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Diffuse redness in linked color imaging is useful for diagnosing current Helicobacter pylori infection in the stomach.

Masaya Iwamuro 2, Hiroyuki Sakae 1, Hiromitsu Kanzaki 1, PhD Hiroyuki Okada 2

Journal of General and Family Medicine

Abstract: Esophagogastroduodenoscopic examination shows diffuse redness of the mucosa of the gastric body, which can be identified as a deep reddish color. The present case underscores the importance of diffuse redness as a key endoscopic feature that enables prompt diagnosis of current Helicobacter pylori infection.

1 Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry
2 Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

Blue laser imaging with acetic acid enhancement improved the detection rate of gastric intestinal metaplasia.

Chen H1, Wu X2, Liu Y1, Wu Q1, Lu Y1, Li C1.

Lasers Med Sci. 2018 Sep 6. doi: 10.1007/s10103-018-2629-z. [Epub ahead of print]

Abstract: Our aim was to evaluate the ability of blue laser imaging (BLI) combined with acetic acid (BLI-AA) to detect gastric intestinal metaplasia (GIM). Participants undergoing gastroscopy from July 2017 to February 2018 in our hospital were enrolled prospectively. The abilities of white light imaging endoscopy, BLI endoscopy, and BLI-AA to detect GIM were compared. One hundred six patients undergoing gastroscopy met the inclusion criteria. GIM was diagnosed in 41 patients. For BLI-AA, the sensitivity, specificity, positive predictive, and negative predictive values were 85.4%, 84.6%, 77.8%, and 90.2% respectively. The diagnostic accuracy rate for BLI-AA was 84.9%, which was higher than that of white light imaging endoscopy and BLI endoscopy. For target biopsy, the GIM detection rate for the BLI-AA mode was significantly higher (77.8%, 105/135) than that for the BLI mode (58.3%, 84/144) or the white light endoscopy mode (40.4%, 57/141) (p < 0.05). BLI-AA is an efficient and simple method for the detection of GIM.

1 Department of Gastrointestinal Endoscopy, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, No.26 Yuancun Er Heng Rd, Tianhe District, Guangzhou 510655, Guangdong Province. People´s Republic of China
2 Department of Gastrointestinal Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, No.26 Yuancun Er Heng Rd, Tianhe District, Guangzhou 510655,
Guangdong Province. People´s Republic of China

Blue laser imaging-bright improves real-time detection rate of early gastric cancer: a randomized controlled study.

Dohi O1, Yagi N2, Naito Y1, Fukui A4, Gen Y4, Iwai N1, Ueda T1, Yoshida N1, Kamada K1, Uchiyama K1, Takagi T1, Konishi H1, Yanagisawa A4, Itoh Y1.

Gastrointest Endosc. 2018 Sep 3. pii: S0016-5107(18)33008-6. doi: 10.1016/j.gie.2018.08.049. [Epub ahead of print]

Background and aims: Blue laser imaging (BLI)-bright (BLI-bright) has shown promise as a more useful tool for detection of early gastric cancer (EGC) than white-light imaging (WLI). However, the diagnostic performance of BLI-bright in the detection of EGC has not been investigated. We aimed to compare real-time detection rates of WLI with that of BLI-bright for EGC.

Methods: This was a prospective, randomized, controlled study in 2 Japanese academic centers. We investigated 629 patients undergoing follow-up endoscopy for atrophic gastritis with intestinal metaplasia or surveillance after endoscopic resection of EGC. Patients were randomly assigned to receive primary WLI followed by BLI-bright or primary BLI-bright followed by WLI. The real-time detection rates of EGC were compared between primary WLI and primary BLI-bright.

Results: Of 298 patients in each group, the real-time detection rate of EGC with primary BLI-bright was significantly greater than that with primary WLI (93.1% vs 50.0%; p = 0.001). Primary BLI-bright had a significantly greater ability to detect EGCs in patients with a history of endoscopic resection for EGC, an HP-negative stomach after eradication therapy, lesions with an open-type atrophic border, lesions in the lower third of the stomach, depressed-type lesions, small lesions measuring <10 mm and 10 to 20 mm in diameter, reddish lesions, well-differentiated adenocarcinomas, and lesions with a depth of invasion of T1a.

Conclusions: BLI-bright has a higher real-time EGC detection rate than WLI. BLI-bright should be performed during surveillance endoscopy in patients at high risk for EGC.

1 Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
2 Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
3 Department of Gastroenterology, Murakami Memorial Hospital, Asahi University, Gifu, Japan
4 Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

Blue Laser Imaging with a Small-Caliber Endoscope Facilitates Detection of Early Gastric Cancer.

Takahashi H1, Miura Y1, Osawa H1, Takezawa T1, Ino Y1, Okada M1, Lefor AK2, Yamamoto H1.

