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Zhang H, Ruan R, Fang J, Yu J, Chen S, Tao Y, Zhu S, Wang S. A novel color-aided system for diagnosis of early gastric cancer using magnifying endoscopy with narrow-band imaging. Surg Endosc 2024; 38:6541-6550. [PMID: 39269480 DOI: 10.1007/s00464-024-11235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND The Pink Zone Pattern (PP) sign is a typical color alteration of early gastric cancer (EGC) under magnifying endoscopic narrow-band imaging (ME-NBI). By integrating the color changes (PP sign) with the "vessel plus surface (VS)" classification system, we developed an innovative diagnostic system for EGC and named it "Pink Microsurface Microvascular (PSV)" system. Here, we aimed to elucidate the diagnostic performance of the PSV system for EGC. METHODS We conducted a single-center prospective clinical study (before-after design) consisting of 2 cross-sectional studies at 2 separate periods. In the before phase, 184 suspected lesions were evaluated using the VS system under ME-NBI; in the after phase, 183 suspected lesions were evaluated using the PSV system. We compared the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) between the VS group and the PSV group. RESULTS The accuracy, sensitivity, specificity, PPV, and NPV of the VS system for EGC were 84.6%, 87.0%, 83.6%, 67.8%, and 94.2%, respectively, and those for the PSV system were 93.0%, 92.0%, 93.4%, 85.2%, and 96.6%, respectively. The accuracy, specificity, and PPV of the PSV system were superior to those of the VS system. However, the sensitivity and NPV did not significantly differ between the VS system and the PSV system. The VS system was inconclusive for 22 lesions (12.0%) and the PSV system was inconclusive for 11 lesions (6.0%). The PSV system could identify more suspicious lesions than the VS system. CONCLUSIONS We propose a new PSV diagnostic system by combining the VS system and the PP sign. Compared with the VS system, the PSV system could identify more suspected lesions and improve the diagnostic performance of EGC.
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Affiliation(s)
- Hui Zhang
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Banshan Road 1, Gongshu District, Hangzhou, 310022, Zhejiang, China
| | - Rongwei Ruan
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Banshan Road 1, Gongshu District, Hangzhou, 310022, Zhejiang, China
| | - Jin Fang
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Banshan Road 1, Gongshu District, Hangzhou, 310022, Zhejiang, China
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, 310022, Zhejiang, China
| | - Jiangping Yu
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Banshan Road 1, Gongshu District, Hangzhou, 310022, Zhejiang, China
| | - Shengsen Chen
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Banshan Road 1, Gongshu District, Hangzhou, 310022, Zhejiang, China
| | - Yali Tao
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Banshan Road 1, Gongshu District, Hangzhou, 310022, Zhejiang, China
| | - Shuwen Zhu
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Banshan Road 1, Gongshu District, Hangzhou, 310022, Zhejiang, China
| | - Shi Wang
- Department of Endoscopy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Banshan Road 1, Gongshu District, Hangzhou, 310022, Zhejiang, China.
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, 310022, Zhejiang, China.
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Maruyama H, Yamagata T, Kanno Y, Shimizu T, Itasaka T, Fujishima F, Sawai T, Ito K. White Globe Appearance-Like Findings Indicating Intralymphatic Cancer Involvement Beneath the Epithelium in Gastric Cancer. Case Rep Gastrointest Med 2024; 2024:8504987. [PMID: 39463779 PMCID: PMC11512643 DOI: 10.1155/2024/8504987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/18/2024] [Indexed: 10/29/2024] Open
Abstract
A 75-year-old female was diagnosed with a type 0-I, moderately differentiated, early gastric carcinoma on the posterior wall of the middle gastric body during esophagogastroduodenoscopy (EGD). Several small whitish structures, referred to as white globe appearances (WGAs), were noted on the oral side outside the demarcation line of the cancerous protrusion. Although this area was flat without cancerous mucosal changes on the surface, subepithelial cancer extension was suspected. The histopathology of the resected specimen revealed that the carcinoma with submucosal invasion had significant lymphatic invasion with submucosal lateral extent along lymphatic vessels. In some areas, the carcinoma within the lymphatic vessels regressed from the submucosal layer towards the mucosal lamina propria, penetrating the muscularis mucosas. The intralymphatic carcinoma reaching just beneath the epithelium was considered to manifest WGA features during endoscopy.
