Osamu Dohi1, Tsugitaka Ishida1, Naohisa Yoshida1
Dig Endosc. 2020 May 28.
Linked color imaging (LCI; Fujifilm Co., Tokyo, Japan) identifies map‐like redness (MR), which indicates gastric intestinal metaplasia (GIM) histopathologically1 and helps clearly visualize minute differences by mucosal colors.2, 3 Early gastric cancer (EGC) visibility after Helicobacter pylori (HP ) eradication is greater using LCI compared with white light imaging (WLI).4 However, depressed lesions similar to EGCs were sometimes detected in MR using LCI in clinical practice. Magnifying blue laser imaging (M‐BLI) has an excellent diagnostic accuracy for EGC.5 Therefore, we recommend M‐BLI following LCI to accurately identify EGC after HP eradication in MR (Video S1).
Case 1 is a 10‐mm depressed lesion, which was detected on the lesser curvature of the upper body after successful HP eradication (Fig. 1). WLI revealed an indistinct depressed area (Fig. 1A). LCI showed a well‐demarcated orange‐colored lesion with a clear margin surrounding the lavender color area (Fig. 1B). The lesion could be diagnosed as EGC with high confidence because M‐BLI shows irregular microvessels and microstructures with a clear border. The lesion was pathologically diagnosed as a well‐differentiated intramucosal adenocarcinoma surrounding GIM. Case 2 is a 10‐mm depressed lesion, which was detected on the greater curvature of lower body after successful HP eradication. Although the lesion could not be detected using WLI (Fig. 2A), LCI detected a well‐demarcated orange‐colored lesion around the lavender color area (Fig. 2B). The lesion could be diagnosed as EGC with high confidence, because M‐BLI shows irregular microvessels and microstructures with a mostly clear border. The pathological diagnosis was a well‐differentiated intramucosal adenocarcinoma partially covered by surrounding GIM at the edge of the lesion.
1 Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan