Magnifying Endoscopy With Narrow-band Imaging Research Articles

A deep learning method for delineating early gastric cancer resection margin under chromoendoscopy and white light endoscopy.

Accurate delineation of cancer margins is critical for endoscopic curative resection. This study aimed to train and validate real-time fully convolutional networks for delineating the resection margin of early gastric cancer (EGC) under indigo carmine chromoendoscopy (CE) or white light endoscopy (WLE), and evaluated its performance and that of magnifying endoscopy with narrow-band imaging (ME-NBI). We collected CE and WLE images of EGC lesions to train fully convolutional networks ENDOANGEL. ENDOANGEL was tested both on stationary images and endoscopic submucosal dissection (ESD) videos. The accuracy and reliability of ENDOANGEL and NBI-dependent delineation were further evaluated by a novel endoscopy-pathology point-to-point marking. ENDOANGEL had an accuracy of 85.7% in the CE images and 88.9% in the WLE images under an overlap ratio threshold of 0.60 in comparison with the manual markers labeled by the experts. In the ESD videos, the resection margins predicted by ENDOANGEL covered all areas of high-grade intraepithelial neoplasia and cancers. The minimum distance between the margins predicted by ENDOANGEL and the histological cancer boundary was 3.44 ± 1.45mm which outperformed the resection margin based on ME-NBI. ENDOANGEL has the potential to assist endoscopists in delineating the resection extent of EGC under CE or WLE during ESD.

Corrigendum to: Comparative evaluation of new and conventional classifications of magnifying endoscopy with narrow band imaging for invasion depth of superficial esophageal squamous cell carcinoma.

A new classification of magnifying endoscopy with narrow band imaging (ME-NBI) for diagnosing and staging superficial esophageal squamous cell carcinoma (SESCC) was proposed by the Japan Esophageal Society in 2011. This study aimed to compare the new classification with the conventional classifications (Inoue's classification and Arima's classification). This was a prospective analysis of data from a single cancer center involving 151 consecutive patients with 156 SESCCs that were endoscopically or surgically resected. Initially, only ME-NBI images were selected and reviewed independently by three experienced endoscopists. White light imaging (WLI) was then evaluated separately after an interval. The diagnostic performance of each classification and interobserver agreement were assessed, and the WLI findings that affect the diagnosis by the new classification were identified. The specificity for classifying invasive depth as epithelium (EP)/lamina propria mucosae (LPM) confined was higher with the new classification than with Inoue's classification (0.512 vs. 0.349; P = 0.02) and Arima's classification (0.512 vs. 0.279; P < 0.01). However, the sensitivity was lower (0.902 vs. 1.000; P < 0.01) compared with Arima's classification. The concordance rates of three evaluators (κ values) were 0.52 for the new classification, 0.50 for Inoue's classification, and 0.23 for Arima's classification. On multivariate analysis, thickness on WLI independently affected the accuracy of diagnosis with the new classification (OR 3.23; 95%CI, 1.30-8.03). The new classification is superior to conventional classifications with respect to specificity for diagnosing SESCC with depth EP/LPM. Thickness on WLI was a factor negatively affecting the diagnostic performance of the new classification.

Image-Enhanced Endoscopy and Its Corresponding Histopathology in the Stomach.

In recent years, the technological innovation and progress of endoscopic equipment have been remarkable, and various endoscopic observation techniques have been developed. Among them, representative techniques are magnified observation and narrow-band imaging. Magnifying endoscopy with narrow-band imaging (M-NBI) can visualize superficial microanatomies in the stomach. The normal morphology of the microanatomy visualized using M-NBI differs according to the part of the stomach. The vessel plus surface (VS) classification system has been developed as a diagnostic criterion for early gastric cancer using M-NBI, and its usefulness has been proven. Based on the VS classification system, a magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G), a simplified algorithm used for early gastric cancer diagnosis, was created. We aimed to describe the anatomic structure of the stomach that can be viewed using M-NBI and outline the principles and clinical application of the VS classification system and MESDA-G. (Gut Liver 2021;15:-337)

Irregularly branched microvessels as visualized by magnifying endoscopy: a reliable marker for predicting deep submucosal invasion of superficial esophageal squamous cell carcinoma.