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Affiliation(s)
- Hiroki Maruyama
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Taku Yamagata
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Takeshi Shimizu
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Takuho Itasaka
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | | | - Takashi Sawai
- Department of Pathology, Sendai City Medical Center, Miyagi, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
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Kamada T, Maruyama Y, Monobe Y, Haruma K. Endoscopic features and clinical importance of autoimmune gastritis. Dig Endosc 2022; 34:700-713. [PMID: 34674318 DOI: 10.1111/den.14175] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 12/13/2022]
Abstract
Autoimmune gastritis (AIG) is a special type of chronic gastritis characterized by autoimmune disorders caused by cellular immunity, resulting in the destruction of parietal cells and production of antiparietal cell antibodies. Endoscopic findings of AIG are mainly characterized by corpus-dominant advanced atrophy. The antral area is generally considered to have no or mild atrophy; however, there are cases wherein the gastric mucosa is red or faded due to past infection with Helicobacter pylori or bile reflux. Currently, there are no diagnostic criteria for AIG in Japan, and it is important to make a diagnosis based on the presence of gastric autoantibodies and characteristic endoscopic and histological findings. AIG is associated with gastric cancer, neuroendocrine tumors (NETs), and other autoimmune diseases, such as thyroid diseases, anemia, and neurological symptoms due to impaired absorption of iron and vitamin B12 , and thus requires systemic treatment. The significance of diagnosing AIG is to include patients as a high-risk group for the development of gastric cancer and gastric NETs, provide an opportunity to detect autoimmune endocrine diseases, and initiate therapeutic intervention before anemia and neurological symptoms develop. It is important to pay close attention to the occurrence of AIG comorbidities not only at the time of AIG diagnosis but also during follow-up after detection.
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Affiliation(s)
- Tomoari Kamada
- Department of, Health Care Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasuhiko Maruyama
- Department of Gastroenterology, Fujieda Municipal General Hospital, Shizuoka, Japan
| | - Yasumasa Monobe
- Department of, Pathology, Kawasaki Medical School, Okayama, Japan
| | - Ken Haruma
- Department of, General Internal Medicine 2, Kawasaki Medical School, Okayama, Japan
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Nishiyama N, Kobara H, Ayaki M, Fujihara S, Nakatani K, Tada N, Koduka K, Matsui T, Takata T, Chiyo T, Kobayashi N, Shi T, Fujita K, Tani J, Yachida T, Masaki T, Haruma K. White Spot, a Novel Endoscopic Finding, May Be Associated with Acid-Suppressing Agents and Hypergastrinemia. J Clin Med 2021; 10:2625. [PMID: 34203619 PMCID: PMC8232144 DOI: 10.3390/jcm10122625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/20/2022] Open
Abstract
White globe appearance (WGA) is defined as a microendoscopic white lesion with a globular shape underlying the gastric epithelium and is considered a marker of gastric cancer. We recently reported that endoscopically visualized white spot (WS) corresponding to WGA appeared on the nonatrophic mucosa of patients with acid-suppressing agents (A-SA) use. We evaluated patients undergoing routine esophagogastroduodenoscopy and divided the patients into an A-SA group (n = 112) and a control group (n = 158). We compared the presence of WS in both groups. We also compared WS-positive- (n = 31) and -negative (n = 43) groups within the A-SA group regarding these patients' backgrounds and serum gastrin concentrations. Comparing the A-SA group with controls, the prevalence of WS was significantly higher (31/112 vs. 2/158; p < 0.001). The number of patients with high serum gastrin concentrations was significantly higher in the WS-positive group (18/31) vs. the WS-negative group (5/43) (p < 0.001). Within the A-SA group, the prevalence of WS was also significantly higher in patients taking potassium-competitive acid blockers vs. proton-pump inhibitors (21/31 vs. 10/31, p < 0.001). The WS-positive group had a significantly greater percentage of patients, with a high serum gastrin level (p < 0.001). WS may be associated with hypergastrinemia and potassium-competitive acid blockers.
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Affiliation(s)
- Noriko Nishiyama
- Department of Gastroenterology, Nishiyama Neurological Hospital, Sakaide City 762-0023, Kagawa, Japan
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Maki Ayaki
- General Medical Center, Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Okayama City 700-8505, Okayama, Japan; (M.A.); (K.H.)
| | - Shintaro Fujihara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Kaho Nakatani
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Naoya Tada
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Kazuhiro Koduka
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Takanori Matsui
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Tadayuki Takata
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Taiga Chiyo
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Nobuya Kobayashi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Tingting Shi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Koji Fujita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Joji Tani
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Tatsuo Yachida
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Ken Haruma
- General Medical Center, Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Okayama City 700-8505, Okayama, Japan; (M.A.); (K.H.)
