• color difference
• endoscopic diagnosis
• esophageal squamous cell carcinoma
• iodine staining
• texture and color enhancement imaging

• cycle‐consistent generative adversarial networks
• deep neural network
• esophageal squamous cell carcinoma
• lugol chromoendoscopy

• Humans
• Deep Learning
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/diagnostic imaging
• Esophageal Neoplasms/diagnosis
• Iodides
• Esophageal Squamous Cell Carcinoma/pathology
• Esophageal Squamous Cell Carcinoma/diagnostic imaging
• Esophageal Squamous Cell Carcinoma/diagnosis
• Esophagoscopy/methods
• Coloring Agents/administration & dosage
• Female
• Male
• Middle Aged
• Color
• Aged

• Japanese Foundation for Research and Promotion of Endoscopy

• Lugol's solution
• endoscopic submucosal dissection
• esophageal cancer
• iodine staining
• laryngitis

Lugol chromoendoscopy (LCE) has served as a standard screening technique in high-risk patients with esophageal cancer. Nevertheless, LCE is not suitable for general population screening given its side effects. Linked color imaging (LCI) is a novel image-enhanced endoscopic technique that can distinguish subtle diff-erences in mucosal color.

To compare the diagnostic performance of LCI with LCE in detecting esophageal squamous cell cancer and precancerous lesions and to evaluate whether LCE can be replaced by LCI in detecting esophageal neoplastic lesions.

In this prospective study, we enrolled 543 patients who underwent white light imaging (WLI), LCI and LCE successively. We compared the sensitivity and specificity of LCI and LCE in the detection of esophageal neoplastic lesions. Clinicopathological features and color analysis of lesions were assessed.

In total, 43 patients (45 neoplastic lesions) were analyzed. Among them, 36 patients (38 neoplastic lesions) were diagnosed with LCI, and 39 patients (41 neoplastic lesions) were diagnosed with LCE. The sensitivity of LCI was similar to that of LCE (83.7% vs 90.7%, P = 0.520), whereas the specificity of LCI was greater than that of LCE (92.4% vs 87.0%, P = 0.007). The LCI procedure time in the esophageal examination was significantly shorter than that of LCE [42 (34, 50) s vs 160 (130, 189) s, P < 0.001]. The color difference between the lesion and surrounding mucosa in LCI was significantly greater than that observed with WLI. However, the color difference in LCI was similar in different pathological types of esophageal squamous cell cancer.

LCI offers greater specificity than LCE in the detection of esophageal squamous cell cancer and precancerous lesions, and LCI represents a promising screening strategy for general populations.

• Linked color imaging
• Lugol chromoendoscopy
• Esophageal squamous cell cancer
• Precancerous lesions
• Color difference

• Humans
• Esophageal Neoplasms/pathology
• Carcinoma, Squamous Cell/pathology
• Prospective Studies
• Early Detection of Cancer/methods
• Esophageal Squamous Cell Carcinoma/diagnostic imaging
• Precancerous Conditions/pathology
• Color

• Ascorbic Acid/adverse effects
• Coloring Agents/adverse effects
• Esophageal Neoplasms/pathology
• Esophageal Squamous Cell Carcinoma
• Esophagoscopy/adverse effects
• Esophagoscopy/methods
• Humans
• Iodides/adverse effects
• Iodine

• Color
• Endoscopy, Gastrointestinal
• Esophagitis, Peptic/diagnostic imaging
• Helicobacter Infections
• Helicobacter pylori
• Humans
• Reproducibility of Results

• demarcation
• endoscopic submucosal dissection
• esophageal squamous cell carcinoma
• lugol's iodine staining
• narrow-band imaging

• Aged
• Cohort Studies
• Endoscopic Mucosal Resection/adverse effects
• Endoscopic Mucosal Resection/methods
• Esophageal Neoplasms/diagnostic imaging
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/surgery
• Esophageal Squamous Cell Carcinoma/surgery
• Esophagoscopy/methods
• Female
• Humans
• Iodides
• Male
• Middle Aged
• Narrow Band Imaging/methods
• Retrospective Studies
• Staining and Labeling

