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Ji XW, Lin J, Wang YT, Ruan JJ, Xu JH, Song K, Mao JS. Endoscopic detection and diagnostic strategies for minute gastric cancer: A real-world observational study. World J Gastrointest Oncol 2024; 16:3529-3538. [PMID: 39171159 PMCID: PMC11334033 DOI: 10.4251/wjgo.v16.i8.3529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/26/2024] [Accepted: 06/18/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Minute gastric cancers (MGCs) have a favorable prognosis, but they are too small to be detected by endoscopy, with a maximum diameter ≤ 5 mm. AIM To explore endoscopic detection and diagnostic strategies for MGCs. METHODS This was a real-world observational study. The endoscopic and clinicopathological parameters of 191 MGCs between January 2015 and December 2022 were retrospectively analyzed. Endoscopic discoverable opportunity and typical neoplastic features were emphatically reviewed. RESULTS All MGCs in our study were of a single pathological type, 97.38% (186/191) of which were differentiated-type tumors. White light endoscopy (WLE) detected 84.29% (161/191) of MGCs, and the most common morphology of MGCs found by WLE was protruding. Narrow-band imaging (NBI) secondary observation detected 14.14% (27/191) of MGCs, and the most common morphology of MGCs found by NBI was flat. Another three MGCs were detected by indigo carmine third observation. If a well-demarcated border lesion exhibited a typical neoplastic color, such as yellowish-red or whitish under WLE and brownish under NBI, MGCs should be diagnosed. The proportion with high diagnostic confidence by magnifying endoscopy with NBI (ME-NBI) was significantly higher than the proportion with low diagnostic confidence and the only visible groups (94.19% > 56.92% > 32.50%, P < 0.001). CONCLUSION WLE combined with NBI and indigo carmine are helpful for detection of MGCs. A clear demarcation line combined with a typical neoplastic color using nonmagnifying observation is sufficient for diagnosis of MGCs. ME-NBI improves the endoscopic diagnostic confidence of MGCs.
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Affiliation(s)
- Xiao-Wei Ji
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Jie Lin
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Yan-Ting Wang
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Jing-Jing Ruan
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Jing-Hong Xu
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Kai Song
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Jian-Shan Mao
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
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Canakis A, Bomman S, Twery B, Varghese N, Ji B, Canakis J, Goldberg EM. The diagnostic utility of endocytoscopy for the detection of gastric cancer: a systematic review and meta-analysis. Minerva Gastroenterol (Torino) 2024; 70:225-230. [PMID: 35511654 DOI: 10.23736/s2724-5985.22.03172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Endocytoscopy (ECS) is an evolving technology that utilizes ultra-high power magnification for real time cellular imaging without the need for physical biopsy. Its application for gastric cancer (GC) detection is not well evaluated at the current time, but there is potential that ECS can make a real time histopathological diagnosis to differentiate neoplastic from benign lesions. We aimed to investigate the diagnostic utility of ECS for GC detection. EVIDENCE ACQUISITION Literature searches through multiple databases were performed for studies using ECS for GC detection until November 2021. Measured outcomes included the pooled sensitivity, specificity and accuracy. Quality assessment of diagnostic studies tool was used to assess the risk of bias. EVIDENCE SYNTHESIS Four studies (N.=245) were included. The pooled sensitivity was 83.5% (95% CI: 75-89%, I2: 0) and specificity was 91.7% (95% CI: 79-97%, I2: 58%). The pooled accuracy was 89.2% (95% CI: 83-94%, I2: 38%). There was a low risk of bias. CONCLUSIONS ECS is an accurate diagnostic modality and has the potential to serve as a complimentary tool in screening for GC. Larger prospective studies are needed to validate these findings before its further widespread use.
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Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA -
| | - Shivanand Bomman
- Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA
| | - Benjamin Twery
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nevin Varghese
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Byung Ji
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Justin Canakis
- Department of Medicine, George Washington University, Washington, DC, USA
| | - Eric M Goldberg
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
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Horiuchi Y, Hirasawa T, Fujisaki J. Endoscopic Features of Undifferentiated-Type Early Gastric Cancer in Patients with Helicobacter pylori-Uninfected or -Eradicated Stomachs: A Comprehensive Review. Gut Liver 2024; 18:209-217. [PMID: 37855088 PMCID: PMC10938157 DOI: 10.5009/gnl230106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 03/16/2024] Open
Abstract
Since the indications for endoscopic submucosal dissection have been expanded to include undifferentiated-type early gastric cancers, improvements in preoperative diagnostic ability have been an area of research. There are also concerns about the impact on the diagnosis of Helicobacter pylori infection. Based on our previous studies, in undifferentiated-type early gastric cancers, magnifying endoscopy with narrow-band imaging is useful for delineating the demarcation regardless of the tumor size. Additionally, inflammatory cell infiltration appears to be a cause of misdiagnosis, suggesting that the resolution of inflammation could contribute to the accurate diagnosis of demarcations. As such, the accuracy of demarcation in eradicated and uninfected cases is higher than that in non-eradicated cases. The common features of the endoscopic findings were discoloration under white-light imaging and a predominance of sites in the lower and middle regions. The uninfected group was characterized by smaller tumor size, flat type, more extended intervening parts in magnifying endoscopy with narrow-band imaging, and pure signet ring cell carcinoma. In contrast, the eradication and non-eradication groups were characterized by larger tumor size, depressed type, and wavy microvessels in magnifying endoscopy with narrow-band imaging. In this comprehensive review, as described above, we discuss the diagnosis of demarcation of undifferentiated-type early gastric cancers, undifferentiated-type early gastric cancers that developed following H. pylori eradication, and H. pylori-uninfected undifferentiated-type early gastric cancers, with a focus on studies with self-examination and endoscopic findings and describe the future direction.
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Affiliation(s)
- Yusuke Horiuchi
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Kobashi M, Ishikawa S, Inaba T, Iwamuro M, Aoyama Y, Kagawa T, Takeuchi Y, Ando M, Nakamura S, Okada H. Diagnostic accuracy of frozen section biopsy for early gastric cancer extent during endoscopic submucosal dissection: a prospective study. Surg Endosc 2023; 37:6736-6748. [PMID: 37217685 PMCID: PMC10462503 DOI: 10.1007/s00464-023-10100-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/22/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Accurate diagnosis of the lateral extent of early gastric cancer during endoscopic submucosal dissection (ESD) is crucial to achieve negative resection margins. Similar to intraoperative consultation with a frozen section in surgery, rapid frozen section diagnosis with endoscopic forceps biopsy may be useful in assessing tumor margins during ESD. This study aimed to evaluate the diagnostic accuracy of frozen section biopsy. METHODS We prospectively enrolled 32 patients undergoing ESD for early gastric cancer. Biopsy samples for the frozen sections were randomly collected from fresh resected ESD specimens before formalin fixation. Two different pathologists independently diagnosed 130 frozen sections as "neoplasia," "negative for neoplasia," or "indefinite for neoplasia," and the frozen section diagnosis was compared with the final pathological results of the ESD specimens. RESULTS Among the 130 frozen sections, 35 were from cancerous areas, and 95 were from non-cancerous areas. The diagnostic accuracies of the frozen section biopsies by the two pathologists were 98.5 and 94.6%, respectively. Cohen's kappa coefficient of diagnoses by the two pathologists was 0.851 (95% confidence interval: 0.837-0.864). Incorrect diagnoses resulted from freezing artifacts, a small volume of tissue, inflammation, the presence of well-differentiated adenocarcinoma with mild nuclear atypia, and/or tissue damage during ESD. CONCLUSIONS Pathological diagnosis of frozen section biopsy is reliable and can be applied as a rapid frozen section diagnosis for evaluating the lateral margins of early gastric cancer during ESD.
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Affiliation(s)
- Mayu Kobashi
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan.
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Shigenao Ishikawa
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Tomoki Inaba
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yuki Aoyama
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Tomo Kagawa
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Yasuto Takeuchi
- Department of Regenerative Medicine, Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Midori Ando
- Department of Pathology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Satoko Nakamura
- Department of Pathology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Ikenoyama Y, Tanaka K, Umeda Y, Hamada Y, Yukimoto H, Yamada R, Tsuboi J, Nakamura M, Katsurahara M, Horiki N, Nakagawa H. Effect of adding acetic acid when performing magnifying endoscopy with narrow band imaging for diagnosis of Barrett's esophageal adenocarcinoma. Endosc Int Open 2022; 10:E1528-E1536. [PMID: 36531673 PMCID: PMC9754883 DOI: 10.1055/a-1948-2910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022] Open
Abstract
Background and study aims Magnifying endoscopy with narrow band imaging (M-NBI) was developed to diagnose Barrett's esophageal adenocarcinoma (BEA); however, this method remains challenging for inexperienced endoscopists. We aimed to evaluate a modified M-NBI technique that included spraying acetic acid (M-AANBI). Patients and methods Eight endoscopists retrospectively examined 456 endoscopic images obtained from 28 patients with 29 endoscopically resected BEA lesions using three validation schemes: Validation 1 (260 images), wherein the diagnostic performances of M-NBI and M-AANBI were compared - the dataset included 65 images each of BEA and non-neoplastic Barrett's esophagus (NNBE) obtained using each modality; validation 2 (112 images), wherein 56 pairs of M-NBI and M-AANBI images were prepared from the same BEA and NNBE lesions, and diagnoses derived using M-NBI alone were compared to those obtained using both M-NBI and M-AANBI; and validation 3 (84 images), wherein the ease of identifying the BEA demarcation line (DL) was scored via a visual analog scale in 28 patients using magnifying endoscopy with white-light imaging (M-WLI), M-NBI, and M-AANBI. Results For validation 1, M-AANBI was superior to M-NBI in terms of sensitivity (90.8 % vs. 64.6 %), specificity (98.5 % vs. 76.9 %), and accuracy (94.6 % vs. 70.4 %) (all P < 0.05). For validation 2, the accuracy of M-NBI alone was significantly improved when combined with M-AANBI (from 70.5 % to 89.3 %; P < 0.05). For validation 3, M-AANBI had the highest mean score for ease of DL recognition (8.75) compared to M-WLI (3.63) and M-NBI (6.25) (all P < 0.001). Conclusions Using M-AANBI might improve the accuracy of BEA diagnosis.
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Affiliation(s)
- Yohei Ikenoyama
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan,Department of Endoscopy, Mie University Hospital, Tsu, Japan
| | - Kyosuke Tanaka
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan,Department of Endoscopy, Mie University Hospital, Tsu, Japan
| | - Yuhei Umeda
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan,Department of Endoscopy, Mie University Hospital, Tsu, Japan
| | - Yasuhiko Hamada
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroki Yukimoto
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Reiko Yamada
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Junya Tsuboi
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Misaki Nakamura
- Department of Endoscopy, Mie University Hospital, Tsu, Japan
| | | | - Noriyuki Horiki
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan,Department of Endoscopy, Mie University Hospital, Tsu, Japan
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Gong L, Wang M, Shu L, He J, Qin B, Xu J, Su W, Dong D, Hu H, Tian J, Zhou P. Automatic captioning of early gastric cancer using magnification endoscopy with narrow-band imaging. Gastrointest Endosc 2022; 96:929-942.e6. [PMID: 35917877 DOI: 10.1016/j.gie.2022.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/03/2022] [Accepted: 07/13/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The detection rate for early gastric cancer (EGC) is unsatisfactory, and mastering the diagnostic skills of magnifying endoscopy with narrow-band imaging (ME-NBI) requires rich expertise and experience. We aimed to develop an EGC captioning model (EGCCap) to automatically describe the visual characteristics of ME-NBI images for endoscopists. METHODS ME-NBI images (n = 1886) from 294 cases were enrolled from multiple centers, and corresponding 5658 text data were designed following the simple EGC diagnostic algorithm. An EGCCap was developed using the multiscale meshed-memory transformer. We conducted comprehensive evaluations for EGCCap including the quantitative and quality of performance, generalization, robustness, interpretability, and assistant value analyses. The commonly used metrics were BLEUs, CIDEr, METEOR, ROUGE, SPICE, accuracy, sensitivity, and specificity. Two-sided statistical tests were conducted, and statistical significance was determined when P < .05. RESULTS EGCCap acquired satisfying captioning performance by outputting correctly and coherently clinically meaningful sentences in the internal test cohort (BLEU1 = 52.434, CIDEr = 36.734, METEOR = 27.823, ROUGE = 49.949, SPICE = 35.548) and maintained over 80% performance when applied to other centers or corrupted data. The diagnostic ability of endoscopists improved with the assistance of EGCCap, which was especially significant (P < .05) for junior endoscopists. Endoscopists gave EGCCap an average remarkable score of 7.182, showing acceptance of EGCCap. CONCLUSIONS EGCCap exhibited promising captioning performance and was proven with satisfying generalization, robustness, and interpretability. Our study showed potential value in aiding and improving the diagnosis of EGC and facilitating the development of automated reporting in the future.
