Endoscopic detection and diagnostic strategies for minute gastric cancer: A real-world observational study

Figure 1 Flowchart of patient enrollment. MGCs: Minute gastric cancers; ESD: Endoscopic submucosal dissection.

Figure 2 Minute gastric cancers found by narrow-band imaging. A–C: 0-IIc lesion in the posterior wall of gastric antrum; D–F: 0-IIb lesion in lesser curvature of gastric body; G–I: 0-IIa lesion in the greater curvature of gastric antrum; A, D and G: Lesions were difficult to be detected under white light endoscopy (arrow); B, E and H: After switching to narrow-band imaging (NBI) endoscopy, the lesions were brownish under NBI; C, F and I: Irregular microstructures and/or microvessels were seen under magnifying endoscopy with NBI.

Figure 3 Minute gastric cancers found by indigo carmine. A and B: 0-IIa lesion near the gastric angle; C and D: 0-IIc lesion in the gastric angle. A and C: Lesions were difficult to be detected under white light endoscopy (arrow); B and D: After spraying indigo carmine, the lesions were more obvious.

Figure 4 Minute gastric cancers diagnosed only using white light endoscopy combined with narrow-band imaging. A and B: 0-IIa lesion in the posterior wall of the gastric antrum; C and D: 0-IIa lesion in lesser curvature of the gastric body; E and F: 0-IIa lesion in the posterior wall of the gastric body. A, C and E: Lesions were yellowish-red or whitish under white light endoscopy; B, D and F: Lesions were brownish under narrow-band imaging with a clear demarcation line.

Figure 5 Diagnostic differences between high-confidence and low-confidence diagnosis groups using magnifying endoscopy with narrow-band imaging. A-C: 0-IIa lesion in the lesser curvature of the pyloric duct. Magnifying endoscopy with narrow-band imaging (ME-NBI) showed irregular microstructure and microvessels with a clear demarcation line, classified as high confidence in endoscopic diagnosis; D-F: 0-IIc type lesion in the lesser curvature of the gastric body. ME-NBI showed regular microstructure and slightly thickened microvessels, classified as low confidence in endoscopic diagnosis.