Prospective Study
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World J Gastroenterol. Nov 21, 2014; 20(43): 16311-16317
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16311
Surveillance using trimodal imaging endoscopy after endoscopic submucosal dissection for superficial gastric neoplasia
Hiroyuki Imaeda, Naoki Hosoe, Kazuhiro Kashiwagi, Yosuke Ida, Rieko Nakamura, Hidekazu Suzuki, Yoshimasa Saito, Naohisa Yahagi, Yasushi Iwao, Yuko Kitagawa, Toshifumi Hibi, Haruhiko Ogata, Takanori Kanai
Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan
Hiroyuki Imaeda, Naoki Hosoe, Kazuhiro Kashiwagi, Rieko Nakamura, Haruhiko Ogata, Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo 108-8345, Japan
Yosuke Ida, Hidekazu Suzuki, Yoshimasa Saito, Toshifumi Hibi, Takanori Kanai, Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo 108-8345, Japan
Naohisa Yahagi, Cancer Center, School of Medicine, Keio University, Tokyo 108-8345, Japan
Yasushi Iwao, Center for Preventive Medicine, School of Medicine, Keio University, Tokyo 108-8345, Japan
Yuko Kitagawa, Department of Surgery, School of Medicine, Keio University, Tokyo 108-8345, Japan
Author contributions: Imaeda H was endoscopist, planner of study design and enrollment of patients; Hosoe N was endoscopist and advisor of study, design, enrollment of patients and statistical analysis; Kashiwagi K and Ida Y were endoscopists and advisors of study design and enrollment of patients; Nakamura R, Suzuki H, Saito Y, Iwao Y and Kitagawa Y were collaborators for enrollment of patients; Yahagi N, Hibi T, Ogata H and Kanai T were supervisors.
Supported by A grant from the Japanese Foundation for Research and Promotion of Endoscopy (JFE) Grant
Correspondence to: Hiroyuki Imaeda, MD, Department of General Internal Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan. imaedahi@yahoo.co.jp
Telephone: +81-49-2761667 Fax: +81-49-2761667
Received: January 10, 2014
Revised: February 22, 2014
Accepted: July 16, 2014
Published online: November 21, 2014
Processing time: 314 Days and 1.4 Hours
Abstract

AIM: To evaluate the effectiveness of trimodal imaging endoscopy (TME) to detect another lesion after endoscopic submucosal dissection (ESD) for superficial gastric neoplasia (SGN).

METHODS: Surveillance esophagogastroduodenoscopy (EGD) using a TME was conducted in 182 patients that had undergone ESD for SGN. Autofluorescence imaging (AFI) was conducted after white-light imaging (WLI). When SGN was suspicious, magnifying endoscopy with narrow-band imaging (ME-NBI) was conducted. Final diagnoses were made by histopathologic findings of biopsy specimens. The detection rates of lesions in WLI, AFI, and NBI, and the characteristics of lesions detected by WLI and ones missed by WLI but detected by AFI were examined. The sensitivity, specificity, and accuracy of endoscopic diagnosis using WLI, AFI and ME-NBI were evaluated.

RESULTS: In 242 surveillance EGDs, 27 lesions were determined pathologically to be neoplasias. Sixteen early gastric cancers and 6 gastric adenomas could be detected by WLI. Sixteen lesions were reddish and 6 were whitish. Five gastric neoplasias were missed by WLI but were detected by AFI, and all were whitish and protruded gastric adenomas. There was a significant difference in color and pathology between the two groups (P = 0.006). Sensitivity, specificity and accuracy in ME-NBI were higher than those in both WLI and AFI. Specificity and accuracy in AFI were lower than those in WLI.

CONCLUSION: Surveillance using trimodal imaging endoscopy might be useful for detecting another lesion after endoscopic submucosal dissection for superficial gastric neoplasia.

Keywords: Autofluorescence imaging, Endoscopic submucosal dissection, Superficial gastric neoplasia

Core tip: We report surveillance esophagogastroduodenoscopy (EGD) using trimodal imaging videoendoscopy (TME) to detect another lesion after endoscopic submucosal dissection (ESD) for superficial gastric neoplasia (SGN). In 242 surveillance EGDs, 16 early gastric cancers and 11 gastric adenomas were detected, 5 of which were missed by white-light imaging (WLI) but were detected by autofluorescence imaging (AFI). The five were whitish and protruded gastric adenomas. Sensitivity, specificity and accuracy in magnifying endoscopy with narrow-band imaging were higher compared to those in both WLI and AFI. Surveillance using TME is useful for detecting another lesion after ESD for SGN.