Nikolas Eleftheriadis, MD from the Digestive Disease Center at Showa University Northern Yokohama Hospital in Japan shares this video case “Acetic acid spray enhances accuracy of narrow-band imaging (NBI) magnifying endoscopy for endoscopic tissue characterization of early gastric cancer.”
In this video case we demonstrated a novel endoscopic technique using acetic acid chromoendoscopy in combination with narrow-band imaging (NBI) magnifying endoscopy for enhancement of endoscopic visual characterization of early gastric cancer and presented for the first time a novel 4-type endoscopic classification for early gastric cancer (Figure 1).
Our findings are important because gastric cancer at early stages may be misdiagnosed as erosion or superficial inflammation, and the novel acetic acid chromoendoscopic technique, first presented in this video, enhanced the accuracy of NBI magnifying endoscopy for endoscopic tissue characterization of early gastric cancer. Furthermore, the novel 4-type endoscopic classification for early gastric cancer, first described in this video, would be useful for endoscopic, real-time, diagnosis of early gastric cancer, which can be easily adopted by all endoscopists.
Our findings are interesting, for focused endoscopists aiming to diagnose and treat early gastric cancer endoscopically, because acetic acid chromoendoscopic technique further emphasized the superficial gastric mucosal glandular structures and enhanced the NBI magnifying endoscopic findings of early gastric cancer, revealing higher quality, specific abnormal endoscopic patterns, increasing the endoscopic visual characterization of early gastric cancer (figure 1). NBI magnifying endoscopic findings after acetic acid spray were comparable to histopathology of ESD specimens, which opened a new area in endoscopic histology. Finally, the novel 4-type endoscopic classification for early gastric cancer could be easily adopted by all endoscopists. These finding are important especially for controversial or atypical cases.
The exact standardization of the 4-type classification of acetic acid spary NBI magnifying endoscopy, is under further investigation.
Watch the video online.
Figure 1. Novel narrow-band imaging magnifying endoscopic (NBI-ME) classification for early gastric cancer after acetic acid spray. A, After acetic acid spray the fine network pattern (A1) of the NBI-ME classification is classified as small pit pattern (A2). B, The intralobular loop pattern 1 (ILL-1) (B1) is classified as irregular increased intensity of villous pattern (B2). C, The intralobular loop pattern 2 (ILL-2) (C1) is classified as irregular villous pattern combined with distorted pattern (C2) and (D). The corkscrew pattern is classified as distorted pattern combined with absence of glandular pattern (D2).