Chromoendoscopy of gastric adenoma using an acetic acid indigocarmine mixture

AIM:To investigate the usefulness of chromoendoscopy,using an acetic acid indigocarmine mixture(AIM),for gastric adenoma diagnosed by forceps biopsy.METHODS:A total of 54 lesions in 45 patients diagnosed as gastric adenoma by forceps biopsy were prospectively enrolled in this study and treated by endoscopic submucosal dissection(ESD)between January 2011 and January 2012.AIM-chromoendoscopy(AIMCE)was performed followed by ESD.AIM solution was sprinkled and images were recorded every 30 s for 3min.Clinical characteristics such as tumor size(<2cm,≥2 cm),surface color in white light endoscopy(WLE)(whitish,normochromic or reddish),macroscopic appearance(flat or elevated,depressed),and reddish change in AIM-CE were selected as valuables.RESULTS:En bloc resection was achieved in all 54 cases,with curative resection of fifty two lesions(96.3%).Twenty three lesions(42.6%)were diagnosed as welldifferentiated adenocarcinoma and the remaining 31lesions(57.4%)were gastric adenoma.All adenocarcinoma lesions were well-differentiated tubular adenocarcinomas and were restricted within the mucosal layer.The sensitivity of reddish color change in AIM-CE is significantly higher than that in WLE(vs tumor size≥2 cm,P=0.016,vs normochromic or reddish surface color,P=0.046,vs depressed macroscopic type,P=0.0030).On the other hand,no significant differences were found in the specificity and accuracy.In univariate analysis,normochromic or reddish surface color in WLE(OR=3.7,95%CI:1.2-12,P=0.022)and reddish change in AIM-CE(OR=14,95%CI:3.8-70,P<0.001)were significantly related to diagnosis of early gastric cancer(EGC).In multivariate analysis,only reddish change in AIM-CE(OR=11,95%CI:2.3-66,P=0.0022)was a significant factor associated with diagnosis of EGC.CONCLUSION:AIM-CE may have potential for screening EGC in patients initially diagnosed as gastric adenoma by forceps biopsy.

Tolerability of magnifying narrow band imaging endoscopy for esophageal cancer screening

AIM:To compare the tolerability of magnifying narrow band imaging endoscopy for esophageal cancer screening with that of lugol chromoendoscopy.METHODS:We prospectively enrolled and analyzed 51 patients who were at high risk for esophageal cancer.All patients were divided into two groups:a magnifying narrow band imaging group,and a lugol chromoendoscopy group,for comparison of adverse symptoms.Esophageal cancer screening was performed on withdrawal of the endoscope.The primary endpoint was a score on a visual analogue scale for heartburn after the examination.The secondary endpoints were scale scores for retrosternal pain and dyspnea after the examinations,change in vital signs,total procedure time,and esophageal observation time.RESULTS:The scores for heartburn and retrosternal pain in the magnifying narrow band imaging group were significantly better than those in the lugol chromoendoscopy group(P =0.004,0.024,respectively,ANOVA for repeated measures).The increase in heart rate after the procedure was significantly greater in the lugol chromoendoscopy group.There was no significant difference between the two groups with respect to othervital sign.The total procedure time and esophageal observation time in the magnifying narrow band imaging group were significantly shorter than those in the lugol chromoendoscopy group(450 ± 116 vs 565 ± 174,P =0.004,44 ± 26 vs 151 ± 72,P < 0.001,respectively).CONCLUSION:Magnifying narrow band imaging endoscopy reduced the adverse symptoms compared with lugol chromoendoscopy.Narrow band imaging endoscopy is useful and suitable for esophageal cancer screening periodically.

Comparing reduced-dose sodium phosphate tablets to 2L of polyethylene glycol: A randomized study

AIM To compare the tolerability and quality of bowel cleansing between 2 L polyethylene glycol(PEG)and reduced-dose sodium phosphate(Na P)tablets as a preparation for colonoscopy.METHODS Two hundred patients were randomly assigned to the PEG or Na P groups at the same ratio.The Na P group patients took 30 tablets with 2 L of clear liquid,while the PEG group patients took 2L of PEG.Tolerability was assessed by a questionnaire about taste,volume,and the overall impression.The bowel cleansing quality was evaluated by colonoscopists.RESULTS Although Na P showed better tolerability in terms of taste,volume and overall impression(P<0.01,P<0.01 and P=0.02,respectively),the overall cleansing quality was better in the PEG group(P<0.01).A subgroup analysis,stratified by sex and age,indicated that Na P was associated with better tolerability and equivalent bowel cleansing quality in females of<50years of age.CONCLUSION Despite the better tolerability,the use of 30 Na P tablets with 2 L of clear liquid should be limited due to its lower cleansing quality;however,in certain cases the regimen may deserve consideration,particularly in cases involving young women.