Narrow-band Imaging System Research Articles

EFFECTIVENESS OF PERORAL CHOLANGIOSCOPY AND NARROW BAND IMAGING FOR ENDOSCOPICALLY DIAGNOSING THE BILE DUCT CANCER

CHF-B260 has thinner diameters, and the quality of the endoscopic images has improved. Recently, narrow band imaging (NBI) system has been developed for high-contrast observation of mucosal structures and vascular patterns. It is available to diagnose for the bile duct cancer endoscopically and it is useful for desciding of surgical margin before operation. As for its applicability to investigating the progression of superficially infiltrated bile duct cancer, additional cases must be examined in the future.

The Diagnosis of Colorectal Lesions By Magnifying Endoscopy with Narrow Band Imaging System

Narrow band imaging (NBI) emphasizes the surface microvasculature of the gastrointestinal tract and may help in detecting small neoplasms, especially in the esophagus. The aim of this prospective study is to clarify the value of the NBI system in tissue characterization and differential diagnosis of colorectal lesions. The subjects were 1473 lesions (53 hyperplastic polyps, 1317 adenomas and 103 submucosally invasive (T1) cancers) which were observed by magnifying scope with NBI and treated endoscopically or surgically from January 2006 to February 2008. The scope used in this study was CF-H260AZI (with magnifying power of × 80 at maximum) (Olympus, Tokyo). We classified colonic microvascular pattern into six groups; normal, faint, network, dense, irregular and sparse. The NBI diagnosis was made by endoscopists who were blinded to the final pathological diagnosis. Most of hyperplastic polyps showed a faint pattern. The vascular patterns of adenomas were mainly network or dense pattern. Of the 20 adenomas that presented a faint pattern, 17 lesions were sessile serrated adenomas. Thus, sessile serrated adenomas are sometimes difficult to be distinguished from hyperplastic polyps. On the other hand, the major vascular patterns of cancers were irregular and sparse pattern. The vascular patterns of massively invasive submucosal cancers included only irregular and sparse patterns. Irregular pattern was characteristic for protruded or flat-elevated cancers, while sparse pattern was unique for depressed cancers. When we assumed that faint pattern was diagnostic for hyperplastic polyps, we could differentiate between neoplastic and non-neoplastic lesions with sensitivity of 88.7% and specificity of 98.5%. Vascular pattern analysis by NBI with magnifying colonoscopy was judged helpful in differentiating between neoplasia and non-neoplasia. When we assumed that irregular and sparse patterns were carcinomatous indices in neoplasia, the sensitivity was 77.7% and the specificity was 98.4%. The overall accuracy rate was 90.3%. Utilizing NBI system is valuable in distinguishing neoplastic from non-neoplastic lesions, as well as to distinguish cancers and adenomas.

Novel Magnifying Endoscopic Classification for Early Gastric Cancer with Narrow Band Imaging System; Particularly Focusing On Micro-Vascular Pattern and Surface Glandular Structure

Background and Aim: Abnormal microvascular pattern for differentiated type adenocarcinoma in the stomach was firstly reported by Yao K et al. Nakayoshi et al. also reported magnifying endoscopic classification of fine network pattern(FNP) and corkscrew pattern(CSP) mainly based upon microvascular pattern. In this study we introduced a newly designed NBI magnifying endoscopic classification. Two additional patterns of intra-lobular loop pattern-1(ILL-1) and intra-lobular loop pattern-2(ILL-2) were added in this novel classification with further assessment of superficial glandular structure. We report actual diagnostic rate of new categories (ILL-1 and ILL-2) and its clinical impacts. Patients and Methods: From June 2006 to September 2008, 257 lesions in 240 cases of early gastric cancer (223 lesions of differentiated type, 34 lesions of poorly differentiated type) were enrolled in this study. Novel NBI magnifying endoscopic classification: NBI magnifying images were classified into four categories based on abnormal microvascular pattern and irregularity of superficial glandular structure (Figure). FNP has small glandular opening to mucosal surface with abnormal mesh-like microvascular structure. Microvascular structure encircles each glandular opening. ILL-1 has villous glandular structure with loop like microvessels in it. In ILL-2, villous glandular structure was started to be destructed. In CSP almost all glandular structures have been disappeared with marked appearance of corkscrew-like abnormal vessels. Results: Among 223 lesions of differentiated type adenocarcinoma, FNP, ILL-1, ILL-2, and CSP were observed respectively in 35 lesions (15.7%), 133 lesions (59.6%), 54 lesions (24.2%), and 1 lesion (0.5%). Differentiated-type adenocarcinoma mainly demonstrated FNP and ILL with the exception of one lesion. More than 80% of differentiated type adenocarcinoma were classified into ILL-1 and ILL-2. Among 34 lesions of poorly differentiated type adenocarcinoma, ILL-2, CSP were observed respectively in 14 lesions (41.2%), 20 lesions (58.8%). Poorly differentiated type adenocarcinoma were all classified in ILL-2 and CSP. Conclusions: Novel NBI magnifying classification included ILL pattern may predict the histological subtype of gastric carcinoma.

