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Linked color imaging can improve the visibility of superficial non-ampullary duodenal epithelial tumors

Kenichiro Okimoto1, Daisuke Maruoka1, Tomoaki Matsumura1, Mamoru Tokunaga1, Tatsuya Kaneko1, Hirotaka Oura1, Naoki Akizue1, Yuki Ohta1, Keiko Saito1, Makoto Arai1, Jun Kato1, Naoya Kato1

Scientific Reports volume 10, Article number: 20667 (2020)

The current study aimed to evaluate the efficacy of linked color imaging (LCI) in improving the visibility of superficial non-ampullary duodenal epithelial tumors (SNADETs). We prospectively evaluated 44 consecutive patients diagnosed with SNADETs. Three trainees and three experts assessed the visibility scores of white light imaging (WLI), LCI, and blue laser imaging-bright (BLI-b) for SNADETs, which ranged from 1 (not detectable without repeated cautious examination) to 4 (excellent visibility). In addition, the L* a* b* color values and color differences (ΔE) were evaluated using the CIELAB color space system. For SNADETs, the visibility scores of LCI (3.53 ± 0.59) were significantly higher than those of WLI and BLI-b (2.66 ± 0.79 and 3.41 ± 0.64, respectively). The color differences (ΔE) between SNADETs and the adjacent normal duodenal mucosa in LCI mode (19.09 ± 8.33) were significantly higher than those in WLI and BLI-b modes (8.67 ± 4.81 and 12.92 ± 7.95, respectively). In addition, the visibility score of SNADETs and the color differences in LCI mode were significantly higher than those in WLI and BLI-b modes regardless of the presence of milk white mucosa (MWM). LCI has potential benefits, and it is considered a promising clinical modality that can increase the visibility of SNADETs regardless of the presence of MWM.

1 Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1‐8‐1, Chiba City 260‐8670, Japan

Prevalence of Barrett’s Epithelium Shown by Endoscopic Observations with Linked color Imaging in Subjects with Different H. pylori Infection Statuses

Kyoichi Adachi1, Norihisa Ishimura2, Kanako Kishi1, Takumi Notsu1, Tomoko Mishiro1, Kazunari Sota1, Shunji Ishihara2

Intern Med. 2020 Sep 30. doi: 10.2169/internalmedicine.5676-20. Online ahead of print.

Objective: This study was conducted to clarify the prevalence of short segment Barrett’s esophagus (SSBE) using endoscopic observations with linked color imaging (LCI). In addition, the relationship between the presence of Barrett’s epithelium (BE) and the status of H. pylori infection was investigated.

Methods: The study subjects were 3,353 individuals (2,186 men, 1,167 women; mean age 55.2±9.4 years old) whose status of H. pylori infection had been determined. An endoscopic observation using LCI was performed to examine the distal margin of palisade vessels and confirm the area of BE. The prevalence of BE ≥5 mm in length was investigated.

Results: BE was diagnosed in 1,884 (56.2%) subjects, with lengths of <10, 10-19, 20-29, and ≥30 mm found in 1,005, 851, 27, and 1, respectively. Its prevalence in H. pylori-negative, H. pylori-positive, and post-eradicated subjects was 41.7%, 64.4%, and 69.9%, respectively (p<0.001). The duration since successful eradication of H. pylori did not affect the prevalence of BE. The degree of gastric mucosal atrophy was higher in cases with BE (p<0.001), although negativity for H. pylori infection and mild gastric mucosal atrophy were significant factors for the development of longer BE.

Conclusion: A high prevalence of SSBE was noted when LCI was used to determine the area of BE, as the distal end of the palisade vessels was easily visualized. Negativity for H. pylori infection and mild gastric mucosal atrophy were not correlated with SSBE prevalence.

1 Health Center, Shimane Environment and Health Public Corporation, Japan
2 Second Department of Internal Medicine, Shimane University, Faculty of Medicine, Japan

Magnification linked color imaging characterization of the irregular vessel network of diffuse mucosal rectal metastatic spread from high-grade serous ovarian cancer

Vincent Zimmer1,2, Elke Eltze3

Dig Liver Dis. 2020 Oct 17;S1590-8658(20)30931-2. doi: 10.1016/j.dld.2020.10.002. Online ahead of print.

