Post written by GIE Associate Editor Seiichiro Abe, MD, PhD, FASGE, FJGES, from the Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

Virtual chromoendoscopy has been used for diagnosing upper GI neoplasms. In particular, magnifying virtual chromoendoscopy using narrow-band imaging and blue-light imaging has been reported to be useful for lesion characterization and margin delineation of GI neoplasms. This article demonstrates the tips and tricks of magnifying endoscopy for superficial esophageal squamous cell carcinoma and early gastric cancer.

Magnifying endoscopy with narrow-band imaging or blue-light imaging highlights microvascular patterns in esophageal lesions, helping us determine depth of invasion. Detailed evaluation of microvascular and microsurface patterns is critical to differentiate early gastric cancer from noncancerous mucosa.

Preoperative endoscopic evaluation using advanced diagnostic techniques is essential to achieve R0 and curative endoscopic resection with endoscopic submucosal dissection. Some technical refinements, such as proper surface cleaning, use of a soft black cap (MAJ-1988 or MAJ-1989, Olympus, Tokyo, Japan), air deflation, lesion positioning, and water/saline immersion, are essential to obtain high-quality magnified endoscopic images.

As some guidelines and expert consensus recommend magnifying endoscopy for accurate diagnosis and appropriate treatment decision, it is desirable to promote and standardize its use in the West.

Endoscopic diagnosis of esophageal squamous cell carcinoma by magnifying endoscopy. A, High-definition white-light endoscopy shows a shallow depressed lesion in the anterior wall of the middle thoracic esophagus. B, Narrow-band imaging shows a well-demarcated brownish area. C, Low-power magnification endoscopy reveals irregular dot-shaped microvessels. D, High-power magnification endoscopy shows that these microvessels maintain a looplike structure, suggesting type B-1 vessels according to the Japan Esophageal Society classification. En bloc endoscopic submucosal dissection resection was performed. The histologic analysis suggests squamous cell carcinoma with the deepest invasion to the lamina propria mucosa without lymphovascular invasion (pT1a-LPM, Ly0, V0, pHM0, pVM0 in the Japanese esophageal cancer classification).

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