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Doyama H, Nakanishi H, Yao K. Image-Enhanced Endoscopy and Its Corresponding Histopathology in the Stomach. Gut Liver 2021; 15:329-337. [PMID: 32200589 PMCID: PMC8129655 DOI: 10.5009/gnl19392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 12/14/2022] Open
Abstract
In recent years, the technological innovation and progress of endoscopic equipment have been remarkable, and various endoscopic observation techniques have been developed. Among them, representative techniques are magnified observation and narrow-band imaging. Magnifying endoscopy with narrow-band imaging (M-NBI) can visualize superficial microanatomies in the stomach. The normal morphology of the microanatomy visualized using M-NBI differs according to the part of the stomach. The vessel plus surface (VS) classification system has been developed as a diagnostic criterion for early gastric cancer using M-NBI, and its usefulness has been proven. Based on the VS classification system, a magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G), a simplified algorithm used for early gastric cancer diagnosis, was created. We aimed to describe the anatomic structure of the stomach that can be viewed using M-NBI and outline the principles and clinical application of the VS classification system and MESDA-G. (Gut Liver 2021;15:-337)
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Affiliation(s)
- Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroyoshi Nakanishi
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan
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Masunaga T, Yoshida N, Akiyama S, Sugiyama G, Hirai H, Miyajima S, Wakita S, Kito Y, Nakanishi H, Tsuji K, Matsunaga K, Tsuji S, Takemura K, Katayanagi K, Minato H, Doyama H. White globe appearance is an endoscopic predictive factor for synchronous multiple gastric cancer. Ann Gastroenterol 2020; 34:183-187. [PMID: 33654357 PMCID: PMC7903575 DOI: 10.20524/aog.2020.0565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background White globe appearance (WGA) is a small white lesion with a globular shape identified during magnifying endoscopy with narrow-band imaging. However, the association between WGA and synchronous multiple gastric cancer (SMGC) remains unclear. Methods Consecutive patients who underwent endoscopic submucosal dissection for gastric cancer (GC) between July 2013 and April 2015 at our institution were eligible for this study. We excluded patients with a history of gastric tumor or gastrectomy. Patients who had more than 2 GCs in their postoperative pathological evaluation were classified as SMGC-positive, and patients who had at least 1 WGA-positive GC were classified as WGA-positive patients. The primary outcome was a comparison of the prevalence of WGA in patients classified as SMGC-positive and SMGC-negative. Univariate and multivariate analyses were performed using the following variables: WGA, age, sex, atrophy, and Helicobacter pylori (H. pylori) status. Results There were 26 and 181 patients classified as SMGC-positive and SMGC-negative, respectively. Univariate analysis revealed that WGA-positive classification (50% vs. 23%, P=0.008) and male sex (88% vs. 66%, P=0.02) were significant factors associated with SMGC classification, while age ≥65 years (81% vs. 81%, P>0.99), severe atrophy (46% vs. 46%, P>0.99), and H. pylori positivity (69% vs. 65%, P=0.8) were not. In the multivariate analysis, only WGA-positive classification (odds ratio 2.78, 95% confidence interval 1.16-6.67; P=0.02) was a significant independent risk factor for SMGC. Conclusions Our exploratory study showed the possibility of WGA as a predictive factor for SMGC. In cases of WGA-positive gastric cancer, careful examination might be needed to diagnose SMGC.
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Affiliation(s)
- Teppei Masunaga
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
| | - Naohiro Yoshida
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
| | - Shinichiro Akiyama
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
| | - Gen Sugiyama
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
| | - Hirokazu Hirai
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
| | - Saori Miyajima
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
| | - Shigenori Wakita
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
| | - Yosuke Kito
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
| | - Hiroyoshi Nakanishi
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
| | - Kunihiro Tsuji
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
| | - Kazuhiro Matsunaga
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
| | - Shigetsugu Tsuji
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
| | - Kenichi Takemura
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
| | - Kazuyoshi Katayanagi
- Department of Diagnostic Pathology (Kazuyoshi Katayanagi, Hiroshi Minato), Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Hiroshi Minato
- Department of Diagnostic Pathology (Kazuyoshi Katayanagi, Hiroshi Minato), Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Hisashi Doyama
- Department of Gastroenterology (Teppei Masunaga, Naohiro Yoshida, Shinichiro Akiyama, Gen Sugiyama, Hirokazu Hirai, Saori Miyajima, Shigenori Wakita, Yosuke Kito, Hiroyoshi Nakanishi, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Hisashi Doyama)
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Kubota Y, Tanabe S, Harada Y, Nakatani S, Furue Y, Wada T, Watanabe A, Ishido K, Katada C, Koizumi W. Barrett's Esophageal Adenocarcinoma Involving a White Globe Appearance within the Long-Segment Barrett's Esophagus. Case Rep Gastroenterol 2020; 14:510-515. [PMID: 33250690 PMCID: PMC7670350 DOI: 10.1159/000508861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 11/19/2022] Open
Abstract
The diagnosis of Barrett's esophageal adenocarcinoma (BEA) in patients with Barrett's esophagus (BE) using endoscopy can be difficult and there are few specific endoscopic findings for BEA. However, white globe appearance (WGA) has been reported to be a specific endoscopic finding for early gastric cancer. We encountered a 51-year-old male patient with BEA exhibiting WGA. Esophagogastroduodenoscopy identified a red, depressed lesion of 10 mm within the long-segment BE (LSBE), while magnifying endoscopy with narrow-band imaging identified WGA. Endoscopic submucosal dissection (ESD) was performed based on our suspicion of BEA. Based on the ESD findings, we diagnosed adenocarcinoma accompanying LSBE histopathologically. WGA was identified, and intraglandular necrotic debris was discovered histologically at the same site. Therefore, WGA may be helpful in the diagnosis of BEA.