• Ascorbic Acid
• Double-Blind Method
• Humans
• Mucous Membrane

• Esophageal neoplasms
• endoscopic mucosal resection
• narrow band imaging (NBI)

• Achalasia
• Caustic injury
• Esophageal cancer
• Head and neck cancers
• Squamous cell carcinoma
• Surveillance
• Tylosis

Background/Aims. The aim of this study was to evaluate the endoscopic recognition of esophageal squamous cell carcinoma (ESCC) using four different methods (Olympus white light imaging (O-WLI), Fujifilm white light imaging (F-WLI), narrow band imaging (NBI), and blue laser imaging- (BLI-) bright). Methods. We retrospectively analyzed 25 superficial ESCCs that had been examined using the four different methods. Subjective evaluation was provided by three endoscopists as a ranking score (RS) of each image based on the ease of detection of the cancerous area. For the objective evaluation we calculated the color difference scores (CDS) between the cancerous and noncancerous areas with each of the four methods. Results. There was no difference between the mean RS of O-WLI and F-WLI. The mean RS of NBI was significantly higher than that of O-WLI and that of BLI-bright was significantly higher than that of F-WLI. Moreover, the mean RS of BLI-bright was significantly higher than that of NBI. Furthermore, in the objective evaluation, the mean CDS of BLI-bright was significantly higher than that of O-WLI, F-WLI, and NBI. Conclusion. The recognition of superficial ESCC using BLI-bright was more efficacious than the other methods tested both subjectively and objectively.

• Dysplasia
• Lugol’s iodine
• Oral
• Squamous cell carcinoma

Early detection of esophageal squamous cell carcinoma (ESCC) is an important prognosticator, but is difficult to achieve by conventional endoscopy. Conventional lugol chromoendoscopy and equipment-based image-enhanced endoscopy, such as narrow-band imaging (NBI), have various practical limitations. Since fluorescence-based visualization is considered a promising approach, we aimed to develop an activatable fluorescence probe to visualize ESCCs. First, based on the fact that various aminopeptidase activities are elevated in cancer, we screened freshly resected specimens from patients with a series of aminopeptidase-activatable fluorescence probes. The results indicated that dipeptidylpeptidase IV (DPP-IV) is specifically activated in ESCCs, and would be a suitable molecular target for detection of esophageal cancer. Therefore, we designed, synthesized and characterized a series of DPP-IV-activatable fluorescence probes. When the selected probe was topically sprayed onto endoscopic submucosal dissection (ESD) or surgical specimens, tumors were visualized within 5 min, and when the probe was sprayed on biopsy samples, the sensitivity, specificity and accuracy reached 96.9%, 85.7% and 90.5%. We believe that DPP-IV-targeted activatable fluorescence probes are practically translatable as convenient tools for clinical application to enable rapid and accurate diagnosis of early esophageal cancer during endoscopic or surgical procedures.

• Lugol's solution
• esophageal stenosis
• radiofrequency ablation
• squamous cell neoplasm

The aim of the present study was to clarify differences between micro-vascular and iodine-staining patterns in the vicinity of the tumor fronts of superficial esophageal squamous cell carcinomas (ESCCs).

Ten consecutive patients with ESCCs who were treated by endoscopic submucosal dissection (ESD) were enrolled. At the edge of the iodine-unstained area, we observed 183 sites in total using image-enhanced magnifying endoscopy. We classified the micro-vascular and iodine-staining patterns into three types: Type A, in which the line of vascular change matched the border of the iodine-unstained area; Type B, in which the border of the iodine-unstained area extended beyond the line of vascular change; Type C, in which the line of vascular change extended beyond the border of the iodine-unstained area. Then, by examining histopathological sections, we compared the diameter of intra-papillary capillary loops (IPCLs) in cancerous areas and normal squamous epithelium.

We investigated 160 sites that the adequate quality of pictures were obtained. There was no case in which the line of vascular change completely matched the whole circumference of the border of an iodine-unstained area. Among the 160 sites, type A was recognized at 76 sites (47.5%), type B at 79 sites (49.4%), and type C at 5 sites (3.1%). Histological examination showed that the mean diameter of the IPCLs in normal squamous epithelium was 16.2±3.7μm, whereas that of IPCLs in cancerous lesions was 21.0±4.4μm.

