indigo-carmine and Stomach-Neoplasms

The indication of endoscopic submucosal dissection for Barrett's esophageal adenocarcinoma (BEA) is superficial BEA without lymph node metastasis. The characteristic endoscopic findings of superficial BEA are elevation, depression, and color change. Indigocarmine spreading is useful for the diagnosis of lateral extension. It is a simple and easy enhancement method. The observation of surface and vascular pattern by magnifying endoscopy with narrow-band imaging is also useful for the diagnosis of lateral extension. The incidence of gastric cancer is high in Japan. The majority of early gastric cancer is detected by conventional endoscopy without random biopsy, or target biopsydiagnosis. The background mucosa of gastric cancer has gastritis, and the carcinogenesis based on inflammation is the same as early BEA. However, random biopsy remains the universal standard for early detection of Barrett's high-grade dysplasia and superficial BEA. A surveillance system that does not use random biopsy can and should be established using high-resolution endoscopy with target biopsy.

Topics: Adenocarcinoma; Barrett Esophagus; Biopsy; Cell Transformation, Neoplastic; Coloring Agents; Dissection; Esophageal Neoplasms; Esophagoscopy; Gastric Mucosa; Gastroscopy; Humans; Image Enhancement; Indigo Carmine; Japan; Narrow Band Imaging; Neoplasm Grading; Neoplasm Invasiveness; Precancerous Conditions; Stomach Neoplasms

Given its morbidity and mortality, the early detection and diagnosis of gastric cancer is an area of intense research focus. This article reviews the emerging use of enhanced endoscopic imaging technologies in the detection and management of gastric cancer. The combined use of white-light endoscopy with enhanced imaging technologies, such as magnification narrow-band imaging, chromoendoscopy, and autofluorescence endoscopy, demonstrates promise in the improved ability to detect and delineate gastric neoplasia. However, widespread clinical use is still limited, mainly because of the restricted availability of the technologies.

Topics: Acetic Acid; Adenocarcinoma; Coloring Agents; Early Detection of Cancer; Gastroscopy; Humans; Indigo Carmine; Methylene Blue; Narrow Band Imaging; Optical Imaging; Precancerous Conditions; Stomach Neoplasms

Because endoscopic submucosal dissection (ESD) of gastric cancer can only be curative if the cancer is detected at an early stage and a precise preoperative diagnosis is made, we reviewed the detection and characterization of early gastric cancer (EGC) using both conventional endoscopy with white-light imaging (C-WLI) and image-enhanced endoscopy (chromoendoscopy [CE] and magnifying narrow-band imaging [M-NBI]). Systematic screening of the stomach by C-WLI after ideal preparation of the patient is important for detecting a mucosal lesion, which can then be characterized using CE. However, a limitation of C-WLI with CE is the diagnosis of flat or small gastric cancers. To overcome this, M-NBI together with a comprehensive diagnostic system, termed the 'vessel plus surface classification' system, was developed and has proven very useful. Preoperative assessment for ESD involves determining: (i) histological type; (ii) size; (iii) depth of invasion; (iv) presence or absence of associated ulceration; and (v) horizontal extent of the cancer. A limitation of endoscopic diagnosis using M-NBI is the histologically undifferentiated type of carcinoma, in which case the biopsy specimen is used to make a histopathological diagnosis.

Topics: Biopsy; Coloring Agents; Diagnosis, Differential; Dissection; Early Diagnosis; Gastric Mucosa; Gastritis; Gastroscopy; Image Enhancement; Indigo Carmine; Mass Screening; Microvessels; Narrow Band Imaging; Neoplasm Invasiveness; Neoplasm Staging; Precancerous Conditions; Prognosis; Stomach Neoplasms; Stomach Ulcer

Topics: Electronics, Medical; Gastroscopes; Gastroscopy; Humans; Indigo Carmine; Neoplasm Staging; Stomach Neoplasms

This study investigated the usefulness of near-focus narrowband imaging (NF-NBI) for determining gastric tumor margins compared with indigo carmine chromoendoscopy (ICC) before endoscopic submucosal dissection (ESD).. This prospective randomized controlled trial was conducted at seven teaching hospitals in Korea. Patients with gastric adenoma or differentiated adenocarcinoma undergoing ESD were enrolled and randomly assigned to the NF-NBI or ICC group. A marking dot was placed on the most proximal margin of the tumor before ESD. The primary endpoint was delineation accuracy, which was defined as presence of marking dots within 1 mm of the tumor margin under microscopic observation.. A total of 200 patients in the NF-NBI group and 195 patients in the ICC group were included. The delineation accuracy rate was 84.5% in the NF-NBI group and 81.0% in the ICC group (P = 0.44). However, the distance from the marking dot to the margin of the tumor was significantly shorter in the NF-NBI group than in the ICC group (0.8 ± 0.8 vs 1.2 ± 1.3 mm, P < 0.01). Even after adjustment of other clinicopathological factors that are associated with difficulty of tumor delineation, NF-NBI did not show significant association with accurate delineation (odds ratio of 0.86, P = 0.60).. This prospective multicenter study showed that NF-NBI is not superior to ICC in terms of accurately delineating gastric tumors (NCT02661945).

Topics: Aged; Endoscopic Mucosal Resection; Endoscopy, Gastrointestinal; Female; Humans; Indigo Carmine; Male; Margins of Excision; Middle Aged; Narrow Band Imaging; Prospective Studies; Stomach Neoplasms; Surgery, Computer-Assisted; Treatment Outcome

Accurate delineation of tumor margins is necessary for curative resection of early gastric cancer (EGC). The objective of this multicenter, randomized, controlled study was to compare the accuracy with which magnifying narrow-band imaging (M-NBI) and indigo carmine chromoendoscopy delineate EGC margins.. Patients with EGC ≥ 10 mm undergoing endoscopic or surgical resection were enrolled. The oral-side margins of the lesions were first evaluated with conventional white-light endoscopy in both groups and then delineated by either chromoendoscopy or M-NBI. Biopsies were taken from noncancerous and cancerous mucosa, each at 5 mm from the margin. Accurate delineation was judged to have been achieved when the histological findings in all biopsy samples were consistent with endoscopic diagnoses. The primary end point was the difference in rate of accurate delineation between the two techniques.. M-NBI does not offer superior delineation of EGC margins compared with chromoendoscopy; the two methods appear to be clinically equivalent.