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Affiliation(s)
- Yo Kubota
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Satoshi Tanabe
- Department of Advanced Medicine Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yohei Harada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Seigo Nakatani
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yasuaki Furue
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takuya Wada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Akinori Watanabe
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kenji Ishido
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Chikatoshi Katada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Wasaburo Koizumi
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
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8
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Miwa W, Hiratsuka T, Sato K, Fujino T, Kato Y. Development of white globe appearance lesions in the noncancerous stomach after vonoprazan administration: a report of two cases with a literature review. Clin J Gastroenterol 2020; 14:48-58. [PMID: 33025345 DOI: 10.1007/s12328-020-01243-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/09/2020] [Indexed: 12/28/2022]
Abstract
White globe appearance has recently been identified as a novel endoscopic marker useful in the diagnosis of early gastric cancer. Recently, this lesion has also been reported in the noncancerous stomach, including cases with autoimmune atrophic gastritis, although the clinical significance remains unclear. We present the details of a 68-year-old woman who began vonoprazan therapy for severe gastroesophageal reflux disease causing esophageal stricture. On follow-up endoscopy 1 year after beginning vonoprazan, multiple white globe appearance lesions developed in all sections of her stomach, except for the antrum. We also detected lesions during a yearly follow-up in the noncancerous stomach of a 70-year-old man who had received vonoprazan for 3 years. Lesions in both cases constituted cystic gland dilatations containing eosinophilic material. There was no evidence of accompanying autoimmune atrophic gastritis in either patient. This report is the first to our knowledge describing newly developed white globe appearance lesions in the noncancerous stomach during follow-up in two cases who received vonoprazan. Our findings suggest that these lesions in the noncancerous stomach might be associated with vonoprazan treatment. We investigated the two cases endoscopically and histologically, and we report our findings with a literature review.
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Affiliation(s)
- Wataru Miwa
- Division of Internal Medicine, Hiratsuka Gastroenterological Hospital, 3-2-16 Nishiikebukuro Toshima-ku, Tokyo, 171-0021, Japan.
| | - Takashi Hiratsuka
- Division of Internal Medicine, Hiratsuka Gastroenterological Hospital, 3-2-16 Nishiikebukuro Toshima-ku, Tokyo, 171-0021, Japan
| | - Ken Sato
- Division of Surgery, Hiratsuka Gastroenterological Hospital, Tokyo, Japan
| | - Takashi Fujino
- Department of Cancer Genomic Medicine, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yo Kato
- Division of Pathology, Hiratsuka Gastroenterological Hospital, Tokyo, Japan
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9
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Cheng J, Xia J, Zhuang Q, Xu X, Wu X, Wan X, Wang J, Zhou H. A new exploration of white globe appearance (WGA) in ulcerative lesions. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 58:754-760. [PMID: 32785912 DOI: 10.1055/a-1200-2287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM White globe appearance (WGA), a small white lesion with a globular shape that can be clearly visualized by magnifying endoscopy with narrow-band imaging (ME-NBI), was reported to be a reliable marker of early gastric cancer (EGC). However, we found that this endoscopic presentation could also be seen in non-cancerous tissues, especially in ulcerative lesions. This study aimed to further investigate the diagnostic value of WGA in differentiating non-cancerous lesions from EGC in ulcer-type cases. MATERIALS AND METHODS We retrospectively reviewed 54 cases of EGC and 155 cases of non-cancerous lesions in this study, all of which had endoscopic imaging data of ME-NBI scanning and pathological data of biopsy or resected specimens. The correlation of the prevalence of WGA and ulcerative lesions, as well as the characteristics of WGA between the 2 groups were analyzed in this study. RESULTS WGA was more common in ulcerative lesions (27.6 %, 21/76) than in non-ulcerative lesions (3.8 %, 5/133) (p < 0.001) in our study. In the ulcerative cases, no significant difference in prevalence of WGA was observed between EGC and non-cancerous lesions (p = 0.532). Compared with WGA in EGC, WGA in non-cancerous lesions tended to show the characteristic of tree-branch-like vessels on globular shape (p < 0.001). CONCLUSIONS WGA is more likely to occur in ulcerative lesions, and the presence of WGA alone cannot distinguish EGC from non-cancerous lesions in ulcer-type cases. In WGA-positive tissue, tree-branch-like vessels of globular shape may provide a certain clinical value in diagnosis of non-cancerous lesions or EGC.
