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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2024; 16(3): 157-167
Published online Mar 16, 2024. doi: 10.4253/wjge.v16.i3.157
Could near focus endoscopy, narrow-band imaging, and acetic acid improve the visualization of microscopic features of stomach mucosa?
Admir Kurtcehajic, Enver Zerem, Tomislav Bokun, Ervin Alibegovic, Suad Kunosic, Ahmed Hujdurovic, Amir Tursunovic, Kenana Ljuca
Admir Kurtcehajic, Department of Gastroenterology and Hepatology, Blue Medical Group, Tuzla 75000, Tuzla Kanton, Bosnia and Herzegovina
Enver Zerem, Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo 71000, Bosnia and Herzegovina
Tomislav Bokun, Department of Gastroenterology and Hepatology, University Clinical Hospital Dubrava, Zagreb 10000, Croatia
Ervin Alibegovic, Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla 75000, Tuzla Kanton, Bosnia and Herzegovina
Suad Kunosic, Department of Physics, Faculty of Natural Sciences and Mathematics, University of Tuzla, Tuzla 75000, Tuzla Kanton, Bosnia and Herzegovina
Ahmed Hujdurovic, Department of Internal Medicine, Blue Medical Group, Tuzla 75000, Tuzla Kanton, Bosnia and Herzegovina
Amir Tursunovic, Department of Surgery, University Clinical Center Tuzla, Tuzla 75000, Bosnia and Herzegovina
Kenana Ljuca, School of Medicine, University of Tuzla, Tuzla 75000, Bosnia and Herzegovina
Author contributions: Kurtcehajic A, Bokun T, and Alibegovic E provided the basic idea and designed, edited, and wrote the core of the manuscript; Zerem E reviewed the manuscript and provided intellectual input and academic writing; Kunosic S analyzed data and performed the statistical analysis; Hujdurovic A, Tursunovic A, and Ljuca K wrote the extended version of the manuscript and reviewed the literature data; and all authors read and approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethical Committee of Blue Medical Group, 75000 Tuzla, Bosnia and Herzegovina.
Informed consent statement: The signed, well-informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: Admir Kurtcehajic, PhD, Academic Research, Research Assistant, Research Scientist, Department of Gastroenterology and Hepatology, Blue Medical Group, 3rd Tuzlanska Brigada No. 7, Tuzla 75000, Tuzla Kanton, Bosnia and Herzegovina. admircg7@gmail.com
Received: October 18, 2023
Peer-review started: October 18, 2023
First decision: December 25, 2023
Revised: January 7, 2024
Accepted: February 18, 2024
Article in press: February 18, 2024
Published online: March 16, 2024
BACKGROUND
Conventional magnifying endoscopy with narrow-band imaging (NBI) observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules, subepithelial capillary network, and gastric pits.
AIM
To evaluate the effectiveness of a new one-dual (near) focus, NBI mode in the assessment of the microscopic features of gastric body mucosa compared to conventional magnification.
METHODS
During 2021 and 2022, 68 patients underwent proximal gastrointestinal endoscopy using magnification endoscopic modalities subsequently applying acetic acid (AA). The GIF-190HQ series NBI system with dual focus capability was used for the investigation of gastric mucosa. At the time of the endoscopy, the gastric body mucosa of all enrolled patients was photographed using the white light endoscopy (WLE), near focus (NF), NF-NBI, AA-NF, and AA-NF-NBI modes.
RESULTS
The WLE, NF and NF-NBI endoscopic modes for all patients (204 images) were classified in the same order into three groups. Two images from each patient for the AA-NF and AA-NF-NBI endoscopic modes were classified in the same order. According to all three observers who completed the work independently, NF magnification was significantly superior to WLE (P < 0.01), and the NF-NBI mode was significantly superior to NF magnification (P < 0.01). After applying AA, the three observers confirmed that AA-NF-NBI was significantly superior to AA-NF (P < 0.01). Interobserver kappa values for WLE were 0.609, 0.704, and 0.598, respectively and were 0.600, 0.721, and 0.637, respectively, for NF magnification. For the NF-NBI mode, the values were 0.378, 0.471, and 0.553, respectively. For AA-NF, they were 0.453, 0.603, and 0.480, respectively, and for AA-NF-NBI, they were 0.643, 0.506, and 0.354, respectively.
CONCLUSION
When investigating gastric mucosa in microscopic detail, NF-NBI was the most powerful endoscopic mode for assessing regular arrangement of collecting venules, subepithelial capillary network, and gastric pits among the five endoscopic modalities investigated in this study. AA-NF-NBI was the most powerful endoscopic mode for analyzing crypt opening and intervening part.
Core Tip: Narrow-band imaging has enabled the analysis of gastrointestinal mucosa in microscopic detail. However, this technique gives a dark image and makes it impossible to identify the color and structural microanatomy changes of the stomach mucosa, and it is necessary to combine it with the mechanical addition on the top of the scope (conventional magnification). These additions improve the visualization of the gastric mucosa but significantly complicate the procedure. We presented a new endoscopic mode called “near focus” that achieves the same or better visualization and does not require any additional accessories.
