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Tribonias G, Theodoropoulou A, Stylianou K, Giotis I, Mpitouli A, Moschovis D, Komeda Y, Manola ME, Paspatis G, Tzouvala M. Irrigating Acetic Acid Solution During Colonoscopy for the Detection of Sessile Serrated Neoplasia: A Randomized Controlled Trial. Dig Dis Sci 2022; 67:282-292. [PMID: 33515378 DOI: 10.1007/s10620-021-06858-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 01/18/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Misdiagnosed sessile serrated lesions (SSLs) are important precursors for interval colorectal cancers. AIMS We investigated the usage of acetic acid (AA) solution for improving the detection of SSLs in the right colon in a randomized controlled trial. METHODS A tandem observation of the right colon was performed in 412 consecutive patients. A first inspection was performed under white light high-definition endoscopy. In the AA group, a low concentration vinegar solution (AA: 0.005%) irrigated by a water pump in the right colon was compared with a plain solution of normal saline (NS) in the diagnostic yield of SSLs during the second inspection. Secondary outcomes in overall polyp detection were measured. RESULTS Qualitative comparisons showed significant differences in the detection rates of all polyps except adenomas, with remarkable improvement in the demonstration of advanced (> 20 mm), SSLs, and hyperplastic polyps during the second inspection of the right colon using the AA solution. Significant improvement was also noted in the AA group, as far as the mean number of polyps/patient detected, not only in SSLs (AA group: 0.14 vs. NS group: 0.01, P < 0.001), but also in all histological types and all size-categories in the right colon. Small (≤ 9 mm) polyps were detected at a higher rate in the sigmoid colon expanding the effect of the method in the rest of the colon. CONCLUSION AA-assisted colonoscopy led to a significant increase in SSLs detection rate in the right colon in a safe, quick, and effective manner.
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Affiliation(s)
- George Tribonias
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece.
| | - Angeliki Theodoropoulou
- Gastroenterology Department, General Hospital of Heraklion "Venizeleio - Pananeio", Crete, Greece
| | | | - Ioannis Giotis
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece
| | - Afroditi Mpitouli
- Gastroenterology Department, General Hospital of Heraklion "Venizeleio - Pananeio", Crete, Greece
| | - Dimitrios Moschovis
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece
| | - Yoriaki Komeda
- Gastroenterology Department, Kindai University Hospital, Osaka, Japan
| | - Margarita-Eleni Manola
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece
| | - Gregorios Paspatis
- Gastroenterology Department, General Hospital of Heraklion "Venizeleio - Pananeio", Crete, Greece
| | - Maria Tzouvala
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece
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Sha J, Wang P, Sang N, Zhang H, Yang A, Chen L, Gong Z, Li C, Qin Y, Li X, Ji Y, Gao F. The value of three narrow-band imaging model in the diagnosis of small colorectal polyps. Sci Rep 2020; 10:22032. [PMID: 33328496 PMCID: PMC7744507 DOI: 10.1038/s41598-020-78708-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/23/2020] [Indexed: 01/07/2023] Open
Abstract
This prospective study was aimed to evaluate the clinical value of narrow-band imaging (NBI), magnification endoscopy with narrow-band imaging (NBIME) and magnification endoscopy with acetic acid enhancement and narrow-band imaging (AA-NBIME) in the diagnosis of small colorectal polyps. We studied 261 small colorectal polyps from 122 patients with the use of above three techniques. Lesions were resected for histopathological analysis. The endoscopic images were independently reviewed by three experts and three non-experts and the diagnostic accuracy and image definition were compared among the modalities. The “experts-agreed” diagnostic accuracy was 87.7% for NBI versus 91.6% for NBIME versus 94.6% for AA-NBIME. The “non-experts-agreed” diagnostic accuracy was 80.1% for NBI versus 84.3% for NBIME versus 89.3% for AA-NBIME. All experts and non-experts diagnosed the small colorectal polyps statistically more accurately with AA-NBIME than NBI (P < 0.05). In all three modalities, the expert group’s diagnostic accuracies were statistically significantly higher compared with the non-expert group. For experts, the Kappa values for AA-NBIME, NBIME and NBI diagnosis were 0.962 (0.892–1.032), 0.577 (0.507–0.647) and 0.567 (0.497–0.637), respectively; while for nonexperts, 0.818 (0.748–0.888), 0.532 (0.462–0.602) and 0.530 (0.460–0.600). This demonstrated a good reproducibility of AA-NBIME diagnosis. The average scores (experts and non-experts) of images acquired using AA-NBIME were significantly higher than those acquired using NBIME and ME (P < 0.05). AA-NBIME is a promising tool to clearly visualize the mucosal pit pattern (PP) of colorectal polyps for better differentiating neoplastic polyps from non-neoplastic ones.