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Affiliation(s)
- Lixin Gong
- College of Medicine and Biological Information Engineering School, Northeastern University, Shenyang, China; CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, The State Key Laboratory for Management and Control of Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Min Wang
- Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Lei Shu
- Department of Gastroenterology, No. 1 Hospital of Wuhan, Wuhan, China
| | - Jie He
- Endoscopy Center, Zhongshan Hospital (Xiamen Branch), Fudan University, Xiamen, China; Department of Gastroenterology, The Affiliated Dongnan Hospital of Xiamen University, Zhangzhou, China
| | - Bin Qin
- Department of Gastroenterology, the Second Affiliated Hospital of Xi'an Jiaotong University, Zhangzhou, China
| | - Jiacheng Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Wei Su
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Di Dong
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, The State Key Laboratory for Management and Control of Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Hao Hu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China; Department of Gastroenterology, Shigatse People's Hospital, Shigatse, China
| | - Jie Tian
- College of Medicine and Biological Information Engineering School, Northeastern University, Shenyang, China; CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, The State Key Laboratory for Management and Control of Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
| | - Pinghong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
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Yao K. Magnifying endoscopy for the diagnosis of early gastric cancer: Establishment of technique, diagnostic system, and scientific evidence from Japan. Dig Endosc 2022; 34 Suppl 2:50-54. [PMID: 34791709 DOI: 10.1111/den.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
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8
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Kakushima N, Fujishiro M, Chan SM, Cortas GA, Dinis‐Ribeiro M, Gonzalez R, Kodashima S, Lee S, Linghu E, Mabe K, Pan W, Parra‐Blanco A, Pioche M, Rollan A, Sumiyama K, Tanimoto M. Proposal of minimum elements for screening and diagnosis of gastric cancer by an international Delphi consensus. DEN OPEN 2022; 2:e97. [PMID: 35873520 PMCID: PMC9302051 DOI: 10.1002/deo2.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/09/2022] [Accepted: 01/22/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Naomi Kakushima
- Department of Gastroenterology and Hepatology Nagoya University Graduate School of Medicine Aichi Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology Nagoya University Graduate School of Medicine Aichi Japan
| | - Shannon Melissa Chan
- Department of Surgery Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong
| | - George Adel Cortas
- Saint George Hospital University Medical Center Faculty of Medicine University of Balamand Beirut Lebanon
| | - Mario Dinis‐Ribeiro
- Department of Gastroenterology Portuguese Oncology Institute of Porto Porto Portugal
| | | | - Shinya Kodashima
- Department of Medicine Division of Gastroenterology School of Medicine, Teikyo University Tokyo Japan
| | - Sun‐Young Lee
- Department of Internal Medicine School of Medicine Konkuk University Seoul Korea
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology The First Medical Center of Chinese PLA General Hospital Beijing China
| | - Katsuhiro Mabe
- Junpukai Health Maintenance Center Kurashiki Okayama Japan
| | - Wensheng Pan
- Department of Gastroenterology Zhejiang Provincial People's Hospital People's Hospital of Hangzhou Medical College Hangzhou China
| | - Adolfo Parra‐Blanco
- NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UK
| | - Mathieu Pioche
- Department of Gastroenterology and Endoscopy Edouard Herriot Hospital Lyon France
| | - Antonio Rollan
- Unidad de Gastroenterología Facultad de Medicina Clinica Alemana Universidad del Desarrollo Santiago Chile
| | - Kazuki Sumiyama
- Department of Endoscopy School of Medicine, The Jikei University Tokyo Japan
| | - Miguel Tanimoto
- Ancillary and Diagnosis Services National Institute of Medical Sciences and Nutrition Salvador Zubiran Mexico City Mexico
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Nkwerem S, Emejulu JK, Adimekwe M. Information communication technology in medical practice: Pattern of usage and knowledge among doctors in a tertiary health institution in Southeastern Nigeria. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_183_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Endoscopic Classifications of Early Gastric Cancer: A Literature Review. Cancers (Basel) 2021; 14:cancers14010100. [PMID: 35008263 PMCID: PMC8750452 DOI: 10.3390/cancers14010100] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/04/2021] [Accepted: 12/22/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Throughout the years, endoscopic technologies have advanced to facilitate better assessment of gastric lesions and early detection of gastric cancer. With improvements in conventional white light endoscopy, we have also witnessed the development of newer endoscopic diagnostic modalities, giving rise to several classifications for early gastric cancer. Different endoscopic classifications of early gastric based on several endoscopic diagnostic modalities were included in this review. In addition to this, newer and novel endoscopic classifications that were specifically developed for the stomach for assessing and diagnosing gastric lesions have also been included. Illustrative representations of each classification have also been provided to aid readers in better understanding of these endoscopic classifications of early gastric cancer. Abstract Endoscopic technologies have been continuously advancing throughout the years to facilitate improvement in the detection and diagnosis of gastric lesions. With the development of different endoscopic diagnostic modalities for EGC, several classifications have been advocated for the evaluation of gastric lesions, aiming for an early detection and diagnosis. Sufficient knowledge on the appearance of EGC on white light endoscopy is fundamental for early detection and management. On the other hand, those superficial EGC with subtle morphological changes that are challenging to be detected with white light endoscopy may now be clearly defined by means of image-enhanced endoscopy (IEE). By combining magnifying endoscopy and IEE, irregularities in the surface structures can be evaluated and highlighted, leading to improvements in EGC diagnostic accuracy. The main scope of this review article is to offer a closer look at the different classifications of EGC based on several endoscopic diagnostic modalities, as well as to introduce readers to newer and novel classifications, specifically developed for the stomach, for the assessment and diagnosis of gastric lesions.
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Ueyama H, Yatagai N, Ikeda A, Akazawa Y, Komori H, Takeda T, Matsumoto K, Ueda K, Matsumoto K, Asaoka D, Hojo M, Yao T, Nagahara A. Dynamic diagnosis of early gastric cancer with microvascular blood flow rate using magnifying endoscopy (with video): A pilot study. J Gastroenterol Hepatol 2021; 36:1927-1934. [PMID: 33533505 PMCID: PMC8359341 DOI: 10.1111/jgh.15425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Magnifying endoscopy (ME) diagnostic algorithm for early gastric cancer (EGC) relies on qualitative features such as microvascular (MV) architecture and microsurface structure; however, it is a "static" diagnostic algorithm that uses still images. ME can visualize red blood cell flow within subepithelial microvessels in real time. Here, we evaluated the utility of using the MV blood flow rate in combination with ME for the diagnosis of EGC as a retrospective study. METHODS Patients with differentiated-type EGC (n = 10) or patchy redness (n = 10) underwent ME with blue laser imaging. The mean MV blood flow rates of EGC, patchy redness, and background mucosa were calculated by the mean movement distance of one tagging red blood cell using split images of ME with blue laser imaging videos. We compared the mean MV blood flow rate between EGC, patchy redness, and background mucosa and also calculated the MV blood flow imaging ratio (inside lesion/background mucosa) between EGC and patchy redness. RESULTS Mean MV blood flow rate was significantly lower in EGC (1481 μm/s; range 1057-1762) than in patchy redness (3859 μm/s; 2435-5899) or background mucosa (4140.6 μm/s; 2820-6247) (P < 0.01). The MV blood flow imaging ratio was significantly lower in EGC (0.39; 0.27-0.62) than in patchy redness (0.90; 0.78-1.1) (P < 0.01). CONCLUSIONS Dynamic diagnosis with MV blood flow rate using ME may be useful for the differential diagnosis of EGC and patchy redness. Endoscopic assessment of dynamic processes within the gastric mucosa may facilitate the diagnosis of EGC.
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Affiliation(s)
- Hiroya Ueyama
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Noboru Yatagai
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Atsushi Ikeda
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Yoichi Akazawa
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Hiroyuki Komori
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Tsutomu Takeda
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Kohei Matsumoto
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Kumiko Ueda
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Kenshi Matsumoto
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Daisuke Asaoka
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Mariko Hojo
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Takashi Yao
- Department of Human PathologyJuntendo University Graduate School of MedicineTokyoJapan
| | - Akihito Nagahara
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
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12
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Abstract
This article explores advances in endoscopic neoplasia detection with supporting clinical evidence and future aims. The ability to detect early gastric neoplastic lesions amenable to curative endoscopic submucosal dissection provides the opportunity to decrease gastric cancer mortality rates. Newer imaging techniques offer enhanced views of mucosal and microvascular structures and show promise in differentiating benign from malignant lesions and improving targeted biopsies. Conventional chromoendoscopy is well studied and validated. Narrow band imaging demonstrates superiority over magnified white light. Autofluorescence imaging, i-scan, flexible spectral imaging color enhancement, and bright image enhanced endoscopy show promise but insufficient evidence to change current clinical practice.
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Affiliation(s)
- Andrew Canakis
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, USA. https://twitter.com/AndrewCanakis
| | - Raymond Kim
- Division of Gastroenterology & Hepatology, University of Maryland Medical Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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13
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Doyama H, Nakanishi H, Yao K. Image-Enhanced Endoscopy and Its Corresponding Histopathology in the Stomach. Gut Liver 2021; 15:329-337. [PMID: 32200589 PMCID: PMC8129655 DOI: 10.5009/gnl19392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 12/14/2022] Open
Abstract
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)
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Affiliation(s)
- Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroyoshi Nakanishi
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan
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14
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Wang S, Cong Y, Zhu H, Chen X, Qu L, Fan H, Zhang Q, Liu M. Multi-Scale Context-Guided Deep Network for Automated Lesion Segmentation With Endoscopy Images of Gastrointestinal Tract. IEEE J Biomed Health Inform 2021; 25:514-525. [PMID: 32750912 DOI: 10.1109/jbhi.2020.2997760] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Accurate lesion segmentation based on endoscopy images is a fundamental task for the automated diagnosis of gastrointestinal tract (GI Tract) diseases. Previous studies usually use hand-crafted features for representing endoscopy images, while feature definition and lesion segmentation are treated as two standalone tasks. Due to the possible heterogeneity between features and segmentation models, these methods often result in sub-optimal performance. Several fully convolutional networks have been recently developed to jointly perform feature learning and model training for GI Tract disease diagnosis. However, they generally ignore local spatial details of endoscopy images, as down-sampling operations (e.g., pooling and convolutional striding) may result in irreversible loss of image spatial information. To this end, we propose a multi-scale context-guided deep network (MCNet) for end-to-end lesion segmentation of endoscopy images in GI Tract, where both global and local contexts are captured as guidance for model training. Specifically, one global subnetwork is designed to extract the global structure and high-level semantic context of each input image. Then we further design two cascaded local subnetworks based on output feature maps of the global subnetwork, aiming to capture both local appearance information and relatively high-level semantic information in a multi-scale manner. Those feature maps learned by three subnetworks are further fused for the subsequent task of lesion segmentation. We have evaluated the proposed MCNet on 1,310 endoscopy images from the public EndoVis-Ab and CVC-ClinicDB datasets for abnormal segmentation and polyp segmentation, respectively. Experimental results demonstrate that MCNet achieves [Formula: see text] and [Formula: see text] mean intersection over union (mIoU) on two datasets, respectively, outperforming several state-of-the-art approaches in automated lesion segmentation with endoscopy images of GI Tract.