Topics: Aged; Biopsy; Coloring Agents; Endoscopy, Gastrointestinal; Female; Humans; Indigo Carmine; Male; Margins of Excision; Middle Aged; Narrow Band Imaging; Stomach; Stomach Neoplasms; Tumor Burden

Intestinal metaplasia (IM) of the gastric mucosa has long attracted attention as a premalignant lesion involved in gastric carcinogenesis. However, endoscopic diagnosis of IM has remained unclear for a long time. In recent years, the methylene blue staining technique and narrow-band imaging (NBI) magnifying endoscopy have facilitated clinical diagnosis of IM, although these methods have some problems due to their complexity. Simple methods for diagnosis of IM using conventional endoscopy and the indigo carmine contrast (IC) method are necessary.. This study was a multicenter, prospective, randomized, comparative study involving 10 facilities. The appearance of IM was examined using conventional and IC methods with an electronic endoscope.. Subjects included 163 patients, of whom 87 and 76 underwent conventional and IC methods, respectively. Sensitivity, specificity, and receiver operating characteristic/area under thecurve (ROC/AUC) of conventional and IC methods for the detection of IM in the gastric antrum showed that diagnostic performance of the conventional method was higher, but not significantly, than that of the IC method. Sensitivity, specificity and ROC/AUC of conventional and IC methods for the detection of IM in the gastric body showed that the IC method yielded better (but not significantly better) results than the conventional method.. The diagnostic performance of the conventional method did not significantly differ from that of the IC method. A villous appearance, whitish mucosa, and rough mucosal surface, as observed by both methods, and areae gastricae pattern, as observed by the IC method, were useful indicators for endoscopic diagnosis of IM.

Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; Biopsy, Needle; Female; Gastric Mucosa; Gastroscopy; Humans; Immunohistochemistry; Indigo Carmine; Intestinal Mucosa; Male; Metaplasia; Middle Aged; Narrow Band Imaging; Predictive Value of Tests; Prospective Studies; Risk Assessment; ROC Curve; Sensitivity and Specificity; Stomach Neoplasms

To prospectively evaluate the clinical value of different magnifying chromoendoscopy(MCE) methods in screening gastric precancerous lesions and early cancers.. Between March 2010 and October 2011, among all the patients aged over 40 who received esophagogastroduodenoscopy at Zhongshan hospital, Fudan University, suspicious lesion was detected in 699 patients, who were randomly assigned to three groups: epinephrine dye(n=240), indigo carmine dye(n=246), and acetic acid-indigo carmine mixture dye(n=213). Diagnosis was made according to surface patterns and microvessels of the lesion. Pathological diagnosis was used as the gold standard. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement(Kappa) test. McNemar Paired chi-square test was used to compare the concordance of three MCE methods, regular white light, magnification alone, and NBI magnifier before and after MCE.. Pathological examination showed inflammatory lesions in 415 patients, intestinal metaplasia in 190, low grade intra-epithelial neoplasia in 17, and high grade intra-epithelial neoplasia or early cancer in 77. The percentage of patients with consistent endoscopic and pathological diagnosis was 77.1%(185/240) for epinephrine dye, 80.5%(198/246) for indigo carmine dye, and 81.2%(173/213) for acetic acid-indigo carmine mixture dye. Kappa values were 0.579, 0.502, and 0.667 respectively(all P<0.01). For the screening of high grade intra-epithelial neoplasia or early cancer, the diagnostic sensitivities were 84.0%, 83.3%, and 92.9%, respectively, and the specificities were 98.6%, 97.3%, and 98.4%. All the three chromoendoscopy methods improved the diagnostic accuracy for precancerous lesions compared with conventional gastroscopic observation with white light(all P<0.01). Indigo carmine and acid-indigo carmine mixture dye improved the diagnostic accuracy of magnification alone(both P<0.05). There was no significant difference in diagnostic accuracy between each MCE method and magnifying NBI observation(all P>0.05).. NBI magnification and all the three MCE methods may improve the diagnostic accuracy of early gastric cancer and precancerous lesions.

Topics: Acetic Acid; Adult; Aged; Aged, 80 and over; Coloring Agents; Epinephrine; Female; Gastroscopy; Humans; Indigo Carmine; Male; Middle Aged; Precancerous Conditions; Prospective Studies; Sensitivity and Specificity; Staining and Labeling; Stomach Neoplasms

Endoscopic submucosal dissection (ESD) has been developed as treatment for early gastric cancer (EGC) by Japanese authors. However, there are no reports about its possible implementation in the Western setting. The aim of the present work is to determine the safety and efficacy of the endoscopic treatments for EGC in an Italian cohort.. Forty-five patients for a total of 48 gastric lesions were enrolled in the study. Thirty-six EMR procedures were performed with the strip biopsy technique using a double-channel endoscope. En bloc resection refers to resection in one piece, while piecemeal refers to resections in which the lesion was removed in multiple fragments. A total of 12 ESD were performed and completed with IT knife. We define as curative treatment lateral and vertical margins of the resected specimens free of cancer and repeat endoscopic finding of no recurrent disease.. Out of 36 EMR procedures, 10 were piecemeal resections (28%), while 26 were en bloc (72%). ESD led to en bloc resection in 11/12 cases (92%). Histological assessment of curability in the EMR group was achieved in 56% of the cases, and in 92% of the ESD group. Mean follow-up period was 31 months (range: 12-71 months). There was no local recurrence or distant metastasis in the curative group patients.. These results seem to confirm the safety and the clinical efficacy of the ESD procedure in the Western world too.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Biopsy; Cohort Studies; Coloring Agents; Dissection; Early Diagnosis; Equipment Design; Female; Gastric Mucosa; Gastroscopes; Gastroscopy; Humans; Indigo Carmine; Italy; Male; Middle Aged; Stomach Neoplasms

Topics: Carmine; Coloring Agents; Early Detection of Cancer; Humans; Indigo Carmine; Stomach Neoplasms

To investigate the diagnostic value of endoscopic narrow-band imaging technique in early gastric cancer and precancerous lesions.. A total of 100 patients with recurrent upper gastrointestinal symptoms in our hospital from January 2017 to January 2022 were selected and divided into group A and group B according to the random number table method, with 50 cases in each group. Group A received white light endoscopy, and group B received narrow-band imaging technology combined with endoscopy. Narrow-band imaging combined with magnifying endoscopy was used to stain the area with suspicious mucosal lesions with indigo carmine and magnified observation.. The endoscopic image clarity of group B was significantly better than that of group A in terms of lesion outline, gastric pit, and microvascular morphology (. The value of narrow-band imaging technology combined with endoscopy in the diagnosis of precancerous lesions and early gastric cancer is better than that of ordinary white light endoscopy, and it can be widely used in clinical practice.

