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Mo1548 Usefulness of Capsule Endoscopy With Selected White-Light LEDs (Contrast Capsule) for Small Intestinal Lesions
Abstracts
Mo1547 Usefulness of Narrow-Band Imaging in Delineating Early Gastric Cancer Sayoko Nakayama1, Hirohisa Machida1, Kazunari Tominaga1, Masatsugu Shiba2, Yasuaki Nagami1, Satoshi Sugimori1, Masami Nakatani1, Natsuhiko Kameda1, Hirotoshi Okazaki1, Hirokazu Yamagami1, Tetsuya Tanigawa1, Kenji Watanabe1, Toshio Watanabe1, Yasuhiro Fujiwara1, Tetsuo Arakawa1 1 Osaka City University Graduate School of Medicine, Osaka, Japan; 2 Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan [Background & Aims]: Endoscopic submucosal dissection (ESD) has been widely accepted as an endoscopic therapy for early gastric cancer (EGC), to obtain a precise pathological diagnosis and promising curability for EGC. Appropriately margining resection at will is one of distinctive features of ESD, therefore, the precise estimation for the lateral extent of the lesion has an important role in successful ESD. The aim of this study is to investigate the usefulness in delineating the lateral extent of EGC using narrow-band imaging (NBI) endoscopy with magnification. [Methods]: February 2004 to October 2010, a total of 503 patients who underwent ESD for EGC achieving en bloc resection were enrolled in this study from. Patients were assigned to two groups, according to whether or not they underwent NBI endoscopy with magnification before ESD; Group A: 37 lesions evaluated with chromoendoscopy, as a historical control and group B: 465 lesions evaluated with NBI endoscopy. As outcome measures, complete resection rate (defined as en bloc resection and cancer free margin), location, size, macroscopic type, histology and presence of ulcer scar (UL) were compared between groups. In estimating the lateral extent, the margin was determined according to surface structure of mucosa in chromoendoscopy with indigo-carmine dye spraying and the presence of irregular microvascular pattern and demarcation line which were specific for EGC in NBI endoscopy. [Results]: Complete resection rate in group B was superior to that in group A (98.3% (8/ 465) vs. 91.9% (34/37), p ⬍ 0.01). The incidence of incomplete resection was as followed; 1) Location; upper/ middle/ low: 1.5% (2/132)/ 3.5% (5/144)/ 0.5% (1/ 189), 2) Size; less than 20mm/ over 20mm: 1.3% (4/305)/ 2.5% (4/160), 3) Macroscopic type; elevated/ flat/ depressed: 0% (0/244)/ 6.7% (1/15)/ 3.4% (7/ 206), 4) Histology; differentiated/ undifferentiated: 1.3% (6/446)/ 5.3% (2/38), 5) Presence of an ulcer scar; 6.2%(5/81)/ 0.8% (3/384). As a result of univariate analysis in group B, complete resection rate was significantly inferior in the point of macroscopic type (p⫽0.01), presence of UL (p⫽0.01) and histology (p⫽0.027), in comparison with cancer positive and negative in margin. And it was not significant in location and size. In multivariate analysis, it was significant in the point of histology (p⫽0.025) and presence of UL (p⫽0.025). [Conclusions]: NBI endoscopy with magnification might be usefulness in an appropriate delineating the lateral extent of EGC. Features of histology or ulcer scar may affect the accurate endoscopic marginal estimation for EGC even though using NBI endoscopy.
