Esófago de Barrett y Cromoscopia Electrónica / Barrett's esophagus and electronic chromoscopy

Introducción: El diagnóstico endoscópico de Esófago de Barrett está dado por el hallazgo de lengüetas o parches de mucosa en esófago tubular, pero la toma de la biopsia puede tener errores de muestreo. La endoscopia con magnificación y cromoscopia electrónica como el Flexible Spectral Imaging Color Enhancement (FICE), es una técnica endoscópica con una alta capacidad diagnostica de Esófago de Barrett. Objetivo: Estudiar la capacidad diagnóstica de la Cromoscopia electrónica, usando el sistema FICE en el Esófago de Barrett. Materiales y métodos: Estudio prospectivo de corte transversal, con un muestreo no probabilístico de tipo intencional. Se incluyeron 206 pacientes evaluados entre mayo de 2007 a febrero de 2016. La clasificación de los hallazgos de los patrones mucosales (Pit), se hizo mediante la clasificación de epitelio de Barrett por magnificación endoscópica de Takao Endo y se les realizó histología e inmunohistoquimica. Resultados: pit 1: 120 (100%), pit 2: 36 (97%%), pit 3: 21 (84%), pit 4: 17 (100%), pit 5: 7(100%). Los hallazgos ratifican la capacidad diagnóstica de la endoscopia cuando se utiliza la clasificación de Takao Endo, con medias iguales para la endoscopia y la histología con Inmunohistoquimica. Conclusión: La Endoscopia con magnificación y Cromoscopia Electrónica FICE tiene una alta capacidad diagnóstica del Esófago de Barrett.

Introduction: Endoscopic diagnosis of Barrett's esophagus is given by the finding of tabs or patches of mucus in tubular esophagus but taking the biopsy may have sampling errors. Magnification endoscopy and electronic chromoscopy as Flexible Spectral Imaging Color Enhancement (FICE) represent the application of endoscopy technique with a high diagnostic capability of Barrett's Esophagus. Objective: To study the diagnostic capacity of electronic Chromoscopy using FICE system in Barrett's esophagus. Materials and Methods: A prospective cross-sectional study with a non-probabilistic intentional sampling, from May 2007 to February 2016. 206 patients were included. The classification of the findings of the mucosal patterns (Pit) was performed by the Classification of Barrett’s epithelium by magnifying endoscopy of Takao Endo and underwent histology and immunohistochemistry. Results: pit 1: 120 (100%), pit 2: 36 (97 %%), pit 3: 21 (84%), pit 4: 17 (100%), pit 5: 7 (100%). These results confirm the ability of endoscopy diagnosed when classification Takao Endo is used, with the same for endoscopy and histology Immunohistochemistry stockings. Conclusion: Endoscopy magnification and Chromoscopy Electronics FICE has a high diagnostic capability of Barrett's Esophagus.

Magnificación endoscópica, ácido acético y “flexible spectral imaging colour enhancement” (FICE) para el diagnóstico de esófago de Barrett / Endoscopic magnification, acetic acid and flexible spectral imaging colour enhancement (FICE) for the diagnosis of Barrett´s esophagus

Con endoscopia estándar no se precisa esófago de Barrett, pero la magnificación endoscópica con o sin cromoscopia puede identificarlo. Objetivo: Diagnosticar esófago de Barrett con magnificación endoscópica, rociado de ácido acético y “Flexible Spectral Imaging Colour Enhancement” (FICE). Pacientes: Previo consentimiento se incluyeron a los individuos con indicación de endoscopia digestiva superior. Materiales y Métodos: Se realizó endoscopia digestiva superior con equipo Fujinon Inc. EG 590 ZW, y procesador EPX 4400, consecutivamente se practicó: a) alta resolución, b) FICE, c) alta resolución, d) magnificación, e) FICE, f) alta resolución con instilación de acido acético al 5% en esófago distal y lavado con agua, g) magnificación y h) FICE. Se tomó biopsia del patrón observado, evaluada sin información del paciente. El procedimiento se grabó, se fotografió y se guardó en JPEG en programa Power Point. Resultados: En 120 pacientes: 44 hombres y 76 mujeres con edades de 20-85 años, el ácido acético destacó los patrones de mucosa observados con magnificación y resaltados con FICE. Esófago de Barrett se diagnosticó en 87,50% de patrón tipo 3 identificados en lengüetas largas. Conclusión: Magnificación endoscópica con rociado de ácido acético, y “Flexible Spectral Imaging Colour Enhancement” (FICE), identificó y resaltó en esófago el patrón sugestivo de esófago de Barrett.