A 62-year-old female patient presented with lower abdominal pain in combination with a 2-kg weight loss and stool retention. Medical history was significant for ovarian cancer that was treated by curative-intent surgery and adjuvant chemotherapy two years before. Imaging studies were consistent with peritoneal carcinomatosis and suggested incipient large bowel obstruction, for which the patient underwent lower GI endoscopy. While a high-grade stricture at the rectosigmoidal junction due to external compression precluded scope advancement, apart from mild unspecific erythema multiple nodular aphthoid-like lesions were identified throughout the rectum (Fig. 1A). Further endoscopic assessment including magnification image-enhanced endoscopy was performed. On blue laser imaging (BLI) no pit pattern was discernible (Fig. 1B). Linked color imaging (LCI) in escalating magnification levels, however, clearly depicted an irregular vessel network within the lesion with avascular areas, marked caliber changes, curtailed interruptions, tortuosity up to irregular loop formation (Fig. 1C,D). Overall, these findings were highly suggestive of diffuse multi-nodular metastases as an exceedingly uncommon type of gastrointestinal metastatic spread in ovarian cancer [1]. This was confirmed by final pathology indicating mucosal infiltration by atypical solid, in part, papillary epithelial complexes (Fig. 2A,B) with CK-7 and WT-1 positivity (Fig. 2C,D) and lymphovascular invasion, consistent with recurrent high-grade serous ovarian cancer.

1 Department of Medicine, Marienhausklinik St. Josef Kohlhof, Neunkirchen, Germany
2 Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
3 Institute of Pathology Saarbrücken-Rastpfuhl, Saarbrücken, Germany

Blue laser imaging combined with JNET (Japan NBI Expert Team) classification for pathological prediction of colorectal laterally spreading tumors

Si-Lin Huang1, Wen-Xin Tan2, Qun Peng2, Wen-Hua Zhang3, Hai-Tao Qing2, Qiang Zhang2, Jun Wu4, Liang-Dou Lin4, Zhi-Bin Lu4, Yu Chen4, Wei-Guang Qiao2

Surg Endosc. 2020 Sep 24. doi: 10.1007/s00464-020-08027-z. Online ahead of print.

Background: Blue laser imaging (BLI) can provide useful information on colorectal laterally spreading tumors (LSTs) by visualizing the surface and vessel patterns in detail. The present research aimed to evaluate the diagnostic performance of BLI-combined JNET (Japan NBI Expert Team) classification for identifying LSTs.

Methods: This retrospective, multicenter study included 172 LSTs consisted of 6 hyperplastic polyps/sessile serrated polyps, 94 low-grade dysplasias (LGD), 60 high-grade dysplasias (HGD), 6 superficial submucosal invasive (m-SMs) carcinomas, and 4 deep submucosal invasive carcinomas. The relationship between the JNET classification and the histologic findings of these lesions were then analyzed.

Results: For all LSTs, non-experts and experts had a 79.7% and 90.7% accuracy for Type 2A (P = 0.004), a sensitivity of 94.7% and 96.8% (P = 0.718), and a specificity of 61.5% and 83.3% (P = 0.002) for prediction of LGD, respectively. The results also demonstrated 80.8% and 91.3% accuracy for Type 2B (P = 0.005), a sensitivity of 65.2% and 83.3% (P = 0.017), and a specificity of 90.6% and 96.2% (P = 0.097) for predicting HGD or m-SMs. For LST-granular (LST-G) lesions, Type 2A in experts had higher specificity (65.6% vs. 83.6%, P = 0.022) and accuracy (81.8% vs. 91.2%, P = 0.022). Type 2B in experts only had higher accuracy (82.5% vs. 92.0%, P = 0.019). However, no significant differences were noted for any comparisons between non-experts and experts for LST-non-granular (LST-NG) lesions.

Conclusions: BLI combined with JNET classification was an effective method for the precise prediction of pathological diagnosis in patients with LSTs. Diagnostic performance of JNET classification by experts was better than that by non-experts for all examined LST or LST-G lesions when delineating between Type 2A and 2B, but there was no difference for the identification of LST-NG lesions by these two groups.

1 Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
2 Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
3 Department of Gastroenterology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
4 Department of Gastroenterology, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China

Comparison of different virtual chromoendoscopy classification systems for the characterization of colorectal lesions

Leonardo Zorron Cheng Tao Pu1,3, Takeshi Yamamura4, Masanao Nakamura3, Doreen S C Koay2, Amanda Ovenden2, Suzanne Edwards1, Alastair D Burt1, Yoshiki Hirooka5, Mitsuhiro Fujishiro3, Rajvinder Singh1,2

JGH Open. 2020 Jul 7;4(5):818-826. doi: 10.1002/jgh3.12382. eCollection 2020 Oct.

