The Usefulness of Magnifying Endoscopy and Narrow-Band Imaging in Measuring the Depth of Invasion before Endoscopic Submucosal Dissection

Jae Young Jang, Jae Young Jang

Abstract

With the widespread application of endoscopic submucosal dissection for the treatment of gastrointestinal neoplasms, accurate determination of the invasion depth prior to intervention has become an indispensable part of treatment planning. Narrow-band imaging (NBI) is a novel endoscopic technique that may enhance the accuracy of diagnosis. Magnifying endoscopy with NBI has been shown to be effective for determining invasion depth for intrapapillary capillary loop classification of esophageal cancer and microvascular pattern of stomach cancer. Such precise pre-treatment staging of early neoplastic lesions in the gastrointestinal tract warrants timely initiation of disease-tailored treatment and, ultimately, better quality of life and improved patient survival.

Keywords: Endoscopic submucosal dissection; Magnifying endoscopy; Narrow-band imaging.

Conflict of interest statement

The author has no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
The intrapapillary capillary loop (IPCL) image of normal esophageal mucosa in magnifying endoscopy with narrow-band imaging. Branching vessel which are located at the surface of muscularis mucosa are shown as a green vascular network. The IPCL is observed as a brown vessel which is positioned in the most superficial layer and is derived upright from the branching vessel.
Fig. 2
Fig. 2
Esophageal squamous cell carcinoma. (A) A slightly depressed lesion with redness extending from 3 to 7 o'clock is observed at the upper esophagus. (B) Under narrow-band imaging (NBI), the lesion is shown as a dark brown color. (C) With iodine staining, it is shown as an iodine-void area with a well-defined boundary. (D) Shiny silver sign. In a couple of minutes after iodine staining, this lesion appears shiny silver under NBI. (E) Magnifying endoscopy with NBI image. Transversely running and irregular-shaped blood vessels as intrapapillary capillary loop (IPCL) deformation are found. The pattern of the vessel is categorized as IPCL V-3. (F) Histopathological image. Squamous cancer, SM1 invasion with lymphatic metastasis (H&E stain, ×100).
Fig. 3
Fig. 3
Esophageal squamous cell carcinoma. (A) A depressed lesion with irregular nodularity and redness is noted at the mid esophagus. (B) With iodine staining, it is shown as an iodine-void area with a well-defined boundary. (C) Magnifying endoscopy with narrow-band image. With the center of the lesion, intrapapillary capillary loop type V-2 and V-3 are observed. (D) Esophagectomy was performed. This lesion was diagnosed as SM1 invasion with lymphatic metastasis (H&E stain, ×25).
Fig. 4
Fig. 4
Type 0-IIc early gastric cancer. (A) A reddish depressed lesion is noted at the gastric antrum. (B) Magnifying endoscopy with narrow-band imaging demonstrates loss of fine mucosal structure, loss of subepithelial capillary network and presence of an irregular microvascular pattern. At the margin of the carcinoma, demarcation line is noted (arrows).
Fig. 5
Fig. 5
Classification of microvascular patterns in superficial depressed gastric cancer. (A) Fine network pattern looks like a mesh, in which abundant microvessels connect with one another. (B) Corkscrew pattern has isolated and tortuous microvessels, in which scanty microvessels do not connect with one another.
Fig. 6
Fig. 6
Another classification of microvascular patterns in the gastric cancer. (A) Mesh pattern. (B) Loop pattern (black circle). (C) Interrupted pattern (white circle).
Fig. 7
Fig. 7
Type 0-IIc early gastric cancer. (A) An irregular shaped, depressed lesion with central nodularity is noted in the gastric body. (B) Magnifying endoscopy with narrow-band imaging demonstrates non-structure, scattery vessels and multi-caliber vessels. This lesion was diagnosed as SM2 cancer.

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