Background and study aims Magnifying endoscopy with narrow-band imaging (M-NBI) is reported to be useful in diagnosing invasion depth of superficial esophageal squamous cell carcinoma (SCC), but accurate diagnosis of deep submucosal invasion (SM2) has remained difficult. However, we discovered that irregularly branched microvessels observed with M-NBI are detected in SM2 cancers with high prevalence. Thus, this retrospective study aimed to investigate the diagnostic performance of irregularly branched microvessels as visualized by M-NBI for predicting SM2 cancers. Patients and methods Patients with superficial esophageal SCC lesions that were endoscopically or surgically resected at our hospital between September 2005 and December 2014 were included. Endoscopic findings by M-NBI of these lesions were presented to an experienced endoscopist who was unaware of the histopathological diagnosis and who then judged whether irregularly branched microvessels were present. Using the invasion depth according to postoperative histopathological diagnosis as the gold standard, we determined the diagnostic performance of the presence of irregularly branched microvessels as an indicator for SM2 cancers. Results A total of 302 superficial esophageal SCC lesions (228 patients) were included in the analysis. When irregularly branched microvessels were used as an indicator of SM2 cancers, the diagnostic accuracy was 94.0 % (95 % confidence interval [CI]: 91.1–96.1 %), sensitivity was 79.4 % (95 % CI: 66.6–88.4 %), specificity was 95.9 % (95 % CI: 94.3–97.0 %), positive predictive value was 71.1 % (95 % CI: 59.6–79.1 %), and negative predictive value was 97.3 % (95% CI: 95.7–98.5 %). Conclusions Irregularly branched microvessels may be a reliable M-NBI indicator for the diagnosis of cancers with deep submucosal invasion.

A Deep Learning Method for Delineating Early Gastric Cancer Resection Margins Under Chromoendoscopy or White Light Endoscopy

Background: Accurate delineation of cancer margins is critical for achieving endoscopic curative resection. This study aimed to train and validate real-time fully convolutional networks (FCNs) for delineating the resection margin of early gastric cancer (EGC) under indigo carmine chromoendoscopy (CE) or white light endoscopy (WLE) and evaluated its performance and that of magnifying endoscopy with narrow-band imaging (ME-NBI). Methods: We collected CE/WLE images of EGC lesions to train FCNs named ENDOANGEL. ENDOANGEL was tested both on still images and endoscopic submucosal dissection (ESD) videos and evaluated the performance of ME-NBI based on post-ESD pathology determined using endoscopy–pathology point-to-point marking. Findings: ENDOANGEL had an accuracy of 85·7% in the CE images and 88·9% in the WLE images under an overlap ratio threshold of 0·60 in comparison with the manual makers made by the expert. In the ESD videos, the resection margins predicted by ENDOANGEL covered all areas of high-grade intraepithelial neoplasia and cancer. The minimum distance between the margins predicted by ENDOANGEL and the cancerous boundary confirmed by pathology was 3·44±1·45 mm, outperforming the resection margin based on ME-NBI. Interpretation: ENDOANGEL has the potential to assist endoscopists in delineating the resection extent of EGCs under CE or WLE during ESD. Funding Statement: Project of Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision (grant no. 2018BCC337); Hubei Province Major Science and Technology Innovation Project (grant no. 2018-916-000-008); the National Natural Science Foundation of China [grant no. 81672387 (to Yu Honggang)]; the National Natural Science Foundation of China [grant no. 81302131(to Ping An)]. Declaration of Interests: The authors stated: None. Ethics Approval Statement: The study protocol was approved by the ethics committee of Renmin Hospital of Wuhan University.