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Affiliation(s)
- Jinnian Cheng
- Department of Gastroenterology, Shanghai General Hospital, Nanjing Medical University, Shanghai 201620, P. R. China
| | - Jie Xia
- Department of Gastroenterology, Shanghai General Hospital, Nanjing Medical University, Shanghai 201620, P. R. China
| | - Qian Zhuang
- Department of Gastroenterology, Shanghai General Hospital, Nanjing Medical University, Shanghai 201620, P. R. China
| | - Xianjun Xu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, P. R. China
| | - Xiaowan Wu
- Department of Gastroenterology, Shanghai General Hospital, Nanjing Medical University, Shanghai 201620, P. R. China
| | - Xinjian Wan
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, P. R. China.,Department of Gastroenterology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P. R. China
| | - Jing Wang
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, P. R. China
| | - Hui Zhou
- Department of Gastroenterology, Shanghai General Hospital, Nanjing Medical University, Shanghai 201620, P. R. China.,Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, P. R. China
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10
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Iwagami H, Kanesaka T, Ishihara R, Ohmori M, Matsuno K, Matsuura N, Nakahira H, Shichijo S, Maekawa A, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Nakatsuka S. Features of Esophageal Adenocarcinoma in Magnifying Narrow-Band Imaging. Dig Dis 2020; 39:89-95. [PMID: 32731221 DOI: 10.1159/000510561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/29/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several endoscopic classifications for esophageal adenocarcinoma have been proposed; however, gastric adenocarcinoma is much more common than esophageal or esophagogastric junctional (EGJ) adenocarcinoma in East Asian countries. We, therefore, investigated whether an endoscopic diagnostic algorithm for gastric adenocarcinoma could be used for esophageal or EGJ adenocarcinoma. METHODS One hundred eighteen consecutive patients who underwent endoscopic resection or surgery for intramucosal esophageal or EGJ adenocarcinoma, at the Osaka International Cancer Institute between January 2006 and December 2017, were included in this retrospective study. Their lesions were classified as Siewert type 1 or 2, and the presence of endoscopic magnifying narrow-band imaging findings for diagnosing gastric adenocarcinoma was evaluated. RESULTS We evaluated 125 adenocarcinomas in 118 patients (29 type 1 and 96 type 2). Demarcation lines (DLs) were seen in 7 (24%) type 1 and 53 (55%) type 2 lesions. Irregular mucosal patterns were present in 2 (7%) type 1 and 22 (23%) type 2 lesions. Irregular vascular patterns were present in 26 (90%) type 1 and 50 (52%) type 2 lesions. According to the magnifying endoscopy diagnostic algorithm for gastric adenocarcinoma, only 7 (24%) type 1 and 52 (54%) type 2 lesions were correctly diagnosed as cancers (p = 0.005). CONCLUSION The magnifying endoscopy diagnostic algorithm for gastric cancer may not be useful for esophageal or EGJ adenocarcinomas because of the low visibility of DLs, especially in Siewert type 1 adenocarcinoma.
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Affiliation(s)
- Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan,
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shinichi Nakatsuka
- Department of Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
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11
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Terao S, Suzuki S, Yaita H, Kurahara K, Shunto J, Furuta T, Maruyama Y, Ito M, Kamada T, Aoki R, Inoue K, Manabe N, Haruma K. Multicenter study of autoimmune gastritis in Japan: Clinical and endoscopic characteristics. Dig Endosc 2020; 32:364-372. [PMID: 31368581 DOI: 10.1111/den.13500] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 07/28/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM In Japan, the prevalence of autoimmune gastritis (AIG) is assumed to be very low. With the recent rapid decrease in Helicobacter pylori (Hp) prevalence, reports on AIG are increasing. This multicenter registry study aimed to clarify the characteristics of AIG, especially its endoscopic appearance. METHODS A total of 245 patients with AIG from 11 institutions in Japan from January 2010 to October 2016 were included, and their clinical and endoscopic findings were evaluated. RESULTS Mean age was 67.2 ± 11.4 years, and 63.7% of the participants were women. The most common approach to diagnose AIG was endoscopic examination. Repeated incorrect treatment for Hp infection, due to a false-positive result in 13 C-urea breath test, ranked third among the basis for diagnosis of AIG. Associated gastric lesions were type 1 neuroendocrine tumor (11.4%), adenocarcinoma (9.8%), and hyperplastic polyps (21.1%). Corpus pan-atrophy was the most common appearance (90.1%); however, remnant oxyntic mucosa was found in 31.5% of the patients (flat, localized type, 48.6%). Sticky adherent dense mucus and scattered minute whitish protrusions were also observed in approximately 30% of the patients. Despite the prevailing presumption of the antral mucosa remaining normal, 42.3% of the patients presented with various extents of atrophy, and patchy redness and circular wrinkle-like patterns were both observed in approximately 20% of the patients. CONCLUSIONS The present study showed some prominent clinical characteristics and endoscopic findings of AIG. We believe that our study will facilitate the diagnosis of potential AIG.
