Dynamic diagnosis of early gastric cancer with microvascular blood flow rate using magnifying endoscopy (with video): A pilot study

Hiroya Ueyama1, Noboru Yatagai1, Atsushi Ikeda1, Yoichi Akazawa1, Hiroyuki Komori1, Tsutomu Takeda1, Kohei Matsumoto1, Kumiko Ueda1, Kenshi Matsumoto1, Daisuke Asaoka1, Mariko Hojo1, Takashi Yao2, Akihito Nagahara1

J Gastroenterol Hepatol. 2021 Feb 3. doi: 10.1111/jgh.15425. Online ahead of print.

Background and aim: Magnifying endoscopy (ME) diagnostic algorithm for early gastric cancer (EGC) relies on qualitative features such as microvascular (MV) architecture and microsurface structure; however, it is a “static” diagnostic algorithm that uses still images. ME can visualize red blood cell flow within subepithelial microvessels in real time. Here, we evaluated the utility of using the MV blood flow rate in combination with ME for the diagnosis of EGC as a retrospective study.

Methods: Patients with differentiated-type EGC (n = 10) or patchy redness (n = 10) underwent ME with blue laser imaging. The mean MV blood flow rates of EGC, patchy redness, and background mucosa were calculated by the mean movement distance of one tagging red blood cell using split images of ME with blue laser imaging videos. We compared the mean MV blood flow rate between EGC, patchy redness, and background mucosa and also calculated the MV blood flow imaging ratio (inside lesion/background mucosa) between EGC and patchy redness.

Results: Mean MV blood flow rate was significantly lower in EGC (1481 μm/s; range 1057-1762) than in patchy redness (3859 μm/s; 2435-5899) or background mucosa (4140.6 μm/s; 2820-6247) (P < 0.01). The MV blood flow imaging ratio was significantly lower in EGC (0.39; 0.27-0.62) than in patchy redness (0.90; 0.78-1.1) (P < 0.01).

Conclusions: Dynamic diagnosis with MV blood flow rate using ME may be useful for the differential diagnosis of EGC and patchy redness. Endoscopic assessment of dynamic processes within the gastric mucosa may facilitate the diagnosis of EGC.

1 Department of Gastroenterology, Juntendo University School of Medicine
2 Department of Human Pathology, Juntendo University Graduate School of Medicine, Tokyo, Japan