A model of predicting infiltration depth of early gastric cancers based on conventional white light endoscopy and magnifying endoscopy with narrow band imaging findings

Objective To analyze the characteristics of early gastric cancer (EGC) with submucosal infiltration under conventional white light endoscopy (C-WLE) and magnifying endoscopy with narrow band imaging (ME-NBI), and to improve the diagnostic accuracy of EGC infiltration by combining C-WLE and ME-NBI findings. Methods Data of patients who received endoscopic submucosal dissection or surgical treatment for EGC at Beijing Friendship Hospital from January 2015 to December 2017 were retrospectively analyzed. The basic information, lesion characteristics, and postoperative pathology of patients were collected. The characteristics of EGC with submucosal infiltration were analyzed, and a model for predicting the depth of EGC invasion was constructed by combining independent risk factors of submucosal infiltration. Results A total of 207 lesions in 195 patients were included in the study, divided into the modeling group (138 lesions) and the testing group (69 lesions) in the ratio 2∶1. In the modeling group, the lesions located in the upper third of the stomach (OR=12.949, 95%CI: 2.148-78.070, P=0.005), middle third of the stomach (OR=7.534, 95%CI: 1.044-54.360, P=0.045), >2 cm in size (OR=6.828, 95%CI: 1.657-28.136, P=0.008) and presence of dilated blood vessel (OR=6.856, 95%CI: 1.577-29.805, P=0.010) were independent risk factors for submucosal infiltration. Based on the above independent risk factors, the infiltration depth predicting scoring system (DPSS) was constructed (5 points for the lesion located in upper third of the stomach, 4 points for the lesions located in the middle third of stomach, 4 points for lesions >2 cm in size, and 4 points for the presence of dilated vessels). The areas under the receiver operating characteristic curve for predicting the infiltration depth of DPSS were 0.884 (95%CI: 0.809-0.960) in the modeling group and 0.799 (95%CI: 0.684-0.914) in the testing group. The sensitivities of the modeling group and the testing group were 83.3% and 71.4% respectively; and the specificities were 76.2% and 74.5%, respectively in the two groups at 8 as the cut-off score. Conclusion The DPSS based on C-WLE and ME-NBI findings can predict the invasion depth of EGC. Key words: Stomach neoplasms; Early diagnosis; Tumor infiltrating; Forecasting models; Magnification endoscopy with narrow band imaging

Effects of radical treatment of Helicobacter pylori on endoscopic diagnosis of early gastric cancer

Objective To investigate the effects of Helicobacter pylori (HP) radical treatment on diagnosis of early gastric cancer using conventional white light endoscopy (WLE), chromoendoscopy of indigo carmine dye added to acetic acid, and magnifying endoscopy with narrow band imaging (ME-NBI). Methods Between January 2013 and March 2018, patients without HP (successful cured before six months) or with HP (no radical treatment for HP in recent 6 months), who underwent endoscopy examinations in the Department of Gastroenterology of Ezhou Hospital, People′s Hospital of Wuhan University or the Department of Gastroenterology of Union Hospital, Tongji Medical College Huazhong University of Science and Technology were enrolled in the study. Endoscopy examinations were performed according to the order of conventional WLE, chromoendoscopy using indigo carmine dye added to acetic acid, and ME-NBI. Among the patients finally diagnosed as early gastric cancer by histopathology, 120 patients without HP and 120 patients with HP were continuously collected, and included in the radical treatment group and the non-radical treatment group, respectively. Diagnostic reliabilities of WLE, chromoendoscopy, and ME-NBI for early gastric cancer between the two groups were statistically analyzed. Results There were no statistical differences between the two groups in terms of hospital source (χ2=2.637, P=0.104), gender composition (χ2=0.074, P=0.785), mean age (t=0.582, P=0.561), and lesion morphology (χ2=0.179, P=0.914). The detection rates of early gastric cancer in the radical treatment group using WLE [75.0% (80/120) VS 81.7% (98/120), χ2=7.046, P=0.008], chromoendoscopy [57.5% (69/120) VS 93.3% (112/120), χ2=41.554, P<0.001], and ME-NBI [90.0% (108/120) VS 98.3% (118/120), χ2=7.585, P=0.006] were significantly lower than those in the non-radical treatment group. In the radical treatment group, chromoendoscopy had the lowest detection rate of early gastric cancer, followed by WLE (χ2=2.142, P=0.143) and ME-NBI (χ2=32.736, P<0.001), while ME-NBI had the highest detection rate of early gastric cancer, which higher than that of WLE (χ2= 19.247, P<0.001). Conclusion The diagnosis of early gastric cancer by WLE, chromoendoscopy using the indigo carmine dye added to acetic acid and ME-NBI becomes more difficult after radical treatment of HP. Among the above three endoscopic methods, ME-NBI has the highest diagnostic efficacy, and becomes the first choice for the clinical diagnosis of early gastric cancer after radical treatment of HP. Key words: Helicobacter pylori; Early gastric cancer; White light endoscopy; Chromoendoscopy; Magnifying endoscopy with narrow band imaging

