Optical Microangiography: High-Definition Magnification Colonoscopy with Narrow Band Imaging (NBI) for Visualizing Mucosal Capillaries and Red Blood Cells in the Large Intestine

( Kenshi Yao ),( George K. Anagnostopoulos ),( Aida U. Jawhari ),( Philip V. Kaye ),( Chris J. Hawkey ),( Krish Ragunath ) 대한소화기기능성질환·운동학회 2008 Gut and Liver Vol.2 No.1

Background/Aims: Recent advances in zoom endoscopy have enabled the subepithelial capillary network (SECN) in different organs of the gastrointestinal tract to be visualized. Ex vivo studies have suggested that the SECN demonstrates a honeycomb-like structure in the large intestine, but this has not yet been visualized in vivo. The high clarity and resolution of narrow-band imaging (NBI) may allow visualization at the single red-blood-cell (RBC) level and more accurate visualization of the SECN. We investigated whether high-definition magnification colonoscopy with NBI is useful for visualizing capillaries and RBCs in the large intestine. Methods: Sixteen patients with bowel symptoms undergoing routine colonoscopy with normal findings in a tertiary referral academic gastroenterology and endoscopy unit were included in the study. Total colonoscopies were performed using a high-definition magnification colonoscope (CF-H260AZI, Olympus, Tokyo) and a prototype high-definition electronic endoscopy system capable of NBI. Each part of the large intestine (cecum, ascending, transverse, descending, and sigmoid colon, and rectum) was observed at the maximum magnification with white-light imaging (WLI) and NBI. The normal honeycomb-like SECN and RBC movement by high-definition magnification colonoscopy with either WLI or NBI was prospectively successfully visualized for each part of the large intestine. Results: In all subjects, high-definition magnification colonoscopy with NBI allowed the visualization of a honeycomb-like SECN together with RBC movement in each segment of the large intestine except for the rectum. In contrast, with WLI alone, neither this SECN structure nor RBC movement could be detected. Conclusions: High-definition magnification colonoscopy with NBI could be a new optical method for facilitating noninvasive investigations of both the microvascular architecture and microcirculation without the need for contrast materials. (Gut and Liver 2008; 2:14-18)

Clinical Application of Magnifying Endoscopy with Narrow-Band Imaging in the Stomach

Kenshi Yao 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.6

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.

Efficacy of endoscopy under general anesthesia for the detection of synchronous lesions in oro-hypopharyngeal cancer

Yoichiro Ono,Kenshi Yao,Yasuhiro Takaki,Satoshi Ishikawa,Kentaro Imamura,Akihiro Koga,Kensei Ohtsu,Takao Kanemitsu,Masaki Miyaoka,Takashi Hisabe,Toshiharu Ueki,Atsuko Ota,Hiroshi Tanabe,Seiji Haraoka 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.3

Background/Aims: Image-enhanced endoscopy can detect superficial oro-hypopharyngeal squamous cell carcinoma; however, reliable endoscopy of the pharyngeal region is challenging. Endoscopy under general anesthesia during transoral surgery occasionally reveals multiple synchronous lesions that remained undetected on preoperative endoscopy. Therefore, we aimed to determine the lesion detection capability of endoscopy under general anesthesia for superficial oro-hypopharyngeal squamous cell carcinoma. Methods: This retrospective study included 63 patients who underwent transoral surgery for superficial oropharyngeal squamous cell carcinoma between April 2005 and December 2020. The primary endpoint was to compare the lesion detection capabilities of preoperative endoscopy and endoscopy under general anesthesia. Other endpoints included the comparison of clinicopathological findings between lesions detected using preoperative endoscopy and those newly detected using endoscopy under general anesthesia. Results: Fifty-eight patients (85 lesions) were analyzed. The mean number of lesions per patient detected was 1.17 for preoperative endoscopy and 1.47 for endoscopy under general anesthesia. Endoscopy under general anesthesia helped detect more lesions than preoperative endoscopy did (p<0.001). The lesions that were newly detected on endoscopy under general anesthesia were small and characterized by few changes in color and surface ruggedness. Conclusions: Endoscopy under general anesthesia for superficial squamous cell carcinoma is helpful for detecting multiple synchronous lesions.