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Affiliation(s)
- Jie Sha
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China
| | - Pin Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Nan Sang
- Department of Gastroenterology, The Geriatric Hospital of Nanjing Medical University, Nanjing, 210024, Jiangsu, China
| | - Huiai Zhang
- Department of Gastroenterology, Taixing People's Hospital, Taizhou, 225400, Jiangsu, China
| | - Aiping Yang
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China
| | - Lei Chen
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China
| | - Zewei Gong
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China
| | - Chao Li
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China
| | - Yumeng Qin
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China
| | - Xueliang Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Yong Ji
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China.
| | - Feng Gao
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, 214500, Jiangsu, China.
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Suzuki Y, Ohata K, Matsuhashi N. Delineating sessile serrated adenomas/polyps with acetic acid spray for a more accurate piecemeal cold snare polypectomy. VideoGIE 2020; 5:519-521. [PMID: 33204905 PMCID: PMC7649831 DOI: 10.1016/j.vgie.2020.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Yuichiro Suzuki
- Department for Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Ken Ohata
- Department for Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Nobuyuki Matsuhashi
- Department for Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
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Shibagaki K, Ishimura N, Yuki T, Taniguchi H, Aimi M, Kobayashi K, Kotani S, Yazaki T, Yamashita N, Tamagawa Y, Mishiro T, Ishihara S, Yasuda A, Kinshita Y. Magnification endoscopy in combination with acetic acid enhancement and narrow-band imaging for the accurate diagnosis of colonic neoplasms. Endosc Int Open 2020; 8:E488-E497. [PMID: 32258370 PMCID: PMC7089791 DOI: 10.1055/a-1068-2056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/25/2019] [Indexed: 12/15/2022] Open
Abstract
Background and study aims Magnification endoscopy with narrow-band imaging (NBIME) and NBIME with acetic acid enhancement (A-NBIME) enable visualization of the vascular and microstructural patterns of colorectal polyp. We compared the diagnostic accuracy and reproducibility of white light endoscopy (WLE), NBIME, and A-NBIME for predictive histologic diagnosis. Patients and methods Consecutive colorectal polyps (N = 628; 38 hyperplasias, 488 adenomas, 72 M-SM1 cancers, and 30 SM2 cancers) were photographed with WLE, NBIME, and A-NBIME. Endoscopic images were independently reviewed by three experts, according to the traditional criteria for WLE, the Japan NBI Expert Team classification for NBIME, and pit pattern classification for A-NBIME to compare diagnostic accuracy and interobserver diagnostic agreement among modalities. Results The specificity (95 % confidence interval) of hyperplasia and SM2 cancer with WLE were 98.2 % (96.8 %-99.1%) and 99.4 % (98.5 %-99.9 %), respectively, showing high accuracy for endoscopic resection without magnifying observation. Diagnostic accuracy of WLE, NBIME, and A-NBIME was 80.8 % (77.4 %-83.8 %), 79.3 % (75.9 %-82.4 %), and 86.1 % (83.2 %-88.7 %), respectively, showing the highest accuracy for A-NBIME among modalities ( P < .05). NBIME showed a lower PPV for M-SM1 cancer ( P < .05), as with WLE ( P = .08) compared to A-NBIME. Fleiss's kappa values for WLE, NBIME, and A-NBIME diagnosis were 0.43 (0.39 - 0.46), 0.52 (0.49 - 0.56) and 0.65 (0.62 - 0.69), respectively, showing insufficient reproducibility of WLE and superiority of A-NBIME among modalities. Conclusion WLE showed high accuracy for endoscopic resection of colorectal polyps in expert diagnosis. NBIME demonstrated a higher diagnostic reproducibility than WLE. A-NBIME showed possible superiority among modalities in both diagnostic accuracy and reproducibility.