Endoscopic alterations in Peyer's patches in patients with ulcerative colitis: A prospective, multicenter study.

Peyer's patches (PPs) play a major role in intestinal mucosal immunity; however, their role in ulcerative colitis (UC) is not well investigated. We evaluated endoscopic features of PPs on narrow-band imaging with magnifying endoscopy (NBI-ME) and investigated their association with clinical factors. We prospectively recruited 105 patients with UC, 18 with Crohn's disease, 16 with disease control, and 33 healthy control subjects at three institutions from 2014 to 2017. NBI-ME images of the villi of PPs were evaluated according to the Villi Index, and patients were divided into the Villi Index low (L) and high (H) types. The 1-year sustained clinical remission rate was evaluated between L-type and H-type PPs in patients with UC. The proportions of patients with H-type PPs were significantly higher among UC, Crohn's disease, and disease control patients than among healthy control patients (P = 0.0125, 0.018, 0.0007). In UC, age, gender, endoscopic score, and extent of disease involvement were not significantly different between L-type and H-type PPs, whereas the sustained clinical remission rate was significantly higher in L-type PPs than in H-type PPs (88% [57/65] vs 65% [17/26], P = 0.019). Multivariate analysis revealed that the L type of PPs was a significant factor for sustained clinical remission (odds ratio 3.8, 95% confidence interval 1.1-12.9, P = 0.033). Patients with UC showed endoscopic alterations in PPs on NBI-ME, and highly altered appearance of PPs can be associated with a high risk of clinical relapse in patients with UC.

Clinical relevance of fluorodeoxyglucose positron emission tomography/computed tomography and magnifying endoscopy with narrow band imaging in decision-making regarding the treatment strategy for esophageal squamous cell carcinoma.

BACKGROUNDRecent advances in endoscopic technology, especially magnifying endoscopy with narrow band imaging (ME-NBI) enable us to detect superficial esophageal squamous cell carcinoma (ESCC), but determining the appropriate method of resection, endoscopic resection (ER) vs surgical resection, is often challenging. Recently, several studies have reported that 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a useful indicator for decision-making regarding treatment for superficial ESCC. Although, there are not enough reports on association between FDG-PET uptake and clinicopathological characteristics of superficial ESCC. And, there are not enough reports on evaluating the usefulness of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC. This study evaluated clinical relevance of FDG-PET and ME-NBI in decision-making regarding the treatment strategy for ESCC.AIMTo investigate the association between FDG uptake and the clinicopathological characteristics of superficial ESCC and its usefulness of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.METHODSA database of all patients with superficial ESCC who had undergone both ME-NBI and FDG-PET for pre-treatment staging at Aichi Cancer Center Hospital between January 2008 and November 2018 was retrospectively analyzed. FDG uptake was defined positive or negative whether the primary lesion was visualized or could be distinguished from the background, or not. The invasion depth of ESCC was classified according to the Japan Esophageal Society. Primary endpoint is to evaluate the association between FDG uptake and clinicopathological characteristics of superficial ESCC. Secondary endpoint is to investigate the efficacy of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.RESULTSA total of 82 lesions in 82 patients were included. FDG-PET showed positive uptake in 29 (35.4%) lesions. Univariate analysis showed that uptake of FDG-PET had significant correlations with circumferential extension (P = 0.014), pathological depth of tumor invasion (P < 0.001), infiltrative growth pattern (P < 0.001), histological grade (P = 0.002), vascular invasion (P = 0.001), and lymphatic invasion (P < 0.001). On multivariate analysis, only depth of tumor invasion was independently correlated with FDG-PET/computed tomography visibility (P = 0.018). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of Type B2 in ME-NBI for the invasion depth of T1a muscularis mucosae and T1b upper submucosal layer were 68.4%/79.4%/50.0%/89.3%/76.8%, respectively, and those of Type B3 for the depth of T1b middle and deeper submucosal layers (SM2 and SM3) were 46.7%/100%/100%/89.3%/90.2%, respectively. On the other hand, those of FDG-PET for SM2 and SM3 were 93.3%/77.6%/48.2%/98.1%/80.5%, respectively, whereas, if the combination of positive FDG uptake and type B2 and B3 was defined as an indicator for radical esophagectomy or definitive chemoradiotherapy, the sensitivity, specificity, PPV, NPV, and accuracy were 78.3%/91.5%/78.3%/91.5%/87.8%, respectively.CONCLUSIONFDG uptake was correlated with the invasion depth of superficial ESCC. Combined use of FDG-PET and ME-NBI, especially with the microvascular findings of Type B2 and B3, is useful to determine whether ER is indicated for the lesion.