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15
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Ueyama H, Kato Y, Akazawa Y, Yatagai N, Komori H, Takeda T, Matsumoto K, Ueda K, Matsumoto K, Hojo M, Yao T, Nagahara A, Tada T. Application of artificial intelligence using a convolutional neural network for diagnosis of early gastric cancer based on magnifying endoscopy with narrow-band imaging. J Gastroenterol Hepatol 2021; 36:482-489. [PMID: 32681536 PMCID: PMC7984440 DOI: 10.1111/jgh.15190] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Magnifying endoscopy with narrow-band imaging (ME-NBI) has made a huge contribution to clinical practice. However, acquiring skill at ME-NBI diagnosis of early gastric cancer (EGC) requires considerable expertise and experience. Recently, artificial intelligence (AI), using deep learning and a convolutional neural network (CNN), has made remarkable progress in various medical fields. Here, we constructed an AI-assisted CNN computer-aided diagnosis (CAD) system, based on ME-NBI images, to diagnose EGC and evaluated the diagnostic accuracy of the AI-assisted CNN-CAD system. METHODS The AI-assisted CNN-CAD system (ResNet50) was trained and validated on a dataset of 5574 ME-NBI images (3797 EGCs, 1777 non-cancerous mucosa and lesions). To evaluate the diagnostic accuracy, a separate test dataset of 2300 ME-NBI images (1430 EGCs, 870 non-cancerous mucosa and lesions) was assessed using the AI-assisted CNN-CAD system. RESULTS The AI-assisted CNN-CAD system required 60 s to analyze 2300 test images. The overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the CNN were 98.7%, 98%, 100%, 100%, and 96.8%, respectively. All misdiagnosed images of EGCs were of low-quality or of superficially depressed and intestinal-type intramucosal cancers that were difficult to distinguish from gastritis, even by experienced endoscopists. CONCLUSIONS The AI-assisted CNN-CAD system for ME-NBI diagnosis of EGC could process many stored ME-NBI images in a short period of time and had a high diagnostic ability. This system may have great potential for future application to real clinical settings, which could facilitate ME-NBI diagnosis of EGC in practice.
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Affiliation(s)
- Hiroya Ueyama
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | | | - Yoichi Akazawa
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Noboru Yatagai
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Hiroyuki Komori
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Tsutomu Takeda
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Kohei Matsumoto
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Kumiko Ueda
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Kenshi Matsumoto
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Mariko Hojo
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Takashi Yao
- Department of Human PathologyJuntendo University School of MedicineTokyoJapan
| | - Akihito Nagahara
- Department of GastroenterologyJuntendo University School of MedicineTokyoJapan
| | - Tomohiro Tada
- AI Medical Service Inc.TokyoJapan,Tada Tomohiro Institute of Gastroenterology and ProctologySaitamaJapan
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16
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Cho JH, Jeon SR, Jin SY. Clinical applicability of gastroscopy with narrow-band imaging for the diagnosis of Helicobacter pylori gastritis, precancerous gastric lesion, and neoplasia. World J Clin Cases 2020; 8:2902-2916. [PMID: 32775373 PMCID: PMC7385595 DOI: 10.12998/wjcc.v8.i14.2902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/01/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
Premalignant gastric lesions such as atrophic gastritis and intestinal metaplasia frequently occur in subjects with long-term Helicobacter pylori (H. pylori) infection. The regular arrangement of collecting venules (RAC) is seen in the normal gastric corpus, whereas mucosal swelling and redness without RAC are observed in H. pylori-infected mucosa. Despite successful H. pylori eradication, the presence of atrophic gastritis and/or gastric intestinal metaplasia (GIM) is a risk factor for gastric cancer. With the development of advanced imaging technologies, recent studies have reported the usefulness of narrow-band imaging (NBI) for endoscopic diagnosis of atrophic gastritis and GIM. Using NBI endoscopy with magnification (M-NBI), atrophic gastritis is presented as irregular coiled microvessels and loss of gastric pits. Typical M-NBI endoscopic findings of GIM are a light blue crest and a white opaque substance. Based on the microvascular patterns, fine network, core vascular, and unclear patterns are useful for predicting gastric dysplasia in polypoid lesions. For diagnosis of early gastric cancer (EGC), a systematic classification using M-NBI endoscopy has been proposed on the basis of the presence of a demarcation line and an irregular microvascular/microsurface pattern. Furthermore, M-NBI endoscopy has been found to be more accurate for determining the horizontal margin of EGC compared to conventional endoscopy. In this review, we present up-to-date results on the clinical usefulness of gastroscopy with NBI for the diagnosis of H. pylori gastritis, precancerous gastric lesion, and neoplasia.
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Affiliation(s)
- Jun-Hyung Cho
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul 04401, South Korea
| | - Seong Ran Jeon
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul 04401, South Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Seoul 04401, South Korea
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17
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Matsui K, Funasaka K, Miyahara R, Furukawa K, Matsushita M, Yamamura T, Ishikawa T, Ohno E, Nakamura M, Kawashima H, Watanabe O, Ohara K, Hirooka Y, Goto H. Generation of magnifying endoscopic images of gastric neoplasms based on an all-in-focus algorithm. J Gastroenterol Hepatol 2020; 35:65-70. [PMID: 31334881 DOI: 10.1111/jgh.14792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/15/2019] [Accepted: 07/14/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Magnifying endoscopy is useful for diagnosis of early gastrointestinal neoplasms by visualizing microvascular (MV) and microsurface (MS) structures of the mucosa when combined with image-enhanced endoscopy. However, precise control of the endoscope is needed because the depth of focus is narrow and the target may move. These problems may be overcome by the all-in-focus (AIF) technique, which was developed in the engineering field. The aim of the study was to evaluate magnifying endoscopic image with AIF algorithm. METHODS Twenty gastric neoplasms were examined. Images were acquired at 80× magnification and converted to endoscopic images with an AIF algorithm (EI-AIF). The focus area and MV and MS patterns in the original image and the EI-AIF were compared on a 5-point Likert scale, where 5 indicates that the EI-AIF was superior. Intraclass correlation coefficients (ICCs) were used to assess the inter-evaluator reliability. An image quality measurement value was calculated for each image as an indicator of the degree of focus. RESULTS The scores for focus area, MV, and MS were 4.78 ± 0.45 (ICC = 0.63), 4.12 ± 0.76 (ICC = 0.70), and 4.72 ± 0.52 (ICC = 0.45), respectively, with the EI-AIF significantly superior for all three items (P < 0.05 by Student's t-test). ICCs for the focus area and MV were > 0.60, indicating strong inter-evaluator reliability. Image quality measurement was higher for the EI-AIF compared with the original image in every case. CONCLUSIONS Endoscopic observation with AIF algorithm gives a better image quality that allows easier evaluation of MV and MS patterns. This technique may resolve the difficulties with magnifying endoscopic observation.
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Affiliation(s)
- Kenichi Matsui
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohei Funasaka
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanobu Matsushita
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Osamu Watanabe
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Ohara
- Department of Mechatronics Engineering, Faculty of Science and Technology, Meijo University, Nagoya, Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Hidemi Goto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Castro R, Rodriguez M, Libânio D, Esposito G, Pita I, Patita M, Santos C, Pimentel-Nunes P, Dinis-Ribeiro M. Reliability and accuracy of blue light imaging for staging of intestinal metaplasia in the stomach. Scand J Gastroenterol 2019; 54:1301-1305. [PMID: 31680561 DOI: 10.1080/00365521.2019.1684555] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background and aims: An endoscopic grading system (EGGIM) using narrow-band-imaging (NBI) has shown to accurately identify patients with extensive gastric intestinal metaplasia (GIM). However, description with alternative systems such as blue-light-imaging (BLI) is limited. The aim of this study is to determine the reliability and accuracy of BLI-bright regarding diagnosis and staging of GIM.Methods: Reliability of WLE (white-light-endoscopy) and BLI among 6 observers was assessed using a standard classification based on endoscopic images. Afterward, 37 patients were submitted to gastroscopy using FujifilmEG-760Z and endoscopists had to determine EGGIM score using BLI-bright and to perform gastric biopsies for operative-link-of-gastric-intestinal-metaplasia (OLGIM) calculation. BLI-bright accuracy was determined by comparing results with prior EGGIM scores with NBI and current OLGIM.Results: Compared with WLE, the interobserver reliability between observers was substantially better with BLI (Weighted Kappa: 0.8 vs 0.41). There was an 84% agreement between BLI and NBI assessing EGGIM intervals (EGGIM 0-4vs5-10). The area under the ROC curve was 0.90 (95%CI: 0.79-1.0) using the cut-off of EGGIM > 4 to determine advanced GIM, with a sensitivity of 100% (95%CI: 88-100%).Discussion: BLI-bright is reliable for the diagnosis of gastric intestinal metaplasia and agrees significantly with NBI evaluation. Preliminary data suggests high sensitivity for identifying patients with increased risk of gastric cancer.
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Affiliation(s)
- Rui Castro
- Gastroenterology Department, Oncology Portuguese Institute of Porto, Porto, Portugal
| | - Marta Rodriguez
- Gastroenterology Department, Oncology Portuguese Institute of Porto, Porto, Portugal
| | - Diogo Libânio
- Gastroenterology Department, Oncology Portuguese Institute of Porto, Porto, Portugal.,Faculty of Medicine, CINTESIS, University of Porto, Porto, Portugal
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sant´Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Inês Pita
- Gastroenterology Department, Oncology Portuguese Institute of Porto, Porto, Portugal
| | - Marta Patita
- Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Cristina Santos
- Faculty of Medicine, CINTESIS, University of Porto, Porto, Portugal.,Faculty of Medicine, MEDCIDS, University of Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Oncology Portuguese Institute of Porto, Porto, Portugal.,Faculty of Medicine, MEDCIDS, University of Porto, Porto, Portugal.,Faculty of Medicine, Department of Surgery and Physiology, University of Porto, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Oncology Portuguese Institute of Porto, Porto, Portugal.,Faculty of Medicine, CINTESIS, University of Porto, Porto, Portugal.,Faculty of Medicine, MEDCIDS, University of Porto, Porto, Portugal
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19
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Development of Image-enhanced Endoscopy of the Gastrointestinal Tract: A Review of History and Current Evidences. J Clin Gastroenterol 2018; 52:295-306. [PMID: 29210900 DOI: 10.1097/mcg.0000000000000960] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endoscopy imaging of the gastrointestinal (GI) tract has evolved tremendously over the last few decades. Key milestones in the development of endoscopy imaging include the use of various dyes for chromoendoscopy, the application of optical magnification in endoscopy, the introduction of high-definition image capturing and display technology and the application of altered illuminating light to achieve vascular and surface enhancement. Aims of this review paper are to summarize the development and evolution of modern endoscopy imaging and in particular, imaged-enhanced endoscopy (IEE), to promote appropriate usage, and to guide future development of good endoscopy practice. A search of PubMed database was performed to identify articles related to IEE of the GI tract. Where appropriate, landmark trials and high-quality meta-analyses and systematic reviews were used in the discussion. In this review, the developments and evolutions in endoscopy imaging and in particular, IEE, were summarized into discernible eras and the literature evidence with regard to the strengths and weaknesses in term of their detection and characterization capability in each of these eras were discussed. It is in the authors' opinion that IEE is capable of fairly good detection and accurate characterization of various GI lesions but such benefits may not be readily reaped by those who are new in the field of luminal endoscopy. Exposure and training in making confident diagnoses using these endoscopy imaging technologies are required in tandem with these new developments in order to fully embrace and adopt the benefits.