Histological Architecture of Gastric Epithelial Neoplasias That Showed Absent Microsurface Patterns, Visualized by Magnifying Endoscopy with Narrow-Band Imaging

Kenta Chuman,Kenshi Yao,Takao Kanemitsu,Takashi Nagahama,Masaki Miyaoka,Haruhiko Takahashi,Kentaro Imamura,Rino Hasegawa,Toshiharu Ueki,Hiroshi Tanabe,Seiji Haraoka,Akinori Iwashita 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.2

Background/Aims: The objective of this study was to elucidate the histological structure of the absent microsurface patterns (MSPs)that were visualized by magnifying endoscopy with narrow-band imaging (M-NBI). Methods: The study included consecutive gastric epithelial neoplasias for which M-NBI findings and histological findings couldbe compared on a one-to-one basis. The lesions were classified as absent MSPs and present MSPs based on the findings obtainedusing M-NBI. Of the histopathological findings for each lesion that corresponded to M-NBI findings, crypt opening densities, cryptlengths, crypt opening diameters, intercrypt distances, and crypt angles were measured and compared. Results: Thirty-six lesions were included in the analysis; of these, 17 lesions exhibited absent MSP and 19 lesions exhibited presentMSP. Comparing the histological measurements for absent MSPs vs. present MSPs, median crypt opening density was 0.9 cryptopenings/mm vs. 4.8 crypt openings/mm (p<0.001), respectively. The median crypt length, median crypt opening diameter, medianintercrypt distance, and median crypt angle were 80.0 μm vs. 160 μm (p<0.001), 40.0 μm vs. 44.2 μm (p=0.09), 572.5 μm vs. 166.7μm (p<0.001), and 21.6 degrees vs. 15.5 degrees (p<0.001), respectively. Conclusions: Histological findings showed that lesions exhibiting absent MSPs had lower crypt opening density, shorter crypt length,greater intercrypt distance, and larger crypt angle.

Magnified Endoscopic Findings of Multiple White Flat Lesions: A New Subtype of Gastric Hyperplastic Polyps in the Stomach

Rino Hasegawa,Kenshi Yao,Shoutomi Ihara,Masaki Miyaoka,Takao Kanemitsu,Kenta Chuman,Go Ikezono,Akikazu Hirano,Toshiharu Ueki,Hiroshi Tanabe,Atsuko Ota,Seiji Haraoka,Akinori Iwashita 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.6

Background/Aims: While the occurrence of multiple whitish flat elevated lesions (MWFL) was first reported in 2007, no studieson MWFL have been published to date. The present retrospective observational study aimed to clarify the endoscopic findings andclinicopathological features of MWFL. Methods: Subjects were consecutive patients who underwent upper gastrointestinal endoscopy as part of routine screening betweenApril 2014 and March 2015. The conventional white-light, non-magnifying and magnifying narrow-band images were reviewed. Clinical features were compared between patients with and without MWFL. Results: The conventional endoscopic findings of MWFL include multiple whitish, flat, and slightly elevated lesions of various sizes,mainly located in the gastric body and fundus. Narrow-band imaging enhanced the contrast of MWFL and background mucosa,and magnifying narrow-band imaging depicted a uniformly long, narrow, and elliptical marginal crypt epithelium with an unclearmicrovascular pattern. Histopathological findings revealed hyperplastic changes of the foveolar epithelium, and parietal cell protrusionsand oxyntic gland dilatations were observed in the fundic glands, without any intestinal metaplasia. The rate of acid-reducing drug usewas significantly higher in patients with MWFL than in those without (100% [13/13] vs. 53.7% [88/164], p<0.001). Conclusions: The present study indicated a relationship between the presence and endoscopic features of MWFL and history of acidreducingdrug use.

Association between occurrence of multiple white and flat elevated gastric lesions and oral proton pump inhibitor intake

Rino Hasegawa,Kenshi Yao,Takao Kanemitsu,Hisatomi Arima,Takayuki Hirase,Yuuya Hiratsuka,Kazuhiro Takeda,Kentaro Imamura,Kensei Ohtsu,Yoichiro Ono,Masaki Miyaoka,Takashi Hisabe,Toshiharu Ueki,Hiroshi T 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.1