Prediction of the depth of invasion in superficial pharyngeal cancer: Microvessel morphological evaluation with narrowband imaging.

Magnifying endoscopy with narrowband imaging (ME-NBI) is useful in predicting the invasion depth by examining the microvascular status of tumor surfaces. This retrospective study aimed to determine its efficacy in pharyngeal cancer. Between April 2016 and March 2018, 59 lesions from 46 patients who underwent transoral resection were retrospectively analyzed. Using ME-NBI, microvascular status was classified into B1, B2, or B3, based on the classification of the Japan Esophageal Society. A significant correlation was observed between microvascular status and invasion depth (P = .011). Mean thickness of lesions with B1, B2, and B3 vessels were 563, 1364, and 2825 μm, respectively (P = .006). In previously treated lesions, a significant correlation was observed between microvascular status and invasion depth (P = .012). ME-NBI is useful in predicting the invasion depth and thickness of pharyngeal tumors, even in patients with previously treated lesions.

Clinical value of JNET classification for non-real-time diagnosis of colorectal lesions

Objective To study the diagnostic value of Japan narrow band imaging expert team (JNET) classification for differentiating pathological type of colorectal lesions. Methods A total of 418 colorectal lesions were retrospectively diagnosed by magnifying endoscopy with narrow band imaging (ME-NBI) using JNET classification by two inexperienced doctors after a short time of training in JNET classification. Then lesions were diagnosed with Sano classification by the two doctors. Diagnostic results were compared with histologic findings as a golden standard. Results The sensitivity, specificity, and accuracy of JNET classification and Sano classification for neoplastic lesion differentiation were 98.2% VS 98.5%, 77.8% VS 66.7%, and 96.9% VS 96.4%, respectively (all P>0.05). These indicators for diagnosing cancerous lesions, including high grade intraepithelial neoplasia, intramucosal carcinoma and submucosal carcinoma, were 66.7% VS 80.2% (P=0.023), 87.6% VS 79.5% (P=0.006), and 82.1% VS 79.7% (P=0.379), respectively, and those for predicting submucosal deep invasive cancers were 34.8% VS 39.1%, 100.0% VS 99.0%, and 96.4% VS 96.3%, respectively (all P>0.05). The diagnostic accuracy of JNET classification for differentiating neoplastic lesions were 95.2% in those with diameter <10 mm, 97.0% in 10~<20 mm, and 97.8% in ≥20 mm (P=0.483), this finding were 95.2%, 85.1% and 72.1% for cancer, respectively (P<0.000 1), and 100%, 96.3%, and 94.4% for submucosal deep invasive cancer, respectively (P=0.026). Shape and location of colorectal lesions showed no significant effect on the diagnostic efficacy of JNET classification. Conclusion JNET classification is valuable for doctors without experience of ME-NBI in diagnosing colorectal lesions and the efficiency is slightly superior to Sano classification. However, the accuracy of diagnosis for cancer with diameter ≥20 mm need to be improved. Key words: Intestinal polyp; Diagnostic techniques, digestive system; Diagnostic imaging; JNET classification