The development of iodine-unstained areas tends to precede any changes in the vascularity of the esophageal surface epithelium.

• Carcinoma, Squamous Cell/blood supply
• Carcinoma, Squamous Cell/pathology
• Early Diagnosis
• Esophageal Neoplasms/blood supply
• Esophageal Neoplasms/pathology
• Esophagoscopy/methods
• Humans
• Image Enhancement/methods
• Iodine/metabolism
• Microvessels/pathology
• Staining and Labeling/methods

AIM: To compare the tolerability of magnifying narrow band imaging endoscopy for esophageal cancer screening with that of lugol chromoendoscopy.

METHODS: We prospectively enrolled and analyzed 51 patients who were at high risk for esophageal cancer. All patients were divided into two groups: a magnifying narrow band imaging group, and a lugol chromoendoscopy group, for comparison of adverse symptoms. Esophageal cancer screening was performed on withdrawal of the endoscope. The primary endpoint was a score on a visual analogue scale for heartburn after the examination. The secondary endpoints were scale scores for retrosternal pain and dyspnea after the examinations, change in vital signs, total procedure time, and esophageal observation time.

RESULTS: The scores for heartburn and retrosternal pain in the magnifying narrow band imaging group were significantly better than those in the lugol chromoendoscopy group (P = 0.004, 0.024, respectively, ANOVA for repeated measures). The increase in heart rate after the procedure was significantly greater in the lugol chromoendoscopy group. There was no significant difference between the two groups with respect to other vital sign. The total procedure time and esophageal observation time in the magnifying narrow band imaging group were significantly shorter than those in the lugol chromoendoscopy group (450 ± 116 vs 565 ± 174, P = 0.004, 44 ± 26 vs 151 ± 72, P < 0.001, respectively).

CONCLUSION: Magnifying narrow band imaging endoscopy reduced the adverse symptoms compared with lugol chromoendoscopy. Narrow band imaging endoscopy is useful and suitable for esophageal cancer screening periodically.

• Narrow band imaging
• Lugol
• Adverse symptoms
• Visual analogue scale score
• Tolerability

• Aged
• Biopsy
• Chest Pain/etiology
• Coloring Agents/adverse effects
• Early Detection of Cancer/adverse effects
• Early Detection of Cancer/methods
• Esophageal Neoplasms/pathology
• Esophagoscopy/adverse effects
• Esophagoscopy/methods
• Female
• Heartburn/etiology
• Humans
• Iodides/adverse effects
• Japan
• Male
• Middle Aged
• Narrow Band Imaging/adverse effects
• Predictive Value of Tests
• Prospective Studies
• Risk Factors
• Time Factors

• esophageal neoplasm
• head and neck neoplasm
• second primary neoplasm
• squamous cell neoplasm

A 53-year-old man was suspected of having an esophageal neoplasm. An endoscopic examination including Lugol chromoendoscopy suggested an esophageal squamous cell neoplasm limited to the lamina propria. A targeted biopsy showed atypical squamous cells, and an endoscopic submucosal dissection was performed 22 days after the previous endoscopy. Although a single 40 mm unstained area was observed by preoperative Lugol chromoendoscopy, intraoperative endoscopy revealed a 25 mm iodine-unstained area, with small unstained areas scattered on the oral side. We included the small unstained areas in the extent of the resection through assessment by preoperative endoscopy. Histopathologically, the tumor extent appeared to coincide with the preoperative assessment. Tumor cells were found in the basal-parabasal layers of the mucosa, in which small unstained areas were scattered, although the superficial layers exhibited well-differentiated cells containing glycogen in the cytoplasm. Although Lugol chromoendoscopy, which can induce chemical esophagitis, is widely used, re-epithelialization after mucosal damage by preoperative iodine staining may complicate the intraoperative demarcation of tumors.