Clin Endosc. 2018 Aug 14. doi: 10.5946/ce.2018.100. [Epub ahead of print]

Abstract: Conventional endoscopy often misses early gastric cancers with minimal red discoloration because they cannot be distinguished from inflamed mucosa. We treated a patient with a small early gastric cancer that was difficult to diagnose using conventional endoscopy. Conventional endoscopy using a small-caliber endoscope showed only subtle red discoloration of the gastric mucosa. However, blue laser imaging showed a clearly discolored area measuring 10 mm in diameter around the red lesion, which was distinct from the surrounding inflamed mucosa. Irregular vessels on the tumor surface (suspicious for early gastric cancer) were observed even with small-caliber endoscopy. Biopsy revealed a well-moderately differentiated tubular adenocarcinoma, and endoscopic submucosal dissection was performed. Histopathological examination of the specimen confirmed well-moderately differentiated adenocarcinoma localized to the mucosa with slight depression compared to the surrounding mucosa, consistent with the endoscopic findings. This small early gastric cancer became clearly visible with blue laser imaging using small-caliber endoscopy.

1 Division of Gastroenterology, Department of Medicine
2 Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan

Additional Thirty Seconds Observation with Linked Color Imaging Improves Detection of Missed Polyps in the Right-Sided Colon.

Yoshida N1, Inada Y2, Yasuda R1, Murakami T1, Hirose R1, Inoue K1, Dohi O1, Naito Y1, Ogiso K3, Morinaga Y4, Kishimoto M4, Konishi E4, Itoh Y1.

Gastroenterol Res Pract. 2018 Jul 8;2018:5059834. doi: 10.1155/2018/5059834. eCollection 2018.

Background and aims: Missed polyps are a pitfall of colonoscopy. In this study, we analyzed the efficacy of an additional 30 seconds observation using linked color imaging (LCI) for detecting adenoma and sessile serrated adenoma/polyp (SSA/P).

Materials and methods: We enrolled patients undergoing colonoscopy from February to October 2017 in two institutions. In all patients, the cecum and ascending colon were observed with white light imaging (WLI) first. The colonoscope was inserted again, and the cecum and ascending colon were observed for an additional 30 seconds using either LCI or WLI. The method for the 30 sec observation was to insufflate the cecum and ascending colon sufficiently and observe them in a distant view, because the length of the second observation was determined to be precisely 30 sec. For the second observation, LCI was performed for the first 65 patients and WLI for the next 65. Adenoma and SSA/P detection rate (ASDR) in the second observation were examined in both groups. According to a pilot study, the sample size was estimated 65.

Results: In the first observation, ASDR were 30.7% in the LCI group and 32.2% in the WLI group (p = 0.85). For the second observation, 13 polyps were detected in the LCI group and 5 polyps in the WLI group (p = 0.04). Additionally, ASDR for the second observation were 18.5% and 6.1%, respectively (p = 0.03). There were no significant differences between the LCI and WLI groups with respect to morphology (ratio of polypoid) (38.5% versus 60.0%, p = 0.52) and histology (ratio of adenoma) (92.3% versus 100.0%, p = 0.91). Total adenoma and SSA/P number were 48 in the LCI group and 36 in the WLI group (p = 0.02).

Conclusion: The 30 seconds additional observation with LCI improved the detection of adenoma and SSA/P in the right-sided colon.

1 Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
2 Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
3 Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
4 Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan

Usefulness of close observation with non-magnified blue laser imaging for determining cold polypectomy indications.

Suzuki T1, Kitagawa Y1, Nankinzan R1, Takashiro H2, Hara T3, Yamaguchi T2.

Scand J Gastroenterol. 2018 Jul 24:1-5. doi: 10.1080/00365521.2018.1488181

Purpose: To examine the usefulness of non-magnified close observation with blue laser imaging (BLI) using a colonoscope with close observation capability in determining indications for cold polypectomy.

Methods: We conducted an image evaluation study on 100 consecutive colorectal lesions of 10 mm or less which were observed endoscopically without magnification using BLI mode prior to treatment. Two experts and two non-experts reviewed the images using the Japan NBI expert team (JNET) classification and the diagnostic accuracy was analyzed.

Results: The final pathological diagnoses of the 100 lesions were hyperplastic/sessile serrated polyp (HP/SSP), low grade dysplasia (LGD), high grade dysplasia (HGD) and deep submucosal invasive cancer (dSM), respectively, in 12, 79, 9 and 0 lesions. When JNET classification type 1 corresponds to HP/SSP; 2A to LGD; 2B to HGD; and 3 to dSM; the overall diagnostic accuracy was 84.3%. Accuracy was 90.5% for experts and 78.0% for non-experts. High confidence rate was 67.5% for experts and 48.0% for non-experts. In diagnostic accuracy for HGD, the sensitivity, specificity, PPV and NPV were, respectively, 77.8%, 98.9%, 87.5% and 97.8% for experts; and 66.6%, 92.3%, 46.2% and 96.6% for non-experts.

Conclusions: The diagnostic accuracy of unmagnified close observation with BLI using a colonoscope with close observation capability is similar to that reported for magnifying endoscopy and is useful in predicting the histological diagnosis of colorectal polyps of 10 mm or less although the effectiveness may be limited for non-experts. This modality is a potentially useful tool in deciding indications for cold polypectomy.

1 Department of Endoscopy, Chiba Cancer Center, Chiba, Japan
2 Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan
3 Hara Clinic