Analysis of factors related to poor outcome after e-learning training in endoscopic diagnosis of early gastric cancer using magnifying narrow-band imaging

An e-learning system teaching endoscopic diagnostic process for early gastric cancer using magnifying endoscopy with narrow-band imaging (M-NBI) was established, and its efficacy in improving the diagnostic performance for early gastric cancer was proven in a multicenter randomized controlled trial. The aim of this study was to clarify the difference in learning effect in each lesion characteristic. Three hundred sixty-five participants diagnosed 40 gastric lesions based on M-NBI findings using the vessel-plus-surface classification system. The diagnosis data collected from each participant were assessed in this study. The accuracy of NBI cancer diagnosis was assessed using area under the receiver operating characteristics curve (AUC/ROC) analysis. AUC/ROCs were separately calculated in each lesion characteristic (shape and size), and the data were compared between tests 1 and3. Continuous net reclassification improvement (cNRI) analysis of all lesions revealed significant improvement in reclassification when participants underwent e-learning (cNRI, 1.17; P< .01). The integrated discrimination improvement analysis demonstrated that the e-learning system improved diagnostic ability (.19; P< .01). According to the analysis depending on the lesion's characteristics, high AUC/ROCs were demonstrated in depressed and small lesions (<10mm; .90 and .93, respectively). The cNRI analysis showed remarkable e-learning improvement in both depressed (cNRI, 1.33; P< .01) and small lesions (cNRI, 1.46; P< .01). However, no significant e-learning improvement was observed in elevated or flat lesions. In M-NBI education for endoscopists, a good learning outcome was obtained in depressed and small lesions, but a poor learning outcome was demonstrated in elevated and flat lesions. (Clinical trial registration number: UMIN000008569.).

Fine-tuning Pre-trained Convolutional Neural Networks for Gastric Precancerous Disease Classification on Magnification Narrow-band Imaging Images

Gastric cancer(GC) is the fourth leading cause of cancer death worldwide. To prevent the occurrence of advanced GCs, there is a need for immediate detection and treatment of gastric precancerous and early cancerous lesions. Magnification endoscopy with narrow-band imaging (M-NBI) system as an advanced diagnostic imaging technology is widely used in evaluating gastric lesion types, which can interpret gastric lesion characteristics by enhancing contrasts between vessels and mucosal surfaces. Based on microvascular morphologies presented on M-NBI images, physicians can manually diagnose gastric lesions; but this is a tough work for unexperienced doctors and it is lacking of objectivity. In this study, we propose a transfer learning framework by fine-tuning pre-trained convolutional neural networks (CNNs) to classify gastric M-NBI images into three classes: chronic gastritis (CGT), low grade neoplasia (LGN) and early gastric cancer (EGC). The method we choose is used to compare with three kinds of traditional handcraft texture feature extraction methods and CNN models trained directly by our dataset. Results show that the performance of fine-tuned CNNs outperforms traditional handcraft features and trained CNNs. Experiments also illustrate that ResNet50 can achieve 0.96 accuracy, 0.92, 0.91 and 0.99 f1-scores for classifying M-NBI images into CGT, LGN and EGC. In conclusion, the proposed framework is suit for multi-classification tasks of gastric M-NBI images.

Artificial intelligence for the real-time classification of intrapapillary capillary loop patterns in the endoscopic diagnosis of early oesophageal squamous cell carcinoma: A proof-of-concept study.

Intrapapillary capillary loops (IPCLs) represent an endoscopically visible feature of early squamous cell neoplasia (ESCN) which correlate with invasion depth - an important factor in the success of curative endoscopic therapy. IPCLs visualised on magnification endoscopy with Narrow Band Imaging (ME-NBI) can be used to train convolutional neural networks (CNNs) to detect the presence and classify staging of ESCN lesions. A total of 7046 sequential high-definition ME-NBI images from 17 patients (10 ESCN, 7 normal) were used to train a CNN. IPCL patterns were classified by three expert endoscopists according to the Japanese Endoscopic Society classification. Normal IPCLs were defined as type A, abnormal as B1-3. Matched histology was obtained for all imaged areas. This CNN differentiates abnormal from normal IPCL patterns with 93.7% accuracy (86.2% to 98.3%) and sensitivity and specificity for classifying abnormal IPCL patterns of 89.3% (78.1% to 100%) and 98% (92% to 99.7%), respectively. Our CNN operates in real time with diagnostic prediction times between 26.17 ms and 37.48 ms. Our novel and proof-of-concept application of computer-aided endoscopic diagnosis shows that a CNN can accurately classify IPCL patterns as normal or abnormal. This system could be used as an in vivo, real-time clinical decision support tool for endoscopists assessing and directing local therapy of ESCN.

