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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Brown slits for colorectal adenoma crypts on conventional magnifying endoscopy with narrow band imaging using the X1 system
Osamu Toyoshima, Toshihiro Nishizawa, Shuntaro Yoshida, Hidenobu Watanabe, Nariaki Odawara, Kosuke Sakitani, Toru Arano, Hirotoshi Takiyama, Hideyuki Kobayashi, Hirofumi Kogure, Mitsuhiro Fujishiro
Osamu Toyoshima, Toshihiro Nishizawa, Shuntaro Yoshida, Nariaki Odawara, Kosuke Sakitani, Toru Arano, Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
Toshihiro Nishizawa, Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Chiba 286-8520, Japan
Hidenobu Watanabe, Department of Pathology, Pathology and Cytology Laboratory Japan, Tokyo 166-0003, Japan
Nariaki Odawara, Hirofumi Kogure, Mitsuhiro Fujishiro, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Kosuke Sakitani, Department of Gastroenterology, Sakitani Endoscopy Clinic, Chiba 275-0026, Japan
Toru Arano, Department of Gastroenterology, The Fraternity Memorial Hospital, Tokyo 130-8587, Japan
Hirotoshi Takiyama, Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
Hideyuki Kobayashi, Department of Internal Medicine, Umegaoka Ekimae Clinic, Tokyo 154-0022, Japan
Author contributions: Toyoshima O contributed to the study design, endoscopic diagnosis, writing the article, statistical analysis, and final manuscript approval; Nishizawa T contributed to study design, editing of article, and final manuscript approval; Yoshida S contributed to study design, endoscopic diagnosis, critical review, and final manuscript approval; Watanabe H contributed to study design, histological diagnosis, and final manuscript approval; Odawara N, Sakitani K, Arano T, Takiyama H, Kobayashi H, Kogure H and Fujishiro M contributed to critical review and final manuscript approval.
Institutional review board statement: This study was approved by the Certificated Review Board, Yoyogi Mental Clinic on July 16, 2021 (approval No. RKK227).
Conflict-of-interest statement: All authors have no any conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Toshihiro Nishizawa, MD, PhD, Professor, Department of Gastroen-terology and Hepatology, International University of Health and Welfare, Narita Hospital, 852 Hatakeda, Chiba 286-8520, Japan. nisizawa@kf7.so-net.ne.jp
Received: January 16, 2022
Peer-review started: January 16, 2022
First decision: March 8, 2022
Revised: March 14, 2022
Accepted: May 14, 2022
Article in press: May 14, 2022
Published online: June 28, 2022
BACKGROUND
Accurate diagnosis of colorectal premalignant polyps, including adenomas, is vital in clinical practice.
AIM
To investigate the diagnostic yields of novel findings of brown slits for adenomas.
METHODS
Patients who underwent colonoscopy at the Toyoshima Endoscopy Clinic were enrolled. Polyps sized ≥ 5 mm suspected of adenomas or clinically significant serrated polyps were included in the study. We defined the surface structures of colorectal polyps, which were brown curves inside and along the tubular glands identified using a combination of a new X1 system (Olympus Corporation) and a conventional magnifying colonoscope with non-staining narrow band imaging (NBI), as brown slits. The brown slits corresponded to slit-like lumens on endocytoscopy and histological crypt openings of an adenoma. We evaluated the diagnostic performance of brown slits for adenoma.
RESULTS
A total of 108 Lesions from 62 patients were eligible. The average age was 60.4 years and 41.9% were male. The mean polyp size was 7.45 ± 2.83 mm. Fifty-seven lesions were positive for brown slits. Histopathological diagnosis comprised 59 low-grade tubular adenomas, 16 sessile serrated lesions, and 33 hyperplastic polyps. Among 59 adenomas, 56 (94.9%) were positive for brown slits. Among 16 sessile serrated lesions, 0 (0%) was positive for brown slits. Among 33 hyperplastic polyps, 1 (3.0%) was positive for brown slits. The sensitivity, specificity, and accuracy of brown slits for adenoma were 94.9%, 98.0%, and 96.3%, respectively. The positive predictive value and negative predictive value of brown slits for adenoma were also excellent for 98.2%, and 94.1%, respectively.
CONCLUSION
Brown slits on conventional magnifying endoscopy with non-staining NBI using the X1 system were useful for diagnosing colorectal adenoma. The new endoscopy system could be examined using new standards.
Core Tip: We defined the polyp’s surface structure observed on conventional magnifying endoscopy with non-staining narrow band imaging using the X1 system as brown slits. The brown slits corresponded to slit-like lumens on endocytoscopy and histological crypt openings of an adenoma. Brown slits were useful for diagnosing colorectal adenoma.
