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

Haruo Takahashi,Yoshimasa Miura,Hiroyuki Osawa,Takahito Takezawa,Yuji Ino,Masahiro Okada,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.3

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

An Ultrathin Endoscope with a 2.4-mm Working Channel Shortens the Esophagogastroduodenoscopy Time by Shortening the Suction Time

Satoshi Shinozaki,Yoshimasa Miura,Yuji Ino,Kenjiro Shinozaki,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.1

Background/Aims: Poor suction ability through a narrow working channel prolongs esophagogastroduodenoscopy (EGD). The aim of this study was to evaluate suction with a new ultrathin endoscope (EG-580NW2; Fujifilm Corp.) having a 2.4-mm working channel in clinical practice. Methods: To evaluate in vitro suction, 200 mL water was suctioned and the suction time was measured. The clinical data of 117 patients who underwent EGD were retrospectively reviewed on the basis of recorded video, and the suction time was measured by using a stopwatch. Results: In vitro, the suction time with the EG-580NW2 endoscope was significantly shorter than that with the use of an ultrathin endoscope with a 2.0-mm working channel (EG-580NW; mean ± standard deviation, 22.7±1.1 seconds vs. 34.7±2.2 seconds; p<0.001). We analyzed the total time and the suction time for routine EGD in 117 patients (50 in the EG-580NW2 group and 67 in the EG-580NW group). In the EG-580NW2 group, the total time for EGD was significantly shorter than that in the EG-580NW group (275.3±42.0 seconds vs. 300.6±46.5 seconds, p=0.003). In the EG-580NW2 group, the suction time was significantly shorter than that in the EG-580NW group (19.2±7.6 seconds vs. 38.0±15.9 seconds, p<0.001). Conclusions: An ultrathin endoscope with a 2.4-mm working channel considerably shortens the routine EGD time by shortening the suction time, in comparison with an endoscope with a 2.0-mm working channel. Background/Aims: Poor suction ability through a narrow working channel prolongs esophagogastroduodenoscopy (EGD). The aim of this study was to evaluate suction with a new ultrathin endoscope (EG-580NW2; Fujifilm Corp.) having a 2.4-mm working channel in clinical practice. Methods: To evaluate in vitro suction, 200 mL water was suctioned and the suction time was measured. The clinical data of 117 patients who underwent EGD were retrospectively reviewed on the basis of recorded video, and the suction time was measured by using a stopwatch. Results: In vitro, the suction time with the EG-580NW2 endoscope was significantly shorter than that with the use of an ultrathin endoscope with a 2.0-mm working channel (EG-580NW; mean ± standard deviation, 22.7±1.1 seconds vs. 34.7±2.2 seconds; p<0.001). We analyzed the total time and the suction time for routine EGD in 117 patients (50 in the EG-580NW2 group and 67 in the EG-580NW group). In the EG-580NW2 group, the total time for EGD was significantly shorter than that in the EG-580NW group (275.3±42.0 seconds vs. 300.6±46.5 seconds, p=0.003). In the EG-580NW2 group, the suction time was significantly shorter than that in the EG-580NW group (19.2±7.6 seconds vs. 38.0±15.9 seconds, p<0.001). Conclusions: An ultrathin endoscope with a 2.4-mm working channel considerably shortens the routine EGD time by shortening the suction time, in comparison with an endoscope with a 2.0-mm working channel.

An Ultrathin Endoscope with a 2.4-mm Working Channel Shortens the Esophagogastroduodenoscopy Time by Shortening the Suction Time

Satoshi Shinozaki,Yoshimasa Miura,Yuji Ino,Kenjiro Shinozaki,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.6

Background/Aims: Poor suction ability through a narrow working channel prolongs esophagogastroduodenoscopy (EGD). The aim of this study was to evaluate suction with a new ultrathin endoscope (EG-580NW2; Fujifilm Corp.) having a 2.4-mm working channel in clinical practice. Methods: To evaluate in vitro suction, 200 mL water was suctioned and the suction time was measured. The clinical data of 117 patients who underwent EGD were retrospectively reviewed on the basis of recorded video, and the suction time was measured by using a stopwatch. Results: In vitro, the suction time with the EG-580NW2 endoscope was significantly shorter than that with the use of an ultrathin endoscope with a 2.0-mm working channel (EG-580NW; mean ± standard deviation, 22.7±1.1 seconds vs. 34.7±2.2 seconds; p<0.001). We analyzed the total time and the suction time for routine EGD in 117 patients (50 in the EG-580NW2 group and 67 in the EG-580NW group). In the EG-580NW2 group, the total time for EGD was significantly shorter than that in the EG-580NW group (275.3±42.0 seconds vs. 300.6±46.5 seconds, p=0.003). In the EG-580NW2 group, the suction time was significantly shorter than that in the EG-580NW group (19.2±7.6 seconds vs. 38.0±15.9 seconds, p<0.001). Conclusions: An ultrathin endoscope with a 2.4-mm working channel considerably shortens the routine EGD time by shortening the suction time, in comparison with an endoscope with a 2.0-mm working channel.

