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Ono S, Inoue M, Higashino M, Hayasaka S, Tanaka S, Egami H, Sakamoto N. Linked color imaging and upper gastrointestinal neoplasia. Dig Endosc 2024. [PMID: 39582388 DOI: 10.1111/den.14957] [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: 07/13/2024] [Accepted: 10/10/2024] [Indexed: 11/26/2024]
Abstract
White light imaging (WLI) can sometimes miss early upper gastrointestinal (UGI) neoplasms, particularly minimal changes and flat lesions. Moreover, endoscopic diagnosis of UGI neoplasia is strongly influenced by the condition of the surrounding mucosa. Recently, image-enhanced endoscopy techniques have been developed and used in clinical practice; one of which is linked color imaging (LCI), which has an expanded color range for better recognition of slight differences in mucosal color and enables easy diagnosis and differentiation of noncancerous mucosa from carcinoma. LCI does not require magnified observation and can clearly visualize structures using an ultrathin scope; therefore, it is useful for screening and surveillance endoscopy. LCI is particularly useful for detecting gastric cancer after Helicobacter pylori eradication, which accounts for most gastric cancers currently discovered, and displays malignant areas in orange or orange-red surrounded by intestinal metaplasia in lavender. Data on the use of convolutional neural network and computer-aided diagnosis with LCI for UGI neoplasm detection are currently being collected. Further studies are needed to determine the clinical role of LCI and whether it can replace WLI.
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Affiliation(s)
- Shoko Ono
- Division of Endoscopy, Hokkaido University Hospital, Hokkaido, Japan
| | - Masaki Inoue
- Division of Endoscopy, Hokkaido University Hospital, Hokkaido, Japan
| | - Masayuki Higashino
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Shuhei Hayasaka
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Shugo Tanaka
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Hiroki Egami
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
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Ogata Y, Hatta W, Koike T, Takahashi S, Matsuhashi T, Iwai W, Asonuma S, Okata H, Ohyauchi M, Ito H, Abe Y, Sasaki Y, Kawamura M, Saito M, Uno K, Fujishima F, Nakamura T, Nakaya N, Iijima K, Masamune A. Is blue light imaging without magnification satisfactory as screening for esophageal squamous cell carcinoma? Post-hoc analysis of multicenter randomized controlled trial. Dig Endosc 2024; 36:1118-1126. [PMID: 38494659 DOI: 10.1111/den.14788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/18/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES Narrow light observation is currently recommended as an alternative to Lugol chromoendoscopy (LCE) to detect esophageal squamous cell carcinoma (ESCC). Studies revealed little difference in sensitivity between the two modalities in expert settings; however, these included small numbers of cases. We aimed to determine whether blue light imaging (BLI) without magnification is satisfactory for preventing misses of ESCC. METHODS This was a post-hoc analysis of a multicenter randomized controlled trial targeting patients at high risk of ESCC in expert settings. In this study, BLI without magnification followed by LCE was performed. The evaluation parameters included: (i) the diagnostic abilities of ESCC; (ii) the endoscopic characteristics of lesions with diagnostic differences between the two modalities; and (iii) the color difference between cancerous and noncancerous areas in BLI and LCE. RESULTS This study identified ESCC in 49 of 699 cases. Of these cases, nine (18.4%) were missed by BLI but detected by LCE. In per-patient analysis, the sensitivity of BLI was lower than that of LCE following BLI (83.7% vs. 100.0%; P = 0.013), whereas the specificity and accuracy of BLI were higher (88.2% vs. 81.2%; P < 0.001 and 87.8% vs. 82.5%; P < 0.001, respectively). No significant endoscopic characteristics were identified, but the color difference was lower in BLI than in LCE (21.4 vs. 25.1; P = 0.003). CONCLUSION LCE following BLI outperformed BLI in terms of sensitivity in patients with high-risk ESCC. Therefore, LCE, in addition to BLI, would still be required in screening esophagogastroduodenoscopy even by expert endoscopists.