Topics: Endoscopy; Humans; Indigo Carmine; Narrow Band Imaging; Precancerous Conditions; Stomach Neoplasms

For successful treatment of early gastric cancers (EGCs), it is crucial to define the horizontal border of the lesion with high accuracy. Acetic acid-indigo carmine (AI) chromoendoscopy has been used to determine the horizontal border in EGCs, but this technique is less potent in certain situations. Mucin phenotype in gastric cancers refers to biological differences in precursor lesions and differences in histopathologic findings, and it might affect AI chromoendoscopy findings. We aimed to investigate the association between mucin phenotype and AI chromoendoscopy findings in EGCs.. We prospectively evaluated 126 lesions in 126 patients with endoscopically diagnosed EGCs. Conventional endoscopy and AI chromoendoscopy findings of these lesions before treatment were prospectively analyzed. The border distinction between the lesion and surrounding mucosa was classified as distinct or indistinct on conventional endoscopy and AI chromoendoscopy, respectively. Mucin phenotypes were classified as gastric, intestinal, gastrointestinal, or null type by immunohistochemistry.. The lesion borders were distinct in 46.8% (59/126) of the lesions assessed using conventional endoscopy and in 73.0% (92/126) of those assessed with AI chromoendoscopy (p < 0.001). The border distinction rate of differentiated-type cancers on AI chromoendoscopy was significantly higher than that on conventional endoscopy (66/71 [93.0%] vs. 34/71 [47.9%], p < 0.001), but the border distinction rate of undifferentiated-type cancers on AI chromoendoscopy was not different from that on conventional endoscopy (26/55 [47.3%] vs. 25/55 [45.5%], p = 0.848). Compared with conventional endoscopy, AI chromoendoscopy identified borders in a significantly higher percentage of gastric, intestinal, and gastrointestinal mucin types; however, there was no difference in AI chromoendoscopy findings according to the mucin phenotype (p = 0.271).. AI chromoendoscopy was effective in horizontal border delineation in differentiated-type EGCs, but not in undifferentiated-type EGCs. Mucin phenotype had no effect on border distinction using AI chromoendoscopy.

Topics: Acetic Acid; Endoscopy, Gastrointestinal; Humans; Indigo Carmine; Mucins; Phenotype; Stomach Neoplasms

Linked color imaging (LCI) is a novel endoscopy system, which enhances slight differences in mucosal color. However, whether LCI is more useful than other kinds of image-enhanced endoscopy (IEE) in recognizing early gastric cancer remains unclear. This study aimed to evaluate LCI efficacy compared with the indigo carmine contrast method (IC), and blue laser imaging-bright (BLI-brt) in early differentiated-type gastric cancer recognition.. We retrospectively analyzed early differentiated-type gastric cancer, which were examined by all four imaging techniques (white light imaging, IC, LCI, BLI-brt) at Asahi University Hospital from June 2014 to November 2018. Both subjective evaluation (using ranking score: RS) and objective evaluation (using color difference score: CDS) were adopted to quantify early differentiated-type gastric cancer recognition.. During this period, 87 lesions were enrolled in this study. Both RS and CDS of LCI were significantly higher (p < 0.01) than those of IC and BLI-brt. Both RS and CDS of BLI-brt had no significant difference compared with those of IC. Subgroup analysis revealed that LCI was especially useful in post-Helicobacter pylori eradication patients and flat or depressed lesions compared with IC and BLI-brt.. LCI appears to be more beneficial for the recognition of early differentiated-type gastric cancer in endoscopic screenings than IC and BLI-brt from the middle to distant view.

Topics: Humans; Image Enhancement; Indigo Carmine; Lasers; Retrospective Studies; Stomach Neoplasms

Accurate delineation of cancer margins is critical for endoscopic curative resection. This study aimed to train and validate real-time fully convolutional networks for delineating the resection margin of early gastric cancer (EGC) under indigo carmine chromoendoscopy (CE) or white light endoscopy (WLE), and evaluated its performance and that of magnifying endoscopy with narrow-band imaging (ME-NBI).. We collected CE and WLE images of EGC lesions to train fully convolutional networks ENDOANGEL. ENDOANGEL was tested both on stationary images and endoscopic submucosal dissection (ESD) videos. The accuracy and reliability of ENDOANGEL and NBI-dependent delineation were further evaluated by a novel endoscopy-pathology point-to-point marking.. ENDOANGEL had an accuracy of 85.7% in the CE images and 88.9% in the WLE images under an overlap ratio threshold of 0.60 in comparison with the manual markers labeled by the experts. In the ESD videos, the resection margins predicted by ENDOANGEL covered all areas of high-grade intraepithelial neoplasia and cancers. The minimum distance between the margins predicted by ENDOANGEL and the histological cancer boundary was 3.44 ± 1.45 mm which outperformed the resection margin based on ME-NBI.. ENDOANGEL has the potential to assist endoscopists in delineating the resection extent of EGC under CE or WLE during ESD.