Background/Aims: Multiple white and flat elevated lesions (MWFL) that develop from the gastric corpus to the fornix may be strongly associated with oral antacid intake. Therefore, this study aimed to determine the association between the occurrence of MWFL and oral proton pump inhibitor (PPI) intake and clarify the endoscopic and clinicopathological characteristics of MWFL. Methods: The study included 163 patients. The history of oral drug intake was collected, and serum gastrin levels and anti-Helicobacter pylori immunoglobulin G antibody titers were measured. Upper gastrointestinal endoscopy was performed. The primary study endpoint was the association between MWFL and oral PPI intake. Results: In the univariate analyses, MWFL were observed in 35 (49.3%) of 71 patients who received oral PPIs and 10 (10.9%) of 92 patients who did not receive oral PPIs. The occurrence of MWFL was significantly higher among patients who received PPIs than in those who did not (p<0.001). Moreover, the occurrence of MWFL was significantly higher in patients with hypergastrinemia (p=0.005). In the multivariate analyses, oral PPI intake was the only significant independent factor associated with the presence of MWFL (p=0.001; odds ratio, 5.78; 95% confidence interval, 2.06–16.2). Conclusions: Our findings suggest that oral PPI intake is associated with the presence of MWFL (UMINCTR 000030144).

White Opaque Substance, a New Optical Marker on Magnifying Endoscopy: Usefulness in Diagnosing Colorectal Epithelial Neoplasms

Kazutomo Yamasaki,Takashi Hisabe,Kenshi Yao,Hiroshi Ishihara,Kentaro Imamura,Tatsuhisa Yasaka,Hiroshi Tanabe,Akinori Iwashita,Toshiharu Ueki 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.4

Background/Aims: A white substance that is opaque to endoscopic light is sometimes observed in the epithelium during narrowbandimaging with magnifying endoscopy of gastric or colorectal epithelial neoplasms. This prospective observational study aimedto determine whether the morphology of the white opaque substance (WOS) allows differential diagnosis between colorectaladenoma and carcinoma. Methods: A consecutive series of patients with colorectal adenomas or early carcinomas who underwent endoscopic resectionor surgical excision were studied. The morphology of the WOS was determined based on endoscopic images before thehistopathological diagnosis was performed. The primary outcome was the diagnostic performance of an irregular WOS as a markerof colorectal carcinoma. Results: The study analyzed 125 lesions. A total of 33 lesions showed an irregular WOS, and 92 lesions showed a regular WOS. Among the 33 lesions found to show an irregular WOS, 30 were carcinomas. Among the 92 lesions showing a regular WOS, 79 wereadenomas. With irregular WOS as a marker of carcinoma, the diagnostic accuracy was 87%, sensitivity was 91%, and specificity was86%. Conclusions: This study demonstrated the potential usefulness of the morphology of the WOS as a marker for the differentialdiagnosis between adenoma and carcinoma in cases of colorectal epithelial neoplasms.

Image-Enhanced Endoscopy and Its Corresponding Histopathology in the Stomach

( Hisashi Doyama ),( Hiroyoshi Nakanishi ),( Kenshi Yao ) 대한간학회 2021 Gut and Liver Vol.15 No.3

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;15:329-337)

Non-atrophic gastric mucosa is an independently associated factor for superficial non-ampullary duodenal epithelial tumors: a multicenter, matched, case-control study

Azusa Kawasaki,Kunihiro Tsuji,Noriya Uedo,Takashi Kanesaka,Hideaki Miyamoto,Ryosuke Gushima,Yosuke Minoda,Eikichi Ihara,Ryosuke Amano,Kenshi Yao,Yoshihide Naito,Hiroyuki Aoyagi,Takehiro Iwasaki,Kunihi 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.1

Background/Aims: The etiology of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. Recent studieshave reported conflicting associations between duodenal tumor development and Helicobacter pylori infection or endoscopic gastricmucosal atrophy. As such, the present study aimed to clarify the relationship between SNADETs and H. pylori infection and/or endoscopicgastric mucosal atrophy. Methods: This retrospective case-control study reviewed data from 177 consecutive patients with SNADETs who underwent endoscopicor surgical resection at seven institutions in Japan over a three-year period. The prevalence of endoscopic gastric mucosal atrophyand the status of H. pylori infection were compared in 531 sex- and age-matched controls selected from screening endoscopies attwo of the seven participating institutions. Results: For H. pylori infection, 85 of 177 (48.0%) patients exhibited SNADETs and 112 of 531 (21.1%) control patients were non-infected(p<0.001). Non-atrophic mucosa (C0 to C1) was observed in 96 of 177 (54.2%) patients with SNADETs and 112 of 531 (21.1%)control patients (p<0.001). Conditional logistic regression analysis revealed that non-atrophic gastric mucosa was an independent riskfactor for SNADETs (odds ratio, 5.10; 95% confidence interval, 2.44–8.40; p<0.001). Conclusions: Non-atrophic gastric mucosa, regardless of H. pylori infection status, was a factor independently associated with SNADETs.