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20
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Horiguchi N, Tahara T, Yamada H, Yoshida D, Okubo M, Nagasaka M, Nakagawa Y, Shibata T, Tsukamoto T, Kuroda M, Ohmiya N. In vivo diagnosis of early-stage gastric cancer found after Helicobacter pylori eradication using probe-based confocal laser endomicroscopy. Dig Endosc 2018; 30:219-227. [PMID: 28731617 DOI: 10.1111/den.12926] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 07/18/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Early-stage gastric cancer (EGC) found after Helicobacter pylori (Hp) eradication often displays non-tumorous regenerative epithelium and/or maturated tumorous epithelium overlying the cancerous tissue, which may confuse endoscopic and histological diagnosis. Probe-based confocal laser endomicroscopy (pCLE) enables in vivo real-time optical biopsy. We compared the diagnostic yields for these EGC cases using conventional white light endoscopy (WL), magnifying endoscopy with narrow-band imaging (ME-NBI), pCLE, and endoscopic biopsy; we also compared the accuracy of the horizontal extent diagnosis between ME-NBI and pCLE. METHODS This study enrolled 30 patients with 36 EGC lesions after successful Hp eradication. Diagnostic yields of WL, ME-NBI, pCLE, and endoscopic biopsy were prospectively compared. Four points of cancerous margins (oral, anal, anterior, and posterior sites) were also prospectively evaluated with M-NBI and pCLE to determine the horizontal extent of the EGC. RESULTS Diagnostic yield was significantly higher with pCLE than with WL and endoscopic biopsy (97 vs 72%, 97 vs 72%, P = 0.0159, 0.0077, respectively), whereas it did not differ from ME-NBI (88.9%, P = 0.371). Height of non-tumorous regenerative epithelium or maturated atypical glands was 104.7 ± 34.2 μm in the pCLE-positive cases, whereas it was 188.3 ± 27.1 μm in a pCLE-negative case (P = 0.0004). Diagnostic accuracy of the horizontal margin of EGC was significantly higher with pCLE than with ME-NBI (92 vs 70%, P = 0.0159). CONCLUSION pCLE may be helpful for the diagnosis of ambiguous ECG found after Hp eradication because it enables real-time scanning throughout the lesion and detection of subsurface microstructure.
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Affiliation(s)
- Noriyuki Horiguchi
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomomitsu Tahara
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hyuga Yamada
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Dai Yoshida
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masaaki Okubo
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mitsuo Nagasaka
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshihito Nakagawa
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyuki Shibata
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tetsuya Tsukamoto
- Department of Diagnostic Pathology I, Fujita Health University School of Medicine, Toyoake, Japan
| | - Makoto Kuroda
- Department of Diagnostic Pathology I, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naoki Ohmiya
- Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
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21
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Kanesaka T, Uedo N, Yao K, Ezoe Y, Doyama H, Oda I, Kaneko K, Kawahara Y, Yokoi C, Sugiura Y, Ishikawa H, Takeuchi Y, Arao M, Iwatsubo T, Iwagami H, Matsuno K, Muto M, Saito Y, Tomita Y. Multiple convex demarcation line for prediction of benign depressed gastric lesions in magnifying narrow-band imaging. Endosc Int Open 2018; 6:E145-E155. [PMID: 29399611 PMCID: PMC5794433 DOI: 10.1055/s-0043-121267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 09/08/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND STUDY AIMS With magnifying narrow-band imaging (M-NBI) of the gastric mucosa, a characteristic demarcation line (DL) is occasionally found in non-cancerous depressed lesions. This DL forms multiple convex shapes along the edge of the epithelia of surrounding mucosa. We have termed this novel finding a multiple convex DL (MCDL). In this study, we clarified the prevalence of an MCDL in depressed gastric lesions detected in patients at high risk for gastric cancer and determined the diagnostic yield necessary to distinguish between cancer and non-cancer. PATIENTS AND METHODS This was a post hoc analysis of a multicenter prospective trial. In total, 362 small (≤ 10 mm) depressed lesions were detected in 1353 patients. Presence or absence of a DL in target lesions was evaluated on M-NBI images. The proportion of MCDLs among lesions with a DL was evaluated. RESULTS Images of 347 lesions (39 cancerous and 308 non-cancerous) were evaluable. A DL was present in 252/347 lesions (73 %). When the cutoff value for the proportion of MCDLs needed to distinguish non-cancer from cancer was set at two-thirds, an MCDL was observed in 86/252 lesions (34 %). In 86 lesions with an MCDL, 83 (97 %) were non-cancerous. The sensitivity, specificity, positive predictive value, and negative predictive value of an MCDL for non-cancerous lesions were 38 %, 91 %, 97 %, and 19 %, respectively. CONCLUSIONS Presence of an MCDL had high specificity and positive predictive value for non-cancerous lesions. Evaluating the shape of the DL is useful for differentiation between cancer and non-cancerous lesions.
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Affiliation(s)
- Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yasumasa Ezoe
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuhiro Kaneko
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Chiba, Japan
| | | | - Chizu Yokoi
- Endoscopy Division, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasushi Sugiura
- Division of Gastroenterology and Hepatology, Kitano Hospital, Osaka, Japan
| | - Hideki Ishikawa
- Department of Molecular Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masamichi Arao
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenji Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiko Tomita
- Department of Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
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22
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Yoshimizu S, Yamamoto Y, Horiuchi Y, Omae M, Yoshio T, Ishiyama A, Hirasawa T, Tsuchida T, Fujisaki J. Diagnostic performance of routine esophagogastroduodenoscopy using magnifying endoscope with narrow-band imaging for gastric cancer. Dig Endosc 2018; 30:71-78. [PMID: 28685858 DOI: 10.1111/den.12916] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/04/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM In Japan, an increase in the number of routine esophagogastroduodenoscopy procedures is expected because several studies have reported that endoscopy screening has reduced gastric cancer mortality. Magnifying narrow-band imaging has been reported to be effective for accurate diagnosis of gastric abnormalities such as cancers, adenomas, and intestinal metaplasia. However, the efficacy of this method in routine esophagogastroduodenoscopy has not been clarified. METHODS We divided 3763 patients into two groups. The non-magnification group included 1842 patients who underwent endoscopy screening using GIF-H260/LUCERA-SPECTRUM between October 2014 and February 2015, whereas the magnification group included 1921 patients who underwent screening using GIF-H290Z/LUCERA-ELITE between March 2015 and May 2015. In the magnification group, diagnosis of cancer was conducted using the VS classification system. We did not carry out a biopsy when results were confirmed as non-cancer using magnifying narrow-band imaging. If cancer was diagnosed, or when a cancer or non-cancer diagnosis was difficult, we carried out a biopsy. We analyzed and compared the diagnostic performance between the two groups. RESULTS Gastric biopsy rate was significantly lower in the magnification group (29%) than in the non-magnification group (41%) (P < 0.001). Positive predictive value (PPV) for gastric cancer was significantly higher in the magnification group (5.5%) than in the non-magnification group (2.5%) (P < 0.001). Furthermore, PPV for gastric epithelial neoplasia was significantly higher in the magnification group (7.9%) than in the non-magnification group (3.2%) (P < 0.001). CONCLUSION Magnifying narrow-band imaging improves the diagnostic performance of routine esophagogastroduodenoscopy.
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Affiliation(s)
- Shoichi Yoshimizu
- Division of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Yorimasa Yamamoto
- Division of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Yusuke Horiuchi
- Division of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Masami Omae
- Division of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Toshiyuki Yoshio
- Division of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Akiyoshi Ishiyama
- Division of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Toshiaki Hirasawa
- Division of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Tomohiro Tsuchida
- Division of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Junko Fujisaki
- Division of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
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23
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Yamaguchi D, Kodashima S, Fujishiro M, Ono S, Niimi K, Mochizuki S, Tsuji Y, Asada-Hirayama I, Sakaguchi Y, Shichijo S, Minatsuki C, Yamamichi N, Koike K. Evaluation of image-enhanced endoscopic technology using advanced diagnostic endoscopy for the detection of early gastric cancer: a pilot study. Endosc Int Open 2017; 5:E825-E833. [PMID: 28924585 PMCID: PMC5595580 DOI: 10.1055/s-0043-113632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 05/24/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Image-enhanced endoscopy (IEE) plays an important role in early detection and detailed examination of early gastric cancer (EGC). The current study aimed to clarify the efficacy of IEE using advanced diagnostic endoscopy for EGC detection without magnification. PATIENTS AND METHODS We performed endoscopic examinations without magnification in patients referred to our hospital with a diagnosis of upper gastrointestinal tumor detected through routine screening endoscopy. In this study, we used three IEE technologies: narrow-band imaging; blue laser imaging; and i-scan optical enhancement. The detection rates for EGC between IEE and white-light imaging (WLI) were compared. RESULTS Between July 2013 and June 2014, 156 patients were enrolled. Among upper gastrointestinal tumors, we analyzed endoscopic examination results of 119 lesions that were histologically diagnosed as EGC in 109 patients. The EGC detection rate in the IEE plus WLI groups was 77.3 %. Although the EGC detection rate in the IEE group was higher than that in the WLI group (80.0 % vs. 70.3 %), there was no significant difference between these two modalities. An important detection factor using IEE was tumor circumference, where the rate of detection in the anterior wall and lesser curvature was significantly higher than that in the posterior wall and greater curvature ( P = 0.046). An important detection factor using WLI was color variation, where the rate of occurrence of a reddened or pale tumor was significantly higher than that of normal colored tumors ( P = 0.030). CONCLUSIONS The detection rate of EGC without magnification was similar between the IEE group and the WLI group. Important detection factors differed between IEE and WLI; therefore, the IEE and WLI modalities have different characteristics regarding EGC detection. Consequently, we propose to use both IEE and WLI in the evaluation of EGC.
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Affiliation(s)
- Daisuke Yamaguchi
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinya Kodashima
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,Corresponding author Shinya Kodashima Department of GastroenterologyGraduate School of MedicineThe University of Tokyo7-3-1 Hongo, Bunkyo-kuTokyo 113-8655Japan.+81-3-5800-9015
| | - Mitsuhiro Fujishiro
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Ono
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiko Niimi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Mochizuki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Itsuko Asada-Hirayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshiki Sakaguchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoki Shichijo
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chihiro Minatsuki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobutake Yamamichi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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24
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Hussain I, Ang TL. Evidence based review of the impact of image enhanced endoscopy in the diagnosis of gastric disorders. World J Gastrointest Endosc 2016; 8:741-755. [PMID: 28042388 PMCID: PMC5159672 DOI: 10.4253/wjge.v8.i20.741] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/27/2016] [Accepted: 09/22/2016] [Indexed: 02/05/2023] Open
Abstract
Gastric cancer is the third most common cause of cancer-related death. Advanced stages of gastric cancers generally have grim prognosis. But, good prognosis can be achieved if such cancers are detected, diagnosed and resected at early stages. However, early gastric cancers and its precursors often produce only subtle mucosal changes and therefore quite commonly remain elusive at the conventional examination with white light endoscopy. Image-enhanced endoscopy makes mucosal lesions more conspicuous and can therefore potentially yield earlier and more accurate diagnoses. Recent years have seen growing work of research in support of various types of image enhanced endoscopy (IEE) techniques (e.g., dye-chromoendoscopy; magnification endoscopy; narrow-band imaging; flexible spectral imaging color enhancement; and I-SCAN) for a variety of gastric pathologies. In this review, we will examine the evidence for the utilization of various IEE techniques in the diagnosis of gastric disorders.
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25
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Soma N. Diagnosis of Helicobacter pylori-related chronic gastritis, gastric adenoma and early gastric cancer by magnifying endoscopy. J Dig Dis 2016; 17:641-651. [PMID: 27577845 DOI: 10.1111/1751-2980.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Indexed: 12/11/2022]
Abstract
Evaluating the prevalence and severity of gastritis by endoscopy is useful for estimating the risk of gastric cancer (GC). Moreover, understanding the endoscopic appearances of gastritis is important for diagnosing GC due to the fact that superficial mucosal lesions mimicing gastritis (gastritis-like lesions) are quite difficult to be detected even with optimum preparation and the best technique, and in such cases tissue biopsy is often not very accurate for the diagnosis of gastric epithelial neoplasia. Magnifying endoscopy is a highly accurate technique for the detection of early gastric cancer (EGC). Recent reports have described that various novel endoscopic markers which, visualized by magnifying endoscopy with image-enhanced system (ME-IEE), can predict specific histopathological findings. Using ME-IEE with vessels and surface classification system (VSCS) may represent an excellent diagnostic performance with high confidence and good reproducibility to the endoscopists if performed under consistent conditions, including observation under maximal magnification. The aim of this review was to discuss how to identify high-risk groups for GC by endoscopy, and how to detect effectively signs of suspicious lesions by conventional white light imaging (C-WLI) or chromoendoscopy (CE). Furthermore, to characterize suspicious lesions using ME-IEE using the criteria and classification of EGC based upon VSCS.