Standard endoscopy does not identify Barrett´s esophagus, but endoscopic magnification and chromoendoscopy diagnose it accurately. Ojective: Diagnose Barrett’s esophagus with magnification endoscopy, spraying of acetic acid and Flexible Spectral Imaging Colour Enhancement (FICE). Patients: Individuals scheduled to undergo routine upper gastrointestinal endoscopy were enrolled. Materials and Methods: Upper gastrointestinal endoscopy was performed with Fujinon Inc. 590 EG ZW and EPX 4400 processor. Endoscopy was consecutively performed with: a) highresolution, b) FICE, c) high resolution d) magnification, e) FICE, f) high resolution with spraying of 5% acetic acid in distal esophagus inmediately washed with 20cc of water, g) magnification and h) FICE. Biopsy was taken and evaluated without patient information. The procedure was recorded, was photographed and was saved in JPEG in Power Point program. Results: In 120 patients: 44 men and 76 women aged 20-85 years, pit patterns of mucosa were enhanced with acetic acid sprayed in distal esophagus and highlighted with magnification and FICE. Barrett’s esophagus was diagnosed in 87.50% of cases with long columnar tongues and pit pattern type 3. Conclusion: Endoscopic magnification with spraying of acetic acid, and Flexible Spectral Imaging Colour Enhancement (FICE), identified and highlighted the pattern suggestive of diagnosis of Barretts esophagus.

Metaplasia intestinal en esófago: diagnóstico con magnificación endoscópica y “flexible spectral imaging colour enhancement” (FICE) corroborado por histología / Intestinal metaplasia in esophagus: diagnosis With magnifying endoscopy and flexible Spectral imaging colour enhancement (fice) Corroborated by histology

La endoscopia estándar no identifica esófago de Barrett. Esta limitación disminuye con magnificación endoscópica, coloración vital y/o virtual que permite observar los patrones de mucosa sugestivos de metaplasia intestinal. Identificar metaplasia intestinal con magnificación endoscópica y cromoscopia virtual realizada con "Flexible Spectral Imaging Colour Enhancement" (FICE) corroborándola con histología. Pacientes: Previo consentimiento se incluyeron a los individuos con indicación electiva de endoscopia digestiva superior. Se realizó endoscopia digestiva superior con equipo Fujinon Inc. EG 590 ZW, y procesador EPX 4400. Consecutivamente se practicó endoscopia con: a) alta resolución, b) FICE, c) alta resolución, d) magnificación, e) FICE y f) alta resolución. Cada patrón encontrado se grabó, se fotografió y se guardó en JPEG en programa Power Point. Los patólogos evaluaron la biopsia del patrón observado sin tener datos del paciente. Se incluyeron 30 pacientes: 11 hombres y 19 mujeres con rango de edad 20-83 años y promedio 51,73 años. Solo con magnificación sola o con cromoscopia virtual se observaron los patrones de mucosa. En el tipo 3 se diagnosticó esófago de Barrett en 33,33% y en ninguno de los otros. Conclusión: La magnificación endoscópica y cromoscopia virtual con FICE identifica metaplasia intestinal y diagnostica esófago de Barrett