Topics: Deep Learning; Early Detection of Cancer; Endoscopic Mucosal Resection; Gastroscopy; Humans; Indigo Carmine; Margins of Excision; Narrow Band Imaging; Prognosis; Stomach Neoplasms

Diagnosing the invasion depth of gastric cancer (GC) is necessary to determine the optimal method of treatment. Although the efficacy of evaluating macroscopic features and EUS has been reported, there is a need for more accurate and objective methods. The primary aim of this study was to test the efficacy of novel artificial intelligence (AI) systems in predicting the invasion depth of GC.. A total of 16,557 images from 1084 cases of GC for which endoscopic resection or surgery was performed between January 2013 and June 2019 were extracted. Cases were randomly assigned to training and test datasets at a ratio of 4:1. Through transfer learning leveraging a convolutional neural network architecture, ResNet50, 3 independent AI systems were developed. Each system was trained to predict the invasion depth of GC using conventional white-light imaging (WLI), nonmagnifying narrow-band imaging (NBI), and indigo-carmine dye contrast imaging (Indigo).. The area under the curve of the WLI AI system was .9590. The lesion-based sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the WLI AI system were 84.4%, 99.4%, 94.5%, 98.5%, and 92.9%, respectively. The lesion-based accuracies of the WLI, NBI, and Indigo AI systems were 94.5%, 94.3%, and 95.5%, respectively, with no significant difference.. These new AI systems trained with multiple images from different angles and distances could predict the invasion depth of GC with high accuracy. The lesion-based accuracy of the WLI, NBI, and Indigo AI systems was not significantly different.

Topics: Artificial Intelligence; Carmine; Humans; Indigo Carmine; Narrow Band Imaging; Sensitivity and Specificity; Stomach Neoplasms

Topics: Endoscopic Mucosal Resection; Gastric Mucosa; Gastroscopy; Humans; Indigo Carmine; Margins of Excision; Narrow Band Imaging; Stomach Neoplasms

Gastric endoscopy is a common clinical practice that enables medical doctors to diagnose the stomach inside a body. In order to identify a gastric lesion's location such as early gastric cancer within the stomach, this work addressed to reconstruct the 3D shape of a whole stomach with color texture information generated from a standard monocular endoscope video. Previous works have tried to reconstruct the 3D structures of various organs from endoscope images. However, they are mainly focused on a partial surface. In this work, we investigated how to enable structure-from-motion (SfM) to reconstruct the whole shape of a stomach from a standard endoscope video. We specifically investigated the combined effect of chromo-endoscopy and color channel selection on SfM. Our study found that 3D reconstruction of the whole stomach can be achieved by using red channel images captured under chromo-endoscopy by spreading indigo carmine (IC) dye on the stomach surface.

Topics: Endoscopy; Humans; Imaging, Three-Dimensional; Indigo Carmine; Motion; Stomach; Stomach Neoplasms

Topics: Acetic Acid; Adenocarcinoma; Aged; Coloring Agents; Gastric Mucosa; Gastroscopy; Histocytochemistry; Humans; Indigo Carmine; Male; Staining and Labeling; Stomach Neoplasms

Magnifying linked color imaging with indigo carmine dye (M-Chromo-LCI) enables sterically enhanced and color image-magnified observation of the superficial gastric mucosa. This study investigated the usefulness of M-Chromo-LCI for the differential diagnosis of gastric lesions.. 100 consecutive small depressed lesions were examined with conventional white-light imaging (C-WLI), magnifying blue-laser imaging (M-BLI), and M-Chromo-LCI. Endoscopic images were reviewed by three experts and three non-experts. Diagnostic accuracy and interobserver agreement were compared among the modalities.. For experts, M-BLI showed a significantly higher diagnostic accuracy than C-WLI (82.7 % vs. 67.0 %;. M-Chromo-LCI is expected to become a useful modality for the accurate diagnosis of gastric lesions.

Topics: Adult; Aged; Aged, 80 and over; Coloring Agents; Cross-Sectional Studies; Female; Follow-Up Studies; Gastric Mucosa; Gastroscopy; Humans; Indigo Carmine; Male; Middle Aged; Narrow Band Imaging; Reproducibility of Results; Retrospective Studies; Stomach Neoplasms

Early-stage gastric cancer (EGC) found after H. pylori eradication often has non-tumorous epithelium on the tumorous tissue and/or surface differentiation of tumors, which may confuse endoscopic and histologic diagnosis. We investigated the diagnostic reliability of EGC using conventional white light endoscopy (WLE), chromoendoscopy (CE) using indigo carmine, and magnifying endoscopy with narrow band imaging (ME-NBI) in patients with EGC with or without history of prior H. pylori eradication therapy.. Diagnostic reliability of EGC by using the WLE, CE and ME-NBI was investigated in 71 EGC lesions diagnosed after successful H. pylori eradication (eradication group) and 115 EGC lesions with current H. pylori infection (control group).. Diagnostic reliability of EGC was lower in the eradication group than in the control group using all three modalities. In particular, the diagnostic accuracy of CE in the eradication group was especially lower compared to that of the control group (WLE: 74.6% vs. 86.1%, P=0.05; CE: 64.8% vs. 91.3%, P<0.0001; ME-NBI: 88.7% vs. 98.2%, P=0.01). The ME-NBI scored better in comparison with WLE and CE in the eradication group (both P<0.05). The indistinct EGC lesions in the eradicated group by using CE were associated with the presence of histological changes such as non-tumorous epithelium on the tumor and/or surface differentiation of tumors (P=0.005).. It should be noted that the diagnostic reliability of EGC after H. pylori eradication becomes lower especially using CE. Indistinguishable cases using CE are associated with histological findings such as non-tumorous epithelium on the tumor and/or surface differentiation of tumors.

Topics: Aged; Aged, 80 and over; Coloring Agents; Early Detection of Cancer; Female; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Indigo Carmine; Male; Middle Aged; Narrow Band Imaging; Reproducibility of Results; Stomach Neoplasms

Premalignant gastric lesions have an increased risk to develop gastric cancer.. To evaluate the usefulness of systematic endoscopy that includes chromoendoscopy with a double dye staining technique for the detection of dysplasia in patients with premalignant gastric lesions.. This longitudinal, prospective study was performed in patients with gastric atrophy, intestinal metaplasia or dysplasia who were referred for endoscopy less than 6 months after the initial diagnosis. The second endoscopy was performed in three phases: phase 1, exhaustive and systematic review of the mucosa with photographic documentation and biopsies of suspicious areas; phase 2, chromoendoscopy with a double dye staining technique using acetic acid 1.2% and indigo carmine 0.5%; phase 3, topographic mapping and random biopsies.. A total of 50 patients were included. Nine (18%) had atrophic gastritis, 38 (76%) had intestinal metaplasia, and 3 (6%) had low-grade dysplasia. Systematic endoscopy with chromoendoscopy using a double dye staining technique detected more patients with dysplasia (9 versus 3, p<.05), and a larger number of biopsies with the diagnosis of dysplasia were obtained. This occurred for visible (6 vs. 0, p<.05) and non-visible lesions (6 vs. 3, p=NS). In one patient, initial low-grade dysplasia was not detected again in the systematic endoscopy, giving a global endoscopic performance for the detection of lesions of 92%.. Patients with premalignant gastric lesions have synchronous lesions with greater histological severity, which are detected when systematic endoscopy is conducted with indigo carmine dye added to acetic acid.

