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Kitae H, Dohi O, Naito Y, Yasuda T, Yoshida T, Ishida T, Azuma Y, Matsumura S, Doi T, Hirose R, Inoue K, Yoshida N, Kamada K, Uchiyama K, Ishikawa T, Takagi T, Konishi H, Morinaga Y, Kishimoto M, Itoh Y. Linked Color Imaging and Blue Laser Imaging for the Diagnosis of Superficial Non-Ampullary Duodenal Epithelial Tumors. Dig Dis 2022; 40:693-700. [PMID: 35176739 DOI: 10.1159/000522399] [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: 10/03/2021] [Accepted: 01/30/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVE This study aimed to evaluate endoscopic findings using linked color imaging (LCI) and blue laser imaging (BLI) and to determine a diagnostic predictor for duodenal adenocarcinomas. METHODS All consecutive patients who underwent endoscopic resection for superficial non-ampullary duodenal epithelial tumors (SNADETs) between October 2012 and June 2019 were enrolled in this study. Two highly experienced endoscopists investigated six morphological findings using both white light imaging and LCI and three magnifying endoscopic findings using magnifying BLI (M-BLI). RESULTS A total of 90 patients with 110 SNADETs, including 87 adenocarcinomas and 23 adenomas, were analyzed in this study. Among the non-magnifying endoscopic findings, the presence of reddish color, orange color on LCI (orange color sign), lobulation, depression, and marginally white opaque substance were found significantly more frequently in adenocarcinomas than in adenomas (p = 0.015, p < 0.001, p = 0.048, p < 0.001, and p = 0.007, respectively). Among the magnifying endoscopic findings, a mixed microsurface pattern (MSP), irregular MSP, and irregular microvascular pattern were found significantly more frequently in adenocarcinomas than in adenomas (p < 0.001, p < 0.001, and p = 0.002, respectively). In the multivariate analysis of all endoscopic findings associated with adenocarcinoma, orange color sign (odds ratio [OR] 10.46; 95% confidence interval [CI]: 1.42-77.08; p = 0.021), mixed MSP (OR 4.66; 95% CI: 1.02-21.40; p = 0.048), and irregular MSP (OR 13.11; 95% CI: 1.41-121.99; p = 0.024) were independent predictors of adenocarcinoma. CONCLUSIONS The presence of orange color sign on LCI and mixed/irregular MSP on M-BLI were independent diagnostic predictors that were frequently observed in duodenal adenocarcinoma.
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Affiliation(s)
- Hiroaki Kitae
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan,
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Naito
- Department of Human Immunology and Nutrition Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Yasuda
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuma Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsugitaka Ishida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuka Azuma
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinya Matsumura
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshifumi Doi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiro Kamada
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Ishikawa
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomohisa Takagi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yukiko Morinaga
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mitsuo Kishimoto
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Pathology, Kyoto City Hospital, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Matsumura S, Dohi O, Yamada N, Harusato A, Yasuda T, Yoshida T, Ishida T, Azuma Y, Kitae H, Doi T, Hirose R, Inoue K, Yoshida N, Kamada K, Uchiyama K, Takagi T, Ishikawa T, Konishi H, Morinaga Y, Kishimoto M, Yagi N, Naito Y, Itoh Y. Improved Visibility of Early Gastric Cancer after Successful Helicobacter pylori Eradication with Image-Enhanced Endoscopy: A Multi-Institutional Study Using Video Clips. J Clin Med 2021; 10:jcm10163649. [PMID: 34441946 PMCID: PMC8397151 DOI: 10.3390/jcm10163649] [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] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022] Open
Abstract
The visibility and diagnostic accuracy of early gastric cancer (EGC) after Helicobacter pylori (HP) eradication have been reported to improve using image-enhanced endoscopy (IEE) compared with white light imaging (WLI). The present study clarified the appropriate IEE for the detection and diagnosis of EGC in clinical settings. This prospective and cross-sectional study evaluated the visibility of EGC and endoscopic findings of gastric mucosa after successful HP eradication (n = 31) using videos with WLI and IEE. Three endoscopists evaluated high-definition videos in a randomized order. The mean visibility scores (MVSs) on linked color imaging (LCI) for atrophic border, intestinal metaplasia, map-like redness, and EGC were the highest among each modality (3.87 ± 0.34, 3.82 ± 0.49, 3.87 ± 0.50, and 3.35 ± 0.92, respectively). The MVSs with blue laser imaging (BLI) were highest for magnifying view of the demarcation line (DL), microsurface pattern (MSP), and microvascular pattern (MVP) for EGC (3.77 ± 0.49, 3.94 ± 0.25, and 3.92 ± 0.34, respectively). LCI had the highest visibility among findings of gastric mucosa and EGC after HP eradication, and BLI had the highest visibility of MVP, MSP, and DL in magnifying observation. These results suggest that LCI observation in the entire stomach and further magnifying BLI are the best methods for detecting and diagnosing EGCs after HP eradication, respectively.
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Affiliation(s)
- Shinya Matsumura
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
- Correspondence: ; Tel.: +81-75-251-5519
| | - Nobuhisa Yamada
- Department of Gastroenterology, Matsushita Memorial Hospital, Osaka 570-8540, Japan;
| | - Akihito Harusato
- Department of Gastroenterology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto 629-2261, Japan;
| | - Takeshi Yasuda
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Takuma Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Tsugitaka Ishida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Yuka Azuma
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Hiroaki Kitae
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Toshifumi Doi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Kazuhiro Kamada
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Tomohisa Takagi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Takeshi Ishikawa
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Yukiko Morinaga
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| | - Mitsuo Kishimoto
- Department of Pathology, Kyoto City Hospital, Kyoto 604-8845, Japan;
| | - Nobuaki Yagi
- Department of Gastroenterology, Asahi University Hospital, Gifu 501-0223, Japan;
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.M.); (T.Y.); (T.Y.); (T.I.); (Y.A.); (H.K.); (T.D.); (R.H.); (K.I.); (N.Y.); (K.K.); (K.U.); (T.T.); (T.I.); (H.K.); (Y.N.); (Y.I.)
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