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Affiliation(s)
- Kotaro Shibagaki
- Department of Endoscopy, Faculty of Medicine, Shimane University, Izumo, Japan,Corresponding author Kotaro Shibagaki, MD, PhD Department of Gastroenterology, Faculty of MedicineShimane University89-1 EnyaIzumoJapan 693-8501+81-85320-2187
| | - Norihisa Ishimura
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Takafumi Yuki
- Division of Gastroenterology, Matsue Red Cross Hospital, Matsue, Japan
| | - Hideaki Taniguchi
- Department of Gastroenterology, Tottori Municipal Hospital, Tottori, Japan
| | - Masahito Aimi
- Department of Gastroenterology, Tottori Municipal Hospital, Tottori, Japan
| | - Keita Kobayashi
- Department of Pathology, Tottori Municipal Hospital, Tottori, Japan
| | - Satoshi Kotani
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tomotaka Yazaki
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Noritsugu Yamashita
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yuji Tamagawa
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tsuyoshi Mishiro
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Shunji Ishihara
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Akira Yasuda
- Department of Medical informatics, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yoshikazu Kinshita
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
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Yamamoto S, Varkey J, Hedenström P. Acetic acid spray for better delineation of recurrent sessile serrated adenoma in the colon. VideoGIE 2019; 4:547-548. [PMID: 31840127 PMCID: PMC6893174 DOI: 10.1016/j.vgie.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Shunsuke Yamamoto
- Department of Internal Medicine, Division of Gastroenterology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Jonas Varkey
- Department of Internal Medicine, Division of Gastroenterology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Per Hedenström
- Department of Internal Medicine, Division of Gastroenterology, Sahlgrenska University Hospital, Göteborg, Sweden
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Guo TJ, Chen W, Chen Y, Wu JC, Wang YP, Yang JL. Diagnostic performance of magnifying endoscopy with narrow-band imaging in differentiating neoplastic colorectal polyps from non-neoplastic colorectal polyps: a meta-analysis. J Gastroenterol 2018; 53:701-711. [PMID: 29383442 DOI: 10.1007/s00535-018-1436-4] [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: 05/07/2017] [Accepted: 01/17/2018] [Indexed: 02/07/2023]
Abstract
Colorectal polyps are commonly seen in colonoscopy and the management of neoplastic polyps and non-neoplastic polyps are different. It is necessary to distinguish neoplastic polyps from non-neoplastic polyps in real-time. Therefore, we conducted a meta-analysis to assess the diagnostic accuracy of magnifying endoscopy with narrow-band imaging (ME-NBI) in diagnosing neoplastic colorectal polyps from non-neoplastic colorectal polyps. PubMed and EMBASE were searched for trials that used magnifying endoscopy with ME-NBI for diagnosing neoplastic colorectal polyps. Sixteen articles and 20 fourfold tables were obtained. Sensitivity (Sen), specificity (Spe), positive likelihood ratios (+ LRs), negative likelihood ratios (- LRs) and diagnostic odds ratios (DORs) were calculated. A summary receiver-operating characteristic (SROC) curve was constructed, and the area under the ROC curve (AUC) was calculated. We performed subgroup analyses based on polyp size and assessment criteria: (1) According to data extracted from 20 fourfold tables, the pooled Sen and Spe of ME-NBI for diagnosing neoplastic colorectal polyps < 10 mm were 0.94 (95% CI 0.92-0.95) and 0.76 (95% CI 0.72-0.80),respectively. The pooled Sen and Spe of ME-NBI for diagnosing all neoplastic polyps were 0.98 (95% CI 0.98-0.99) and 0.88 (95% CI 0.85-0.90), respectively. (2) Data pertaining to the following three assessment methods were analysed from 15 fourfold tables: surface pattern (SP), vessel pattern (VP) and the combination of SP and VP. The AUCs for these assessment criteria were 0.9533, 0.9518 and 0.9954, respectively. Conclusions were made that ME-NBI has high diagnostic accuracy in diagnosing neoplastic colorectal polyps based on the combination of SP with VP and is helpful in making real-time diagnoses.