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Affiliation(s)
- Yohei Ogata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - So Takahashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Wataru Iwai
- Department of Gastroenterology, Miyagi Cancer Center, Miyagi, Japan
| | - Sho Asonuma
- Department of Gastroenterology, South Miyagi Medical Center, Miyagi, Japan
| | - Hideki Okata
- Department of Gastroenterology, South Miyagi Medical Center, Miyagi, Japan
| | - Motoki Ohyauchi
- Department of Gastroenterology, Osaki Citizen Hospital, Miyagi, Japan
| | - Hirotaka Ito
- Department of Gastroenterology, Osaki Citizen Hospital, Miyagi, Japan
| | - Yasuhiko Abe
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yu Sasaki
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Masashi Kawamura
- Department of Gastroenterology, Sendai City Hospital, Miyagi, Japan
| | - Masahiro Saito
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | | | | | - Naoki Nakaya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Katsunori Iijima
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Takeda T, Asaoka D, Ueyama H, Abe D, Suzuki M, Inami Y, Uemura Y, Yamamoto M, Iwano T, Uchida R, Utsunomiya H, Oki S, Suzuki N, Ikeda A, Akazawa Y, Matsumoto K, Ueda K, Hojo M, Nojiri S, Tada T, Nagahara A. Development of an Artificial Intelligence Diagnostic System Using Linked Color Imaging for Barrett's Esophagus. J Clin Med 2024; 13:1990. [PMID: 38610762 PMCID: PMC11012507 DOI: 10.3390/jcm13071990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Barrett's esophagus and esophageal adenocarcinoma cases are increasing as gastroesophageal reflux disease increases. Using artificial intelligence (AI) and linked color imaging (LCI), our aim was to establish a method of diagnosis for short-segment Barrett's esophagus (SSBE). Methods: We retrospectively selected 624 consecutive patients in total at our hospital, treated between May 2017 and March 2020, who experienced an esophagogastroduodenoscopy with white light imaging (WLI) and LCI. Images were randomly chosen as data for learning from WLI: 542 (SSBE+/- 348/194) of 696 (SSBE+/- 444/252); and LCI: 643 (SSBE+/- 446/197) of 805 (SSBE+/- 543/262). Using a Vision Transformer (Vit-B/16-384) to diagnose SSBE, we established two AI systems for WLI and LCI. Finally, 126 WLI (SSBE+/- 77/49) and 137 LCI (SSBE+/- 81/56) images were used for verification purposes. The accuracy of six endoscopists in making diagnoses was compared to that of AI. Results: Study participants were 68.2 ± 12.3 years, M/F 330/294, SSBE+/- 409/215. The accuracy/sensitivity/specificity (%) of AI were 84.1/89.6/75.5 for WLI and 90.5/90.1/91.1/for LCI, and those of experts and trainees were 88.6/88.7/88.4, 85.7/87.0/83.7 for WLI and 93.4/92.6/94.6, 84.7/88.1/79.8 for LCI, respectively. Conclusions: Using AI to diagnose SSBE was similar in accuracy to using a specialist. Our finding may aid the diagnosis of SSBE in the clinic.
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Affiliation(s)
- Tsutomu Takeda
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Daisuke Asaoka
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan; (D.A.); (M.S.); (Y.I.)
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Daiki Abe
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Maiko Suzuki
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan; (D.A.); (M.S.); (Y.I.)
| | - Yoshihiro Inami
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan; (D.A.); (M.S.); (Y.I.)
| | - Yasuko Uemura
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Momoko Yamamoto
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Tomoyo Iwano
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Ryota Uchida
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Hisanori Utsunomiya
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Shotaro Oki
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Nobuyuki Suzuki
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Atsushi Ikeda
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Yoichi Akazawa
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Kohei Matsumoto
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Kumiko Ueda
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
| | - Shuko Nojiri
- Department of Medical Technology Innovation Center, Juntendo University School of Medicine, Tokyo 113-8421, Japan;
| | | | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan; (H.U.); (D.A.); (Y.U.); (M.Y.); (T.I.); (R.U.); (H.U.); (S.O.); (N.S.); (A.I.); (Y.A.); (K.M.); (K.U.); (M.H.); (A.N.)
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Saito M, Koike T, Ohara Y, Ogata Y, Kanno T, Jin X, Hatta W, Uno K, Asano N, Imatani A, Masamune A. Linked Color Imaging of Barrett’s Esophageal Adenocarcinoma: Effects on Visibility. GASTROENTEROLOGY INSIGHTS 2024; 15:145-155. [DOI: 10.3390/gastroent15010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2025] Open
Abstract
Since linked color imaging (LCI) has been reported to increase the color differences in Barrett’s esophageal adenocarcinoma (BA) compared to white light imaging (WLI), a comparison of the visibility scores of various imaging techniques for BA is warranted to determine best practice standards. This study is to clarify the role of LCI, blue light imaging (BLI), and WLI in the evaluation of BA. A group of 19 endoscopists, comprised of 6 experts and 13 trainees, evaluated the visibility of WLI, BLI, and LCI images in 21 superficial BA cases. Visibility scores were compared between WLI, BLI, and LCI. Visibility scores were also evaluated for lesion morphology, background Barrett’s mucosa, and circumferential location. The visibility scores of experts and trainees were analyzed for comparison. The visibility scores of LCI and BLI were 3.83 and 3.31, respectively, compared to three points for WLI. The visibility of LCI was better than that of WLI regardless of lesion morphology, color, background Barrett’s mucosa, and circumferential location. The LCI improved visibility in BA more than the WLI for both experts and trainees. LCI improved the visibility of BA independent of lesion morphology, color, background Barrett’s mucosa, circumferential location, and the endoscopist’s experience.