Influence of Helicobacter pylori Infection on Endoscopic Findings of Gastric Adenocarcinoma of the Fundic Gland Type.

PurposeGastric adenocarcinoma of the fundic gland type (chief cell predominant type) (GA-FG-CCP) was first reported as a rare adenocarcinoma found in the normal fundic mucosa. Recent studies have proposed the possibility that GA-FG-CCPs were also generated in the atrophic mucosa after Helicobacter pylori (HP) eradication therapy. However, little is known on the endoscopic findings of GA-FG-CCP generated in the atrophic mucosa due to its extreme rarity.Materials and MethodsA total of 8 patients who underwent endoscopic submucosal resection and were diagnosed with GA-FG-CCP generated in the HP-uninfected mucosa (4 cases, HP-uninfected group) or HP-eradicated atrophic mucosa (4 cases, HP-eradicated group) were retrospectively analyzed, and their endoscopic findings, including magnifying endoscopy with narrow band imaging (M-NBI), and pathological features were compared.ResultsWhile GA-FG-CCPs in the 2 groups displayed similar macroscopic appearance, M-NBI demonstrated that characteristic microvessels (tapered microvessels like withered branches) were specifically identified in the HP-eradicated group. Pathological investigation revealed that a decreasing number of fundic glands and thinned foveolar epithelium covering tumor ducts were thought to lower the thickness of the covering layer over tumor ducts in the HP-eradicated group. Moreover, dilation of vessels just under the surface of the lesions contributed to the visualization of microvessels by M-NBI.ConclusionsThe change in background mucosa due to HP infection influenced the thickness of the covering layer over the tumor ducts and M-NBI finding of GA-FG-CCP.

Success of Endoscopy with Narrow Band Imaging in Diagnosis of Cervixcal Metaplasia

Flexible magnifying endoscopy with narrow band imaging (ME-NBI) has outstanding diagnostic correctness for gastrointestinal Metaplasia and is hope for to be highly useful for diagnosis cervixcal Metaplasia in this study aiming to detect the feature findings and access the diagnostic power of ME-NBI for diagnosis of cervixcal Metaplasia.

Success of Endoscopy with Narrow Band Imaging in Diagnosis of Cervical Metaplasia

Flexible magnifying endoscopy with narrow band imaging (ME-NBI) has outstanding diagnostic correctness for gastrointestinal metaplasia and is hoped for being highly useful in the diagnosis of cervical metaplasia. This study aims to detect the feature findings and access the diagnostic power of ME-NBI for diagnosis of cervical metaplasia.

Risk factors associated with histological upgrade of gastric low-grade dysplasia on pretreatment biopsy.

Histological discrepancies between biopsy and resection specimens are common. In this study, we aimed to analyze the risk factors predicting histological upgrade or downgrade of biopsy-diagnosed gastric low-grade dysplasia (LGD). The medical records of patients with 104 biopsy-diagnosed gastric LGD from January 2011 to December 2017 were collected. The association of endoscopic characteristics with histological discrepancies between the biopsy and resection specimens was analyzed. The risk factors for histological upgrade were studied using the multivariate analysis. Among the 104 lesions, 88 were removed by endoscopic resection and 16 were monitored. The upgrade and downgrade rates of the pathological diagnosis were 48.9% and 12.5%, respectively. Lesion size >20 mm, surface redness and positive results in magnifying endoscopy with narrow band imaging (ME-NBI) were risk factors for histological upgrade. Compared with the negative ME-NBI group, the positive ME-NBI group had a higher upgrade rate (56.8% vs 7.1%) but a lower downgrade rate (2.7% vs 64.3%). In addition, 11 of the 16 the gastric LGD with negative ME-NBI findings were monitored, and all 11 lesions regressed to gastritis during follow-up. Endoscopic resection should be recommended in cases of LGD showing surface redness, with a lesion size of >20 mm or positive ME-NBI result, whereas regular follow-up may be an option for LGD with negative ME-NBI result.