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Affiliation(s)
- Shuichi Terao
- Department of Gastroenterology, Kakogawa Central City Hospital, Hyogo, Japan
| | - Shiho Suzuki
- Department of Gastroenterology, Kakogawa Central City Hospital, Hyogo, Japan
| | - Hiroki Yaita
- Division of Gastroenterology, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Koichi Kurahara
- Division of Gastroenterology, Matsuyama Red Cross Hospital, Ehime, Japan
| | | | - Takahisa Furuta
- Center for Clinical Research, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuhiko Maruyama
- Department of Gastroenterology, Fujieda Municipal General Hospital, Shizuoka, Japan
| | - Masanori Ito
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoari Kamada
- Department of Health Care Medicine, Kawasaki Medical School, Okayama, Japan
| | - Rika Aoki
- Tokushima Health Screening Center, Tokushima, Japan
| | | | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Okayama, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
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12
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Two Cases of White Globe Appearance in Autoimmune Atrophic Gastritis. Case Rep Gastrointest Med 2018; 2018:7091520. [PMID: 30510814 PMCID: PMC6232817 DOI: 10.1155/2018/7091520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/23/2018] [Indexed: 12/15/2022] Open
Abstract
In this report, we described two patients with white globe appearance in autoimmune atrophic gastritis. Endoscopy revealed multiple white substances in the stomach in both cases. Biopsied specimens from the lesions contained dilated glands and showed a decrease in parietal cells. Intraglandular necrotic debris and carcinoma were absent. These results confirmed that white globe appearance can be observed in autoimmune atrophic gastritis. Moreover, microscopic features for white globe appearance observed in these cases were different from those reported previously in gastric cancer lesions and were similar to those observed for noncancerous stomach.
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13
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Iwamuro M, Tanaka T, Sakae H, Yamasaki Y, Kanzaki H, Kawano S, Kawahara Y, Okada H. Two cases of white globe appearance in non-cancerous stomach. Ecancermedicalscience 2018; 12:856. [PMID: 30174718 PMCID: PMC6113981 DOI: 10.3332/ecancer.2018.856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Indexed: 01/04/2023] Open
Abstract
In this report, we describe two patients with white globe appearance in the non-cancerous stomach. The patient in Case 1 was an 82-year-old Japanese man who had been taking vonoprazan, dimethicone, acotiamide, sitagliptin, candesartan, dutasteride, etizolam and zolpidem. The patient in Case 2 was a 74-year-old Japanese woman who had been taking esomeprazole, rebamipide, sitagliptin, candesartan, ezetimibe, mirabegron, levocetirizine, zolpidem and lactobacillus preparation. In both cases, endoscopy revealed multiple white spots in the stomach. Magnifying endoscopy and blue laser imaging revealed a slightly elevated, round, white substance. Biopsied specimens from the lesions contained parietal cell protrusions and fundic gland cysts. Intraglandular necrotic debris was absent. Consequently, microscopic features in these cases were different from those reported previously for white globe appearance observed in gastric cancer lesions. These results indicate that white globe appearance can be observed in non-cancerous stomach. Although the macroscopic features could be confusing or misleading, thorough endoscopic observation and pathological analysis of white globe appearance will aid oncologists and endoscopists in differentiating between cancer-related lesions and non-cancerous lesions.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Hiroyuki Sakae
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yasushi Yamasaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yoshiro Kawahara
- Department of Endoscopy, Okayama University Hospital, Okayama 700-8558, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
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14
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Yang G, Du W, Zhang X, Huang T, Zhang J, Liu J, Ling Y. The white substance may be a potential endoscopic marker for flat esophageal mucosal neoplastic lesions: A new endoscopic observation. Medicine (Baltimore) 2018; 97:e11885. [PMID: 30170379 PMCID: PMC6392511 DOI: 10.1097/md.0000000000011885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine whether the white substance can act as an endoscopic marker for flat esophageal mucosal neoplastic lesions.Esophageal mucosal neoplastic lesions are mainly identified using white light endoscopy, because it is cost-effective; however, this method is limited for detecting early esophageal cancer and precancerous lesions, because these are typically flat mucosal neoplastic lesions. In our experience, a white substance surrounds or covers some flat esophageal mucosal lesions that are eventually diagnosed as neoplastic lesions by biopsy pathology.After retrospective analysis of pathological and clinical data of 20,390 patients, we identified 352 patients with flat esophageal mucosal lesions on endoscopic images. Images were re-evaluated by 2 experienced endoscopists and the prevalence of the white substance recorded. Patients were divided into non-neoplastic and neoplastic groups, based on pathology.The white substance was present in 3.5% (5/144) of non-neoplastic and 14.9% (31/208) of neoplastic cases (P < .05). The diagnostic sensitivity and specificity of the white substance for neoplastic lesions diagnosis were 14.9% and 96.5%, respectively. The presence of white substance was more common in males and in those aged 50 to 79 years. It was more commonly observed in the middle third of the esophagus, and its presence did not correlate with sex, age, or lesion location (P > .05).The white substance, which is easily detected by white light endoscopy, may be an endoscopic marker facilitating detection of flat esophageal mucosal neoplastic lesions, irrespective of sex, age, and lesion location.
