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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
ARTICLE HIGHLIGHTS
Research background
Narrow-band imaging (NBI) is too dark to identify the color and structural microanatomy of stomach mucosa due to large lumen. Therefore, these should be combined with magnification.
Research motivation
Conventional magnification endoscopy using a soft rubber at the top of the scope, which requires demanding manipulation, could be replaced with a simple, more pragmatic, and novel endoscopic magnification technique.
Research objectives
We evaluated the possibility of a near focus (NF) magnification, NBI mode with acetic acid (AA), in the assessment of venules, capillary network, pits, and crypts in the gastric body mucosa.
Research methods
The endoscopic video information system, EVIS EXERA III CLV-190, was used with an Olympus high-resolution endoscope, GIF-190HQ series NBI system, with dual focus capability for the investigation of the gastric mucosa. At the time of the endoscopy, the gastric body mucosa of all enrolled patients was photographed using the white light endoscopy (WLE), NF, NF-NBI, AA-NF, and AA-NF-NBI modes.
Research results
From 68 patients, 204 images were classified in the same order into three groups (WLE, NF, and NF-NBI). They were observed separately and scored by two experienced endoscopists and one inexperienced endoscopist. According to all three observers 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). Interobserver kappa values for WLE were 0.609, 0.704, and 0.598, respectively, and in the case of NF magnification, they were 0.600, 0.721, and 0.637, respectively. For the NF-NBI mode, the values were 0.378, 0.471, and 0.553, respectively. AA-NF-NBI was significantly superior to AA-NF (P < 0.01) by all three observers independently. Interobserver kappa values for the AA-NF were 0.453, 0.603, and 0.480, respectively, and for AA-NF-NBI, they were 0.643, 0.506, and 0.354, respectively.
Research conclusions
Among the five endoscopic modalities investigated in this study, NF-NBI was the most powerful endoscopic mode for assessing venules, capillary network, and gastric pits. AA-NF-NBI was the most powerful endoscopic mode for analyzing crypts and space between crypts.
Research perspectives
The forthcoming studies of NF-NBI and AA-NF-NBI endoscopic modalities aim to evaluate the presence/absence of venules, the regularity/irregularity of capillary network, and the shape and size of the gastric pits and crypts in relation to Helicobacter pylori infection, intestinal metaplasia, and atrophic gastritis, etc.
