Endoscopic features of nonampullary duodenal tumors with narrow-band imaging.

BACKGROUND/AIMS: Endoscopic features of nonampullary duodenal adenomas and early adenocarcinomas are not well known. The aims of this study were to investigate the endoscopic features of the tumors using conventional endoscopy and narrow-band imaging magnified endoscopy, and to reveal the relationship between the endoscopic features and histological grades. METHODOLOGY: The study included 24 nonampullary duodenal adenomas and early adenocarcinomas in 22 patients who underwent conventional endoscopy and narrow-band imaging magnified endoscopy. The tumors were divided into histological groups according to the modified Vienna classification system. RESULTS: The 24 tumors were 17 adenomas and 7 carcinomas in situ, and divided into 10 Category 3 and 14 Category 4 lesions. On conventional endoscopy, 22 of the 24 (92%) lesions, had a milk-white mucosa and the frequency of a marginal-type one was significantly higher for the Category 4 group (p = 0.028). On narrow-band imaging magnified endoscopy, all tumors had a heterogeneous pattern. The frequency of an obscure mucosal pattern and a network microvascular pattern was significantly higher for the Category 4 group (p = 0.024 and 0.001, respectively). CONCLUSIONS: Narrow-band imaging magnified endoscopy following conventional endoscopy might be a promising approach to realizing lesions or predicting histological grade of nonampullary duodenal intraepithelial tumors.

Usefulness of magnifying endoscopy with narrow band imaging for the detection of specialized intestinal metaplasia in columnar-lined esophagus and Barrett's adenocarcinoma.

BACKGROUND: Barrett's esophagus with specialized intestinal metaplasia (SIM) from columnar-lined esophagus is difficult to distinguish with routine endoscopy. OBJECTIVE: To examine the values of fine mucosal patterns and the capillary patterns observed by magnifying endoscopy with narrow band imaging (MENBI) for the detection of SIM in columnar-lined esophagus and superficial Barrett's adenocarcinoma. We also undertook a histologic investigation regarding whether the capillary pattern observed by MENBI corresponds to the 3-dimensional (3D) structure of the capillary as depicted by using a confocal laser-scanning microscope (CLSM). DESIGN: To compare the findings of MENBI, at 217 sites of columnar-lined esophagus, with histologic findings. Capillaries of the superficial mucosal layer were observed and were analyzed by 3D with a CLSM in 45 biopsied specimens. PATIENTS: Fifty-eight patients, including 4 with superficial Barrett's adenocarcinoma. SETTING: Jikei University Hospital, Tokyo, Japan. RESULTS: Upon observation, all 6 adenocarcinoma sites were classified as irregular patterns in both the fine mucosal patterns and capillary patterns. The most characteristic endoscopic patterns of SIM were revealed to be the cerebriform fine mucosal pattern (sensitivity, 56%; specificity, 79%; odds ratio, 4.78) and ivy- or deoxyribonucleic acid (DNA)-like capillary pattern (sensitivity, 77%; specificity, 94%; odds ratio, 51.6). The addition of capillary patterns to fine mucosal patterns improved the accuracy of diagnosing SIM (P < .0001). CONCLUSIONS: MENBI was able to precisely visualize the structure of capillaries in the superficial mucosal layer. The addition of capillary patterns to fine mucosal patterns appeared to improve the diagnostic value for detecting SIM and superficial Barrett's adenocarcinoma upon observation by MENBI.

New approach to diagnosing ampullary tumors by magnifying endoscopy combined with a narrow-band imaging system.

BACKGROUND: A newly developed narrow-band imaging (NBI) system, which uses modified optical filters, can yield clear images of microvessels and surface structure in gastric and colonic diseases. In the present study, we investigated the ability of magnifying endoscopy with NBI (MENBI) to diagnose and differentiate between benign and malignant ampullary tumors. METHODS: Fourteen patients, whose ampullas were noted to be significantly enlarged or protruding with conventional endoscopy, were enrolled in the study. Specimens, which were obtained by forceps biopsy, endoscopic papillectomy, and/or surgery, were retrieved for histopathological examination. The correlation between MENBI images and histopathological findings was investigated. MENBI findings were classified as I, oval-shaped villi; II, pinecone/leaf-shaped villi; or III, irregular/nonstructured. In addition, tortuous, dilated, and network-like vessels noted on the ampullary lesions with MENBI were defined as abnormal vessels. RESULTS: In 6 of 14 patients, the ampullary changes were proven to be inflammatory in forceps biopsy specimens, without any evidence of malignancy after more than 1 year of follow-up. In five patients, ampullary lesions were treated by endoscopic papillectomy, and in three, by pancreatoduodenectomy. All adenomas and adenocarcinomas had type II and/or type III surface structures, and patients whose ampulla had a type I surface structure had only inflammatory or hyperplastic changes. In addition, abnormal vessels were seen only in adenocarcinomas and never in adenomas. CONCLUSIONS: MENBI has the ability and potential to predict histological characteristics of ampullary lesions.

Combined use of a magnifying endoscope with a narrow band imaging system and a multibending endoscope for en bloc EMR of early stage gastric cancer.

BACKGROUND: En bloc EMR is performed in Japan as a curative treatment for early stage gastric cancer. However, current methods of EMR are technically difficult and require proficiency in determining the extent of the cancer. This study assessed the feasibility of a new method to obviate these problems and to facilitate en bloc EMR. METHODS: The new method uses two types of endoscopes: a magnifying endoscope with a narrow band imaging system to enhance the definition of mucosal and microcirculatory structure, and an endoscope with multibending tip deflection to maintain orientation during EMR. Forty-two consecutive cases of mucosal gastric cancer treated by EMR were reviewed retrospectively. In 12 of these patients, 12 lesions that fulfilled guideline criteria for EMR were treated by the modified, en bloc EMR method of circumferential incision and snare resection by using the two endoscopes. RESULTS: The rate of complete en bloc resection with the new method of EMR was 91.7%, (11/12). There was no major complication. CONCLUSIONS: The new en bloc resection method for EMR with two endoscopes described here is feasible and may be a safe and a reliable technique for curative treatment of mucosal gastric cancer.