Magnifying endoscopy with narrow-band imaging is more accurate for determination of horizontal extent of early gastric cancers than chromoendoscopy

Background and study aims: Although magnifying endoscopy with narrow-band imaging (ME-NBI) is reported to be useful for delineating the horizontal extent of early gastric cancers (EGCs), there are few reports which have objectively demonstrated the superiority of ME-NBI over chromoendoscopy with indigo carmine for this purpose. We conducted an exploratory comparison of the diagnostic accuracy of both modalities for the delineation of EGCs using prospectively collected data, and clarified the clinicopathological features related to inaccurate evaluation of the horizontal extent of EGCs. Patients and methods: EGCs were assigned to the oral narrow-band imaging (O-NBI) group or the oral chromoendoscopy (O-CE) group before endoscopic submucosal dissection (ESD). The oral border was observed according to assignment, and the anal border with the other modality. The horizontal extent of the tumor was evaluated by each modality and a marking dot was placed on the visible delineation line. After ESD, the marking dots were identified pathologically and defined as “accurate evaluation” if they were located within 1 mm of the pathological tumor border. We compared the rate of accurate evaluation of ME-NBI and chromoendoscopy, and analyzed the clinicopathological features related to inaccurate evaluation. Results: A total of 113 marking dots evaluated by ME-NBI and 116 evaluated by chromoendoscopy were analyzed. The rate of accurate evaluation by ME-NBI was significantly higher than that by chromoendoscopy (89.4 % vs 75.9 %, P = 0.0071). The EGCs with flat borders and large EGCs were significantly related to inaccurate evaluation using ME-NBI. There were no significant factors related to inaccurate evaluation with chromoendoscopy. Conclusions: The accurate evaluation rate of the horizontal extent of EGCs by ME-NBI is significantly higher than that by chromoendoscopy. Study registration: UMIN000007641

[1]  胃癌研究会.  Japanese classification of gastric carcinoma , 1995 .

[2]  Y. Nakanishi,et al.  Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers , 2000, Gastric Cancer.

[3]  H. Ono,et al.  Endoscopic Submucosal Dissection of Early Gastric Cancer , 2008, Digestion.

[4]  H. Ono,et al.  ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER: TECHNICAL FEASIBILITY, OPERATION TIME AND COMPLICATIONS FROM A LARGE CONSECUTIVE SERIES , 2005 .

[5]  R. Soetikno,et al.  Endoscopic submucosal dissection of early gastric cancer , 2006, Journal of gastroenterology.

[6]  T. Yoshino,et al.  Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success , 2006, Endoscopy.

[7]  F. Kondo,et al.  Chromoendoscopy with indigo carmine dye added to acetic acid in the diagnosis of gastric neoplasia: a prospective comparative study. , 2008, Gastrointestinal endoscopy.

[8]  Mitsuhiro Fujishiro,et al.  Endoscopic submucosal dissection for gastrointestinal neoplasms. , 2008, World journal of gastroenterology.

[9]  M. Hara,et al.  Risk factors for complications of endoscopic submucosal dissection in gastric tumors: analysis of 478 lesions , 2009, Journal of Gastroenterology.

[10]  B. Keum,et al.  Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. , 2008, Gastrointestinal endoscopy.

[11]  K. Yao,et al.  Magnifying endoscopy for diagnosing and delineating early gastric cancer. , 2009, Endoscopy.

[12]  M. Mori,et al.  STRICTURE AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCERS AND ADENOMAS , 2010, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[13]  Japanese Gastric Cancer Association.  Japanese classification of gastric carcinoma: 3rd English edition , 2011, Gastric Cancer.

[14]  Young-Mi Park,et al.  The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis , 2011, Surgical Endoscopy.

[15]  Toshiyuki Matsui,et al.  Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (with video). , 2011, Gastrointestinal endoscopy.

[16]  M. Shimizu,et al.  Usefulness of the DL in ME with NBI for determining the expanded area of early-stage differentiated gastric carcinoma. , 2012, World journal of gastrointestinal endoscopy.

[17]  J. Nishikawa,et al.  Risk factors for delayed bleeding from endoscopic submucosal dissection of gastric neoplasms , 2012, Scandinavian journal of gastroenterology.

[18]  Y. Yamaji,et al.  Endoscopic Submucosal Dissection is an Effective and Safe Therapy for Early Gastric Neoplasms: A Multicenter Feasible Study , 2012, Journal of clinical gastroenterology.

[19]  N. Yamamichi,et al.  Factors predictive of inaccurate determination of horizontal extent of intestinal‐type early gastric cancers during endoscopic submucosal dissection: A retrospective analysis , 2013, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.