017;7(1):1-5.

Flexible Gastro-intestinal Endoscopy — Clinical Challenges and Technical Achievements

Flexible gastro-intestinal (GI) endoscopy is an integral diagnostic and therapeutic tool in clinical gastroenterology. High quality standards for safety, patients' comfort, and efficiency have already been achieved. Clinical challenges and technical approaches are discussed in this short review.Image enhanced endoscopy for further characterization of mucosal and vascular patterns includes dye-spray or virtual chromoendoscopy. For confocal laser endoscopy, endocytoscopy, and autofluorescence clinical value has not yet been finally evaluated. An extended viewing field provided by additional cameras in new endoscopes can augment detection of polyps behind folds. Attachable caps, flaps, or balloons can be used to flatten colonic folds for better visualization and stable position.Variable stiffness endoscopes, radiation-free visualization of endoscope position, and different overtube devices help reducing painful loop formation in clinical routine. Computer assisted and super flexible self-propelled colonoscopes for painless sedation-free endoscopy need further research. Single-use devices might minimize the risk of infection transmission in the future.Various exchangeable accessories are available for resection, dissection, tunneling, hemostasis, treatment of stenosis and closure of defects, including dedicated suturing devices. Multiple arm flexible devices controlled via robotic platforms for complex intraluminal and transmural endoscopic procedures require further improvement.

Eosinophilic gastroenteritis: A state-of-the-art review.

Eosinophilic gastrointestinal disorders are a series of diseases that include eosinophilic esophagitis, eosinophilic gastritis, eosinophilic gastroenteritis, eosinophilic enteritis, and eosinophilic colitis. Among these disorders, eosinophilic gastroenteritis is an uncommon and heterogeneous disease characterized by eosinophilic infiltration of the gastrointestinal tract in the absence of secondary causes, presenting with a variety of gastrointestinal manifestations. Up to now, epidemiology and pathophysiology of eosinophilic gastroenteritis are still unclear. Based on clinical manifestations and depth of eosinophilic infiltration into the gastrointestinal tract wall, eosinophilic gastroenteritis is classified into three different patterns including predominantly mucosal pattern, predominantly muscular pattern, and predominantly serosal pattern. For diagnosing eosinophilic gastroenteritis, it is necessary for clinicians to have a high degree of clinical suspicion. In addition to the gastrointestinal symptoms, other evidences such as laboratory results, radiological findings and endoscopy can also provide important diagnostic evidences for eosinophilic gastroenteritis. And these indirect pieces of information together with histological results will lead to a definitive diagnosis of eosinophilic gastroenteritis. To avoid specific allergen, dietary treatments can be considered as initial treatment strategy before drug treatment. Corticosteroids are the main medication for eosinophilic gastroenteritis and have a dramatic therapeutic efficacy. Yet other medications need to further verify their effects in clinical practice, and surgery should be avoided as far as possible.