Standard endoscopy does not identify Barrett's esophagus or mucosa patterns suggestive of intestinal metaplasia. Endoscopic magnification, vital and or virtual chromoscopy reduces this limitation. Aim: Identify intestinal metaplasia with endoscopic magnification and Flexible Spectral Imaging Colour Enhancement (FICE) corroborating it with histology. Patients: Individuals scheduled to undergo routine upper gastrointestinal endoscopy were enrolled. Upper gastrointestinal endoscopy was performed with Fujinon Inc. 590 EG ZW and EPX 4400 processor. Endoscopy was consecutively performed with: a) high resolution, b) FICE, c) high resolution, d) magnification, e) FICE, f) high resolution. Each found pattern was recorded, was photographed and was saved in JPEG in program Power Point. Biopsy was obtained of the predominant pattern and the pathologist assessed without patient information. Results: 30 patients were included, 11 men and 19 women with 20-83 years and 51.73 years average age range. Patterns of mucosa were observed only with magnification and virtual chromoscopy, Barrett's esophagus was diagnosed in 33.33% of type 3 and none in type 1 and 2. The endoscopic magnification and virtual chromoscopy with FICE identifies intestinal metaplasia and let diagnose Barrett's esophagus.

The Relationship between Gastric Juice Nitrate/Nitrite Concentrations and Gastric Mucosal Surface pH

PURPOSE: To investigate gastric juice nitrate/nitrite concentration according to mucosal surface pH extent (area) of gastric corpus intimately contacting the gastric juice. MATERIALS AND METHODS: We included ninety-nine patients with dyspepsia. To evaluate gastric mucosal surface pH and its extent, gastric chromosocpy was performed by spraying phenol red dye on the corpus mucosa and estimating the extent of area with color changed. Nitrate/nitrite concentrations and pH of gastric juice were measured by ELISA and pH meter, respectively. Silver staining was done to histologically confirm the presence of Helicobacter pylori. RESULTS: Intragastric nitrate/nitrite concentrations in patients, showing phenol red staining mucosa were higher than those of unstaining mucosa (p=0.001): the more extensive in the area of phenol red staining area of corpus, the higher gastric juice pH found (r=0.692, p<0.001). Furthermore, the intragastric nitrate/nitrite concentrations correlated positively with gastric juice pH (r=0.481, p<0.001). CONCLUSION: The changes of mucosal surface pH and its extent in gastric corpus might affect either pH or nitrate/nitrite level of gastric juice.

Narrow Band Imaging and White Light Colonoscopy for Detection of Polyps / 대한소화기내시경학회지

BACKGROUND/AIMS: Narrow band imaging (NBI) is a new technique that is expected to improve the detection rate of colorectal polyps, but results have been inconsistent. The aim of this study was to compare the polyp miss rate and the characteristics of missed colorectal polyps using white light (WL) and NBI. METHODS: 62 patients were randomized into two groups. In the first group (NBI first, NBIF), a colonoscopic examination of each segment (cecum-ascending, transverse, descending, and rectosigmoid colons) was performed first with NBI followed by a re-examination of the same segment using WL. An opposite sequence was applied for the other group (white light first, WLF). RESULTS: 67 polyps were found in the first examination, and 31 polyps were found on the re-examination, resulting in a polyp miss rate of 31.6%. The polyp miss rate was 39% for WLF and 23% for NBIF (p>0.05). Seventy-four small polyps (<5 mm) were found, and miss rates for NBIF and WLF were 20% and 46%, respectively (p=0.01). The polyp miss rate at the rectosigmoid was 11% for NBIF and 54% for WLF (p=0.01). CONCLUSIONS: The polyp miss rate was not significantly different between NBI or WL when a colonoscopy was performed. NBI resulted in a lower polyp miss rate for small (<5 mm) and rectosigmoid polyps than WL.

The Current Status of Virtual Chromoscopy / 대한소화기내시경학회지

Virtual chromoscopy is a novel technology that enhances endoscopic visualization of superficial mucosal surfaces and microvascular architecture. Currently available virtual chromoscopy techniques include narrow band imaging, Fujinon intelligent color enhancement and I-scan. Refinements are expected to improve detection of the lesions, which will lead to further insight into the pathological processes, in turn, providing guidance in selecting the optimal treatment. Presently, we review the currently available literature regarding virtual chromoscopy and provide technical principles, clinical usefulness, and limitations.

