Magnifying Narrow-band Imaging Endoscopy Research Articles

The diagnostic utility of narrow band imaging magnifying endoscopy in clinical practice in a population with intermediate gastric cancer risk

Narrow band imaging (NBI) and NBI-magnifying endoscopy (ME) have been reported to facilitate the diagnosis of intestinal metaplasia (IM) and early gastric cancer (EGC) in high-risk populations. This study aimed at comparing the detection rate of focal gastric lesions by NBI against white light endoscopy (WLE), and examined the utility of NBI-ME in differentiating gastric mucosal pathology in a population with intermediate gastric cancer risk. Chinese patients aged 35-70 years undergoing diagnostic gastroscopy (GIF FQ260Z) by six experienced endoscopists were enrolled prospectively. The sequence of endoscopic evaluation was WLE followed by NBI. Focal lesions were re-examined by NBI-ME. The incremental diagnostic yield of NBI over WLE and ability of NBI-ME to differentiate gastric mucosal pathology were analyzed. Over a 30-month period, 458 patients (mean age: 52 years; men: 53.7%; Helicobacter pylori positive: 20.1%) were recruited. WLE detected a focal gastric lesion in 43.7% (200/458). WLE made a definitive diagnosis in 148 out of 200 patients (147 benign lesions and one gastric cancer), whereas NBI-ME correctly clarified the nature of the remaining 52 lesions (benign: 51; EGC: one). NBI detected an additional 69 out of 458 lesions (type 0_IIa: 91.3%; type 0_IIb: 8.7%) missed by WLE; the diagnoses based on NBI-ME were IM (67/69), EGC (1/69), and benign lesion (1/69). Interobserver agreement study revealed a κ statistic of 0.71. NBI detected IM missed by WLE. NBI-ME was useful in differentiating the pathology of focal gastric mucosal lesions.

CLINICAL IMPACT OF NARROW‐BAND IMAGING MAGNIFYING ENDOSCOPY FOR ‘BASAL LAYER TYPE SQUAMOUS CELL CARCINOMA’ IN THE ESOPHAGUS

A 61-year-old man had received endoscopic submucosal dissection (ESD) for early gastric cancer twice. Then he had undergone annual control esophagogastroduodenoscopy using narrow-band imaging (NBI) magnifying endoscope. At the esophagogastroduodenoscopy, we were not able to detect any significant finding in the esophagus by conventional endoscopy. Switching to NBI mode, a brownish area was showed in the middle esophagus. The lesion showing the brownish area was predicted to be mucosal squamous cell carcinoma (SCC) as a result of assessment of morphologic change of intraepithelial papillary capillary loop under magnifying NBI observation. Lugol chromoendoscopy displayed the lesion as unstained area corresponding to the brownish area visualized by NBI. The ESD was performed for the lesion. Histology from ESD specimen showed SCC with minimal invasion to lamina propria at multifocal sites. The SCC was surrounded by low-grade intraepithelial neoplasia. Most of the SCC showed a high degree of cytological and architectural atypia confined to the lower half of the epithelium. The type of SCC was called as 'basal layer type SCC' mainly by Japanese pathologists. We suggest that magnifying NBI endoscopy can be useful for detecting and diagnosing 'basal layer type SCC'.

Mo1522 The Diagnosis of Colorectal Cancer With NBI Magnifying Endoscopy, Magnifying Chromoendoscopy and Endocytoscopy

Mo1522 The Diagnosis of Colorectal Cancer With NBI Magnifying Endoscopy, Magnifying Chromoendoscopy and Endocytoscopy

Topographic differences in gastric micromucosal patterns observed by magnifying endoscopy with narrow band imaging

The distributions and grades of Helicobacter pylori induced gastritis are known to vary among H. pylori-associated diseases. The aim of this study was to investigate the differences in distributions of gastric micromucosal structures observed by magnifying narrow band imaging (NBI) endoscopy among patients with different H. pylori-associated diseases. Ninety-five patients with active duodenal ulcers (n = 24) and diffuse-type (n = 24) and intestinal-type (n = 47) early gastric cancers were enrolled. The magnified NBI findings were evaluated at the lesser and greater curvatures in the upper gastric corpus and were classified according to the modified A-B classification system. Biopsy specimens were also evaluated. In a total of 190 areas observed with magnifying NBI, histological grading (inflammation, activity, atrophy and intestinal metaplasia) showed significant differences among the classified micromucosal patterns (P < 0.001). Types B-1 and B-2, with mild atrophic changes and few areas of intestinal metaplasia, were seen mostly in the duodenal ulcers group. Types B-3 and A-1, with moderate atrophic changes, were seen in the diffuse-type early gastric cancers at the lesser curvature. Types A-1 and A-2, with severe atrophic change and a high frequency of intestinal metaplasia, were seen in the intestinal-type early gastric cancers at the lesser curvature. The prevalence of micromucosal structures differed significantly among the three groups both at the lesser and greater curvatures (P < 0.001). Magnifying NBI endoscopy clearly revealed detailed micromorphological differences corresponding to the histology and endoscopic findings among patients with different H. pylori-associated diseases.

