Fabian Emura

Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps

BACKGROUND Although microvascular vessels on the surface of colorectal polyps are observed by narrow-band imaging (NBI) with magnification, its clinical usefulness is still uncertain. OBJECTIVE Our purpose was to evaluate the usefulness of meshed capillary (MC) vessels observed by NBI magnification for differentiating between nonneoplastic and neoplastic colorectal lesions. DESIGN Prospective polyp study. SETTING National Cancer Center Hospital East, Chiba, Japan. PATIENTS A total of 702 consecutive patients who underwent total colonoscopy between September and December 2004 were prospectively evaluated. Patients with polyps >10 mm and those with polyps previously evaluated by histologic examination or colonoscopy were excluded. INTERVENTION Lesions were classified into 2 groups: polyps with invisible or faintly visible MC vessels as nonneoplastic and polyps with clearly visible MC vessels as neoplastic. Lesions judged as nonneoplastic were subjected to biopsy and those as neoplastic were removed endoscopically. Histologic analysis was performed in all lesions. MAIN OUTCOME MEASUREMENT Visible or invisible surface MC vessels, prediction of histologic diagnosis. RESULTS Of 92 eligible patients enrolled in this study, 150 lesions, including 39 (26%) hyperplastic polyps and 111 (74%) adenomatous polyps, were detected. Observation of MC vessels detected 107 of 111 neoplastic polyps and 36 of 39 nonneoplastic polyps. The overall diagnostic accuracy, sensitivity, and specificity were 95.3%, 96.4%, and 92.3%, respectively. LIMITATIONS MC vessel judgment performed by a single colonoscopist with extensive experience in magnifying NBI. CONCLUSION Observation of surface MC vessels by magnifying NBI is a useful and simple method for differentiating colorectal nonneoplastic and neoplastic polyps.

The pharynx: Examination of an area too often ignored during upper endoscopy

Head and neck cancer may be the most costly cancer to treat in the United States. This is particularly noteworthy for health care providers, their patients, and those paying for health care services because of the high morbidity of such cancers and the fact that only 48% of survivors return to work. There are nearly 30,000 incident cases of oral and pharyngeal cancer in the United States annually, with approximately 8000 deaths as the survival rates have improved little over the past 3 decades. Worldwide, pharyngeal cancer accounts for 130,000 incident cases and 83,000 deaths each year. It is predominantly a cancer in men who use tobacco and consume alcoholic beverages, which are both identified as group 1 carcinogens. Pharyngeal cancer has a poor prognosis because most cases are diagnosed at an advanced stage, and there is no standardized screening test. Traditional therapies such as surgical resection and chemoradiotherapy may increase survival to some extent, but often result in a considerably diminished quality of life because of speech defects, problems in swallowing, salivary disorders, and cosmetic deformities of the neck. Recent articles, however, on the effectiveness of both endoscopic diagnosis and curative treatment using EMR and endoscopic submucosal dissection (ESD) for early pharyngeal cancer have been encouraging. Interestingly, GI endoscopists in most of the reported cases have made both the diagnosis and performed the treatment rather than head and neck surgeons who usually treat such cancer with radical surgery. Although these pharyngeal cancers were detected during screening EGD examinations, upper endoscopy guidelines do not currently recommend examination or photo documentation of the pharynx during EGD.

Effectiveness of systematic alphanumeric coded endoscopy for diagnosis of gastric intraepithelial neoplasia in a low socioeconomic population.

Background and study aims: In the Western world, gastric cancer (GC) usually presents at an advanced stage, carrying a high mortality rate. Studies have reported that 14 % to 26 % of GCs are missed at endoscopy up to 3 years before diagnosis. Systematic Alphanumeric Coded Endoscopy (SACE) has been proposed to improve quality of esophagogastroduodenoscopy (EGD) by facilitating a complete examination of the upper gastrointestinal tract. This prospective cross-sectional study was designed to determine the frequency of gastric intraepithelial neoplasia (GIN) by using the SACE approach in cohort of patients from low socioeconomic level. It also used non-targeted biopsies to evaluate the frequency of premalignant conditions. Patients and methods: A total of 601 consecutive asymptomatic or dyspeptic patients were enrolled between January 2013 and November 2014 at the Huacho regional hospital in Peru. The SACE method proposed by Emura et al, which divides the stomach into 5 regions and 21 areas, was routinely used for diagnosis. Biopsy samples were obtained from any endoscopically detected focal lesion. To evaluate gastric premalignant conditions, 4 non-targeted biopsies were taken. Results: A total of 573 patients were analyzed. The mean age was 57 years, and the female:male ratio was 1.9 : 1. In all cases, complete photo-documentation of the 21 gastric areas was achieved. The overall rate of detection of GIN was 2.8 %. Low-grade displasia, high-grade dysplasia, and adenocarcinoma were found in 13 (2.3 %), 2 (0.3 %), and 1 (0.2 %) of the patients, respectively. The prevalence of at least 1 premalignant condition was 31 %, and helicobacter pylori infection was found in 57 % of patients. Conclusions: Using the SACE approach and with proper training, we have reported herein a high frequency of GIN in patients from a low socioeconomic status. Gastric cancer detection can be improved in a Western endoscopy setting when SACE, as a screening method, is performed by a trained endoscopist.