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Affiliation(s)
- Masahiro Saito
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Yuki Ohara
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Yohei Ogata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Takeshi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Xiaoyi Jin
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Naoki Asano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Akira Imatani
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
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Lee SP. Role of linked color imaging for upper gastrointestinal disease: present and future. Clin Endosc 2023; 56:546-552. [PMID: 37430400 PMCID: PMC10565447 DOI: 10.5946/ce.2023.015] [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: 12/17/2022] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 07/12/2023] Open
Abstract
Techniques for upper gastrointestinal endoscopy are advancing to facilitate lesion detection and improve prognosis. However, most early tumors in the upper gastrointestinal tract exhibit subtle color changes or morphological features that are difficult to detect using white light imaging. Linked color imaging (LCI) has been developed to overcome these shortcomings; it expands or reduces color information to clarify color differences, thereby facilitating the detection and observation of lesions. This article summarizes the characteristics of LCI and advances in LCI-related research in the upper gastrointestinal tract field.
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Affiliation(s)
- Sang Pyo Lee
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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Abe Y, Sasaki Y, Yagi M, Mizumoto N, Onozato Y, Kon T, Shoji M, Sakuta K, Sakai T, Umehara M, Ito M, Nakamura S, Tsuchida H, Ueno Y. Linked color imaging improves the diagnostic accuracy of eosinophilic esophagitis. DEN OPEN 2023; 3:e146. [PMID: 35898847 PMCID: PMC9310047 DOI: 10.1002/deo2.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/03/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022]
Abstract
Objectives To assess the usefulness of linked color imaging (LCI), a recently developed image‐enhanced endoscopy technique, in the endoscopic diagnosis of eosinophilic esophagitis (EoE). Methods Thirty white light images (WLIs) and 30 WLI+LCI images collected from patients with and without EoE were randomly and blindly reviewed by 10 endoscopists, including four experts (Exs) and six non‐Exs. Edema, ring, exudate furrows, and strictures were rated on the adjusted EoE endoscopic reference score; the diagnosis of EoE was assessed. Using the kappa value, inter‐ and intra‐observer agreements were analyzed among endoscopists. Results WLI+LCI images had a higher diagnostic accuracy for EoE than WLIs (0.85 vs. 0.70, respectively), especially in non‐Exs or endoscopists with no experience with EoE patients. Inter‐observer agreement for WLI+LCI images statistically surpassed WLIs for furrows (kappa, 0.73 vs. 0.67, respectively; p = 0.0013), stricture (kappa, 0.51 vs. 0.39, respectively; p = 0.0072), and diagnosis (kappa, 0.67 vs. 0.57, respectively; p < 0.0001) of EoE. The increase in inter‐observer agreement in WLI+LCI images allowed for a reduction in the differences between the Exs and non‐Ex endoscopists. Intra‐observer agreement for WLI+LCI images surpassed WLIs for a ring (kappa, 0.62 vs. 0.43, p = 0.0052), and a similar trend was found in exudates, furrows, and diagnosis irrespective of the Exs or non‐Exs. Conclusions LCI can contribute to the improvement of the endoscopic diagnosis for EoE, with “moderate” to “substantial” consistency, by enhancing the visibility of abnormal findings, leading to reduced diagnostic disparities among endoscopists.