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Affiliation(s)
- Nei Soma
- Department of Gastroenterology, Medical Center, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China
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26
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Accuracy of diagnostic demarcation of undifferentiated-type early gastric cancer for magnifying endoscopy with narrow-band imaging: surgical cases. Surg Endosc 2016; 31:1906-1913. [PMID: 27572067 DOI: 10.1007/s00464-016-5192-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/17/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM The usefulness of magnifying endoscopy with narrow-band imaging (ME-NBI) in undifferentiated-type early gastric cancers (UD-type EGCs) is unclear. This study investigated the accuracy of ME-NBI in the diagnostic demarcation. METHODS Among UD-type EGCs that were initially surgically resected between June 2011 and August 2014 in this hospital, 74 lesions were studied that were preoperatively diagnosed with white-light imaging (WLI) or endoscopic ultrasonography as lesions for which endoscopic treatment was not indicated and found to be early gastric cancers by postoperative pathology. The demarcation line was marked on the most oral and anal sides with argon plasma coagulation using WLI and ME-NBI, and the diagnostic demarcation of cancer was defined as correct, if consistent with the results of postoperative pathology. The length of extension into the proliferative zone, distance between crypts and inflammatory cell infiltration (updated Sydney classification: USC) were compared between the correctly diagnosed and the misdiagnosed cases. RESULTS The diagnosis was correct in 62 cases (83.8 %). The average distance between crypts in correctly diagnosed and misdiagnosed cases was approximately 1.9 and 1.3 times, respectively, that in normal mucosa (p < 0.0001). The accuracy of diagnosis was higher when atrophy and neutrophil and monocyte infiltration were mild according to the USC (p < 0.05). The additional use of ME-NBI improved the accuracy of diagnosis by 36.5 % compared with the use of WLI alone. CONCLUSION The use of ME-NBI in the preoperative diagnosis of the demarcation of cancer is useful to prevent postoperative positive surgical margins.
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27
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Hamada K, Itoh T, Kawaura K, Azukisawa S, Kobayashi R, Okamura H, Kitakata H, Urashima S, Nojima T, Fujino MA. Findings of the margin around lesions by magnifying endoscopy with narrow-band imaging in early gastric carcinoma and intestinal metaplasia. J Dig Dis 2016; 17:377-82. [PMID: 27115792 DOI: 10.1111/1751-2980.12352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Many endoscopists have reported their own classifications of early gastric carcinoma (EGC) using magnifying narrow-band imaging (M-NBI). However, few reports on classifying the margin around lesions by M-NBI have been published. The aim of this study was to advocate the usefulness of the demarcation area classification for the diagnosis of EGC. METHODS Altogether 197 lesions that could be investigated by M-NBI were included in this study, consisting of 115 EGC and 82 intestinal metaplasias (IM). We hypothesized that the changes in white zone (fusion and erasure signs) and blood vessel (extend and draw sign) were the indications of EGC and we retrospectively investigated this hypothesis. RESULTS For the investigation of the white zone in the demarcation area, both fusion (P < 0.0001) and erasure signs (P < 0.0001) were observed more often in EGC than in IM, with an accuracy of 80.7%. For the investigation of blood vessel in the demarcation area, both the extend (P < 0.001) and the draw sign (P < 0.0001) were observed more often in EGC than in IM, with an accuracy of 59.9%. CONCLUSION Estimations of the white zone and blood vessels in the demarcation area are useful for the diagnosis of EGC.
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Affiliation(s)
- Kazu Hamada
- Department of Gastroenterological Endoscopy, School of Kanazawa Medical University, Ishikawa, Japan
| | - Tohru Itoh
- Department of Gastroenterological Endoscopy, School of Kanazawa Medical University, Ishikawa, Japan
| | - Ken Kawaura
- Department of Gastroenterological Endoscopy, School of Kanazawa Medical University, Ishikawa, Japan
| | - Sadafumi Azukisawa
- Department of Gastroenterological Endoscopy, School of Kanazawa Medical University, Ishikawa, Japan
| | - Rika Kobayashi
- Department of Gastroenterological Endoscopy, School of Kanazawa Medical University, Ishikawa, Japan
| | - Hideyuki Okamura
- Department of Gastroenterological Endoscopy, School of Kanazawa Medical University, Ishikawa, Japan
| | - Hidekazu Kitakata
- Department of Gastroenterological Endoscopy, School of Kanazawa Medical University, Ishikawa, Japan
| | - Sachio Urashima
- Department of Gastroenterological Endoscopy, School of Kanazawa Medical University, Ishikawa, Japan
| | - Takayuki Nojima
- Department of Pathology, School of Kanazawa Medical University, Ishikawa, Japan
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28
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Muto M, Yao K, Kaise M, Kato M, Uedo N, Yagi K, Tajiri H. Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G). Dig Endosc 2016; 28:379-393. [PMID: 26896760 DOI: 10.1111/den.12638] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 12/13/2022]
Abstract
Gastric cancer is the third leading cause of cancer death worldwide. Early detection and accurate diagnosis of mucosal cancer is desirable in order to achieve decreased mortality; cause-specific survival of patients with early gastric cancer is reported to exceed 95%. Endoscopy is the functional modality to detect early cancer; however, the procedure is not definitive when using conventional white-light imaging. In contrast, magnifying narrow-band imaging (M-NBI), a novel endoscopic technology, is a powerful tool for characterizing gastric mucosal lesions because it can visualize the microvascular architecture and microsurface structure. To date, many reports on the diagnosis of early gastric cancer by M-NBI, including multicenter prospective randomized studies conducted in Japan, have been published in peer-reviewed international journals. Based on these published data, we devised a proposal for a diagnostic strategy for gastric mucosal cancer using M-NBI to simplify the process of diagnosis and improve accuracy. Herein, we recommend a diagnostic algorithm for early gastric cancer using magnifying endoscopy.
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Affiliation(s)
- Manabu Muto
- The Japanese Gastroenterological Association, Tokyo, Japan.,Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,The Japanese Gastric Cancer Association, Kyoto, Japan
| | - Kenshi Yao
- The Japanese Gastroenterological Association, Tokyo, Japan.,Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,The Japanese Gastric Cancer Association, Kyoto, Japan
| | - Mitsuru Kaise
- The Japanese Gastroenterological Association, Tokyo, Japan.,Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,The Japanese Gastric Cancer Association, Kyoto, Japan
| | - Mototsugu Kato
- The Japanese Gastroenterological Association, Tokyo, Japan.,Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,The Japanese Gastric Cancer Association, Kyoto, Japan
| | - Noriya Uedo
- The Japanese Gastroenterological Association, Tokyo, Japan.,Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,The Japanese Gastric Cancer Association, Kyoto, Japan
| | - Kazuyoshi Yagi
- The Japanese Gastroenterological Association, Tokyo, Japan.,Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,The Japanese Gastric Cancer Association, Kyoto, Japan
| | - Hisao Tajiri
- The Japanese Gastroenterological Association, Tokyo, Japan.,Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,The Japanese Gastric Cancer Association, Kyoto, Japan
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29
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Enjoji M, Kohjima M, Ohtsu K, Matsunaga K, Murata Y, Nakamuta M, Imamura K, Tanabe H, Iwashita A, Nagahama T, Yao K. Intracellular mechanisms underlying lipid accumulation (white opaque substance) in gastric epithelial neoplasms: A pilot study of expression profiles of lipid-metabolism-associated genes. J Gastroenterol Hepatol 2016; 31:776-81. [PMID: 26513060 DOI: 10.1111/jgh.13216] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/06/2015] [Accepted: 10/17/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM White opaque substance (WOS) is a novel endoscopic finding in gastric neoplasms, indicating the intracellular accumulation of lipid droplets (LDs). However, gastric lipid metabolism has not been extensively investigated, even in normal mucosa. We investigated the expression profiles of lipid-metabolism-associated genes in gastric neoplasms. METHODS Thirty-four patients with early gastric cancer or adenoma were enrolled in this study. Paired biopsy samples from tumor and adjacent non-tumor areas were obtained and analyzed by real-time polymerase chain reaction. Endoscopically resected specimens were evaluated histopathologically. RESULTS Genes associated with β-oxidation (peroxisome proliferator-activated receptor α, carnitine palmitoyltransferase 1A, and hydroxyacyl-CoA dehydrogenase), lipoprotein excretion (apolipoprotein B, microsomal triglyceride transfer protein, and acyl-CoA:cholesterol acyltransferase 2), fatty acid transport (fatty acid-binding protein), construction of triglycerides in the endoplasmic reticulum (acyl-CoA:diacylglycerol acyltransferase 1), and LD degradation/lipolysis (comparative gene identification-58, adipose triglyceride lipase) were significantly downregulated in neoplasms compared with non-tumor areas. Pyruvate dehydrogenase lipoamide kinase isozyme 4 (negative regulator of glycolysis) and adipophilin (LD surface component) were also repressed. Conversely, expression levels of genes associated with de novo lipogenesis (sterol regulatory element-binding protein 1c, acyl-CoA:diacylglycerol acyltransferase 2) were significantly enhanced in neoplasms. There was no significant difference in gene expression levels between carcinomas and adenomas, or between WOS-positive and WOS-negative neoplasms. CONCLUSION Gene expression profiles in neoplasms suggest a predominance of lipid storage (lipogenesis/LD formation) over consumption (β-oxidation/excretion/lipolysis). Lipid accumulation and WOS in gastric epithelial neoplasms may be caused by impaired mitochondrial oxidation, lipoprotein excretion, and LD degradation.
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Affiliation(s)
- Munechika Enjoji
- Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
| | - Motoyuki Kohjima
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kensei Ohtsu
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | | | - Yusuke Murata
- Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
| | - Makoto Nakamuta
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kentaro Imamura
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Hiroshi Tanabe
- Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Akinori Iwashita
- Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Takashi Nagahama
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
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30
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Accuracy of diagnostic demarcation of undifferentiated-type early gastric cancers for magnifying endoscopy with narrow-band imaging: endoscopic submucosal dissection cases. Gastric Cancer 2016; 19:515-523. [PMID: 25744291 DOI: 10.1007/s10120-015-0488-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/24/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The usefulness of magnifying endoscopy with narrow-band imaging (ME-NBI) for undifferentiated-type early gastric cancers (UD-type EGCs) is unclear. The present study examined the accuracy of the diagnostic demarcation of lesions using ME-NBI. METHODS The study population consisted of 76 patients with UD-type EGC lesions measuring ≤20 mm in diameter using white-light imaging (WLI) and endoscopic ultrasonography and diagnosed as intramucosa and UL(-); all the lesions were confirmed as early gastric cancer based on postoperative pathological examination. All the patients had undergone an initial endoscopic submucosal dissection (ESD) at this hospital between January 2010 and January 2014. After marking with demarcation lines at the utmost oral and anal sites of the lesion using argon plasma coagulation under ME-NBI for intervention, the cases with demarcations that were consistent with the postoperative pathological findings were defined as having been accurately diagnosed. The inflammatory cell infiltration (Updated Sydney System, USS) were also assessed. RESULTS The diagnostic demarcations of the lesion were consistent in 62 cases (81.6 %). The accurate diagnosis rate was higher for the USS cases with mild neutrophil and monocyte infiltration (P < 0.05). The addition of ME-NBI to WLI improved the accurate diagnosis rate by 27.6 %. CONCLUSION The use of ME-NBI in diagnostic demarcation of UD-type EGCs is recommended.
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31
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Kanesaka T, Uedo N, Yao K, Ezoe Y, Doyama H, Oda I, Kaneko K, Kawahara Y, Yokoi C, Sugiura Y, Ishikawa H, Kato M, Takeuchi Y, Muto M, Saito Y. A significant feature of microvessels in magnifying narrow-band imaging for diagnosis of early gastric cancer. Endosc Int Open 2015; 3:E590-6. [PMID: 26716118 PMCID: PMC4683127 DOI: 10.1055/s-0034-1392608] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/16/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Magnifying narrow-band imaging (NBI) is more useful than conventional endoscopy for diagnosing early gastric cancer (EGC). However, evaluation of irregular microvascular patterns is subjective and is often difficult, even with expert eyes. The aim of this study was to clarify the most important microvascular patterns in magnifying NBI for diagnosis of EGC. PATIENTS AND METHODS This was a post-hoc analysis of a multicenter prospective trial among nine Japanese hospitals. A total of 1353 patients underwent screening with white-light endoscopy and 362 patients had small (≤ 10 mm) depressed lesions. They were randomly assigned to magnifying NBI or white-light endoscopy followed by magnifying NBI. During diagnosis, magnifying NBI images were recorded before biopsy. All magnifying NBI images were reviewed and evaluated for the association of four features of microvessels - that is, dilation, tortuosity, difference in caliber, and variation in shape - with cancer diagnosis. RESULTS Images of 343 lesions (40 cancerous and 303 benign depression lesions) were evaluable. The diagnostic performance (sensitivity/specificity) of each finding was: dilation, 25/90 %; tortuosity, 55/24 %; difference in caliber, 13 /99 %; and variation in shape, 70/95 %. Multivariate analysis identified only variation in shape as being statistically significantly associated with diagnosis of cancer (odds ratio 38.0, 95 % confidence interval: 16.1 - 95.7, P < 0.001). All findings showed moderate agreement (κ values): dilation, 0.44; tortuosity, 0.33; difference in caliber, 0.26; and variation in shape, 0.48. CONCLUSIONS A variation in shape was the most significant feature of microvessels observed in magnifying NBI for diagnosis of small depressed-type EGC. STUDY REGISTRATION UMIN-CTR000001072.
