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        Diagnostic Ability of High-definition Imaging Using Ultraslim Endoscopes in Early Gastric Cancer

        Sugita, Tomomi,Suzuki, Sho,Ichijima, Ryoji,Ogura, Kanako,Kusano, Chika,Ikehara, Hisatomo,Gotoda, Takuji,Moriyama, Mitsuhiko The Korean Gastric Cancer Association 2021 Journal of gastric cancer Vol.21 No.3

        Purpose: It is unclear whether high-definition (HD) imaging improves visibility and diagnostic ability in early gastric cancer (EGC) compared with standard-definition (SD) imaging. We aimed to compare the diagnostic performance and visibility scores of HD and SD ultraslim endoscopes in EGC. Materials and Methods: We used HD and SD ultraslim endoscopes to obtain 60 images with similar compositions of gastric environments. Of the 60 images, 30 showed EGC (15 images for each modality) and 30 showed no EGC (15 images for each modality). Seventeen endoscopists evaluated the presence and location of the lesions in each image. Diagnostic ability was compared between modalities. The color difference between a lesion and the surrounding mucosa (ΔE) was measured and compared between the modalities. Results: The ability of HD to detect EGC was significantly higher than that of SD (accuracy: 80.8% vs. 71.6%, P=0.017; sensitivity: 94.9% vs. 76.5%, P<0.001; positive predictive value, 76.2% vs. 55.3%, P<0.001; and negative predictive value (NPV), 94.1% vs. 73.5%, P<0.001). The ability of HD to determine the horizontal extent of EGC was significantly higher than that of SD (accuracy: 71.0% vs. 57.8%, P=0.004; sensitivity: 75.3% vs. 49.0%, P<0.001; NPV, 72.9% vs. 55.9%, P<0.001; and area under the curve: 0.891 vs. 0.631, P=0.038). The mean ΔE was significantly higher for HD than for SD (10.3 vs. 5.9, P=0.011). Conclusions: The HD ultraslim endoscope showed a higher diagnostic performance in EGC than the SD endoscope because it provided good color contrast.

      • KCI등재

        Reduced Intravenous Fluorescein Dose for Upper and Lower Gastrointestinal Tract Probe-Based Confocal Laser Endomicroscopy

        Kazuya Inoki,Seiichiro Abe,Yusaku Tanaka,Koji Yamamoto,Daisuke Hihara,Ryoji Ichijima,Yukihiro Nakatani,Hsin- Yu Chen,Hiroyuki Takamaru,Masau Sekiguchi,Masayoshi Yamada,Taku Sakamoto,Satoru Nonaka,Haru 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.3

        Background/Aims: Probe-based confocal laser endomicroscopy (pCLE) requires the administration of intravenous (IV) fluorescein. This study aimed to determine the optimal dose of IV fluorescein for both upper and lower gastrointestinal (GI) tract pCLE. Methods: Patients 20 to 79 years old with gastric high-grade dysplasia (HGD) or colorectal neoplasms (CRNs) were enrolled in thestudy. The dose de-escalation method was employed with five levels. The primary endpoint of the study was the determination ofthe optimal dose of IV fluorescein for pCLE of the GI tract. The reduced dose was determined based on off-line reviews by threeendoscopists. An insufficient dose of fluorescein was defined as the dose of fluorescein with which the pCLE images were notdeemed to be visible. If all three endoscopists determined that the tissue structure was visible, the doses were de-escalated. Results: A total of 12 patients with gastric HGD and 12 patients with CRNs were enrolled in the study. Doses were de-escalated to0.5 mg/kg of fluorescein for both non-neoplastic duodenal and colorectal mucosa. All gastric HGD or CRNs were visible with pCLEwith IV fluorescein at 0.5 mg/kg. Conclusions: In the present study, pCLE with IV fluorescein 0.5 mg/kg was adequate to visualize the magnified structure of both theupper and lower GI tract.

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