Topics: Endoscopy; Gastric Mucosa; Humans; Indigo Carmine; Longitudinal Studies; Precancerous Conditions; Prospective Studies; Staining and Labeling; Stomach Neoplasms

Identifying a precise demarcation line (DL) is indispensable for pathological complete en bloc endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). We evaluated the useful condition of chromoendoscopy with indigo carmine and acetic acid for marking dots around lesions before ESD for EGC.. We examined 98 consecutive patients with 109 intramucosal EGCs (mean diameter, 17.8 ± 12.4 mm; main histologic type, 96 intestinal and 13 diffuse) resected by en bloc ESD after chromoendoscopy with indigo carmine and acetic acid between December 2012 and February 2014. The DL was identified by this technique just before ESD (mean chromoendoscopy observation time, 71.6 s); subsequently, marking dots were placed around the EGC. EGCs were classified into two groups: useful for identifying the DL or useless. Clinicopathological characteristics and clinical outcomes were evaluated in each group.. Forty-two of the 109 cases (38.5 %) were determined useful for chromoendoscopy with indigo carmine and acetic acid. Multivariate analysis with logistic regression showed that macroscopic type (protruded or flat elevated-type) and atrophic border (the oral side of tumor) were independently associated with the usefulness of chromoendoscopy using indigo carmine and acetic acid for identifying the DL of EGCs (P < 0.05). The histologically positive horizontal margin after ESD was 0 % (0/42) in useful cases, and 7.5 % (5/67) in useless cases.. Before ESD, chromoendoscopy with indigo carmine and acetic acid can be used for creating precise markings in protruded or flat elevated-type EGC or at the atrophic border on the oral side of EGCs.

Topics: Acetic Acid; Aged; Endoscopic Mucosal Resection; Endoscopy, Gastrointestinal; Female; Gastric Mucins; Humans; Immunohistochemistry; Indigo Carmine; Male; Middle Aged; Stomach Neoplasms

Various techniques using magnifying endoscopy (ME) and chromoendoscopy are being developed to enhance images of gastrointestinal tumor. The aim of this study was to evaluate the diagnostic performance of ME enhanced by acetic acid-indigo carmine mixture (ME-AIM) and ME enhanced with narrow-band imaging (ME-NBI) for differential diagnosis of superficial gastric lesions identified with conventional white-light endoscopy (WLE).. Patients with superficial gastric lesions picked up with WLE were enrolled in the study. ME-NBI and ME-AIM were used to further characterize the lesions. All images of the lesions were evaluated by four skilled endoscopists blinded to the clinical data. The microarchitectural patterns in the lesions were analyzed with reference to the "VS classification" system.. A total of 643 lesions (mean diameter, 7 mm) from 508 patients (316 men, 192 women; mean age, 63 years) were evaluated. Pathologically, 24 of the 643 lesions were diagnosed as gastric cancer; the others were noncancerous lesions. For diagnosis of gastric cancer, the negative predictive value of each of the three magnified findings (irregular microvascular pattern, irregular microsurface pattern, and demarcation line) was high (nearly 100 %). According to the "VS classification" system, either ME-NBI or ME-AIM had a higher specificity (99.5 % or 99.4 % vs. 89.5 %, P < 0.001) and accuracy (99.2 % or 98.9 % vs. 89.0 %, P < 0.001) than WLE, and ME-AIM was not superior to ME-NBI for identifying carcinoma.. Enhanced ME is useful for correctly diagnosing early gastric cancer, and in contrast with ME-AIM, ME-NBI is a more feasible and efficient method for clinical practice.

Topics: Adult; Aged; Diagnosis, Differential; Female; Gastroscopy; Humans; Image Processing, Computer-Assisted; Indigo Carmine; Male; Microvessels; Middle Aged; Sensitivity and Specificity; Stomach; Stomach Neoplasms

To investigate the usefulness of chromoendoscopy, using an acetic acid indigocarmine mixture (AIM), for gastric adenoma diagnosed by forceps biopsy.. A total of 54 lesions in 45 patients diagnosed as gastric adenoma by forceps biopsy were prospectively enrolled in this study and treated by endoscopic submucosal dissection (ESD) between January 2011 and January 2012. AIM-chromoendoscopy (AIM-CE) was performed followed by ESD. AIM solution was sprinkled and images were recorded every 30 s for 3 min. Clinical characteristics such as tumor size (< 2 cm, ≥ 2 cm), surface color in white light endoscopy (WLE) (whitish, normochromic or reddish), macroscopic appearance (flat or elevated, depressed), and reddish change in AIM-CE were selected as valuables.. En bloc resection was achieved in all 54 cases, with curative resection of fifty two lesions (96.3%). Twenty three lesions (42.6%) were diagnosed as well-differentiated adenocarcinoma and the remaining 31 lesions (57.4%) were gastric adenoma. All adenocarcinoma lesions were well-differentiated tubular adenocarcinomas and were restricted within the mucosal layer. The sensitivity of reddish color change in AIM-CE is significantly higher than that in WLE (vs tumor size ≥ 2 cm, P = 0.016, vs normochromic or reddish surface color, P = 0.046, vs depressed macroscopic type, P = 0.0030). On the other hand, no significant differences were found in the specificity and accuracy. In univariate analysis, normochromic or reddish surface color in WLE (OR = 3.7, 95%CI: 1.2-12, P = 0.022) and reddish change in AIM-CE (OR = 14, 95%CI: 3.8-70, P < 0.001) were significantly related to diagnosis of early gastric cancer (EGC). In multivariate analysis, only reddish change in AIM-CE (OR = 11, 95%CI: 2.3-66, P = 0.0022) was a significant factor associated with diagnosis of EGC.. AIM-CE may have potential for screening EGC in patients initially diagnosed as gastric adenoma by forceps biopsy.