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Affiliation(s)
- Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan,Corresponding author Noriya Uedo, MD Department of Gastrointestinal OncologyOsaka Medical Center for Cancer and Cardiovascular Diseases1-3-3 Nakamichi Higashinari-kuOsaka 537-8511Japan+81-6-69814067
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yasumasa Ezoe
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuhiro Kaneko
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Chiba, Japan
| | | | - Chizu Yokoi
- Endoscopy Division, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasushi Sugiura
- Division of Gastroenterology and Hepatology, Kitano Hospital, Osaka, Japan
| | - Hideki Ishikawa
- Department of Molecular Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Minoru Kato
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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32
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Yao K. Clinical Application of Magnifying Endoscopy with Narrow-Band Imaging in the Stomach. Clin Endosc 2015; 48:481-90. [PMID: 26668793 PMCID: PMC4676664 DOI: 10.5946/ce.2015.48.6.481] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/11/2015] [Accepted: 11/13/2015] [Indexed: 12/17/2022] Open
Abstract
Magnifying endoscopy with narrow-band imaging (M-NBI) can visualize superficial microanatomies in the stomach. The normal morphology of the microanatomy visualized by M-NBI differs according to the part of the stomach. The gastric fundic glandular mucosa appears as a regular honeycomb-like subepithelial capillary network (SECN) pattern with a regular collecting venule pattern and regular oval crypt opening with circular marginal crypt epithelium (MCE) pattern. The gastric pyloric glandular mucosa displays a regular coil-shaped SECN pattern and regular polygonal or curved MCE pattern. For a diagnosis of early gastric cancer using M-NBI, the vessel plus surface classification system was developed. This system is clinically useful for the differential diagnosis of focal gastritis and small depressed cancer and for determining the horizontal extent of early gastric cancer for successful endoscopic resection. Advantages of M-NBI over conventional endoscopic imaging techniques with white light include accurate diagnosis and cost effectiveness. This technique is a breakthrough in the endoscopic diagnostic field.
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Affiliation(s)
- Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan
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Uchita K, Yao K, Uedo N, Shimokawa T, Iwasaki T, Kojima K, Kawada A, Nakayama M, Okazaki M, Iwamura S. Highest power magnification with narrow-band imaging is useful for improving diagnostic performance for endoscopic delineation of early gastric cancers. BMC Gastroenterol 2015; 15:155. [PMID: 26526857 PMCID: PMC4630876 DOI: 10.1186/s12876-015-0385-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/21/2015] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Magnifying endoscopy with narrow-band imaging (ME-NBI) is more reliable than chromoendoscopy (CE) for delineating the horizontal extent of early gastric cancers prior to endoscopic submucosal dissection (ESD). However, the added benefits of ME-NBI over CE in terms of the difference in magnification level have yet to be elucidated. The aim of this study was to investigate the improvement in diagnostic accuracy for tumor delineation obtained with different magnification levels of ME-NBI following CE. Patients and methods This was a retrospective study, performed at a single tertiary referral center. A series of 158 consecutive patients with 161 early gastric cancers resected en bloc using ESD was included in the study. The margins of each lesion were examined in their entirety using CE, followed by low power optical magnifying endoscopy with narrow-band imaging (LM-NBI), and finally the highest power optical magnifying endoscopy with narrow-band imaging (HM-NBI). The primary endpoint was the added benefit, as measured using the successful delineation rate, for the delineation of gastric cancer margins using CE + LM-NBI vs CE, and for CE + LM-NBI + HM-NBI vs CE + LM-NBI. Results The successful delineation rates (95 % CI) using CE, CE + LM-NBI and CE + LM-NBI + HM-NBI were 72.7 % (68.5-79.9 %), 88.9 % (84.2-93.8 %), and 98.1 % (95.8-100 %). The diagnostic accuracy improved significantly for CE + LM-NBI compared with CE (P < 0.001), and for HM-NBI compared with LM-NBI (P < 0.001). Conclusions HM-NBI is useful for improving diagnostic performance for endoscopic delineation of early gastric cancers, following CE and LM-NBI.
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Affiliation(s)
- Kunihisa Uchita
- Department of Gastroenterology, Kochi Red Cross Hospital Japan, 2-13-51 Sinhonmachi, Kochi-city, Kochi, 780-8562, Japan.
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital Japan, 1-1-1 Zokumyoin, Chikushino-city, Fukuoka, 818-8502, Japan.
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases Japan, 3-3, Nakamichi 1-chome, Higashinari-ku, 537-8511, Osaka, Japan.
| | - Toshio Shimokawa
- Graduate School of Medicine and Engineering, University of Yamanashi, 4-3-11 Takeda, Kofu City, 400-8511, Yamanashi, Japan.
| | - Takehiro Iwasaki
- Department of Gastroenterology, Kochi Red Cross Hospital Japan, 2-13-51 Sinhonmachi, Kochi-city, Kochi, 780-8562, Japan.
| | - Koji Kojima
- Department of Gastroenterology, Kochi Red Cross Hospital Japan, 2-13-51 Sinhonmachi, Kochi-city, Kochi, 780-8562, Japan.
| | - Ai Kawada
- Department of Gastroenterology, Kochi Red Cross Hospital Japan, 2-13-51 Sinhonmachi, Kochi-city, Kochi, 780-8562, Japan.
| | - Mizu Nakayama
- Department of Gastroenterology, Kochi Red Cross Hospital Japan, 2-13-51 Sinhonmachi, Kochi-city, Kochi, 780-8562, Japan.
| | - Michiyo Okazaki
- Department of Gastroenterology, Kochi Red Cross Hospital Japan, 2-13-51 Sinhonmachi, Kochi-city, Kochi, 780-8562, Japan.
| | - Shinichi Iwamura
- Department of Gastroenterology, Kochi Red Cross Hospital Japan, 2-13-51 Sinhonmachi, Kochi-city, Kochi, 780-8562, Japan.
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Ohtsu K, Yao K, Matsunaga K, Nagahama T, Kanemitsu T, Matsushima Y, Yasaka M, Ono Y, Fujiwara S, Hisabe T, Takaki Y, Hirai F, Matsui T, Hanada T, Imamura K, Tanabe H, Iwashita A, Shimokawa T. Lipid is absorbed in the stomach by epithelial neoplasms (adenomas and early cancers): a novel functional endoscopy technique. Endosc Int Open 2015; 3:E318-22. [PMID: 26357677 PMCID: PMC4554501 DOI: 10.1055/s-0034-1392095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/16/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS The authors have successfully demonstrated that the white opaque substance (WOS) identified in gastric epithelial neoplasms is an accumulation of minute lipid droplets on the epithelial neoplasm. It is not known whether the lipid droplets originate from externally ingested lipids (typically foods). The purpose of this study was to investigate whether the oral ingestion of foods containing emulsified fats increases the density of the WOS in epithelial neoplasms. PATIENTS AND METHODS We examined 92 gastric epithelial neoplastic lesions in 89 patients. The patients were given emulsified fatty foods before the procedure, and magnifying endoscopy with narrow-band imaging (M-NBI) was used to image the lesions. An increase in WOS density after the ingestion of emulsified fatty foods was defined as a positive fat-loading test result. The patients were divided into the following groups: control group, no emulsified fat administered; group 1, fatty food administered 16 hours prior; group 3, fatty food administered both 16 and 4 hours prior. The proportion of positive fat-loading test results was determined in all groups. RESULTS The rates of positive fat-loading test results were as follows: control group, 9 %; group 1, 26 %; group 2, 52 %; group 3, 78 %. The increase in the rates of positive fat-loading test results in groups 2 and 3 relative to the rate in the control group was statistically significant (chi-squared test). CONCLUSIONS This study demonstrated for the first time that the ingestion of external lipids causes lipid droplets to aggregate in situ on the gastric epithelial neoplasm. These results can be used to develop a novel functional endoscopy technique that harnesses the lipid absorption capacity of neoplasms.
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Affiliation(s)
- Kensei Ohtsu
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan,Corresponding author Kensei Ohtsu, MD Department of GastroenterologyFukuoka University Chikushi Hospital1-1-1 ZokumyoinChikushinoFukuoka 818-8052Japan+81-(0)92-929-2630
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | | | - Takashi Nagahama
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Takao Kanemitsu
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yu Matsushima
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Motochika Yasaka
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yoichiro Ono
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Shoko Fujiwara
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Takashi Hisabe
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yasuhiro Takaki
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Fumihito Hirai
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Toshiyuki Matsui
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Teruyo Hanada
- Department of Nutrition, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kentaro Imamura
- Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Hiroshi Tanabe
- Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Akinori Iwashita
- Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Toshio Shimokawa
- Clinical Research Center, Wakayama Medical University, Wakayama, Japan
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Fujiwara S, Yao K, Nagahama T, Uchita K, Kanemitsu T, Tsurumi K, Takatsu N, Hisabe T, Tanabe H, Iwashita A, Matsui T. Can we accurately diagnose minute gastric cancers (≤5 mm)? Chromoendoscopy (CE) vs magnifying endoscopy with narrow band imaging (M-NBI). Gastric Cancer 2015; 18:590-6. [PMID: 25005559 DOI: 10.1007/s10120-014-0399-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/11/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chromoendoscopy (CE) is relatively ineffective at identifying the cancer-specific morphological characteristics of minute gastric cancers less than or equal to 5 mm in diameter, and on its own is insufficient to make an accurate diagnosis. The aim of this study is to assess the diagnostic performance of magnifying endoscopy with narrow band imaging (M-NBI) for minute gastric cancers. METHODS The minute cancer group comprised consecutive endoscopic submucosal dissection-resected minute gastric cancers histologically measured as no larger than 5 mm in diameter. The non-cancer group comprised consecutive non-cancer lesions no larger than 5 mm in diameter. The two groups were subject to retrospective analysis to evaluate the diagnostic ability (sensitivity, specificity, and diagnostic accuracy) and reproducibility of CE and M-NBI. RESULTS The results for CE versus M-NBI were as follows: sensitivity 43.7 % (95 % CI, 26.5-61.0 %) versus 78.0 % (95 % CI, 64.0-92.0 %); specificity 81.6 % (95 % CI, 72.6-90.6 %) versus 92.9 % (95 % CI, 87.0-98.9 %); and diagnostic accuracy 69.9 % (95 % CI, 61.0-78.6 %) versus 88.3 % (95 % CI, 82.0-94.5 %). The sensitivity and diagnostic accuracy were, therefore, significantly higher for M-NBI than for CE. The inter-observer variability was κ = 0.08 for CE and κ = 0.56 for M-NBI, while the intra-observer variability was κ = 0.38 and κ = 0.65, respectively. CONCLUSIONS M-NBI has greater sensitivity and reproducibility than CE for the diagnosis of minute gastric cancers.