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15
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Omura H, Yoshida N, Hayashi T, Miwa K, Takatori H, Tsuji H, Inamura K, Shirota Y, Aoyagi H, Masunaga T, Katayanagi K, Kurumaya H, Kaneko S, Doyama H. Interobserver agreement in detection of "white globe appearance" and the ability of educational lectures to improve the diagnosis of gastric lesions. Gastric Cancer 2017; 20:620-628. [PMID: 27915451 DOI: 10.1007/s10120-016-0676-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 11/20/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND White globe appearance (WGA) refers to a small white lesion of globular shape underneath cancerous gastric epithelium that can be clearly visualized by magnifying endoscopy with narrowband imaging (M-NBI). WGA has been reported to be a novel endoscopic marker that is highly specific in differentiating early gastric cancer (GC) from low-grade adenoma, and has a significantly higher prevalence in early GCs than in noncancerous lesions. However, interobserver agreement in detecting WGA and whether training intervention can improve diagnostic accuracy are unknown. METHODS Twenty sets of M-NBI images were examined by 16 endoscopists. The endoscopists attended a lecture about WGA, and examined the images again after the lecture. Interobserver agreement in detecting WGA in the second examination and increases in the proportion of correct diagnoses and the degree of confidence of diagnoses of cancerous lesions were evaluated. RESULTS The kappa value for interobserver agreement in detecting WGA in the second examination was 0.735. The proportion of correct diagnoses was significantly higher in the second examination compared with the first examination when WGA was present (95.5% vs 55.4%; P < 0.001), but not when WGA was absent (61.6% vs 52.7%; P = 0.190). The proportion of correct diagnoses with a high degree of confidence was significantly higher in the second examination, both with WGA (91.1% vs 29.5%; P < 0.001) and without WGA (36.6% vs 20.5%; P = 0.031). CONCLUSIONS The detection of WGA by endoscopists was highly reproducible. A brief educational lecture about WGA increased the proportion of correct diagnoses and the degree of confidence of diagnoses of GC with WGA.
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Affiliation(s)
- Hitoshi Omura
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa, Ishikawa, 920-8530, Japan.,Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Naohiro Yoshida
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa, Ishikawa, 920-8530, Japan
| | - Tomoyuki Hayashi
- Department of Gastroenterology, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Kazuhiro Miwa
- Department of Gastroenterology, Japan Community Health care Organization Kanazawa Hospital, Kanazawa, Ishikawa, Japan
| | - Hajime Takatori
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Hirokazu Tsuji
- Department of Gastroenterology, Kanazawa Municipal Hospital, Kanazawa, Ishikawa, Japan
| | - Katsuhisa Inamura
- Department of Gastroenterology, Tonami General Hospital, Tonami, Toyama, Japan
| | - Yukihiro Shirota
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Aoyagi
- Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Fukui, Japan
| | - Takaharu Masunaga
- Department of Gastroenterology, Hokuriku Hospital, Kanazawa, Ishikawa, Japan
| | - Kazuyoshi Katayanagi
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroshi Kurumaya
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa, Ishikawa, 920-8530, Japan.
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16
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Lee JWJ, Lim LG, Yeoh KG. Advanced endoscopic imaging in gastric neoplasia and preneoplasia. BMJ Open Gastroenterol 2017; 4:e000105. [PMID: 28176895 PMCID: PMC5253458 DOI: 10.1136/bmjgast-2016-000105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/30/2016] [Indexed: 12/17/2022] Open
Abstract
Conventional white light endoscopy remains the current standard in routine clinical practice for early detection of gastric cancer. However, it may not accurately diagnose preneoplastic gastric lesions. The technological advancements in the field of endoscopic imaging for gastric lesions are fast growing. This article reviews currently available advanced endoscopic imaging modalities, in particular chromoendoscopy, narrow band imaging and confocal laser endomicroscopy, and their corresponding evidence shown to improve diagnosis of preneoplastic gastric lesions. Raman spectrometry and polarimetry are also introduced as promising emerging technologies.
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Affiliation(s)
- Jonathan W J Lee
- Department of Gastroenterology and Hepatology , National University Hospital , Singapore
| | - Lee Guan Lim
- Department of Internal Medicine , Raffles Hospital , Singapore
| | - Khay Guan Yeoh
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore; Department of Medicine, National University of Singapore, Singapore
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17
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Abstract
PURPOSE OF REVIEW Gastric cancer remains a leading cause of mortality worldwide and gastroenterologists are playing an increasingly larger role in its management. This article reviews the endoscopic management of gastric cancer, with emphasis on recent advances in the field. RECENT FINDINGS Long-term studies comparing surgery and endoscopic resection for early gastric cancer have shown no difference in 10-year survival rates. Second-look endoscopy, performed 2 days after endoscopic submucosal dissection (ESD) to address the concern of delayed bleeding, may not affect rebleeding rates. Magnesium, proton pump inhibitors, and bupivacaine may help reduce post-ESD pain. New devices such as the Clutch Cutter and EndoLifter may help make ESD easier and safer. SUMMARY Endoscopic therapy for early gastric cancer is becoming increasingly popular and innovations are constantly being made to improve technique and technology. This review focuses on the latest approaches to the endoscopic management of gastric cancer.
