Clin Endosc.  2015 Nov;48(6):481-490. 10.5946/ce.2015.48.6.481.

Clinical Application of Magnifying Endoscopy with Narrow-Band Imaging in the Stomach

• Yao K

• KMID: 2380404
• DOI: http://doi.org/10.5946/ce.2015.48.6.481

Abstract

Magnifying endoscopy with narrow-band imaging (M-NBI) can visualize superficial microanatomies in the stomach. The normal morphology of the microanatomy visualized by M-NBI differs according to the part of the stomach. The gastric fundic glandular mucosa appears as a regular honeycomb-like subepithelial capillary network (SECN) pattern with a regular collecting venule pattern and regular oval crypt opening with circular marginal crypt epithelium (MCE) pattern. The gastric pyloric glandular mucosa displays a regular coil-shaped SECN pattern and regular polygonal or curved MCE pattern. For a diagnosis of early gastric cancer using M-NBI, the vessel plus surface classification system was developed. This system is clinically useful for the differential diagnosis of focal gastritis and small depressed cancer and for determining the horizontal extent of early gastric cancer for successful endoscopic resection. Advantages of M-NBI over conventional endoscopic imaging techniques with white light include accurate diagnosis and cost effectiveness. This technique is a breakthrough in the endoscopic diagnostic field.

Keyword

Magnifying endoscopy; Narrow band imaging; Stomach; Early gastric cancer; Endoscopic resection

MeSH Terms

Capillaries
Classification
Cost-Benefit Analysis
Diagnosis
Diagnosis, Differential
Endoscopy*
Epithelium
Gastritis
Mucous Membrane
Narrow Band Imaging
Stomach Neoplasms
Stomach*
Venules

Figure

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  Fig. 1. A black soft hood mounted at the tip of the scope.

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  Fig. 2. (A) Magnifying endoscopy with narrow-band imaging (M-NBI) findings of the normal gastric fundic gland mucosa. V (microvascular architecture): regular honeycomb-like subepithelial capillary network (SECN) pattern with regular collecting venule (CV) pattern is present. S (microsurface structure): regular oval crypt opening (CO) pattern with circular marginal crypt epithelium (MCE) pattern. (B) Anatomical components visualized by M-NBI in the normal gastric fundic gland mucosa. (C) Correlation between visualized microanatomies by M-NBI (upper part) and histological findings (lower part) in the superficial part of the gastric fundic glandular mucosa. SEC, subepithelial capillary; IP, intervening part between crypts.

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  Fig. 3. (A) Magnifying endoscopy with narrow-band imaging (M-NBI) findings of the normal gastric pyloric gland mucosa. V (microvascular architecture): regular coil-shaped subepithelial capillary (SEC) network pattern but absent regular collecting venule pattern. S (microsurface structure): regular polygonal or curved marginal crypt epithelium (MCE) pattern. (B) Anatomical components visualized by M-NBI in the normal gastric fundic gland mucosa. (C) Correlation between visualized microanatomies by M-NBI (upper part) and histological findings (lower part) in the superficial part of the gastric pyloric glandular mucosa. IP, intervening part between crypts.

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  Fig. 4. (A) Magnifying endoscopy with narrow-band imaging (M-NBI) findings of light blue crest (LBC) in gastric mucosa with intestinal metaplasia. Fine light blue (light cyan colored) linear reflections are located on the epithelial margins, visualized using M-NBI. (B) M-NBI findings of white opaque substance (WOS) in gastric mucosa with intestinal metaplasia. WOS visualized by reflections/strong scattering of whole projected lights located in the surface epithelium of the intervening part.

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  Fig. 5. Vessel plus surface (VS) classification. Adapted from Yao et al., [1] with permission from Thieme.

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  Fig. 6. Magnifying endoscopy with narrow-band imaging (M-NBI) findings of small depressed gastric lesions. (A) An example of non-cancerous lesion. A distinct demarcation line (arrows) is detected between the background mucosa and the depressed lesion. Within the demarcation line, it shows regular microvascular (MV) pattern plus regular microsurface (MS) pattern according to the vessel plus surface classification. Histological findings of biopsy specimen showed non-cancerous lesion (chronic gastritis with intestinal metaplasia). (B) An example of cancerous lesion. A demarcation line (arrows) is present between the background mucosa and the lesion. Within the demarcation line, irregular MV pattern plus irregular MS pattern is identified. Histological findings of endoscopically resected specimens demonstrated well-differentiated adenocarcinoma (2 mm in diameter). Adapted from Fujiwara et al., [21] with permission from Springer.

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  Fig. 7. A good example of limitations of magnifying endoscopy with narrow-band imaging (M-NBI) in screening endoscopy. (A) Conventional white light imaging shows a slightly depressed pale lesion in the gastric antrum. (B) M-NBI demonstrates regular microvascular pattern plus regular microsurface pattern with a demarcation line. (C) The histological findings of the biopsy specimen show signet-ring cell carcinoma (H&E stain, ×25). Adapted from Nagahama et al., [23] with permission from Elsevier.

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  Fig. 8. Usefulness of magnifying endoscopy with narrow-band imaging (M-NBI) for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (CE). (A) CE findings of a differentiated 0-IIb type early gastric cancer. The margins of lateral extent cannot be clearly delineated, let alone, the presence of cancer. (B) M-NBI findings of the oral margin of the cancer. Using M-NBI, a clear demarcation line (arrows) was identified. Within the demarcation line, an irregular microvascular pattern plus an absent microsurface pattern was present. Therefore, we successfully identified the cancer specific margin. (C) Because we determined the cancer-specific margins defining the cancer by M-NBI, we placed the markings just outside the demarcation lines according to the magnifying endoscopy using the M-NBI findings. Markings were traced by the white dotted line for the comparison with the following resected specimen after histopathological investigation. (D) The en bloc resected specimen by endoscopic submucosal dissection. According to the histopathological findings, the extent of the carcinoma (yellow lines) was reconstructed on the macroscopic photograph. The preoperative markings were clearly identified around the perimeter of carcinoma as shown by the white dotted line. Therefore, the lesion had been successfully delineated using M-NBI. Adapted from Nagahama et al., [23] with permission from Elsevier.

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  Fig. 9. A strategy for determining the lateral extent of early gastric cancer for curative endoscopic resection. C-WLI, conventional white light imaging; CE, chromoendoscopy; M-NBI, magnifying endoscopy with narrow-band imaging.

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