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Affiliation(s)
- Shoko Fujiwara
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Zokumyoin, Chikushino-shi, Fukuoka, 818-8502, Japan
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A computer system to be used with laser-based endoscopy for quantitative diagnosis of early gastric cancer. J Clin Gastroenterol 2015; 49:108-15. [PMID: 24583752 DOI: 10.1097/mcg.0000000000000104] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
GOALS To evaluate the usefulness of a newly devised computer system for use with laser-based endoscopy in differentiating between early gastric cancer, reddened lesions, and surrounding tissue. BACKGROUND Narrow-band imaging based on laser light illumination has come into recent use. We devised a support vector machine (SVM)-based analysis system to be used with the newly devised endoscopy system to quantitatively identify gastric cancer on images obtained by magnifying endoscopy with blue-laser imaging (BLI). We evaluated the usefulness of the computer system in combination with the new endoscopy system. STUDY We evaluated the system as applied to 100 consecutive early gastric cancers in 95 patients examined by BLI magnification at Hiroshima University Hospital. We produced a set of images from the 100 early gastric cancers; 40 flat or slightly depressed, small, reddened lesions; and surrounding tissues, and we attempted to identify gastric cancer, reddened lesions, and surrounding tissue quantitatively. RESULTS The average SVM output value was 0.846 ± 0.220 for cancerous lesions, 0.381 ± 0.349 for reddened lesions, and 0.219 ± 0.277 for surrounding tissue, with the SVM output value for cancerous lesions being significantly greater than that for reddened lesions or surrounding tissue. The average SVM output value for differentiated-type cancer was 0.840 ± 0.207 and for undifferentiated-type cancer was 0.865 ± 0.259. CONCLUSIONS Although further development is needed, we conclude that our computer-based analysis system used with BLI will identify gastric cancers quantitatively.
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Jang HY, Hong SJ, Han JP, Park SK, Yun HK, Ko BJ. Comparison of the Diagnostic Usefulness of Conventional Magnification and Near-focus Methods with Narrow-band Imaging for Gastric Epithelial Tumors. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2015. [DOI: 10.7704/kjhugr.2015.15.1.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Hee Yoon Jang
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Su Jin Hong
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Pil Han
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Se Kyung Park
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Han Kyeol Yun
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Bong Jin Ko
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
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Serrano M, Kikuste I, Dinis-Ribeiro M. Advanced endoscopic imaging for gastric cancer assessment: new insights with new optics? Best Pract Res Clin Gastroenterol 2014; 28:1079-91. [PMID: 25439073 DOI: 10.1016/j.bpg.2014.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 09/22/2014] [Accepted: 10/01/2014] [Indexed: 01/31/2023]
Abstract
The most immediate strategy for improving survival of gastric cancer patients is secondary prevention through diagnosis of early gastric cancer either through screening or follow-up of individuals at high risk. Endoscopy examination is therefore of paramount importance and two general steps are to be known in assessing gastric mucosa - detection and characterization. Over the past decade, the advent of advanced endoscopic imaging technology led to diverse descriptions of these modalities reporting them to be useful in this setting. In this review, we aim at summarizing the current evidence on the use of advance imaging in individuals at high-risk (i.e., advance stages of gastric atrophy/intestinal metaplasia) and in those harbouring neoplastic lesions, and address its potential usefulness providing the readers a framework to use in daily practice. Further research is also suggested.
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Affiliation(s)
- M Serrano
- Gastroenterology Department, Portuguese Oncology Institute, Rua Professor Lima Basto, 1099-023 Lisbon, Portugal.
| | - I Kikuste
- Faculty of Medicine, University of Latvia, Riga, Latvia; Digestive Diseases Centre GASTRO, 6 Linezera Street, LV1006 Riga, Latvia.
| | - M Dinis-Ribeiro
- Center for Health Technology and Services Research (CINTESIS), Porto Faculty of Medicine, Porto, Portugal; Gastroenterology Department, Portuguese Oncology Institute, Rua Dr. Bernardino de Almeida, 4200-072 Porto, Portugal.
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Yu CH, Jeon SW, Kim SK, Lee HS, Heo J, Kwon YH, Kim GY, Kim SZ, Bae HI. Endoscopic resection as a first therapy for gastric epithelial atypia: is it reasonable? Dig Dis Sci 2014; 59:3012-20. [PMID: 24927801 DOI: 10.1007/s10620-014-3249-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/04/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Gastric atypical cell (GAC), an indefinite pathologic finding, often requires repeated biopsy or other diagnostic treatments, such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or operation (OP). The aim of this study was to analyze the initial endoscopic and histologic findings of GAC and to discuss the necessity of EMR/ESD at establishing a correct diagnosis. METHODS This retrospective study enrolled 96 patients proven as GAC on index forceps biopsy. ESD (17/96, 17.7%), EMR (5/96, 5.2%), OP (20/96, 20.8%), and other treatment or follow-up (54/96, 56.3%) were performed. We analyzed the initial endoscopic and histologic characteristics of GAC lesions, predictive of neoplasm. RESULTS After diagnostic modalities, the final pathologic diagnoses were cancer (36/96, 37.6%), dysplasia (9/96, 9.4%), and non-neoplasm (51/96, 53.0%). In univariate analysis, age [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.07], lesion size of 10 mm or greater (OR 3.94, 95% CI 1.61-9.61), lesion with depressed type (OR 2.50, 95% CI 1.09-5.72), and presence of H. pylori (OR 2.83, 95% CI 1.11-7.25) were risk factors for neoplasm. In multivariate analysis, lesion size of 10 mm or greater (OR 3.63, 95% CI 1.23-10.66), lesion with depressed type (OR 2.86, 95% CI 1.11-7.38) were independent risk factors for cancer. CONCLUSION Considering the neoplastic risk of GAC, which could be missed on biopsy, more comprehensive tissue sampling via EMR/ESD might be necessary to establish a definite diagnosis.
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Affiliation(s)
- Chung Hoon Yu
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea
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Kawai T, Yanagizawa K, Naito S, Sugimoto H, Fukuzawa M, Gotoda T, Matsubayashi J, Nagao T, Hoshino S, Tsuchida A, Moriyasu F. Evaluation of gastric cancer diagnosis using new ultrathin transnasal endoscopy with narrow-band imaging: preliminary study. J Gastroenterol Hepatol 2014; 29 Suppl 4:33-6. [PMID: 25521731 DOI: 10.1111/jgh.12797] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM The new developed ultrathin transnasal endoscope, the GIF-XP290N, makes possible a resolving power similar to the GIF-H260 at a distance of 3 mm. In this study, using the GIF-XP290N, we evaluated whether endoscopic diagnosis (discrimination between benign and malignant) of gastric lesions is possible using nonmagnified narrow-band imaging (NBI) endoscopy. METHODS The subjects were 255 consecutive patients who underwent screening of the gastrointestinal tract using new ultrathin transnasal endoscopy. Their average age was 65.2 ± 11.4 years. The male-female ratio was 2.5:1. All cases were examined using conventional white-light imaging (WLI) and nonmagnified NBI. When a depressed lesion was detected in the stomach, it was examined using WLI, then NBI close examination (at about 3 mm). We observed the mucosal structure of the lesion using close visualization with NBI. Concerning mucosal structural changes, we looked for a clear demarcation line between the lesion and the surrounding mucosa, and loss, irregularity, or nonuniformity of the lesion mucosal microsurface pattern. RESULTS A total of 52 depressed lesions were examined. The histological diagnosis was cancer for 8 lesions, and noncancer for 44 lesions. WLI examination yielded a sensitivity of 50.0% (4/8), specificity of 63.6% (28/44), and accuracy 61.5% (32/52). On the other hand, NBI close examination yielded a sensitivity of 87.5% (7/8), specificity of 93.2% (41/44), and accuracy of 92.3% (48/52), significantly higher. CONCLUSION NBI close examination using ultrathin transnasal endoscopy enables mucosal diagnosis even without magnification and was considered to be an effective technique for improving endoscopic diagnosis.
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Affiliation(s)
- Takashi Kawai
- Endoscopy Centre, Tokyo Medical University Hospital, Tokyo, Japan
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Yao K, Doyama H, Gotoda T, Ishikawa H, Nagahama T, Yokoi C, Oda I, Machida H, Uchita K, Tabuchi M. Diagnostic performance and limitations of magnifying narrow-band imaging in screening endoscopy of early gastric cancer: a prospective multicenter feasibility study. Gastric Cancer 2014; 17:669-79. [PMID: 24407989 DOI: 10.1007/s10120-013-0332-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 12/16/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Curative treatment of patients with gastric cancer requires reliable detection of early gastric cancer. Magnifying endoscopy with narrow-band imaging (M-NBI) is useful for the accurate preoperative diagnosis of early gastric cancer. However, the role of M-NBI in screening endoscopy has not been established. The aims of this study were to determine the feasibility and limitations of M-NBI in screening endoscopy. METHODS We conducted a multicenter prospective uncontrolled trial of patients undergoing routine screening endoscopy patients. We determined the diagnostic accuracy, sensitivity and specificity of M-NBI according to the degree of certainty and need for biopsy, as assessed using the VS (vessel plus surface) classification system. We analyzed the endoscopic and histopathological characteristics of both false negative and false positive high confidence M-NBI diagnoses. We then developed a provisional diagnostic strategy based on the diagnostic performance and limitations identified in this study. RESULTS A total of 1097 patients were enrolled in the study. We analyzed 371 detected lesions (20 cancers and 351 non-cancers). The accuracy, sensitivity and specificity of high confidence M-NBI diagnoses were 98.1, 85.7 and 99.4 %, respectively. The false negative case was a pale mucosal lesion with tissue diagnosis of signet-ring cell carcinoma. Exclusion of pale mucosal lesions increased the accuracy, sensitivity and specificity of high confidence M-NBI diagnoses to 99.4, 100 and 99.4 %, respectively. We therefore propose a practical strategy targeting non-pale mucosal lesions. CONCLUSIONS With a refined strategy considering its limitations, M-NBI can act as an "optical biopsy" in screening endoscopies.
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Affiliation(s)
- Kenshi Yao
- Department of Endoscopy, Central Research Institute for Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka University, 1-1-1 Zokumyoin, Chikushino, Fukuoka, 818-8502, Japan,
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Assessment of still and moving images in the diagnosis of gastric lesions using magnifying narrow-band imaging in a prospective multicenter trial. PLoS One 2014; 9:e100857. [PMID: 24988209 PMCID: PMC4079511 DOI: 10.1371/journal.pone.0100857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/25/2014] [Indexed: 12/18/2022] Open
Abstract
Objectives Magnifying narrow-band imaging (M-NBI) is more accurate than white-light imaging for diagnosing small gastric cancers. However, it is uncertain whether moving M-NBI images have additional effects in the diagnosis of gastric cancers compared with still images. Design A prospective multicenter cohort study. Methods To identify the additional benefits of moving M-NBI images by comparing the diagnostic accuracy of still images only with that of both still and moving images. Still and moving M-NBI images of 40 gastric lesions were obtained by an expert endoscopist prior to this prospective multicenter cohort study. Thirty-four endoscopists from ten different Japanese institutions participated in the prospective multicenter cohort study. Each study participant was first tested using only still M-NBI images (still image test), then tested 1 month later using both still and moving M-NBI images (moving image test). The main outcome was a difference in the diagnostic accuracy of cancerous versus noncancerous lesions between the still image test and the moving image test. Results Thirty-four endoscopists were analysed. There were no significant difference of cancerous versus noncancerous lesions between still and moving image tests in the diagnostic accuracy (59.9% versus 61.5%), sensitivity (53.4% versus 55.9%), and specificity (67.0% versus 67.6%). And there were no significant difference in the diagnostic accuracy between still and moving image tests of demarcation line (65.4% versus 65.5%), microvascular pattern (56.7% versus 56.9%), and microsurface pattern (48.1% versus 50.9%). Diagnostic accuracy showed no significant difference between the still and moving image tests in the subgroups of endoscopic findings of the lesions. Conclusions The addition of moving M-NBI images to still M-NBI images does not improve the diagnostic accuracy for gastric lesions. It is reasonable to concentrate on taking sharp still M-NBI images during endoscopic observation and use them for diagnosis. Trial registration Umin.ac.jp UMIN-CTR000008048
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Evaluating the diagnoses of gastric antral lesions using magnifying endoscopy with narrow-band imaging in a Chinese population. Dig Dis Sci 2014; 59:1513-9. [PMID: 24488235 DOI: 10.1007/s10620-014-3027-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/02/2014] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the accuracy of diagnosing gastric antral lesions in routine clinical practice using magnifying endoscopy with narrow-band imaging (M-NBI) as a real-time diagnosing technique. METHODS Consecutive patients undergoing upper endoscopy were selected for the study. In each patient, the mucosa of the gastric antrum was observed by M-NBI, and the gastric microstructure was categorized into five types (A-E). Based on these patterns, histological types were predicted in a real-time manner. The accuracy of these predictions was evaluated based on histological findings. Inter-observer agreement was also assessed. RESULTS A total of 207 sites in 90 patients were examined by M-NBI. Compared with type A gastric microstructure, types B and C gastric microstructure showed a significantly higher degree of inflammation (P < 0.001). The sensitivity, specificity and accuracy of types B + C microstructure as a predictor of gastric inflammation were 85.4, 81.7 and 83.1 %, respectively. Similarly, the sensitivity, specificity and accuracy of type D microstructure as a predictor of gastric intestinal metaplasia were 71.8, 95.2 and 90.8 %, respectively, and those of type E microstructure as a predictor of early gastric cancer were 80.0, 98.9 and 97.6 %, respectively. The sensitivity and specificity of type B alone, type C alone and types B + C combined for the detection of Helicobacter pylori infection were 52.2 and 87.0 %, 22.8 and 92.2 %, 75.0 and 79.1 %, respectively. The kappa value for the inter-observer agreement was 0.715 (95 % confidence interval 0.655-0.895). CONCLUSIONS In conclusion, M-NBI can significantly improve the accuracy of the prediction of histopathology of gastric antral lesions in vivo, implying the possibility of using M-NBI as an effective diagnosis technique.