Background and aim: Commonly used classifications for colorectal lesions (CLs) include the Narrow Band Imaging (NBI) International Colorectal Endoscopic (NICE) and Japan NBI Expert Team (JNET) classifications. However, both lack a sessile serrated adenoma/polyp (SSA/P) category. This has been addressed by the modified Sano’s (MS) and Workgroup serrAted polypS and Polyposis (WASP) classifications. This study aims to compare the accuracy of wNICE and wJNET (WASP added to both) with the stand-alone MS classification.

Methods: Patients undergoing colonoscopy at an Australian tertiary hospital who had at least one CL detected were prospectively enrolled. In the exploratory phase, CLs were characterized in real time with NBI and magnification using all classifications. In the validation phase, CLs were assessed with both NBI and Blue Laser Imaging (BLI) by four external endoscopists in Japan. The primary outcome was the comparison of wJNET and MS. Secondary outcomes included comparisons among all classifications and the calculation of interrater reliability.

Results: A total of 483 CLs were evaluated in real time in the exploratory phase, and four sets of 30 CL images (80 on NBI and 40 on BLI) were scored in the validation phase. For high-confidence diagnoses, MS accuracy was superior to wJNET in both the exploratory (86% vs 79%, P < 0.05) and validation (85% vs 69%, P < 0.05) phases. The interrater reliability was substantial for all classifications (κ = 0.74, 0.69, and 0.63 for wNICE, wJNET, and MS, respectively).

Conclusions: MS classification achieved the highest accuracy in both the exploratory and validation phases. MS can differentiate serrated and adenomatous polyps as a stand-alone classification.

1 Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
2 Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, Australia
3 Department of Gastroenterology and Hepatology, Nagoya University, Najoya, Japan
4 Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
5 Department of Gastroenterology and Gastroenterological Oncology, Fujita Health University, Toyoake, Japan

The Efficacy of Linked Color Imaging in the Endoscopic Diagnosis of Barrett’s Esophagus and Esophageal Adenocarcinoma

Mamoru Tokunaga1, Tomoaki Matsumura1, Kentaro Ishikawa1, Tatsuya Kaneko1, Hirotaka Oura1, Tsubasa Ishikawa1, Ariki Nagashima1, Wataru Shiratori1, Kenichiro Okimoto1, Naoki Akizue1, Daisuke Maruoka1, Yuki Ohta1, Keiko Saito1, Tomoo Nakagawa1, Tetsuhiro Chiba1, Makoto Arai1,2, Jun Kato1, Naoya Kato1

Gastroenterol Res Pract. 2020 Sep 29;2020:9604345. doi: 10.1155/2020/9604345. eCollection 2020.

Background: The present study aimed to evaluate the efficacy of linked color imaging (LCI) in diagnosing Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC).

Methods: A total of 112 and 12 consecutive patients with BE and EAC were analyzed. The visibility scores of BE and EAC ranging from 4 (excellent visibility) to 0 (not detectable) were evaluated by three trainees and three experts using white light imaging (WLI), LCI mode, and blue laser imaging bright (BLI-b) mode. In addition, L∗a∗b∗ color values and color differences (ΔE∗) were evaluated using the CIELAB color space system.

Results: The visibility score of the BE in LCI mode (2.94 ± 1.32) was significantly higher than those in WLI (2.46 ± 1.48) and BLI-b mode (2.35 ± 1.46) (p < 0.01). The color difference (ΔE∗) from the adjacent gastric mucosa in LCI mode (17.11 ± 8.53) was significantly higher than those in other modes (12.52 ± 9.37 in WLI and 11.96 ± 6.59 in BLI-b mode, p < 0.01). The visibility scores of EAC in LCI mode (2.56 ± 1.47) and BLI-b mode (2.51 ± 1.28) were significantly higher than that in WLI (1.64 ± 1.46) (p < 0.01). The color difference (ΔE∗) from the adjacent normal Barrett’s mucosa in LCI mode (19.96 ± 7.97) was significantly higher than that in WLI (12.95 ± 11.86) (p = 0.03).

Conclusion: The present findings suggest that LCI increases the visibility of BE and EAC and contributes to the improvement of the detection of these lesions.

1 Department of Gastroenterology, Graduate School of Medicine, Chiba University Chiba, Japan
2 Department of Medical Oncology, Chiba University Chiba, Japan