Linked Color Imaging and Blue Laser Imaging for Upper Gastrointestinal Screening

Hiroyuki Osawa,Yoshimasa Miura,Takahito Takezawa,Yuji Ino,Tsevelnorov Khurelbaatar,Yuichi Sagara,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.6

White light imaging (WLI) may not reveal early upper gastrointestinal cancers. Linked color imaging (LCI) produces bright imagesin the distant view and is performed for the same screening indications as WLI. LCI and blue laser imaging (BLI) provide excellentvisibility of gastric cancers in high color contrast with respect to the surrounding tissue. The characteristic purple and green colorof metaplasias on LCI and BLI, respectively, serve to increase the contrast while visualizing gastric cancers regardless of a history ofHelicobacter pylori eradication. LCI facilitates color-based recognition of early gastric cancers of all morphological types, including flat lesions or those in an H. pylori-negative normal background mucosa as well as the diagnosis of inflamed mucosae including erosions. LCI reveals changes inmucosal color before the appearance of morphological changes in various gastric lesions. BLI is superior to LCI in the detection ofearly esophageal cancers and abnormal findings of microstructure and microvasculature in close-up views of upper gastrointestinalcancers. Excellent images can also be obtained with transnasal endoscopy. Using a combination of these modalities allows one to obtainimages useful for establishing a diagnosis. It is important to observe esophageal cancers (brown) using BLI and gastric cancers (orange)surrounded by intestinal metaplasia (purple) and duodenal cancers (orange) by LCI.

New Diagnostic Approach for Esophageal Squamous Cell Neoplasm Using Linked Color Imaging and Blue Laser Imaging Combined with Iodine Staining

Masato Tsunoda,Yoshimasa Miura,Hiroyuki Osawa,Tsevelnorov Khurelbaatar,Mio Sakaguchi,Hisashi Fukuda,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.5

A 62-year-old man with a flat early esophageal cancer was referred for endoscopic treatment. White light imaging revealed a pale redlesion, whereas linked color imaging (LCI) and blue laser imaging (BLI) yielded purple and brown images, respectively. Iodine stainingdemonstrated a large unstained area with a homogenous but very weak pink-color sign. This area appeared more clearly as purpleand green on LCI and BLI, respectively; however, a different colored portion was observed at the 4 o’clock position inside the iodineunstainedarea. Histopathology findings of the resected specimen revealed squamous intraepithelial neoplasia at the 4 o’clock positionand an esophageal squamous cell carcinoma in the remaining iodine-unstained area. LCI and BLI combined with iodine stainingproduce characteristic images that overcomes the pink-color sign, reflecting the histological features of a flat esophageal neoplasm. Thisnew method is useful for detailed evaluation of early flat squamous cell neoplasms.

Linked Color Imaging Demonstrates Characteristic Findings in Semi-Pedunculated Gastric Adenocarcinoma in Helicobacter pylori-Negative Normal Mucosa

Yuji Hiraoka,Yoshimasa Miura,Hiroyuki Osawa,Mio Sakaguchi,Masato Tsunoda,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.1

BRIEF REPORT

Appropriate Color Enhancement Settings for Blue Laser Imaging Facilitates the Diagnosis of Early Gastric Cancer with High Color Contrast

Hiraoka, Yuji,Miura, Yoshimasa,Osawa, Hiroyuki,Nomoto, Yoshie,Takahashi, Haruo,Tsunoda, Masato,Nagayama, Manabu,Ueno, Takashi,Lefor, Alan Kawarai,Yamamoto, Hironori The Korean Gastric Cancer Association 2021 Journal of gastric cancer Vol.21 No.2