Usefulness of Demarcation of Differentiated-Type Early Gastric Cancers after Helicobacter pylori Eradication by Magnifying Endoscopy with Narrow-Band Imaging

Background/Aims: Early gastric cancer after Helicobacter pylori (Hp) eradication is difficult to demarcate. We used the vessel plus surface classification system (VSCS) to determine whether magnifying endoscopy with narrow-band imaging (ME-NBI) could demarcate differentiated-type early gastric cancers after Hp eradication, and to identify causes of an unclear demarcation line (DL). Methods: Among 100 lesions of differentiated-type early gastric cancer resected endoscopically, 34 lesions in the Hp-eradicated group and 66 in the Hp-infected group were retrospectively compared. Clinicopathological factors and ME-NBI findings, including the presence or absence of the DL, were examined. Histopathologically, histological gastritis, the surface structure at the tumor border, well-differentiated adenocarcinoma with low-grade atypia (tub1-low), and non-neoplastic epithelium (NE) coverage rate on the tumor surface and at the tumor border were evaluated. Results: DL (–) cases were more frequent in the Hp-eradicated group (11.8%, 4/34) than in the Hp-infected group (1.5%, 1/66; p < 0.05). The Hp-eradicated group had a higher NE coverage rate than the Hp-infected group (p < 0.05). All DL (–) cases had tub1-low or NE at the tumor border. Conclusion: ME-NBI with VSCS can identify the DL in most patients (88.2%) with differentiated-type early gastric cancer after Hp eradication.

Sa1244 MAGNIFYTING ENDOSCOPY FOR GASTRIC HETEROTOPIC PANCREAS: PRESENCE OF MICROSCOPIC OPENING

Heterotopic pancreas is a common subepithelial lesion in the stomach, but its histological diagnosis is usually difficult when tissue samples are obtained with a conventional biopsy forceps. The aim of this study was to describe the magnifying endoscopy with narrow-band imaging (ME-NBI) features of gastric heterotopic pancreas. We retrospectively analyzed a database of all patients who underwent endoscopic ultrasonography (EUS) at Pusan National University Hospital from January 2010 to December 2010. A total of 36 patients with endosonographically diagnosed as heterotopic pancreas who underwent ME-NBI at the same time were included in the study. ME-NBI features of their lesions were analyzed. Thirty lesions were located in the antrum, and 6 lesions were located in the body. Six lesions (17%) showed an umbilication or central dimpling on the surface, and 9 lesions (25%) had a macroscopic opening on the surface. On ME-NBI, a microscopic opening was identified in 22 (81%) of 27 lesions in which a macroscopic opening was not observed during conventional endoscopy. As a total, a macroscopic or microscopic opening was observed in 31 lesions (86%). The frequency of a macroscopic or microscopic opening was higher in lesions with anechoic duct-like structures than in lesions without anechoic duct-like structures on EUS (91% [29/32] vs 50% [2/4], P = 0.027). Focal loss of microsurface structure and presence of a thickened submucosal vessel were observed in 6 lesions (17%) and in 5 lesions (14%), respectively. The characteristic ME-NBI feature of heterotopic pancreas is presence of a microscopic opening on its surface. This ME-NBI feature is potentially useful for differentiating heterotopic pancreas from other subepithelial tumors in the stomach.Tabled 1Magnifying endoscopy with narrow-band imaging of gastric heterotopic pancreasMicroscopic opening, n (%)Present31 (86)Absent5 (14)Focal loss of microsurface structure, n (%)Present6 (17)Absent30 (83)Thickened submucosal vessel, n (%)Present5 (14)Absent31 (86) Open table in a new tab