Endoscopic Screening of Esophageal Cancer in Patients with Head and Neck Cancers: A Prospective Study By Comparison of Narrow-Band-Imaging with High-Magnification and Conventional Endoscopy

Background and Aims: Esophageal cancers coexistent with patients with head and neck cancers are not unusual. Early detection of esophageal cancer in these patients may alter treatment planning and thus further improve the survival. Recent advances in narrow-band-imaging (NBI) in endoscopy permits adjustment of reflected light, enhancement of the vascular pattern, and improvement of the detection rate of early-stage mucosal malignancies. In this prospective study we aimed to evaluate the prevalence of concomitant esophageal cancers in patients with head and neck cancers. We also compared the detection rate of NBI with high-magnification and conventional endoscopy in screening these esophageal cancers. Patients and Methods: A prospective study was undertaken in single endoscopy center in South Taiwan from April 2008 to November 2008. A total of 50 patients with documented head and neck cancer were enrolled. Demographic data and risk factors were recorded. All patients underwent a meticulous endoscopic examination of the esophagus with conventional white light system, followed by switching to NBI system. If a brownish area under NBI was detected, high-magnification was applied to determine the microvascular pattern in the lesion. Biopsy for all suspicious neoplastic lesions by conventional endoscopy and/with/or NBI with high-magnification was done for final pathology. Results: A total of 19 endoscopic suspected lesions were obtained from 15 patients using conventional endoscopy, while there were 30 endoscopic suspected lesions obtained from 20 patients using NBI with magnification. All suspicious lesions found by conventional endoscopy could be also detected by NBI with magnification. NBI system could detect more superficial lesions than conventional endoscopy (20 vs. 9 lesions). After histological analysis, NBI with magnification found more neoplastic lesions than conventional endoscopy (24 lesions in 14 patients vs. 15 lesions in 12 patients), especially in patients with high grade dysplasia (5 lesions in 4 patients vs. 0 lesion). Totally 14 patients were diagnosed as squamous cell carcinoma of esophagus in 50 patients with head and neck cancers, resulting in a prevalence of 28%. The overall concordance in interpretation between these two methods was 81.7%. Conclusion: The prevalence of esophageal neoplasia reached 28% in patients with head and neck cancers, which was higher than previous study. NBI with magnification significantly increased the detection rate of suspicious neoplastic lesion, especially the superficial neoplasia. Periodical endoscopic surveillance of esophagus in patients with head and neck cancers is warranted.