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Affiliation(s)
- Tian-Jiao Guo
- Department of Gastroenterology, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Wei Chen
- Department of Gastroenterology, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yao Chen
- Department of Gastroenterology, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Jun-Chao Wu
- Department of Gastroenterology, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yi-Ping Wang
- Department of Gastroenterology, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Jin-Lin Yang
- Department of Gastroenterology, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China.
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Wang R. Applications of acetic acid spray combined with narrow band imaging in diagnosis of early gastrointestinal cancers and precancerous lesions. Shijie Huaren Xiaohua Zazhi 2017; 25:2605-2614. [DOI: 10.11569/wcjd.v25.i29.2605] [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] [Indexed: 02/06/2023] Open
Abstract
Many new endoscopic techniques have been used for the diagnosis of early gastrointestinal cancers and precancerous lesions, such as magnifying endoscopy, narrow-band imaging (NBI), Fuji intelligent chromoendiscopy, i-scan imaging, confocal laser endomicroscopy, and chromoendoscopy (Lugol's iodine, indigo carmine, methylene blue, acetic acid, and crystal violet). Each technique has its own advantages and disadvantages (e.g., being expensive and prolonged examination duration). Spraying acetic acid onto the mucosal surface can enhance the recognition of mucosal surface architecture, and NBI has the advantage to display the microvascular morphology. Thus, acetic acid spray combined with NBI endoscopy can greatly improve the diagnosis of early gastrointestinal cancers and precancerous lesions. Since this combination has low cost and no adverse reactions, they can be used in primary hospitals without magnification endoscopy.
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Affiliation(s)
- Rong Wang
- Department of Gastroenterology, Guangming Hospital of Traditional Chinese Medicine of Shanghai Pudong New Area, Shanghai 201399, China
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Zhang JJ, Gu LY, Chen XY, Gao YJ, Ge ZZ, Li XB. Endoscopic diagnosis of invasion depth for early colorectal carcinomas: a prospective comparative study of narrow-band imaging, acetic acid, and crystal violet. Medicine (Baltimore) 2015; 94:e528. [PMID: 25700314 PMCID: PMC4554180 DOI: 10.1097/md.0000000000000528] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Several studies have validated the effectiveness of narrow-band imaging (NBI) in estimating invasion depth of early colorectal cancers. However, comparative diagnostic accuracy between NBI and chromoendoscopy remains unclear. Other than crystal violet, use of acetic acid as a new staining method to diagnose deep submucosal invasive (SM-d) carcinomas has not been extensively evaluated. We aimed to assess the diagnostic accuracy and interobserver agreement of NBI, acetic acid enhancement, and crystal violet staining in predicting invasion depth of early colorectal cancers. A total of 112 early colorectal cancers were prospectively observed by NBI, acetic acid, and crystal violet staining in sequence by 1 expert colonoscopist. All endoscopic images of each technique were stored and reassessed. Finally, 294 images of 98 lesions were selected for evaluation by 3 less experienced endoscopists. The accuracy of NBI, acetic acid, and crystal violet for real-time diagnosis was 85.7%, 86.6%, and 92.9%, respectively. For image evaluation by novices, NBI achieved the highest accuracy of 80.6%, compared with that of 72.4% by acetic acid, and 75.8% by crystal violet. The kappa values of NBI, acetic acid, and crystal violet among the 3 trainees were 0.74 (95% CI 0.65-0.83), 0.68 (95% CI 0.59-0.77), and 0.70 (95% CI 0.61-0.79), respectively. For diagnosis of SM-d carcinoma, NBI was slightly inferior to crystal violet staining, when performed by the expert endoscopist. However, NBI yielded higher accuracy than crystal violet staining, in terms of less experienced endoscopists. Acetic acid enhancement with pit pattern analysis was capable of predicting SM-d carcinoma, comparable to the traditional crystal violet staining.
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Affiliation(s)
- Jing-Jing Zhang
- From the State Key Laboratory for Oncogenes and Related Genes (JJ Z, XY C, YJ G, ZZ G, XB L), Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai Institute of Digestive Disease; and Department of Rheumatology (LY G), South campus, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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