Elsevier

Gastrointestinal Endoscopy

Volume 59, Issue 2, February 2004, Pages 288-295
Gastrointestinal Endoscopy

Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions

https://doi.org/10.1016/S0016-5107(03)02532-XGet rights and content

Abstract

Background

By assessing the intrapapillary capillary loop in esophageal mucosa, magnifying endoscopy can play an important role in the evaluation of superficial esophageal lesions. A newly developed narrow-band imaging system was applied to magnifying endoscopy in a clinical setting; the benefit of the narrow-band imaging system was evaluated.

Methods

Forty-one patients (37 men, 4 women; mean age 63.5 [7.3] years) were enrolled between March 2002 and January 2003 in the study. Endoscopy was performed with a magnifying endoscope, a standard videoendoscopic system, and a narrow-band imaging system. The assessment consisted of 3 phases: a numerical analysis of the red, green, blue color value of endoscopic images, creation of model images, and assessment on the actual images. In the numerical analysis, the red, green, blue color value for intrapapillary capillary loop and background mucosa were obtained, and the ratio and contrast value were calculated.

Results

In the numerical analysis, both the ratio and the contrast value between the intrapapillary capillary loop and background mucosa were statistically different. Based on an evaluation of created model images, almost all assessors found the narrow-band imaging system to be superior. In the assessment of actual images, the narrow-band imaging system improved overall accuracy for depth of invasion, especially for inexperienced endoscopists.

Conclusions

The narrow-band imaging system improved the accuracy of magnifying endoscopy for assessment of esophageal lesion.

Section snippets

Patients

A total of 41 consecutive patients (37 men, 4 women; mean age 63.5 [7.3] years) were enrolled in the study between March 2002 and January 2003. There were 18 patients with superficial esophageal squamous cell carcinoma, 8 with dysplasia, two with esophagitis, and 13 with normal mucosa. All patients with superficial esophageal cancer were treated by EMR, and all resected specimens were retrieved for histopathologic evaluation. Depth of invasion was classified according to the esophageal cancer

Results

Magnifying endoscopic images with the standard videoendoscopic system and NBI system were obtained in all cases; no complication was encountered.

Representative pairs of regular and NBI images are shown in Figure 4. In the regular images, IPCL appear as reddish lines, and the background mucosa is light orange in color. In NBI images, IPCL are shown as dark-brownish lines, and the background mucosa is a light brownish color. The respective RGB band images obtained from the original regular and

Discussion

Since EMR has become established as a therapeutic option for mucosal cancer, the differential diagnosis between mucosal and submucosal cancer in the GI tract has became critical. For squamous cell carcinoma of the esophagus, this differentiation is of particular importance, and such lesions should be subclassified according to microinvasion of the tumor as m1, m2, m3, sm1, sm2, sm3.9 Of all superficial squamous cell carcinomas, m1 or m2 cancers rarely have lymph node metastases and can,

Acknowledgements

We thank Dr. Philip W. Y. Chiu from the Department of Surgery, United Christian Hospital, Hong Kong, for his assistance with preparation of this manuscript.

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The development of the NBI system was supported by a portion of the grant for the 2nd-Term Comprehensive 10-Year Strategy for Cancer Control in National Cancer Center Hospital East, Japan.

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