Changes in gastric mucosal patterns seen by magnifying NBI during H. pylori eradication

Magnifying narrow-band imaging (NBI) endoscopy visualizes superficial gastric mucosal and capillary patterns. We aimed to investigate changes in gastric mucosal patterns seen by magnifying NBI endoscopy after Helicobacter pylori eradication. Gastric mucosal patterns in non-pathological gastric corpus were observed by magnifying NBI endoscopy before and 12 weeks after H. pylori eradication in thirty patients. By using paired photographs of each case, changes in NBI mucosal patterns during H. pylori eradication were judged in a consensus manner by three blinded endoscopists. At 12 weeks after H. pylori eradication, 20 of 24 subjects who had been successfully treated showed remarkable changes in gastric mucosal patterns (sensitivity 83.3%, specificity 100%). In the specimens from these subjects, the patterns of enlarged or elongated pits were improved to small oval or pinhole-like round pits, and the density of fine irregular vessels was decreased. Histological assessment showed alleviation of chronic inflammation in all subjects (p < 0.0001), while such a change was not observed for four subjects showing severe gastric atrophy and intestinal metaplasia. When the subjects were divided according to the presence of severe gastric atrophy, the diagnostic efficacy of magnifying NBI for predicting the results of H. pylori eradication was excellent in subjects without severe gastric atrophy and intestinal metaplasia (sensitivity and specificity, 100%). However, no change in the NBI mucosal pattern was observed in subjects with severe gastric atrophy and intestinal metaplasia, regardless of the H. pylori eradication result. At least in subjects without severe gastric atrophy or intestinal metaplasia, successful H. pylori eradication treatment shows improvements in gastric mucosal patterns with the use of magnifying NBI endoscopy early after successful treatment.

M1581: Change in Gastric Mucosal Patterns Seen by Magnifying NBI Endoscopy During H. Pylori Eradication

Magnifying narrow-band imaging (NBI) endoscopy visualizes superficial gastric mucosal and capillary patterns. We aimed to investigate the change in gastric mucosal patterns seen by magnifying NBI endoscopy during H. pylori eradication.

Gastric mucosal pattern by using magnifying narrow-band imaging endoscopy clearly distinguishes histological and serological severity of chronic gastritis

Magnifying narrow-band imaging (NBI) endoscopy clearly visualizes superficial gastric mucosal patterns and capillary patterns. To investigate gastric mucosal patterns by using magnifying NBI endoscopy and identify any relationship between those patterns and Helicobacter pylori-induced gastritis. Gastric mucosal patterns seen with magnifying NBI in uninvolved gastric corpus were divided into the following categories: normal--small, round pits with regular subepithelial capillary networks; type 1-slightly enlarged, round pits with unclear or irregular subepithelial capillary networks; type 2--obviously enlarged, oval or prolonged pits with increased density of irregular vessels; and type 3-well--demarcated oval or tubulovillous pits with clearly visible coiled or wavy vessels. Department of Gastroenterology, Fujita Health University. This study involved 106 participants undergoing upper endoscopy. H pylori infection-positive ratios of normal and types 1, 2, and 3 patterns were 7.5%, 92.9%, 94.5%, and 66.7%, respectively. Sensitivity and specificity for types 1 + 2 + 3 for detection of H pylori positivity and type 3 for detection of intestinal metaplasia were 95.2%, 82.2%, 73.3%, and 95.6%, respectively. Development of mucosal patterns from normal to types 1, 2, and 3 was correlated with all histological parameters (P < .0001), lower pepsinogen I/II ratios (P < .0001), and degree of endoscopic atrophy (P < .0001). Sensitivity and specificity of type 3 for the prediction of severe histological atrophy was also better than those of serum pepsinogen level and standard endoscopy. Only 1 endoscopist performed endoscopic procedures, and interobserver agreement could not be assessed. Magnifying NBI endoscopy is useful for predicting H pylori infection and the histological severity of gastritis and is valuable for predicting gastric atrophy in the entire stomach.

Usefulness of NBI Magnifying Endoscopy in the Pharynx and Esophagus

近年，高解像度の “NBI拡大” 内視鏡の登場により，とくに扁平上皮領域では微小な腫瘍性病変の発見も容易になってきた。NBI通常観察 (非拡大) でbrown spot (あるいはbrownish area) を同定して，その後に同部のNBI拡大内視鏡をおこなうことで病変の性状診断をおこなうことができる。扁平上皮領域における通常の拡大内視鏡観察 (約100倍) においては，IPCLパターン分類 (IPCL：扁平上皮乳頭内血管) が指標となる。IPCLの変化は，組織の構造異型を反映していると考えられる。今後の将来展望として，超・拡大内視鏡 (endocytoscopy) (500倍) (未発売) があり，こちらでは細胞や核を生体内で直接観察することができる。これにより細胞異型をも捉えることができる。ECA (endocytoscopic atypia) 分類として，パパニコロウ分類に従い5段階評価をおこなっている。このような診断機器の進歩により，組織の内視鏡的異型度診断が現実のものとなりつつある。ここではIPCLパターン分類，ECA分類を中心に概説したい。