Study of Patients with Malignant Lymphoma Diagnosed By Upper Endoscopy

Background and Aim: The gastrointestinal tract is one of the most commonly involved extranodal sites of malignant lymphoma (ML). These lesions may be seen as primary GI lymphoma or as secondary one. Our interest in lymphomatous neoplasia of the GI tract is due to the large number of patients with ML diagnosed by upper endoscopy. A retrospective study of patients with ML was conducted in an attempt to examine clinical and endoscopic features of ML. Patients and Methods: 56 patients with ML (75 lesions) diagnosed by upper endoscopy between April 1, 2000 and August 31, 2008 were enrolled. We analyzed clinical features, localization, macroscopic morphology, and differences in the histological diagnosis. And, we also examined the feature of magnified endoscopic images with the narrow band imaging (NBI) system in recent 4 patients. Results: 56 patients (age: 62.91 ± 14.23, sex: M/F 34/22) with ML were confirmed. 27 lesions (36%) of ML occurred in middle third stomach, 20 lesions (26.7%) in lower third stomach, 13 lesions (17.3%) in duodenum, 8 lesions (10.7%) in upper third stomach, 5 lesions (6.7%) in entire stomach, and 2 lesions (2.7%) in esophagus. In terms of macroscopic morphology, 32 lesions (42.7%) were present as superficial depressed type, 19 lesions (25.3%) as ulcer type, 13 lesions (17.3%) as fungated type, 6 lesions (8%) as polypoid type, 5 lesions (6.7%) as giant fold type. Out of them, 13 lesions (17.3%) were present as a single ulcer. In the histological diagnosis, there were 38 patients (67.9%) with diffuse large B-cell lymphoma (DLBCL) (50 lesions, including 5 entire stomach lesions), 8 patients (14.3%) with MALT lymphoma (11 lesions), 4 patients (7.1%) with follicular lymphoma (6 lesions), 4 patients (7.1%) with mantle cell lymphoma (6 lesions), 1 patient (1.8%) with Burkitt's lymphoma, and 1 patient (1.8%) with adult T-cell lymphoma. Helicobacter pylori was present histologically in 6 patients (75%) of MALT lymphoma group. In a magnified endoscopic imaging with NBI, we could recognize disappearance of regular gastric pits or appearance of irregular vessel pattern in all of 4 patients with ML (2 with DLBCL, 1 with Mantle cell lymphoma, and 1 with MALT lymphoma). Limitation: This was a single-center study. Conclusion: Clinical and endoscopic features of malignant lymphoma were varied. Therefore, we should treat these lesions carefully.

Prevalence of Small Bowel Polyps in Patients with Familial Adenomatous Polyposis Using the Single-Balloon Enteroscope

Background: Duodenal and periampullary cancer are major cause of death in patients with familial adenomatous polyposis (FAP) after colectomy. The endoscopic study of the duodenal or periampullary lesions is easily performed with forward or side-viewing endoscopy. However, the endoscopic evaluation of polyps located distal to the duodenum is limited. The Single-Balloon enteroscopy (SBE) that allows therapeutic endoscopy, in association to the narrow-band imaging system (NBI) became a good tool to evaluate the small bowel in such patients with FAP.

Narrow-band imaging system with magnifying endoscopy in differentiating colorectai neoplasms from non-neoplasms

Objective To observe the meshed capillary pattern （CP） on the surface of colorectal lesions by narrow-band imaging system with magnifying endoscopy （NBI-ME）, and to distinguish neoplasm from non-neoplasm by the change of capillary patterns. Methods A total of 144 eolorectal lesions in 102 patients detected by conventional eolonoscopy were evaluated by NBI-ME to observe the CP on surface, and by staining magnifying colonoscopy to observe the pit pattern. Results All lesions were resected endoscopically （129/144） or by surgery （15/144）, and the pathological evaluation diagnosed 30 cases of non-neoplasm （including 20 cases of hyperproliferative polyps and 10 of inflammatory polyps） and 114 cases of neoplasm （including 95 cases of adenoma and 19 cases of adenocarcinoma）. The diagnostic accuracy rate, sensitivity and specificity of conventional colonoscopy were 75.7% , 85. 1% and 40. 0% , respectively, which were significantly lower than those of NBI-ME and staining magnifying colonoscopy （ P 〈 0. 005 ） , while there was no significant difference between NBI-ME and staining magnifying colonoscopy. The CP of type Ⅰ , Ⅱ , Ⅳand Ⅵa were totally correspondent with pit pattern of type Ⅰ , Ⅱ , ⅣandⅤ1 Conclusion NBI-ME findings of colorectal lesions correlated with those of staining magnifying colonoscopy. These two techniques are both helpful in differentiating colorectal neoplasms from non-neoplasms. Key words: Colorectal neoplasm ; Endoscopy ; Narrow-band imaging system ; Magnifying endoscopy; Pit pattern