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18
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Soma N. Diagnosis of Helicobacter pylori-related chronic gastritis, gastric adenoma and early gastric cancer by magnifying endoscopy. J Dig Dis 2016; 17:641-651. [PMID: 27577845 DOI: 10.1111/1751-2980.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Indexed: 12/11/2022]
Abstract
Evaluating the prevalence and severity of gastritis by endoscopy is useful for estimating the risk of gastric cancer (GC). Moreover, understanding the endoscopic appearances of gastritis is important for diagnosing GC due to the fact that superficial mucosal lesions mimicing gastritis (gastritis-like lesions) are quite difficult to be detected even with optimum preparation and the best technique, and in such cases tissue biopsy is often not very accurate for the diagnosis of gastric epithelial neoplasia. Magnifying endoscopy is a highly accurate technique for the detection of early gastric cancer (EGC). Recent reports have described that various novel endoscopic markers which, visualized by magnifying endoscopy with image-enhanced system (ME-IEE), can predict specific histopathological findings. Using ME-IEE with vessels and surface classification system (VSCS) may represent an excellent diagnostic performance with high confidence and good reproducibility to the endoscopists if performed under consistent conditions, including observation under maximal magnification. The aim of this review was to discuss how to identify high-risk groups for GC by endoscopy, and how to detect effectively signs of suspicious lesions by conventional white light imaging (C-WLI) or chromoendoscopy (CE). Furthermore, to characterize suspicious lesions using ME-IEE using the criteria and classification of EGC based upon VSCS.
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Affiliation(s)
- Nei Soma
- Department of Gastroenterology, Medical Center, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China
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Tonai Y, Ishihara R, Yamasaki Y, Kanesaka T, Yamamoto S, Akasaka T, Hanaoka N, Takeuchi Y, Higashino K, Uedo N, Tomita Y, Iishi H. First reports of esophageal adenocarcinoma with white globe appearance in Japanese and Caucasian patients. Endosc Int Open 2016; 4:E1075-E1077. [PMID: 27747281 PMCID: PMC5063742 DOI: 10.1055/s-0042-114983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/29/2016] [Indexed: 01/14/2023] Open
Abstract
Background and study aims: Better endoscopic diagnosis in case of Barrett's esophagus is still needed. White globe appearance (WGA) is a novel endoscopic marker for gastric adenocarcinoma, with high sensitivity for differentiating between gastric cancer/high-grade dysplasia and other lesions. We report 2 cases of esophageal adenocarcinoma with WGA. In Case 1, esophagogastroduodenoscopy (EGD) revealed a 10-mm esophageal adenocarcinoma in a 48-year-old Japanese woman with short-segment Barrett's esophagus. A small (< 1 mm) white globular lesion, typical of WGA, was observed under the epithelium by magnifying narrow-band imaging. A dilated neoplastic gland with eosinophilic material and necrotic epithelial fragments was identified at the site of the WGA by histologic examination. In Case 2, EGD revealed a 5-mm esophageal adenocarcinoma in a 60-year-old Caucasian man with long-segment Barrett's esophagus. A typical WGA was observed by magnifying narrow-band imaging and similar histologic findings were identified at the site of the WGA. WGA could be a reliable endoscopic finding for target biopsy in esophageal adenocarcinoma, if its specificity is as high as in gastric cancer. The clinical implications of WGA in patients with Barrett's esophagus should be investigated further.
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Affiliation(s)
- Yusuke Tonai
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan,Corresponding author Ryu Ishihara, MD Department of Gastrointestinal OncologyOsaka Medical Center for Cancer and Cardiovascular Diseases1-3-3 Nakamichi, Higashinari-kuOsaka 537-8511Japan+81-6-6981-4067
| | - Yasushi Yamasaki
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Tomofumi Akasaka
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Noboru Hanaoka
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Yasuhiko Tomita
- Department of Pathology and Cytology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Hiroyasu Iishi
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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Yao K. Clinical Application of Magnifying Endoscopy with Narrow-Band Imaging in the Stomach. Clin Endosc 2015; 48:481-90. [PMID: 26668793 PMCID: PMC4676664 DOI: 10.5946/ce.2015.48.6.481] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/11/2015] [Accepted: 11/13/2015] [Indexed: 12/17/2022] Open
Abstract
Magnifying endoscopy with narrow-band imaging (M-NBI) can visualize superficial microanatomies in the stomach. The normal morphology of the microanatomy visualized by M-NBI differs according to the part of the stomach. The gastric fundic glandular mucosa appears as a regular honeycomb-like subepithelial capillary network (SECN) pattern with a regular collecting venule pattern and regular oval crypt opening with circular marginal crypt epithelium (MCE) pattern. The gastric pyloric glandular mucosa displays a regular coil-shaped SECN pattern and regular polygonal or curved MCE pattern. For a diagnosis of early gastric cancer using M-NBI, the vessel plus surface classification system was developed. This system is clinically useful for the differential diagnosis of focal gastritis and small depressed cancer and for determining the horizontal extent of early gastric cancer for successful endoscopic resection. Advantages of M-NBI over conventional endoscopic imaging techniques with white light include accurate diagnosis and cost effectiveness. This technique is a breakthrough in the endoscopic diagnostic field.
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Affiliation(s)
- Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan
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