Mo1548 Usefulness of Capsule Endoscopy With Selected White-Light LEDs (Contrast Capsule) for Small Intestinal Lesions Noriyuki Ogata, Kazuo Ohtsuka, Seiko Hayashi, Kenta Kodama, Hideyuki Miyachi, Nobunao Ikehara, Fuyuhiko Yamamura, Haruhiro Inoue, Shin-Ei Kudo Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama City, Japan Background and Aims: Capsule endoscopy (CE) is useful in patients with obscure gastrointestinal bleeding (OGIB). However, normal white-light CE images are often hard to assess compared to enteroscopy. The current technique and technology of image-enhanced endoscopy is available in conventional endoscopy, to augment the detection, diagnosis and treatment of lesions. Therefore, image-enhanced video capsule endoscopy is hopeful that it assists accurate diagnosis of small intestinal lesions. Recently Contrast Capsule is developed. That is equipped with selected white-light light emission diodes (LEDs) which have increased illumination intensity in blue light i.e. the main absorption range of hemoglobin. The normal white-light image is consisting of all colors (red, green and blue). The contrast image is generated out of green and blue. Here, we evaluated whether this contrast image improved the visibility of small intestinal lesions and was useful for diagnosis of small intestinal diseases in patients with OGIB. Methods: From October 2009 to October 2010, sixteen patients (8 males and 8 females) with OGIB were enrolled this study. The contrast capsule, Olympus EC Type 1 (Olympus Medical Systems, Tokyo, Japan) was used. The size of this capsule is 26 mm ⫻ 11 mm. Two blinded gastrointestinal physicians evaluated the contrast images. The visibility of small intestinal lesions was compared with the normal white-light image. It was also assessed whether the contrast image was useful for diagnosis of small intestinal diseases. Inter- and intra-observer agreement was calculated by using kappa statics. Results: Twenty small intestinal lesions of 16 patients (13 lesions: erosion/ ulceration, 4 lesions: inflammation, 3 lesions: angioectagia) were detected.
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Visibility of small intestinal lesions was improved in 75% (15/20), equivalent in 20% (4/20), and reduced in 5% (1/20). The mean (95% CI) inter- and intraobserver kappa values for visibility were 0.57 and 0.78. The contrast image was useful for diagnosis in 85% (17/20). The mean (95% CI) inter- and intra-observer kappa values for usefulness for diagnosis were 0.44 and 0.46. Conclusion: Contrast Capsule improved the visibility of small intestinal lesions. This new technology may be useful for diagnosis of small intestinal diseases.
Mo1549 Diagnostic Utility of Narrow-Band Imaging Endoscopy for Superficial Pharyngeal Squamous Cell Carcinoma Akira Dobashi1, Kenichi Goda1, Noboru Yoshimura1, Kazuki Sumiyama1, Hirobumi Toyoizumi1, Tomohiro Kato1, Hisao Tajiri2, Masahiro Ikegami3 1 Endoscopy, The Jikei University School of Medicine, Tokyo, Japan; 2 Gastroenterology and Hepatology, The Jikei University School of Medicine, Tokyo, Japan; 3Pathology, The Jikei University School of Medicine, Tokyo, Japan Aim: To reveal endoscopic characteristics of superficial pharyngeal squamous cell carcinoma, and to investigate diagnostic utility of narrow-band imaging (NBI). Patients and Methods: This is the prospective and single-center study. A total of 335 patients underwent conventional white-light imaging (CWI) endoscopy and non-magnifying/magnifying NBI endoscopy, followed by endoscopic biopsy for 445 pharyngeal superficial lesions. Macroscopic type of superficial lesion was defined as elevated (less than 5mm in height), flat or depressed (not ulcerous). We assessed CWI endoscopic findings of color, demarcation, and macroscopic type. NBI endoscopic findings were also made assessment of brownish area, intervascular brownish epithelium, and proliferation and irregular pattern of superficial microvessels. Histology was defined superficial carcinoma (SC) as squamous cell carcinoma and high-grade intraepithelial dysplasia. We investigated endoscopic characteristics of SC lesions in the oropharynx and hypopharyx. Resuls: Three hundred thirty three of the 445 lesions were classified into the non-SC and 112 into the SC. In univariate analysis, incidence of the red in color (p⬍0.001) and the elevated type (p⫽0.013) on CWI endoscopy were significantly higher than in the SC lesions compared with the non-SC lesions. As for non-magnifying NBI endoscopic findings, the incidence of a brownish area in the SC lesions was significantly higher than that in the non-SC lesions (p⬍0.001). In terms of magnifying NBI endoscopic findings, the SC lesions showed significantly higher incidence of intervascular brownish epithelium (p⬍0.001), proliferation (p⬍0.001), dilation (p⫽0.001), irregular pattern (p⬍0.001) compared with the non-SC lesions. Multivariate analysis revealed that, compared to the non-SC lesions, the SC lesions showed significantly higher incidences of red in color (p⫽0.022) on CWI endoscopy and intervascular brownish epithelium (p⬍0.001) and an irregular pattern of microvessels (p⬍0.001) on magnifying NBI endoscopy. Conclusion: Magnifying NBI endoscopy seems to increase the diagnostic yield of CWI endoscopy for the superficial pharyngeal squamous cell carcinoma.