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Affiliation(s)
- Yasuhiko Abe
- Division of Endoscopy Yamagata University Hospital Yamagata Japan
| | - Yu Sasaki
- Department of Gastroenterology Faculty of Medicine Yamagata University Yamagata Japan
| | - Makoto Yagi
- Division of Endoscopy Yamagata University Hospital Yamagata Japan
| | - Naoko Mizumoto
- Department of Gastroenterology Faculty of Medicine Yamagata University Yamagata Japan
| | - Yusuke Onozato
- Department of Gastroenterology Faculty of Medicine Yamagata University Yamagata Japan
| | - Takashi Kon
- Department of Gastroenterology Faculty of Medicine Yamagata University Yamagata Japan
| | - Masakuni Shoji
- Department of Gastroenterology Faculty of Medicine Yamagata University Yamagata Japan
| | - Kazuhiro Sakuta
- Department of Gastroenterology Faculty of Medicine Yamagata University Yamagata Japan
| | - Takayuki Sakai
- Department of Gastroenterology Faculty of Medicine Yamagata University Yamagata Japan
| | - Matsuki Umehara
- Department of Gastroenterology Faculty of Medicine Yamagata University Yamagata Japan
| | - Minami Ito
- Department of Gastroenterology Faculty of Medicine Yamagata University Yamagata Japan
| | - Shuhei Nakamura
- Department of Gastroenterology Faculty of Medicine Yamagata University Yamagata Japan
| | - Hidemoto Tsuchida
- Department of Gastroenterology Faculty of Medicine Yamagata University Yamagata Japan
| | - Yoshiyuki Ueno
- Department of Gastroenterology Faculty of Medicine Yamagata University Yamagata Japan
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Abe Y, Sasaki Y, Yagi M, Mizumoto N, Onozato Y, Umehara M, Ueno Y. Endoscopic Diagnosis of Eosinophilic Esophagitis: Basics and Recent Advances. Diagnostics (Basel) 2022; 12:diagnostics12123202. [PMID: 36553209 PMCID: PMC9777529 DOI: 10.3390/diagnostics12123202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease, characterized by esophageal dysfunction and intense eosinophil infiltration localized in the esophagus. In recent decades, EoE has become a growing concern as a major cause of dysphagia and food impaction in adolescents and adults. EoE is a clinicopathological disease for which the histological demonstration of esophageal eosinophilia is essential for diagnosis. Therefore, the recognition of the characteristic endoscopic features with subsequent biopsy are critical for early definitive diagnosis and treatment, in order to prevent complications. Accumulating reports have revealed that EoE has several non-specific characteristic endoscopic findings, such as rings, furrows, white exudates, stricture/narrowing, edema, and crepe-paper esophagus. These findings were recently unified under the EoE endoscopic reference score (EREFS), which has been widely used as an objective, standard measurement for endoscopic EoE assessment. However, the diagnostic consistency of those findings among endoscopists is still inadequate, leading to underdiagnosis or misdiagnosis. Some endoscopic findings suggestive of EoE, such as multiple polypoid lesions, caterpillar sign, ankylosaurus back sign, and tug sign/pull sign, will aid the diagnosis. In addition, image-enhanced endoscopy represented by narrow band imaging, endocytoscopy, and artificial intelligence are expected to render endoscopic diagnosis more efficient and less invasive. This review focuses on suggestions for endoscopic assessment and biopsy, including recent advances in optical technology which may improve the diagnosis of EoE.
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Affiliation(s)
- Yasuhiko Abe
- Division of Endoscopy, Yamagata University Hospital, Yamagata 990-2321, Japan
- Correspondence:
| | - Yu Sasaki
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata 990-2321, Japan
| | - Makoto Yagi
- Division of Endoscopy, Yamagata University Hospital, Yamagata 990-2321, Japan
| | - Naoko Mizumoto
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata 990-2321, Japan
| | - Yusuke Onozato
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata 990-2321, Japan
| | - Matsuki Umehara
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata 990-2321, Japan
| | - Yoshiyuki Ueno
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata 990-2321, Japan
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Koike T, Saito M, Ohara Y, Hatta W, Masamune A. Current status of surveillance for Barrett's esophagus in Japan and the West. DEN OPEN 2022; 2:e94. [PMID: 35898591 PMCID: PMC9302351 DOI: 10.1002/deo2.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/08/2022] [Accepted: 01/12/2022] [Indexed: 11/06/2022]
Abstract
Prospective studies in western countries have shown that the obvious risk factors for Barrett's esophageal cancer are male sex, smoking habit, a longer length of Barrett's esophagus, and low‐grade dysplasia. However, few reports have prospectively examined risk factors for adenocarcinoma development from Barrett's esophagus in Japan. In the West, where adenocarcinoma is common among esophageal cancer, endoscopic surveillance of Barrett's esophagus every 2–5 years is recommended for early detection of adenocarcinoma. However, there is no established surveillance method in Japan. In recent years, the incidence of adenocarcinoma from long‐segment Barrett's esophagus and short‐segment Barrett's esophagus longer than 2 cm in Japan has been reported to be similar to the West. For surveillance of adenocarcinoma arising from Barrett's esophagus, recognizing the characteristics of superficial adenocarcinoma and carefully observing the entire Barrett's esophagus are needed. It has been reported that representative characteristics of Barrett's adenocarcinoma are a reddish area or a lesion located on the anterior to the right sidewall. It is necessary to establish surveillance methods for Barrett's esophagus sooner in Japan.
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Affiliation(s)
- Tomoyuki Koike
- Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan
| | - Masahiro Saito
- Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan
| | - Yuki Ohara
- Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan
| | - Waku Hatta
- Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan
| | - Atsushi Masamune
- Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan
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