Topics: Acetic Acid; Adenocarcinoma; Adenoma; Biopsy; Chi-Square Distribution; Coloring Agents; Early Detection of Cancer; Gastroscopy; Humans; Indigo Carmine; Japan; Logistic Models; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Prospective Studies; Stomach Neoplasms

To evaluate the usefulness of flexible spectral imaging color enhancement with indigo carmine (I-FICE) in early gastric cancer (EGC) demarcation.. The study participants were 29 patients with differentiated-type EGC. The endoscope was fixed and images of the same area of EGC demarcations in each lesion were obtained using four different methods (WLE, flexible spectral imaging color enhancement (FICE), CE, and I-FICE). FICE mode at R 550 nm (Gain: 2), G 500 nm (Gain: 4), and B 470 nm (Gain: 4) was used. Four endoscopists ranked the images obtained by each method on the basis of the ease of recognition of demarcation using a 4-point system. We calculated the standard deviation of pixel values based on L*, a*, and b* color spaces in the demarcation region (Lab-SD score).. The median ranking score for I-FICE images was significantly higher than that obtained from the other methods. Further, the average Lab-SD score was significantly higher for I-FICE images than for images obtained by the other methods. There was a good correlation between the ranking score and Lab-SD score.. EGC demarcations were most easily recognized both subjectively and objectively using I-FICE image, followed by CE, FICE and WLE images.

Topics: Adenocarcinoma; Aged; Coloring Agents; Early Detection of Cancer; Female; Gastroscopy; Humans; Image Enhancement; Indigo Carmine; Male; Middle Aged; Stomach Neoplasms

Endoscopic treatments, such as endoscopic submucosal dissection (ESD) and laparoscopic gastrectomy, are increasingly used to treat a subset of patients with early gastric cancer (EGC). To achieve successful outcomes, it is very important to accurately determine the lateral extent of the tumor. Therefore, we investigated the diagnostic performance of chromoendoscopy using indigo carmine dye added to acetic acid (AI chromoendoscopy) in delineating differentiated or undifferentiated adenocarcinomas in patients with EGC.. We prospectively included 151 lesions of 141 patients that had an endoscopic diagnosis of EGC. All the lesions were examined by conventional endoscopy and AI chromoendoscopy before ESD or laparoscopic gastrectomy. The border clarification between the lesion and the normal mucosa was classified as distinct or indistinct before and after AI chromoendoscopy.. The borders of the lesions were distinct in 66.9% (101/151) with conventional endoscopy and in 84.1% (127/151) with AI chromoendoscopy (P < 0.001). Compared with conventional endoscopy, AI chromoendoscopy clarified the border in a significantly higher percentage of differentiated adenocarcinomas (74/108 [68.5%] vs 97/108 [89.8%], respectively, P < 0.001). However, the border clarification rate for undifferentiated adenocarcinomas did not differ between conventional endoscopy and AI chromoendoscopy (27/43 [62.8%] vs 30/43 [70.0%], respectively, P = 0.494).. AI chromoendoscopy is useful in determining the lateral extent of EGCs. However, its usefulness is reduced in undifferentiated adenocarcinomas.

Topics: Acetic Acid; Adenocarcinoma; Adult; Aged; Aged, 80 and over; Coloring Agents; Diagnosis, Differential; Endoscopy, Gastrointestinal; Female; Gastrectomy; Gastric Mucosa; Humans; Indicators and Reagents; Indigo Carmine; Male; Middle Aged; Multivariate Analysis; Prospective Studies; Retrospective Studies; Stomach Neoplasms

Topics: Acetic Acid; Administration, Topical; Coloring Agents; Gastroscopy; Indicators and Reagents; Indigo Carmine; Stomach Neoplasms

Recent endoscopic imaging techniques for recognition of unclear lesions in the stomach (e.g. narrow band imaging, magnifying endoscopy) require special equipment and therefore are not commonly used. The aim of the present study was to estimate the accuracy of a new chromoendoscopic method using an acetic acid-indigo carmine mixture (AIM) in diagnosing early gastric cancers (EGC).. Studied were 108 EGC lesions in 104 patients. EGC were initially observed by white light (WL) after which indigo carmine (IC) solution was sprinkled onto the gastric mucosa. Images by WL and IC observation were recorded by a digital filing system. After washing away IC solution with water, AIM solution was sprinkled onto the gastric mucosa and images were recorded. Margin lines of EGC determined by each observation were drawn on recorded images by graphic software for comparison with resected specimens. After lines were similarly drawn on images of resected specimens, the extent of the lesions was compared with that determined by endoscopic images.. Diagnostic accuracy of WL, IC, and AIM observations were 50.0%, 75.9% and 90.7%, respectively. No adverse events occurred with the AIM method.. This chromoendoscopic method can be used to delineate the margin of EGC accurately, easily, safely and inexpensively.

Topics: Acetic Acid; Aged; Aged, 80 and over; Coloring Agents; Female; Gastroscopy; Humans; Indigo Carmine; Male; Middle Aged; Stomach Neoplasms

Detection of early gastric tube cancers (GTCs) has increased with more detailed surveillance endoscopy using indigo carmine dye following esophagectomy. This retrospective study clarified the clinicopathological features and application of endoscopic submucosal dissection (ESD) for GTCs. Data collected for eight GTCs treated by ESD included clinical and pathological features and outcomes following ESD. Overall, eight GTCs were identified in seven (6.3 %) of 112 patients who underwent esophagectomy and gastric tube reconstruction. Almost all lesions were macroscopically type 0-IIa with mucosal to submucosal invasion, and seven GTCs were successfully resected en bloc by ESD. Submucosal invasion to > 500 microm was observed in one case with associated delayed perforation that was treated conservatively. No local recurrences of GTCs were observed. Detailed surveillance endoscopy using indigo carmine dye appears useful for diagnosing early-stage GTC. Furthermore ESD represents a feasible alternative to conventional endoscopic mucosal resection as a minimally invasive therapy for early-stage GTC.