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Song M, Ang TL. Early detection of early gastric cancer using image-enhanced endoscopy: Current trends. GASTROINTESTINAL INTERVENTION 2014. [DOI: 10.1016/j.gii.2014.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Yoo CH, Park MI, Park SJ, Moon W, Kim HH, Song JY, Kim DH. Observer variability in gastric neoplasm assessment using the vessel plus surface classification for magnifying endoscopy with narrow band imaging. Clin Endosc 2014; 47:74-8. [PMID: 24570886 PMCID: PMC3928496 DOI: 10.5946/ce.2014.47.1.74] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/30/2013] [Accepted: 08/14/2013] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Recent studies have demonstrated that magnifying endoscopy with narrow band imaging (ME-NBI) facilitates differentiation of early gastric cancer from gastric adenoma using vessel plus surface (VS) classification. This study estimated the interobserver and intraobserver agreement of endoscopists using the Yao VS classification system for the gastric mucosal surface. Methods We retrospectively reviewed patients who underwent endoscopic submucosal dissection or endoscopic mucosal resection, and selected cases in which preoperative ME-NBI was conducted. Before testing endoscopists, a 20-minute training module was given. Static ME-NBI images (n=47 cases) were presented to seven endoscopists (two experts and five trainees) who were asked to assess the images in 20 seconds using the Yao VS classification system. After 2 weeks, the endoscopists were asked to analyze the images again. The κ statistic was calculated for intraobserver and interobserver variability. Results The mean κ for intraobserver agreement was 0.69 (experts, 0.74; trainees, 0.64). The mean κ for interobserver agreement was 0.42 (experts, 0.49; trainees, 0.40). Conclusions We obtained reliable results as assessed by observer variability, with only brief training on VS classification. The VS classification appears to provide an objective assessment of ME-NBI for trainees who are not familiar with ME-NBI.
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Affiliation(s)
- Chan Hui Yoo
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Moo In Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hyung Hun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jun Young Song
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Do Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Tao G, Xing-Hua L, Ai-Ming Y, Wei-Xun Z, Fang Y, Xi W, Li-Yin W, Chong-Mei L, Gui-Jun F, Hui-Jun S, Dong-Sheng W, Yue L, Xiao-Qing L, Jia-Ming Q. Enhanced magnifying endoscopy for differential diagnosis of superficial gastric lesions identified with white-light endoscopy. Gastric Cancer 2014; 17:122-9. [PMID: 23494118 DOI: 10.1007/s10120-013-0250-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/19/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Various techniques using magnifying endoscopy (ME) and chromoendoscopy are being developed to enhance images of gastrointestinal tumor. The aim of this study was to evaluate the diagnostic performance of ME enhanced by acetic acid-indigo carmine mixture (ME-AIM) and ME enhanced with narrow-band imaging (ME-NBI) for differential diagnosis of superficial gastric lesions identified with conventional white-light endoscopy (WLE). METHODS Patients with superficial gastric lesions picked up with WLE were enrolled in the study. ME-NBI and ME-AIM were used to further characterize the lesions. All images of the lesions were evaluated by four skilled endoscopists blinded to the clinical data. The microarchitectural patterns in the lesions were analyzed with reference to the "VS classification" system. RESULTS A total of 643 lesions (mean diameter, 7 mm) from 508 patients (316 men, 192 women; mean age, 63 years) were evaluated. Pathologically, 24 of the 643 lesions were diagnosed as gastric cancer; the others were noncancerous lesions. For diagnosis of gastric cancer, the negative predictive value of each of the three magnified findings (irregular microvascular pattern, irregular microsurface pattern, and demarcation line) was high (nearly 100 %). According to the "VS classification" system, either ME-NBI or ME-AIM had a higher specificity (99.5 % or 99.4 % vs. 89.5 %, P < 0.001) and accuracy (99.2 % or 98.9 % vs. 89.0 %, P < 0.001) than WLE, and ME-AIM was not superior to ME-NBI for identifying carcinoma. CONCLUSIONS Enhanced ME is useful for correctly diagnosing early gastric cancer, and in contrast with ME-AIM, ME-NBI is a more feasible and efficient method for clinical practice.
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Affiliation(s)
- Guo Tao
- Department of Gastroenterology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dong Cheng District, Beijing, 100730, China
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47
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An efficient diagnostic strategy for small, depressed early gastric cancer with magnifying narrow-band imaging: a post-hoc analysis of a prospective randomized controlled trial. Gastrointest Endosc 2014; 79:55-63. [PMID: 23932092 DOI: 10.1016/j.gie.2013.07.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/07/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND We previously reported that magnifying narrow-band imaging (M-NBI) is a high-performance diagnostic tool for small, depressed gastric cancer. However, an efficient diagnostic strategy using endoscopic findings has not been fully elucidated. OBJECTIVE To identify the endoscopic findings that contribute to accurate diagnosis of small, depressed gastric cancer and to propose the ideal diagnostic approach to such lesions. DESIGN Post-hoc analysis of a prospective, randomized, controlled trial. SETTING Nine hospitals. PATIENTS Three hundred fifty-three patients with small, depressed gastric lesions. INTERVENTIONS In the M-NBI group (n = 177), cancer diagnosis was made with diagnostic criteria including a demarcation line (DL) and an irregular microvascular pattern (IMVP). In the conventional white-light imaging (C-WLI) group (n = 176), diagnostic criteria were both an irregular margin and a spiny depressed area. In the C-WLI group, M-NBI was performed after C-WLI diagnosis. MAIN OUTCOME MEASUREMENTS The diagnostic performance of each criterion in M-NBI alone, C-WLI, and M-NBI after C-WLI was investigated. RESULTS M-NBI after C-WLI ultimately showed the best diagnostic performance in each diagnostic criterion. In M-NBI after C-WLI, evaluation of DL is technically easier than that of IMVP, and DL alone had a high sensitivity (95%) and negative predictive value (99%). The IMVP in M-NBI after C-WLI had a high sensitivity and specificity (95% and 96%, respectively) for diagnosis of cancer. LIMITATIONS Lesions were limited to the small, depressed type. CONCLUSIONS For a diagnosis using M-NBI after C-WLI, identification of DL is the first step, and subsequent inspection of IMVP diagnosed by DL is an efficient strategy.
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48
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Sumie H, Sumie S, Nakahara K, Watanabe Y, Matsuo K, Mukasa M, Sakai T, Yoshida H, Tsuruta O, Sata M. Usefulness of magnifying endoscopy with narrow-band imaging for diagnosis of depressed gastric lesions. Mol Clin Oncol 2013; 2:129-133. [PMID: 24649321 DOI: 10.3892/mco.2013.213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/04/2013] [Indexed: 12/12/2022] Open
Abstract
The usefulness of magnifying endoscopy with narrow-band imaging (ME-NBI) for the diagnosis of early gastric cancer is well known, however, there are no evaluation criteria. The aim of this study was to devise and evaluate a novel diagnostic algorithm for ME-NBI in depressed early gastric cancer. Between August, 2007 and May, 2011, 90 patients with a total of 110 depressed gastric lesions were enrolled in the study. A diagnostic algorithm was devised based on ME-NBI microvascular findings: microvascular irregularity and abnormal microvascular patterns (fine network, corkscrew and unclassified patterns). The diagnostic efficiency of the algorithm for gastric cancer and histological grade was assessed by measuring its mean sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Furthermore, inter- and intra-observer variation were measured. In the differential diagnosis of gastric cancer from non-cancerous lesions, the mean sensitivity, specificity, PPV, NPV, and accuracy of the diagnostic algorithm were 86.7, 48.0, 94.4, 26.7, and 83.2%, respectively. Furthermore, in the differential diagnosis of undifferentiated adenocarcinoma from differentiated adenocarcinoma, the mean sensitivity, specificity, PPV, NPV, and accuracy of the diagnostic algorithm were 61.6, 86.3, 69.0, 84.8, and 79.1%, respectively. For the ME-NBI final diagnosis using this algorithm, the mean κ values for inter- and intra-observer agreement were 0.50 and 0.77, respectively. In conclusion, the diagnostic algorithm based on ME-NBI microvascular findings was convenient and had high diagnostic accuracy, reliability and reproducibility in the differential diagnosis of depressed gastric lesions.
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Affiliation(s)
- Hiroaki Sumie
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011
| | - Shuji Sumie
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011
| | - Keita Nakahara
- Prevention Center for Adult Diseases, Saga Medical Association, Saga, Saga 849-0942
| | - Yasutomo Watanabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011
| | - Ken Matsuo
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011
| | - Michita Mukasa
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011
| | - Takeshi Sakai
- Saiseikai Futsukaichi Hospital, Chikushino, Fukuoka 818-8516, Japan
| | - Hikaru Yoshida
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011
| | - Osamu Tsuruta
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011
| | - Michio Sata
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011
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Kikuchi O, Ezoe Y, Morita S, Horimatsu T, Muto M. Narrow-band Imaging for the Head and Neck Region and the Upper Gastrointestinal Tract. Jpn J Clin Oncol 2013; 43:458-65. [DOI: 10.1093/jjco/hyt042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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50
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Miyaki R, Yoshida S, Tanaka S, Kominami Y, Sanomura Y, Matsuo T, Oka S, Raytchev B, Tamaki T, Koide T, Kaneda K, Yoshihara M, Chayama K. Quantitative identification of mucosal gastric cancer under magnifying endoscopy with flexible spectral imaging color enhancement. J Gastroenterol Hepatol 2013; 28:841-7. [PMID: 23424994 DOI: 10.1111/jgh.12149] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Magnifying endoscopy with flexible spectral imaging color enhancement (FICE) is clinically useful in diagnosing gastric cancer and determining treatment options; however, there is a learning curve. Accurate FICE-based diagnosis requires training and experience. In addition, objectivity is necessary. Thus, a software program that can identify gastric cancer quantitatively was developed. METHODS A bag-of-features framework with densely sampled scale-invariant feature transform descriptors to magnifying endoscopy images of 46 mucosal gastric cancers was applied. Computer-based findings were compared with histologic findings. The probability of gastric cancer was calculated by means of logistic regression, and sensitivity and specificity of the system were determined. RESULTS The average probability was 0.78 ± 0.25 for the images of cancer and 0.31 ± 0.25 for the images of noncancer tissue, with a significant difference between the two groups. An optimal cut-off point of 0.59 was determined on the basis of the receiver operating characteristic curves. The computer-aided diagnosis system yielded a detection accuracy of 85.9% (79/92), sensitivity for a diagnosis of cancer of 84.8% (39/46), and specificity of 87.0% (40/46). CONCLUSION Further development of this system will allow for quantitative evaluation of mucosal gastric cancers on magnifying gastrointestinal endoscopy images obtained with FICE.
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Affiliation(s)
- Rie Miyaki
- Departments of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan
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