Mo1550 Interobserver Agreement on the Evaluation of the Neoplastic and Non Neoplastic Polypoid Colo-Rectal Lesions Visualized With Pentax I-Scan Technique: An Italian Multicenter Study Benedetto Mangiavillano1, Paolo Viaggi1, Pier Alberto Testoni6, Sandro Zambelli4, Federico Buffoli3, Teresa Staiano3, Cristiano Crosta2, Giancarla Fiori2, Cristina Trovato2, Manfredi Guido4, Francesco Manguso5, Monica Arena1, Maria Mangano1, Tara Santoro1, Enzo Masci1 1 San Paolo University Hospital - University of Milan, Milan, Italy; 2 IEO, Milan, Italy; 3Azienda Istituti Ospitalieri, Milan, Italy; 4Maggiore Hospital, Crema, Italy; 5Cardarelli Hospital, Naples, Italy; 6San Raffalele Hospital, Milan, Italy Background and Aim: Endoscopic HD i-Scan processors incorporate highdefinition endoscopic images with the possibility of matching, real time, three different type of image enhancement: Surface Enhancement (SE), for the improving light-dark contrast allowing detailed observation of a mucosal surface structure; Contrast Enhancement (CE), digitally adds blue colour in relatively dark areas allowing detailed observation of subtle irregularities around the surface, and Tone Enhancement (TE) that recombining the individual Red Green Blue (RGB) components, producing a new colour image enhancing vessel and minute mucosal structures (electronic chromoendoscopy). Combining these advanced techniques is possible to improve the endoscopic visualization of the surface (pit-pattern) and margin of the polyps, distinguishing between neoplastic and non-neoplastic polyps. The aim of this multicentric study was to assess the interobserver agreement in the visualization of the polyps’ surface and margin and in the distinguishing of neoplastic and non neoplastic (n/nn) colo-rectal polyps using different preset enhancement settings. Materials and Methods: 400
Volume 73, No. 4S : 2011
GASTROINTESTINAL ENDOSCOPY
AB383
Mo1547 Usefulness of Narrow-Band Imaging in Delineating Early Gastric Cancer Sayoko Nakayama1, Hirohisa Machida1, Kazunari Tominaga1, Masatsugu Shiba2, Yasuaki Nagami1, Satoshi Sugimori1, Masami Nakatani1, Natsuhiko Kameda1, Hirotoshi Okazaki1, Hirokazu Yamagami1, Tetsuya Tanigawa1, Kenji Watanabe1, Toshio Watanabe1, Yasuhiro Fujiwara1, Tetsuo Arakawa1 1 Osaka City University Graduate School of Medicine, Osaka, Japan; 2 Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan [Background & Aims]: Endoscopic submucosal dissection (ESD) has been widely accepted as an endoscopic therapy for early gastric cancer (EGC), to obtain a precise pathological diagnosis and promising curability for EGC. Appropriately margining resection at will is one of distinctive features of ESD, therefore, the precise estimation for the lateral extent of the lesion has an important role in successful ESD. The aim of this study is to investigate the usefulness in delineating the lateral extent of EGC using narrow-band imaging (NBI) endoscopy with magnification. [Methods]: February 2004 to October 2010, a total of 503 patients who underwent ESD for EGC achieving en bloc resection were enrolled in this study from. Patients were assigned to two groups, according to whether or not they underwent NBI endoscopy with magnification before ESD; Group A: 37 lesions evaluated with chromoendoscopy, as a historical control and group B: 465 lesions evaluated with NBI endoscopy. As outcome measures, complete resection rate (defined as en bloc resection and cancer free margin), location, size, macroscopic type, histology and presence of ulcer scar (UL) were compared between groups. In estimating the lateral extent, the margin was determined according to surface structure of mucosa in chromoendoscopy with indigo-carmine dye spraying and the presence of irregular microvascular pattern and demarcation line which were specific for EGC in NBI endoscopy. [Results]: Complete resection rate in group B was superior to that in group A (98.3% (8/ 465) vs. 91.9% (34/37), p ⬍ 0.01). The incidence of incomplete resection was as followed; 1) Location; upper/ middle/ low: 1.5% (2/132)/ 3.5% (5/144)/ 0.5% (1/ 189), 2) Size; less than 20mm/ over 20mm: 1.3% (4/305)/ 2.5% (4/160), 3) Macroscopic type; elevated/ flat/ depressed: 0% (0/244)/ 6.7% (1/15)/ 3.4% (7/ 206), 4) Histology; differentiated/ undifferentiated: 1.3% (6/446)/ 5.3% (2/38), 5) Presence of an ulcer scar; 6.2%(5/81)/ 0.8% (3/384). As a result of univariate analysis in group B, complete resection rate was significantly inferior in the point of macroscopic type (p⫽0.01), presence of UL (p⫽0.01) and histology (p⫽0.027), in comparison with cancer positive and negative in margin. And it was not significant in location and size. In multivariate analysis, it was significant in the point of histology (p⫽0.025) and presence of UL (p⫽0.025). [Conclusions]: NBI endoscopy with magnification might be usefulness in an appropriate delineating the lateral extent of EGC. Features of histology or ulcer scar may affect the accurate endoscopic marginal estimation for EGC even though using NBI endoscopy.