Topics: Adenocarcinoma; Adenocarcinoma, Papillary; Aged; Aged, 80 and over; Coloring Agents; Dissection; Endoscopy, Gastrointestinal; Esophageal Neoplasms; Esophagectomy; Esophagostomy; Female; Gastrectomy; Gastric Mucosa; Gastrostomy; Humans; Indigo Carmine; Middle Aged; Neoplasms, Squamous Cell; Plastic Surgery Procedures; Stomach Neoplasms

Conventional endoscopy and chromoendoscopy with indigo carmine dye are usually performed for recognizing adequate tumor-negative lateral margins for successful endoscopic resection of gastric neoplasia. However, chromoendoscopy with indigo carmine dye added to acetic acid has not been used for this purpose.. Our purpose was to compare the diagnostic performance of chromoendoscopy with indigo carmine dye added to acetic acid with that of conventional endoscopy and chromoendoscopy with indigo carmine dye or acetic acid alone.. Prospective study.. Social Insurance Funabashi Central Hospital.. Forty-seven consecutive patients (53 lesions) with early gastric cancer and gastric adenomas who underwent endoscopic submucosal dissection (ESD) from April 2006 to July 2007 were studied.. All the lesions were examined by the endoscopic modalities before ESD, and the resected specimens were analyzed histopathologically.. Two endoscopists independently evaluated the diagnostic performance of each image in terms of recognition of tumor borders with reference to macroscopic and histopathologic findings of resected specimens. We also conducted a substudy to assess interobserver variability.. There was good interobserver agreement between the 2 endoscopists in this study (kappa index = 0.764). The diagnostic performance of chromoendoscopy with indigo carmine dye added to acetic acid was significantly greater than that of any of the other modalities (vs each: P < .005).. The diagnostic performance of chromoendoscopy with indigo carmine dye added to acetic acid was better compared with conventional endoscopy and chromoendoscopy by using only indigo carmine dye or acetic acid. The applicability of this method for gastric neoplasia merits further investigation.

Topics: Acetic Acid; Adenoma; Adult; Aged; Aged, 80 and over; Endoscopy; Female; Gastroscopy; Humans; Indigo Carmine; Male; Middle Aged; Observer Variation; Prospective Studies; Stomach Neoplasms

For the purpose of precise preoperative diagnosis that ensures complete endoscopic resection, it is important to accurately determine the lateral spread of gastric cancer lesions. The acetic acid + indigocarmine (AI) method used by us has been found to meet this need. This paper reports its usefulness in the determination of lateral spread of gastric cancer before endoscopic submucosal dissection (ESD).. The present study was conducted in 114 patients who were operated on for an early-stage gastric cancer, after determining the lateral spread of cancerous lesions by the AI method, between September 2005 and December 2006. The negative lateral stump reaction rate obtained in ESD was conducted in areas delineated by the AI method. The borderline clarification rate obtained by the AI method and the indigocarmine (I) method were compared between the lesions with and without clear borders under observation with the naked eye.. The lateral stump after ESD conducted using the AI method was histologically negative in 111 of the 114 patients (97%). The lesion spread was clarified by the AI method in 103 patients (90%): 55 (95%) and 48 (86%) patients with and without clear macroscopic lesion borders, respectively. Compared to the I method, the AI method clarified the lesion spread in a significantly higher percentage of patients with macroscopically unclear lesion borders (P = 0.015).. The present study stresses that the AI method should be used to conduct ESD more safely and accurately in patients with well or moderately differentiated adenocarcinoma.

Topics: Acetic Acid; Adenocarcinoma; Adult; Aged; Aged, 80 and over; Cell Differentiation; Coloring Agents; Dissection; Endosonography; Female; Gastrectomy; Gastric Mucosa; Gastroscopy; Humans; Indigo Carmine; Male; Middle Aged; Neoplasm Invasiveness; Predictive Value of Tests; Preoperative Care; Stomach Neoplasms; Treatment Outcome

Topics: Acetic Acid; Adenocarcinoma; Biopsy; Coloring Agents; Gastric Mucosa; Gastroscopy; Humans; Indicators and Reagents; Indigo Carmine; Sensitivity and Specificity; Stomach; Stomach Neoplasms

In recent years chromoendoscopy has become popular as a diagnostic enhancement tool in endoscopy. Using the macroscopic description of gastric ulcers, experienced endoscopists may be able to differentiate malignant and benign lesions. The aim of our study was to determine whether indigo carmine staining improves the ulcer differentiation by experienced and inexperienced endoscopists.. 50 patients were enrolled, 7 with malignant gastric ulcers and 43 with benign gastric ulcers. Gastroscopy was initially videotaped native, then on a second tape after staining with 0.2% indigo carmine. Later on biopsies were taken for histology. Subsequently the tapes were randomly evaluated by three experienced (>2000 gastroscopies; group A) and by three inexperienced (<100 gastroscopies; group B) investigators blinded from any personal data of the patients. The investigators had to classify the ulcers, using published criteria, native as well as stained. The results were compared within each group and with the histology.. The endoscopic native diagnosis showed a sensitivity of 66.3%, a specificity of 86.3%, a positive predictive value of 48.1% and a negative predictive value of 94% for group A, respectively 66%, 62.5%, 22.7% and 92% for group B. After staining, the values of these parameters were reduced insignificantly to a sensitivity of 60.2%, a specificity of 78.5%, a positive predictive value of 36.1% and a negative predictive value of 92.8% for group A. Group B, on account of one investigator who demonstrated excellent skills, showed a significant better sensitivity (79.9%) and a slight improvement of the positive and negative predictive values to 25.7% respectively 94.8%, whereas the specificity very slightly decreased to 61.3%. The diagnostic accuracy before and after staining was 83.6%, respectively 76.5%, in group A and 63.2%, respectively 63.9% in group B. The correlation with the histology, determined by Cohen's kappa coefficient (median value), decreased from 0.46 for the native to 0.30 for the chromoendoscopic diagnosis in group A and remained unchanged (0.17) in group B.. We concluded that chromoendoscopy does not improve the classification of gastric ulcers with respect to malignant or benign origin. The role of endoscopic experience could only be proved in the native macroscopic diagnosis of the investigators. After staining, with the exception of one investigator, experienced as well as inexperienced endoscopists lost their diagnostic accuracy.

