Ease of early gastric cancer demarcation recognition: A comparison of four magnifying endoscopy methods

Abstract

Background and Aim: Various techniques using magnifying endoscopy (ME) have been developed to enhance images of early gastric cancer (EGC) demarcations, which are often obscure. We investigated four ME methods to determine which is most effective in enhancing the recognition of EGC demarcations: conventional ME (CME), ME with narrow band imaging (NBI-ME), enhanced-magnification endoscopy with acetic acid (EME), and ME with NBI and acetic acid (NBI-EME). Methods: Thirty-seven successive patients having a total of 40 EGCs participated in the investigation. The endoscope was fixed and magnification images of EGC demarcations in each patient were recorded using four different ME methods (CME, NBI-ME, EME and NBI-EME). Eight experts and eight non-experts scored each of the four images of each lesion for ease of recognition of demarcation (1 to 4, with 4 being easiest). Results: The mean scores of expert and non-expert judges, respectively, for images acquired using each technique were: CME 1.23, 1.24; NBI-ME 2.61, 2.95; EME 2.62, 2.32 and NBI-EME 3.54, 3.50. There were significant differences between the mean scores for the four techniques (P < 0.0001) using one-way repeated-measures anova. In a Bonferroni's multiple comparison, the average scores (expert and non-expert) of images acquired using NBI-EME were significantly higher than those acquired using other methods; images acquired by NBI-ME or EME also scored significantly higher than those by CME. Nonexperts also scored NBI-ME images significantly higher than CME and EME images. Conclusions: Early gastric cancer demarcations were recognized most easily using NBI-EME, and more easily using EME or NBI-ME than CME.

Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED)

“…The recent technology of NBI has been found to have good sensitivity and specificity for the diagnosis of gastric lesions [68][69][70][71][72][73][74][75][76][77]. However, there is no agreement on which NBI patterns are associated with gastric precancerous lesions.…”

Enhanced magnifying endoscopy for differential diagnosis of superficial gastric lesions identified with white-light endoscopy

“…In our experience, the fine microstructural pattern is often too subtle to be detected clearly with a standard magnifying endoscope. Enhanced ME that yields clearer images of microstructures on a mucosal surface has been shown to be capable of predicting the histological characteristics of EGC and recognizing the demarcations easily [1,2,8]. It has been reported [2,9] that acetic acid spray appears to improve surface pattern visualization by means of the aceto-white reaction.…”

Non-sequential narrow band imaging for targeted biopsy and monitoring of gastric intestinal metaplasia

“…Magnifying narrow band imaging (NBI) has been introduced which negates the need for dye spray. This technique provides better details of the mucosa and vascular patterns of minute lesions, including early gastric adenocarcinoma and GIM [9,10] . Uedo et al [11] reported on the excellent accuracy (91%) of the light blue crest (LBC) pattern detected by NBI in predicting the likelihood of GIM.…”