• Esophageal squamous cell neoplasm
• Lugol chromoendoscopy
• Re-epithelialization

Chromoendoscopy with Lugol's staining remains the gold standard technique for detecting superficial SCC. An alternative technique, such as narrow-band imaging (NBI), for “optical staining” would be desirable, since NBI is a simpler technique and has no known complications. In this study, we compare NBI without magnification and chromoendoscopy with Lugol's staining for detecting high-grade dysplasia and intramucosal esophageal squamous cell carcinoma (SCC) in patients with achalasia. This was a prospective observational study of 43 patients with achalasia referred to the Gastrointestinal Endoscopy Unit of the Hospital of Clinics, São Paulo, University Medical School, Brazil, from October 2006 to February 2007. Conventional examinations with white light, NBI, and Lugol staining were consecutively performed, and the suspected lesions were mapped, recorded, and sent for biopsy. The results of the three methods were compared regarding sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood value, and negative likelihood value. Of the 43 patients, one was diagnosed with esophageal squamous cell carcinoma, and it was detected by all of the methods. NBI technology without magnification has high sensitivity and negative predictive value for detecting superficial esophageal squamous cell carcinoma, and it has comparable results with those obtained with Lugol's staining.

AIM: To compare narrow-band imaging (NBI) without image magnification, and chromoendoscopy with Lugol’s solution for detecting high-grade dysplasia and intramucosal esophageal squamous cell carcinoma (SCC) in patients with head and neck cancer.

METHODS: This was a prospective observational study of 129 patients with primary head and neck tumors consecutively referred to the Gastrointestinal Endoscopy Unit of Hospital das Clínicas, São Paulo University Medical School, Brazil, between August 2006 and February 2007. Conventional examinations with NBI and Lugol chromoendoscopy were consecutively performed, and the discovered lesions were mapped, recorded and sent for biopsy. The results of the three methods were compared regarding sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood value and negative likelihood value.

RESULTS: Of the 129 patients, nine (7%) were diagnosed with SCC, 5 of which were in situ and 4 which were intramucosal. All carcinomas were detected through NBI and Lugol chromoendoscopy. Only 4 lesions were diagnosed through conventional examination, all of which were larger than 10 mm.

CONCLUSION: NBI technology with optical filters has high sensitivity and high negative predictive value for detecting superficial esophageal SCC, and produces results comparable to those obtained with 2.5% Lugol chromoendoscopy.

• Gastrointestinal endoscopy
• Squamous cell carcinoma
• Esophageal neoplasms
• Diagnosis
• Lugol’s solution

Endoscopy is a widely used diagnostic tool to detect reflux esophagitis. Although its specificity was reported to be excellent at 90%-95%, its sensitivity was only 50%. Therefore, it is quite difficult to detect these lesions under the standard white light endoscopy especially in patients with minimal change esophageal reflux disease (MERD). In recent years, endoscopic technologies have evolved tremendously; these include high resolution and magnification digital chromoendoscopy. These technologies are useful practically for detecting various subtle lesions along the gastrointestinal tract starting from esophagus to colon. Currently, these technologies can be classified in 2 systems; pre-processed system (NBI, Olympus) and post processed system (FICE and i-SCAN, Fujinon and Pentax respectively). Over a few years, there have been many emerging publications on the benefit of these systems on MERD detection. The overall sensitivities to diagnose MERD were reported as much better than controls. However, large, multi-center and randomized controlled studies comparing these new imaging modalities with the conventional white light chromoendoscopy are warranted to validate its accuracy. Standard, simple and precise endoscopic reading criteria for the identification of MERD are also required.

• Digital
• Chromoendoscopy
• Minimal change
• Erosive reflux esophagitis
• Diagnosis
• Pre-processed
• Post processed

• Adult
• Duodenal Diseases/chemically induced
• Duodenal Diseases/diagnosis
• Gastrointestinal Hemorrhage/chemically induced
• Gastrointestinal Hemorrhage/diagnosis
• Humans
• Iodides/administration & dosage
• Iodides/adverse effects
• Male
• Thyroid Crisis/diagnosis
• Thyroid Crisis/drug therapy