Magnifying endoscopy with image-enhanced endoscopy (ME-IEE) may provide improved diagnostic performance for early gastric cancer, according to a new study.
A review of studies by Soma Nei, of Tsinghua University (Beijing, China) addresses the evaluation of high-risk patients for gastric cancer by endoscopy, focusing on the signs of suspicious lesions by conventional white light imaging (C-WLI) or chromoendoscopy (CE). The author notes that surface and color changes are distinct markers for detecting superficial mucosal neoplasia by C-WLI or CE; other markers include changes in light reflection and spontaneous bleeding.
But while C-WLI endoscopy is the standard imaging modality for diagnosis of gastric mucosal cancers, diagnosis of minute or superficial flat gastric cancers is difficult using C-WLI or CE, and in these cases, advanced imaging is recommended using ME-IEE with narrow-band imaging. In these cases, the vessel plus surface classification system (VSCS) was found to be effective for identifying early gastric cancer, and may be able to differentiate between low-grade adenoma and early gastric cancer. The study was published on August 31, 2016, in the Journal of Digestive Diseases.
“Recent reports have described various novel endoscopic markers which visualized by ME-IEE can predict specific histopathological findings,” concluded Nei, of the Tsinghua University department of gastroenterology. “Diagnosis using ME-IEE with VSCS may provide excellent diagnostic performance with high confidence and good reproducibility to the endoscopist, if it is performed under consistent conditions, including observation under maximal magnification.”
Understanding the endoscopic appearances of gastritis is important for diagnosing gastric cancer due to superficial mucosal lesions that mimic gastritis that are very difficult to detect, even with optimum preparation and the best technique. In such cases even tissue biopsy is often not very accurate for the diagnosis of gastric epithelial neoplasia. ME-IEE can enhance visualization of the microvessels of the mucosa, which are altered in abnormal tissue; the microvessels of neoplasms are typically enlarged, tortuous and increased in density.