Narrow Band Imaging in Gastroesophageal Reflux Disease and Barrett’s Esophagus

Narrow Band Imaging (NBI), developed by Olympus Medical Systems (Olympus, Japan), is a new and well-recognized advance in endoscopic imaging. Although conventional white-light endoscopy uses the entire spectrum of visible light (400 nm to 700 nm) to examine tissue, the NBI system uses optic filters to isolate two specific bands of light: 415 nm blue and 540 nm green (1–4). By isolating these two bands of light and taking into account their absorptive and reflective properties on the mucosal surface, an image that enhances visualization of superficial mucosal and vascular structures is created. The highlight of NBI endoscopy is the proposed ability to predict pathology in real-time based on the mucosal and vascular changes detected. NBI has been investigated for use as a diagnostic modality in a variety of lesions in the gastrointestinal, respiratory and genitourinary tract (4–6). Conveniently, the NBI mode on an endoscope can be activated with the depression of a switch similar to taking a picture. Dr Robert Enns NBI, often referred to as ‘digital chromoendoscopy’, was developed as an alternative method of obtaining visual enhancement of tissue similar to that seen in chromoendoscopy – a procedure that uses the absorptive properties of various dyes, such as indigo carmine, rather than optical filters (1–4). Although much research concerning the use of chromoendoscopy has been conducted, its widespread use has not been adopted for various reasons including the increased time involved with the procedure and the lack of training (ie, many training centres do not use it regularly). In the January 2009 issue of The Canadian Journal of Gastroenterology, we discussed the role of NBI for the detection of neoplastic lesions of the lower gastrointestinal tract; specifically its utility in the diagnosis of adenomatous polyps and dysplasia in ulcerative colitis, hereditary nonpolyposis colorectal cancer and screening colonoscopy. The purpose of the present paper is to review the use of NBI endoscopy as a diagnostic modality for lesions of the upper gastrointestinal tract with particular emphasis on Barrett’s esophagus (BE).

Curative ESD for intraepithelial esophageal carcinoma with leiomyoma mimicking submucosal invasive carcinoma

This case report presents a 65-year-old man who developed early esophageal cancer with leiomyoma treated by endoscopic submucosal dissection (ESD). There have been several reports of co-existing superficial esophageal cancer and leiomyoma treated by endoscopic mucosal resection. However, there is no previous report describing the co-existing lesion treated by ESD. In order to determine treatment strategies for esophageal cancer, accurate endoscopic evaluation of the cancerous depth is essential. In the present case, the combination of endoscopic ultrasonography and narrow-band imaging system with magnifying endoscopy was extremely useful to evaluate the superficial esophageal cancer with leiomyoma, which lead to the appropriate treatment, ESD.

Magnifying endoscopic observation of primary follicular lymphoma of the duodenum by using the narrow-band imaging system

Magnifying endoscopic observation of primary follicular lymphoma of the duodenum by using the narrow-band imaging system

Narrow-Band Imaging Without Optical Magnification for Histologic Analysis of Colorectal Polyps

The ability to determine colorectal polyp pathology by endoscopy could reduce the risks of polypectomy and the cost of pathologic evaluation. This study evaluated the ability of the Olympus Exera 180 high-definition colonoscope (Olympus America, Inc, Center Valley, PA), with narrow-band imaging, to predict colorectal polyp histology. A library of 320 endoscopic photographs with correlated histologic information was used to identify endoscopic features associated with adenomatous and hyperplastic histology. These features were tested in a prospective study of 451 consecutively identified colorectal polyps. Polyps were observed endoscopically and assigned a designation of high or low confidence. The primary end points were the predictive value of high-confidence endoscopic interpretations of adenoma and hyperplastic histology for polyps 5 mm and smaller in size. Endoscopic predictions of adenoma and hyperplastic histology were made with high confidence for 80% and 83% of cases, respectively. High-confidence predictions were more likely than low-confidence predictions to be correct (P<.001). High-confidence predictions of adenoma and hyperplastic histology were correct for 91% and 95%, respectively, of polyps 5 mm and smaller in size. Introduction of confidence levels to the endoscopic interpretation of colorectal polyp histology allows sufficient accuracy for the use of the Exera narrow-band imaging system in the identification of distal hyperplastic polyps that do not need resection, as well as to plan postpolypectomy surveillance without pathologic evaluation of polyps 5 mm in size or smaller.