Mo1548 Usefulness of Capsule Endoscopy With Selected White-Light LEDs (Contrast Capsule) for Small Intestinal Lesions Noriyuki Ogata, Kazuo Ohtsuka, Seiko Hayashi, Kenta Kodama, Hideyuki Miyachi, Nobunao Ikehara, Fuyuhiko Yamamura, Haruhiro Inoue, Shin-Ei Kudo Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama City, Japan Background and Aims: Capsule endoscopy (CE) is useful in patients with obscure gastrointestinal bleeding (OGIB). However, normal white-light CE images are often hard to assess compared to enteroscopy. The current technique and technology of image-enhanced endoscopy is available in conventional endoscopy, to augment the detection, diagnosis and treatment of lesions. Therefore, image-enhanced video capsule endoscopy is hopeful that it assists accurate diagnosis of small intestinal lesions. Recently Contrast Capsule is developed. That is equipped with selected white-light light emission diodes (LEDs) which have increased illumination intensity in blue light i.e. the main absorption range of hemoglobin. The normal white-light image is consisting of all colors (red, green and blue). The contrast image is generated out of green and blue. Here, we evaluated whether this contrast image improved the visibility of small intestinal lesions and was useful for diagnosis of small intestinal diseases in patients with OGIB. Methods: From October 2009 to October 2010, sixteen patients (8 males and 8 females) with OGIB were enrolled this study. The contrast capsule, Olympus EC Type 1 (Olympus Medical Systems, Tokyo, Japan) was used. The size of this capsule is 26 mm ⫻ 11 mm. Two blinded gastrointestinal physicians evaluated the contrast images. The visibility of small intestinal lesions was compared with the normal white-light image. It was also assessed whether the contrast image was useful for diagnosis of small intestinal diseases. Inter- and intra-observer agreement was calculated by using kappa statics. Results: Twenty small intestinal lesions of 16 patients (13 lesions: erosion/ ulceration, 4 lesions: inflammation, 3 lesions: angioectagia) were detected.
www.giejournal.org
Visibility of small intestinal lesions was improved in 75% (15/20), equivalent in 20% (4/20), and reduced in 5% (1/20). The mean (95% CI) inter- and intraobserver kappa values for visibility were 0.57 and 0.78. The contrast image was useful for diagnosis in 85% (17/20). The mean (95% CI) inter- and intra-observer kappa values for usefulness for diagnosis were 0.44 and 0.46. Conclusion: Contrast Capsule improved the visibility of small intestinal lesions. This new technology may be useful for diagnosis of small intestinal diseases.