Topics: Coloring Agents; Endoscopy, Gastrointestinal; Gastroscopy; Humans; Indigo Carmine; Observer Variation; Predictive Value of Tests; Sensitivity and Specificity; Single-Blind Method; Stomach Neoplasms; Stomach Ulcer

Topics: Coloring Agents; Endosonography; Gastric Mucosa; Gastroscopy; Humans; Indigo Carmine; Neoplasm Staging; Stomach Neoplasms

Circumferential mucosal incision around a lesion is effective for reliable endoscopic mucosal resection. However, mucosal incision with a needle knife is difficult, even with submucosal injection of normal saline solution. To make needle-knife incision easier and safer, sodium hyaluronate has been used rather than normal saline solution. The aim of this study was to evaluate the clinical outcome of endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate.. For 70 gastric lesions treated by submucosal injection of sodium hyaluronate, the size of the lesion and the resection specimen, the en bloc resection rate, complications, and local recurrence during follow-up were assessed.. The mean size of the lesions and resection specimens were, respectively, 19.9 mm and 30.0 mm. The en bloc resection rates were 89% (42/47) for lesions up to 20 mm in diameter and 48% (11/23) for those greater than 20 mm (1-20 mm vs. >20 mm, p = 0.0004). Three patients underwent surgery because of invasive cancer in the EMR specimen. During follow-up (median 14 months, range 3-38 months), 2 recurrent lesions were found. No major complication occurred.. Submucosal injection of sodium hyaluronate is a reliable method with a high success rate for en bloc resection of lesions up to 20 mm in diameter. Mucosal incision with a needle knife can be performed safely with submucosal injection of sodium hyaluronate.

Topics: Adenocarcinoma; Adenoma; Adjuvants, Immunologic; Aged; Aged, 80 and over; Female; Gastric Mucosa; Gastroscopy; Humans; Hyaluronic Acid; Indigo Carmine; Injections; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Prospective Studies; Safety; Staining and Labeling; Stomach Neoplasms; Treatment Outcome

Topics: Aged; Coloring Agents; Female; Gastroscopy; Humans; Indigo Carmine; Preoperative Care; Reproducibility of Results; Staining and Labeling; Stomach Neoplasms; Surgical Instruments

Microadenomas or aberrant crypt foci (ACFs) are regarded as early neoplastic lesions that precede the development of macroscopic adenomas. The aim of this study was to characterize surface features of ileal microadenomas in patients with familial adenomatous polyposis (FAP). Magnifying ileoscopy was performed in 19 patients with FAP. A histologically verified adenomatous tubule, the existence of which was suggested by magnified observation, was regarded as a microadenoma. Magnifying ileoscopy detected microadenoma in five patients. In four of the five cases, the ileal microadenomas were identified as areas with tiny crypt openings or serrated surfaces, which were distinctive of nonneoplastic, diminutive protrusions. Magnifying ileoscopy seems to be useful in the detection of ileal microadenomas.

Topics: Adenoma; Adenomatous Polyposis Coli; Adult; Aged; Biopsy; Colectomy; Colonoscopes; Coloring Agents; Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Humans; Ileal Neoplasms; Indigo Carmine; Intestinal Mucosa; Male; Middle Aged; Population Surveillance; Precancerous Conditions; Rectal Neoplasms; Stomach Neoplasms

Topics: Diagnosis, Differential; Duodenal Ulcer; Duodenoscopy; Follow-Up Studies; Gastroscopy; Humans; Indigo Carmine; Stomach Neoplasms; Stomach Ulcer

The image resolution of fiberoptic and video endoscopy was compared in a series of patients with early gastric cancer. Eighteen patients were divided into two groups. One group of patients (n = 9) was evaluated with fiberoptic endoscopy while the second group (n = 9) was evaluated using video endoscopy. The extent of cancer invasion, with special attention to size, shape and type of the lesions, was evaluated in each patient. Attempts were also made to identify the proximal and distal limits of tumor invasion and the endoscopic and postoperative findings were compared. Endoscopic delineation of lesions was possible in more patients undergoing video endoscopy compared to fiberoptic endoscopy. Video endoscopy gave better endoscopic images for determination of the limits and of the size of cancer invasion. Indigo dye spraying enhanced the accuracy rates in both groups of patients. The results of this study suggest that video endoscopy may be more useful than fiberoptic endoscopy in the evaluation of minimal mucosal changes of the gastrointestinal tract. We believe that video endoscopy may have a useful role in the gastrointestinal endoscopy if the problem of expense, which is its main drawback, can be solved.

Topics: Aged; Aged, 80 and over; Female; Fiber Optic Technology; Gastrectomy; Gastric Mucosa; Gastroscopy; Humans; Indigo Carmine; Lymph Node Excision; Male; Middle Aged; Stomach Neoplasms; Video Recording

During the last 10 years, we have experienced 41 cases of minute cancer, which is equivalent to 13.9% of all resected early stomach cancers. Out of 44 lesions in 41 cases, 17 lesions were diagnosed preoperatively, while 27 were unexpectedly detected by serial sections of the resected stomach. Most lesions were located along the lesser curvature of the body and antrum. There was no nodal involvement or vessel permeation. Histologically differentiated adenocarcinomas were encountered in 86.4%, associated with intensive intestinal mucosa in many cases. We have stressed that dye endoscopy using indigo carmine and methylene blue is very useful for the diagnosis of minute cancer.

Topics: Adenocarcinoma; Adenocarcinoma, Papillary; Adult; Aged; Female; Gastric Mucosa; Humans; Hyperplasia; Indigo Carmine; Male; Metaplasia; Methylene Blue; Middle Aged; Sex Factors; Staining and Labeling; Stomach Neoplasms

Forty patients with stomach cancer, including 25 patients with early carcinoma, were examined endoscopically during the perfusion of Indigo carmine dye into the celiac artery in association with vasomotors. In all of these patients the diagnosis had been established definitively by aimed biopsies before the procedure. This new endoscopic examination is useful not only to determine the margin of the superficial carcinoma, even when it is covered with regenerative epithelium, but also to detect small lesion less than 10 mm in diameter. Liver function tests in 31 patients who underwent the examination have negated the possibility of acute toxicity of the dye. But this new method should be employed with caution in hypertensive or high-risk patients.

Topics: Adenocarcinoma; Celiac Artery; Chemical and Drug Induced Liver Injury; Epinephrine; Gastroscopy; Humans; Indigo Carmine; Indoles; Injections, Intra-Arterial; Stomach Neoplasms

Topics: Adenocarcinoma; Gastroscopy; Humans; Indigo Carmine; Indoles; Methylene Blue; Staining and Labeling; Stomach Neoplasms