New cystoscopic diagnosis for interstitial cystitis/painful bladder syndrome using narrow‐band imaging system

Diagnosing the bladder lesions associated with interstitial cystitis/painful bladder syndrome (IC/PBS) is sometimes difficult for general urologists. We therefore aimed to develop an IC/PBS diagnosis method using a cystoscope with a narrow-band imaging (NBI) system that can detect mucosal angiogenic lesions. Fifty-two subjects suspected of having IC between October 2006 and June 2007 were included in this study. There were 49 women and three men, ranging in age from 19 through 85 with an average age of 59. First, conventional cystoscopy under spinal anesthesia was performed to examine the ulcerative lesions by a urological specialist. Then, other health care professionals made a separate observation of capillary-rich areas of the superficial layer of the bladder mucosa by cystoscopy with the NBI system. Among the 52 patients, 37 cases were found to have ulcers by conventional cystoscopy, which were also recognized as capillary-rich brownish areas using the NBI system (100% accuracy); 13 cases were found to have NBI-positive areas without ulcer, which were coincided with those with petechial hemorrhages and glomerulations following subsequent hydrodistention; and two cases of normal mucosa were detected. Furthermore, six cases of bladder cancer (carcinoma in situ) were detected by biopsies that were obtained from the ulcerative lesions positively identified by NBI cystoscopy. Examining the urinary bladder mucosa with a flexible cystoscope with the NBI system makes it possible to easily detect ulcers of bladder mucosa and areas with angiogenesis. Therefore, it is considered that the use of a flexible cystoscope with the NBI system is highly practical for the IC/PBS diagnosis.

The value of narrow band imaging for early detection of laryngeal cancer

We evaluate the value of laryngoscopy using narrow band imaging (NBI) system in the diagnosis of precancerous and cancerous laryngeal lesions. Thirty-four patients were suspected of having a total of 35 precancerous or cancerous laryngeal lesions among patients receiving conventional white-light laryngoscopy. All 34 patients underwent laryngoscopy with NBI system to determine whether those lesions were malignant before biopsy procedure. The diagnostic criteria of malignancy by NBI view was the presence of demarcated brownish area with scattered brown spots in the lesion. Histopathologic results were retrospectively compared with results of determination of malignancy made by NBI view. Of the 23 lesions histopathologically proved to be malignancies, 21 lesions were classified as malignant by NBI view. Sensitivity and specificity for the diagnosis of malignancy by means of NBI view compared with histopathologic results were 91.3% for sensitivity and 91.6% for specificity. NBI endoscopy seems to be a very promising diagnostic tool in the diagnosis of laryngeal malignant disease.

NEWLY DEVELOPED OPTIMAL BAND IMAGING SYSTEM FOR THE DIAGNOSIS OF EARLY GASTRIC CANCER

Background: Magnifying narrow band imaging system is useful for the diagnosis of early gastric cancer. However, it is difficult for the operator of the scope to maintain the correct distance between the tip of the endoscope and the gastric mucosa for appropriate visualization. The newly developed optimal band imaging system can reconstruct good spectral images derived from ordinary endoscopic images and enhance the mucosal surface without magnification as well as with low magnification. This imaging technique is based on narrowing the bandwidth of the conventional image arithmetically, using spectral estimation technology. Methods: We evaluated endoscopic features of 30 lesions with elevated-type, 32 lesions with depressed-type and two lesions with flat-type early gastric cancer using this new system. Results: We found the best images in all cases of early gastric cancers by using a specific combination of the following three wavelengths available in this system: 470 nm for blue, 500 nm for green and 550 nm for red. The optimal band images showed the depressed-type early gastric cancer as reddish lesions distinct from the surrounding yellowish non-cancerous area, leading to a clear demarcation line between the cancerous and non-cancerous mucosa without magnification. Moreover, 30–40-fold magnified optimal band images showed a clearly irregular microvascular pattern or a microstructure pattern of the mucosal surface in all types of gastric cancers. Conclusion: This new system can provide useful information for diagnosing various types of early gastric cancers without and with low magnification.

