Clin Endosc.  2018 Nov;51(6):527-533. 10.5946/ce.2018.186.

Usefulness of Narrow-Band Imaging in Endoscopic Submucosal Dissection of the Stomach

• Kim JW

• KMID: 2430393
• DOI: http://doi.org/10.5946/ce.2018.186

Abstract

There have been many advances in endoscopic imaging technologies. Magnifying endoscopy with narrow-band imaging is an innovative optical technology that enables the precise discrimination of structural changes on the mucosal surface. Several studies have demonstrated its usefulness and superiority for tumor detection and differential diagnosis in the stomach as compared with conventional endoscopy. Furthermore, magnifying endoscopy with narrow-band imaging has the potential to predict the invasion depth and tumor margins during gastric endoscopic submucosal dissection. Classifications of the findings of magnifying endoscopy with narrow-band imaging based on microvascular and pit patterns have been proposed and have shown excellent correlations with invasion depth confirmed by microscopy. In terms of tumor margin prediction, magnifying endoscopy with narrow-band imaging offers superior delineation of gastric tumor margins compared with traditional chromoendoscopy with indigo carmine. The limitations of narrow-band imaging, such as the need for considerable training, long procedure time, and lack of studies about its usefulness in undifferentiated cancer, should be resolved to confirm its value as a complementary method to endoscopic submucosal dissection. However, the role of magnifying endoscopy with narrow-band imaging is expected to increase steadily with the increasing use of endoscopic submucosal dissection for the treatment of gastric tumors.

Keyword

Magnifying endoscopy; Narrow band imaging; Stomach; Application; Delineation

MeSH Terms

Classification
Diagnosis, Differential
Discrimination (Psychology)
Endoscopy
Indigo Carmine
Methods
Microscopy
Narrow Band Imaging
Stomach*
Indigo Carmine

Figure

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  Fig. 1. Schema of the narrow-band imaging (NBI) system. RGB, red-greenblue; WLI, white-light image.

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  Fig. 2. Flow diagram of the simple diagnostic algorithm for magnifying endoscopy in gastric cancer proposed by Muto et al[25]. DL, demarcation line; IMVP, irregular microvascular pattern; IMSP, irregular microsurface pattern.

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  Fig. 3. Chromoendoscopic finding of gastric adenoma with low-grade dysplasia. (A) A conventional white-light image showing an unclear lesion with ambiguous margins. (B) After indigo carmine spraying, a slightly elevated lesion with a clear margin is evident.

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  Fig. 4. Early gastric cancer observed using magnifying endoscopy with narrow-band imaging. (A) A demarcation line is clearly revealed. (B) The tumor margins are well delineated based on the irregular microvascular pattern.

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  Fig. 5. Dual-focus magnification with the updated narrow-band imaging (NBI) system. (A) Updated NBI system with an improved light source that allows brighter images. (B) The near-focus mode of dual-focus NBI provides accurate delineation of the tumor by about 45-fold near-field magnification.

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