Purpose: Screening image-enhanced endoscopy for gastrointestinal malignant lesions has progressed. However, the influence of the color enhancement settings for the laser endoscopic system on the visibility of lesions with higher color contrast than their surrounding mucosa has not been established. Materials and Methods: Forty early gastric cancers were retrospectively evaluated using color enhancement settings C1 and C2 for laser endoscopic systems with blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI). The visibilities of the malignant lesions in the stomach with the C1 and C2 color enhancements were scored by expert and non-expert endoscopists and compared, and the color differences between the malignant lesions and the surrounding mucosa were assessed. Results: Early gastric cancers mainly appeared orange-red on LCI and brown on BLI-bright or BLI. The surrounding mucosae were purple on LCI regardless of the color enhancement but brown or pale green with C1 enhancement and dark green with C2 enhancement on BLI-bright or BLI. The mean visibility scores for BLI-bright, BLI, and LCI with C2 enhancement were significantly higher than those with C1 enhancement. The superiority of the C2 enhancement was not demonstrated in the assessments by non-experts, but it was significant for experts using all modes. The C2 color enhancement produced a significantly greater color difference between the malignant lesions and the surrounding mucosa, especially with the use of BLI-bright (P=0.033) and BLI (P<0.001). C2 enhancement tended to be superior regardless of the morphological type, Helicobacter pylori status, or the extension of intestinal metaplasia around the cancer. Conclusions: Appropriate color enhancement settings improve the visibility of malignant lesions in the stomach and color contrast between the malignant lesions and the surrounding mucosa.

Long-term outcomes of progestin plus metformin as a fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer patients

Akira Mitsuhashi,Yuji Habu,Tatsuya Kobayashi,Yoshimasa Kawarai,Hiroshi Ishikawa,Hirokazu Usui,Makio Shozu 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.6

Objective: The present study investigated long-term outcomes of medroxyprogesteroneacetate (MPA) plus metformin therapy in terms of control of atypical endometrial hyperplasia(AEH) and endometrial cancer (EC), and post-treatment conception. Methods: We retrospectively analyzed 63 patients (42 with EC; 21 with AEH) who underwentfertility-sparing management using MPA plus metformin. MPA (400 mg/day) and metformin(750–2,250 mg/day) were administered to achieve complete response (CR). Metformin wasadministered until conception, even after MPA discontinuation. Results: Of the total patients, 48 (76%) had a body mass index (BMI) ≥25 kg/m2 and 43 (68%)showed insulin resistance. Sixty-one patients (97%) achieved CR within 18 months. CR ratesat 6, 8–9, and 12 months were 60%, 84%, and 90%, respectively. During a median followupperiod of 57 months (range, 13–115 months), relapse occurred in 8 of 61 patients (13.1%)who had achieved CR. Relapse-free survival (RFS) in all patients at 5 years was 84.8%. Uponunivariate analysis, patients with BMI ≥25 kg/m2 had significantly better prognoses than didthose with BMI <25 kg/m2 (odds ratio=0.19; 95% confidence interval=0.05–0.66; p=0.009). Overall pregnancy and live birth rates per patient were 61% (19/31) and 45% (14/31), respectively. Conclusions: MPA plus metformin is efficacious in terms of RFS and post treatmentconception. Moreover, metformin may be more efficacious for patients with BMI ≥25 kg/m2.

Advanced Treatment and Imaging in Colonoscopy: The Pocket-Creation Method for Complete Resection and Linked Color Imaging for Better Detection of Early Neoplastic Lesions by Colonoscopy

Hironori Yamamoto,Satoshi Shinozaki,Yoshikazu Hayashi,Yoshimasa Miura,Tsevelnorov Khurelbaatar,Hiroyuki Osawa,Alan Kawarai Lefor 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.2

Early detection and resection of neoplastic lesions are key objectives to diminish colorectal cancer mortality. Resection of superficialcolorectal neoplasms, cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection have all beendeveloped and used worldwide. The pocket-creation method facilitates the resection of tumors in diffcult and routine locations. Earlydetection is the most important first step to maximize the benefits of recent advancements in endoscopic techniques. However, thedetection of small, flat-shaped, or faded color lesions remains diffcult. Linked color imaging, a novel multi-light technology, facilitatesthe recognition of minor differences in tissue by enhancing the color contrast between early colorectal neoplasms and surroundingnormal mucosa in a bright field of view. The most striking feature of linked color imaging is its ability to display the color of earlyneoplastic lesions as distinct from inflammatory changes, both of which have similar “redness” when viewed using white light imaging. To increase the detection rate of neoplasms, linked color imaging should be used from the outset for endoscopic observation. Earlydetection of superficial colorectal tumors can result in decreased mortality from colorectal cancer and maintain a good quality of life forpatients.