Narrow Band Imaging (NBI) Enhancing the Visualization of Diverticula in a Rare Case of Esophageal Intramural Pseudodiverticulosis with Esophageal Strictures

Purpose: Introduction: Esophageal Intramural Pseudodiverticulosis (EIP) are abnormal dilated ducts of submucosal glands often associated with conditions that cause chronic esophageal inflammation such as gastroesophageal reflux, chronic candidiasis, previous caustic ingestion and esophageal cancer. EIP is most commonly seen in the sixth or seventh decade of age. Methods: Case: A 56-year-old caucasian woman diagnosed with EIP in 1990 and submitted to esophageal dilation every 2 years in average due to intermittent dysphagia presents with new onset of upper esophageal discomfort pointed at the level of the thyroid cartilage. Previous barium-contrast esophagogram showed a diffuse narrowed esophagus and multiple flask-shaped outpouchings in the esophageal wall. Results: Endoscopy was performed and revealed two areas of circumferential stenosis at 20 cm and 37 cm from incisors associated with multiple small diverticula in the esophageal wall. Initially a white lamp examination was performed then NBI system was applied and a considerable enhancement of the diverticula images was observed with a better appreciation of the disease extension throughout the esophagus. We choose to approach the double stenosis with a guidewire Savary dilation using a 36 Fr probe. Patient's symptoms improved considerably 2 days after the procedure. Conclusion: Discussion: EIP is a rare condition with only about 200 cases reported although autopsy studies showed its incidence being as high as 55%. The endoscopic appearance of EIP is characteristic but the diverticula openings are small and often missed. Our report shows that NBI might be a helpful tool in the endoscopic armamentarium for diagnosis of this condition.Figure: Esophageal Pseudodiverticulosis using white light.Figure: Esophageal Pseudododiverticulosis using Narrow Band Imaging.

S195 – Laryngeal Observation of Early Cancer with NBI System

Objectives The Narrow Band Imaging (NBI) is an illumination method for medical endoscopes that can visualize the micro-vascular structure of the organ surface. The effectiveness of NBI has been reported in detecting the oropharyngeal and hypopharyngeal neoplasm lesion. The aim of this study is to identify the usefulness of NBI in laryngeal lesion, especially in observing cases of post-operated or post-irradiated early laryngeal cancers. Methods 16 patients of early laryngeal cancer after treatment for at least 6 months were entered in this study: 1 case of T1s, 8 cases of T1a, 3 cases of T1b, and 4 cases of T2. 3 cases of T1a underwent cordectomy under direct laryngoscope using KTP laser. 13 cases were treated with irradiation. Results The cases for which NBI was suggested to be useful were: T1b, undergoing laser surgery, supra-glottic carcinoma, appearing hyper-adduction of the false vocal fold during phonating, and causing severe mucosal edema after irradiation. Conclusions NBI system may play an important role in the observation of post-therapy of early laryngeal cancer.

Can narrow-band imaging be used to determine the surgical margin of superficial hypopharyngeal cancer?

Narrow-band imaging (NBI) is a novel optical technique that uses narrow bandwidth filters in a video endoscope system to improve the diagnostic capability of endoscopes in characterizing tissues. It is well known that early identification of neoplasia in the gastrointestinal tract using this technique might make it possible to reduce the suffering of patients caused by loss of function or severe complications after radical surgery. Several reports have introduced this system as a preoperative examination to evaluate the lateral spread of the neoplastic lesions in the oropharynx or hypopharynx. We experienced a case with hypopharyngeal cancer in which we were able to avoid underestimating cancer lesions following insufficient resection using the NBI system. A 62-year-old female underwent partial hypopharyngectomy with the margin estimated by an NBI view coupled with reconstruction of the hypopharynx while preserving the larynx. The resected specimen was cut into serial sections for a detailed pathology examination. The surgical margin seemed to be wide enough and it could be assumed that if possible we should observe these cancers with conventional electroendoscopy and NBI before treatment.

ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER USING MAGNIFYING ENDOSCOPY WITH A COMBINATION OF NARROW BAND IMAGING AND ACETIC ACID INSTILLATION

Demarcation of early gastric cancers is sometimes unclear. Enhanced‐magnification endoscopy with acetic acid instillation and magnifying endoscopy with a narrow band imaging (NBI) system have been useful for recognition of demarcation of early gastric cancers. We report a patient with early gastric cancer who underwent a successful endoscopic submucosal dissection (ESD) by magnifying endoscopy with the combined use of NBI and acetic acid instillation. A 72‐year‐old man with early gastric cancer underwent ESD. Demarcation of the lesion was not clear, but magnifying endoscopy using the combination of NBI and acetic acid clearly revealed the demarcation. ESD was carried out after spots were marked circumferentially. We identified the positional relation between the demarcation and all markings. Resection of the lesion was on the outside of the markings. Histopathologically, the lesion was diagnosed as a well‐differentiated adenocarcinoma limited to the mucosa. The margins were carcinoma free. Magnifying endoscopy combining the use of NBI with acetic acid instillation is simple and helpful for identifying the demarcation of early gastric cancer. This method may be useful in increasing the rate of complete resection by ESD for early gastric cancer.

Narrow-band imaging system with magnifying endoscopy for rectal amyloidosis

Infiltration of the colonic mucosa with amyloid may result in a clinical picture masquerading colorectal neoplasia.1 Narrow-band imaging (NBI) is a new technique that uses optical filters to enhance the mucosal morphology without the need for dye spraying. When used with high-resolution endoscopy (HRE), it enables endoscopic differentiation between neoplastic and nonneoplastic lesions.2 It is uncertain whether such advance in technology is useful in distinguishing GI amyloidosis from neoplastic disease.

Narrow Band Imaging for Esophageal Surveillance in Patients with Head and Neck Cancers

Backgrounds: Squamous dysplasia and carcinoma in situ in the esophagus can be visualized by Lugol chromoendoscopy. However, the Lugol staining method often leads to pain and discomfort because iodine causes severe mucosal irritation. The narrow band imaging (NBI) system is a novel technology based on visualization of microvasculature and mucosal patterns. The aim of this study is to assess the feasibility of the NBI system for screening for esophageal cancer in patients with head and neck cancers. Patients and Methods: Patients with head and neck squamous cell carcinoma were examined by NBI esophageal endoscopy followed by chromoendoscopy using iodine dye from April 2006 to November 2007. All procedures were performed using a magnifying endoscope (GIF-Q240Z or GIF-FQ260Z, Olympus Co.). If abnormal mucosal areas (well demarcated brownish area) were identified under the non-magnifying NBI and if scattered brownish dots were observed within the lesion under the magnifying NBI, we defined the lesion as being abnormal. After NBI endoscopy, Lugol idodine solution was sprayed over the entire esophageal mucosa. A well demarcated, unstained lesion was defined as a Lugol-voiding lesion (LVL). Biopsy specimens were taken when the LVL was > 5 mm in size, and divided into 4 categories: squamous cell carcinoma (SCC); high grade intraepithelial neoplasia (HGN); low grade intraepithelial neoplasia (LGN); and lesion without atypia (no atypia). The detection of esophageal SCC and HGN were evaluated. Results: A total of 109 patients were enrolled. The median age of the patients was 64 years (range, 29-86 years), and approximately three fourths of all patients were male. Fourteen superficial lesions were detected by NBI endoscopy. Of these, 6 lesions were diagnosed as SCC and 1 lesion as HGN. Among the patients without positive findings by NBI endoscopy, LVL > 5 mm was shown in 12 lesions. Five lesions were diagnosed as LGN and 7 leisons as no atypia. There was no esophageal SCC or HGN in patients with normal findings by NBI endoscopy. Conclusions: NBI is useful for screening for esophageal squamous cell carcinoma in patients with head and neck cancer. By introducing the NBI system, chromoendoscopy using iodine dye may be necessary less often for the diagnosis of superficial esophageal squamous cell carcinoma.