Tu1148 Magnification Endoscopy With i-SCAN Imaging and Acetic Acid Chromoendoscopy in Barrett's Esophagus Improves Neoplasia Detection
Gideon LipmanRaf BisschopsJacobo Ortiz Fernández‐SordoRami SweisJosé Miguel Esteban López-JamarLaurence LovatKrish RagunathRehan Haidry
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Chromoendoscopy
Barrett's esophagus
Endomicroscopy
Chromoendoscopy
Narrow-band imaging
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Endomicroscopy
Barrett's esophagus
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Chromoendoscopy
Hyperplastic Polyp
Narrow-band imaging
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Minute lesions in the colon are of increasing clinical interest. Conventional endoscopic techniques are inadequate for visualizing these lesions, and magnification chromoendoscopy is required to identify them. This study compared the effectiveness of a simpler colon preparation method with the standard technique. Patients and Methods : Seven patients received dilute methylene blue (0.05 %) by enema prior to the endoscopic evaluation. The extent, quality, and ease of dye delivery were compared with the standard methods.Dye delivery by enema extended to the splenic flexure and was uniformly applied, and advancement of the endoscope was easier. This alternative method was better tolerated by patients (visual analogue scale 1.9 +/- 0.3 vs. 3.8 +/- 0.8; P = 0.004).This rapid and reliable method of visualizing the entire left colon with dye magnification allows magnification chromoendoscopy to be carried out in a convenient manner that is also less painful for the patient.
Chromoendoscopy
Enema
Endoscope
Sigmoidoscopy
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Flat and depressed lesions in the colons are difficult to detect with conventional colonoscopic techniques, and chromoendoscopy with high magnification has consequently gained wide application for early detection of colorectal cancer and its precursors. These techniques allow targeted in vivo luminal treatments and make possible earlier and more accurate diagnosis on the basis of pit pattern classification as proposed by Kudo Sinei. According to studies conducted by Japanese researchers, magnification chromoendoscopy can be used to assess the histology and invasive depth of the cancer, and thus help in the detection of flat and depressed colonic lesions and the subsequent surgical treatment of these lesions by way of endoscopic mucosal resection (EMR) or endoscopic piecemeal mucosal resection (EPMR). Due attention should be given to the clinical significance of high-magnification chromoendoscopy in the identification of the lesions.
Chromoendoscopy
Endoscopic mucosal resection
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Chromoendoscopy
Endomicroscopy
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Objective
To explore the clinical diagnostic value of narrow-band imaging combined with magnification chromoendoscopy for suspicious neoplasia lesions of early gastric cancer.
Methods
A total of 115 patients which had been diagnosed as having suspicious lesions by conventional endoscopy were enrolled from Jan. 2010 to Dec. 2012.They were observed by magnifying endoscopy(C-WLI), magnifying endoscopy combined with narrow-band imaging (ME-NBI), magnification chromoendoscopy and magnification chromoendoscopy combined with narrow-band imaging, respectively. The lesion outline sharpness, opening of the gland sharpness and microvascular morphology sharpness were recorded and the subtypes of opening of the gland and microvascular morphology were compared. The histological examination was performed on the most significant changes in lesion site and the accuracy, sensitivity and specificity of the four procedures were calculated.
Results
The score of outline sharpness was 377 and the score of pit sharpness was 458 by magnification chromoendoscopy combined with narrow-band imaging, higher than those of ME-NBI (340 and 408 respectively) and magnification chromoendoscopy (354 and 386 respectively) (P<0.05), significantly higher than those of C-WLI (276 and 280 respectively) (P<0.01). The score of microvascular morphology sharpness was 380 by magnification chromoendoscopy combined with narrow-band imaging, higher than that of ME-NBI(348, P<0.05), C-WLI (267, P<0.01) and magnification chromoendoscopy (280, P<0.01). The detection rate of C type by magnification chromoendoscopy combined with narrow-band imaging was higher than that by magnification chromoendoscopy (93.0% VS 79.7%, P<0.05). The accuracy, sensitivity and specificity of magnification chromoendoscopy combined with narrow-band imaging was 92.17%, 88.33%, 96.36% respectively.
Conclusion
Narrow-band imaging endoscopy combined with pigment amplification can yield more clear image of the microvascular morphology and opening of the gland, significantly improve the lesion detection rate, reduce the missing rate, and is worthy of further clinical observation and promotion.
Key words:
Precancerous lesion; Diagnosis; Narrow band imaging; Magnifying endoscopy
Chromoendoscopy
Narrow-band imaging
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Chromoendoscopy
Barrett's esophagus
Intestinal metaplasia
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Narrow-band imaging (NBI) is a new technique that allows us to distinguish neoplastic and non-neoplastic lesions without chromoendoscopy, and should be very useful in detecting small or flat lesions missed by standard endoscopy. A study recently examined 148 colorectal lesions, 16 hyperplastic polyps, 84 tubular adenomas, and 48 early carcinomas [1]. Lesions were observed first under NBI magnification and then under standard magnification with chromoendoscopy. Correspondence between the two diagnostic methods was 88 % for type II, 100 % for type IIIs, 98 % for type IIIl, 88 % for type IV, 78 % for type Vi, and 100 % (3/3) for type Vn pit patterns. NBI depicted a brownish change on the basis of surface capillaries in 6 % of hyperplasia and 99 % of tubular adenomas (P < 0.005) [1] . In a second, prospective study, 180 colorectal lesions were observed with conventional colonoscopy, under low- and high-magnification NBI, and chromoendoscopy [2]. The diagnostic accuracy of NBI with low or high magnification was significantly higher than that of conventional colonoscopy (P = 0.0434 and P < 0.001), and was comparable to that of chromoendoscopy. Both low- and high-magnification NBI were capable of distinguishing neoplastic from non-neoplastic colorectal lesions [2].
Chromoendoscopy
Hyperplastic Polyp
Narrow-band imaging
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Chromoendoscopy
Narrow-band imaging
Hyperplastic Polyp
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