Mo1549 Diagnostic Utility of Narrow-Band Imaging Endoscopy for Superficial Pharyngeal Squamous Cell Carcinoma Akira Dobashi1, Kenichi Goda1, Noboru Yoshimura1, Kazuki Sumiyama1, Hirobumi Toyoizumi1, Tomohiro Kato1, Hisao Tajiri2, Masahiro Ikegami3 1 Endoscopy, The Jikei University School of Medicine, Tokyo, Japan; 2 Gastroenterology and Hepatology, The Jikei University School of Medicine, Tokyo, Japan; 3Pathology, The Jikei University School of Medicine, Tokyo, Japan Aim: To reveal endoscopic characteristics of superficial pharyngeal squamous cell carcinoma, and to investigate diagnostic utility of narrow-band imaging (NBI). Patients and Methods: This is the prospective and single-center study. A total of 335 patients underwent conventional white-light imaging (CWI) endoscopy and non-magnifying/magnifying NBI endoscopy, followed by endoscopic biopsy for 445 pharyngeal superficial lesions. Macroscopic type of superficial lesion was defined as elevated (less than 5mm in height), flat or depressed (not ulcerous). We assessed CWI endoscopic findings of color, demarcation, and macroscopic type. NBI endoscopic findings were also made assessment of brownish area, intervascular brownish epithelium, and proliferation and irregular pattern of superficial microvessels. Histology was defined superficial carcinoma (SC) as squamous cell carcinoma and high-grade intraepithelial dysplasia. We investigated endoscopic characteristics of SC lesions in the oropharynx and hypopharyx. Resuls: Three hundred thirty three of the 445 lesions were classified into the non-SC and 112 into the SC. In univariate analysis, incidence of the red in color (p⬍0.001) and the elevated type (p⫽0.013) on CWI endoscopy were significantly higher than in the SC lesions compared with the non-SC lesions. As for non-magnifying NBI endoscopic findings, the incidence of a brownish area in the SC lesions was significantly higher than that in the non-SC lesions (p⬍0.001). In terms of magnifying NBI endoscopic findings, the SC lesions showed significantly higher incidence of intervascular brownish epithelium (p⬍0.001), proliferation (p⬍0.001), dilation (p⫽0.001), irregular pattern (p⬍0.001) compared with the non-SC lesions. Multivariate analysis revealed that, compared to the non-SC lesions, the SC lesions showed significantly higher incidences of red in color (p⫽0.022) on CWI endoscopy and intervascular brownish epithelium (p⬍0.001) and an irregular pattern of microvessels (p⬍0.001) on magnifying NBI endoscopy. Conclusion: Magnifying NBI endoscopy seems to increase the diagnostic yield of CWI endoscopy for the superficial pharyngeal squamous cell carcinoma.
Mo1550 Interobserver Agreement on the Evaluation of the Neoplastic and Non Neoplastic Polypoid Colo-Rectal Lesions Visualized With Pentax I-Scan Technique: An Italian Multicenter Study Benedetto Mangiavillano1, Paolo Viaggi1, Pier Alberto Testoni6, Sandro Zambelli4, Federico Buffoli3, Teresa Staiano3, Cristiano Crosta2, Giancarla Fiori2, Cristina Trovato2, Manfredi Guido4, Francesco Manguso5, Monica Arena1, Maria Mangano1, Tara Santoro1, Enzo Masci1 1 San Paolo University Hospital - University of Milan, Milan, Italy; 2 IEO, Milan, Italy; 3Azienda Istituti Ospitalieri, Milan, Italy; 4Maggiore Hospital, Crema, Italy; 5Cardarelli Hospital, Naples, Italy; 6San Raffalele Hospital, Milan, Italy Background and Aim: Endoscopic HD i-Scan processors incorporate highdefinition endoscopic images with the possibility of matching, real time, three different type of image enhancement: Surface Enhancement (SE), for the improving light-dark contrast allowing detailed observation of a mucosal surface structure; Contrast Enhancement (CE), digitally adds blue colour in relatively dark areas allowing detailed observation of subtle irregularities around the surface, and Tone Enhancement (TE) that recombining the individual Red Green Blue (RGB) components, producing a new colour image enhancing vessel and minute mucosal structures (electronic chromoendoscopy). Combining these advanced techniques is possible to improve the endoscopic visualization of the surface (pit-pattern) and margin of the polyps, distinguishing between neoplastic and non-neoplastic polyps. The aim of this multicentric study was to assess the interobserver agreement in the visualization of the polyps’ surface and margin and in the distinguishing of neoplastic and non neoplastic (n/nn) colo-rectal polyps using different preset enhancement settings. Materials and Methods: 400
Volume 73, No. 4S : 2011
GASTROINTESTINAL ENDOSCOPY
AB383