Evaluation of gastric cancer diagnosis using new ultrathin transnasal endoscopy with narrow‐band imaging: Preliminary study

Abstract

Background and Aim: The new developed ultrathin transnasal endoscope, the GIF-XP290N, makes possible a resolving power similar to the GIF-H260 at a distance of 3 mm. In this study, using the GIF-XP290N, we evaluated whether endoscopic diagnosis (discrimination between benign and malignant) of gastric lesions is possible using nonmagnified narrow-band imaging (NBI) endoscopy. Methods: The subjects were 255 consecutive patients who underwent screening of the gastrointestinal tract using new ultrathin transnasal endoscopy. Their average age was 65.2 ± 11.4 years. The male-female ratio was 2.5:1. All cases were examined using conventional white-light imaging (WLI) and nonmagnified NBI. When a depressed lesion was detected in the stomach, it was examined using WLI, then NBI close examination (at about 3 mm). We observed the mucosal structure of the lesion using close visualization with NBI. Concerning mucosal structural changes, we looked for a clear demarcation line between the lesion and the surrounding mucosa, and loss, irregularity, or nonuniformity of the lesion mucosal microsurface pattern. Results: A total of 52 depressed lesions were examined. The histological diagnosis was cancer for 8 lesions, and noncancer for 44 lesions. WLI examination yielded a sensitivity of 50.0% (4/8), specificity of 63.6% (28/44), and accuracy 61.5% (32/52). On the other hand, NBI close examination yielded a sensitivity of 87.5% (7/8), specificity of 93.2% (41/44), and accuracy of 92.3% (48/52), significantly higher. Conclusion: NBI close examination using ultrathin transnasal endoscopy enables mucosal diagnosis even without magnification and was considered to be an effective technique for improving endoscopic diagnosis.

An Asian consensus on standards of diagnostic upper endoscopy for neoplasia

“…Pimentel-Nunes et al proposed diagnostic criteria to characterise gastric premalignant lesions including chronic gastritis, IM and carcinoma using non-magnifying NBI,96 and these criteria were validated in a multicentre prospective cohort study 37. One observational study indicated that diagnostic accuracy for differentiating adenocarcinoma from benign gastric lesions was significantly higher in non-magnification NBI than in WLE (92.3% vs 61.5%) 97. At present, the consensus panel recommended the use of equipment-based IEE without magnification for characterisation and delineation of EGC as evidenced by the accuracy of IEE without magnification demonstrated in prospective cohort studies 96 97…”

Etiology and Prevention of Gastric Cancer

“…The data from five case-control studies and two cohort studies in Japan demonstrated that photofluoroscopy for gastric cancer screening can decrease gastric cancer mortality by 40-60% [12]. By now, many new advanced approaches providing better visualization of gastric mucosa lesions have been developed, such as chromoendoscopy [62], confocal laser endomicroscopy [63], narrow-band imaging endoscopy [64], magnifying endoscopy [65] and narrow-band imaging with magnifying endoscopy [66]. A large number of studies showed that these new advanced endoscopic imaging technologies have better accuracy for diagnosing premalignant gastric lesions than standard ‘white light' endoscopy [67,68,69].…”

The Evaluation of Esophageal Motility Using Infusion Manometry with a Trans-nasal Endoscope: A Preliminary Study

“…In the present study, we demonstrated the clinical utility of M-TNE in patients with dysphagia. TNE is becoming popular worldwide, particularly for cancer screening (13). Using a trans-nasal endoscope, the catheter can be inserted under direct vision, resulting in smooth and safe insertion.…”