Focos de criptas aberrantes correlación endoscópico-morfológica con el uso de Endoscopios de alta resolución sin magnificación

Este trabajo tiene como propósito la descripción de los focos de criptas aberrantes utilizando colonoscopio de alta resolución sin magnificación. Los focos de criptas aberrantes se observan como lesiones planas o ligeramente elevadas, con un diámetro entre 1-4 mm, pueden presentar depresión central y con endoscopia de alta resolución, aún sin magnificación es posible ver el patrón de criptas. Usualmente se encuentran en la cercanía de adenomas. Una vez visualizada la lesión se procedió a realizar cromoscopía previa irrigación con 3-5 cc de ácido acético al 0,5 % como agente mucolítico, luego de 30 segundos se irrigó la zona con el colorante: azul de metileno al 0,5% o índigo carmín 0,5-1 %. Se intentó clasificar las lesiones de acuerdo a los criterios establecidos en la literatura para tratar de establecer correlación con el diagnóstico histológico. Se incluyeron 40 pacientes, en 67,5 % de los casos los focos de criptas aberrantes fueron localizados en colon recto-sigmoides. Existió una correlación endoscópica e histológica entre los focos de criptas aberrantes displásica y alta asociación con pólipos.

In our study, we used standard high resolution colonoscope to describe aberrant crypt foci. Aberrant crypt foci are either flat or slightly elevated lesions with a 1 to 4 mm of diameter with central depression. Usually these foci have been close to adenomas. Once the lesion was identified, it was first irrigated with 0.5% of acetic acid to remove mucus from the surface. After 30 seconds it was irrigated again with 0.5 % methylene blue or 0.5 to 1% indigo carmine. We tried to classify the lesion based on the literature criteria and compare it with the histopathology diagnosis. 40 patients were evaluated in this study, 67, 5 % of the aberrant crypt foci were located in rectosigmoid colon. We found direct histopathologic and endoscopic correlation between dysplasic aberrant crypt foci and high association with polyps.

Clinical application of magnifying chromoscopy in detection and diagnosis of colorectal elevated lesion / 中华消化杂志

Objective To evaluate the clinical value of magnifying chromoscopy in combination with Kudo criteria in detection and diagnosis of colorectal lesions. Methods After conventional electronic colonoscopic diagnosis of 125 colorectal lesions, staining and magnifying observation by chromoscopy were made with Kudo criteria, and biopsy specimen and resected samples were sent for pathologic examinations. Results The accuracy of ordinary colonoscopy and magnifying colonoscopy compared with histological diagnosis of inflammatory polyps, tubular adenomas, villous adenomas and colorectal cancer was 95.62%, 80%, 90% and 100% respectively and 100%, 93.75%, 92.86% and 100% respectively. The overall accuracy of two procedures was 85.6% and 95.2% respectively. Conclusions Magnifying chromoscopy is valuable in detection of tiny and slightly elevated colorectal lesion, and has high efficacy in judging the nature of lesions with Kudo criteria.

Usefulness of Magnifying Chromoscopy in Ulcerative Colitis / 대한소화기내시경학회지

BACKGROUND/AIMS: Ulcerative colitis is an inflammatory bowel disease with unknown etiology, which has waxed and waned course. It is diagnosed by colon study, pathology, and especially colonoscopy. It is difficult to differentiate between ulcerative colitis and other infectious colitis, especially amebic colitis, and to confirm of remnant lesion by endoscopic findings. METHODS: Magnifying colonoscopy has 100 time magnifying power compared to 30 time of conventional colonoscopy. By spraying 0.2% indigo carmine dye, we evaluated the magnifying and microscopic findings of 31 colonic mucosa of 23 patients with ulcerative colitis. RESULTS: Initial and magnifying chromoscopic findings in ulcerative colitis were loss of cryptal opening 72% (13/18), loss of submucosal vessel 89% (16/18), mucosal denudation (or microscopic erosion) 83% (15/18), and mucosal unevenness 94% (17/18). Recovery rate of magnifying chromoscopic findings after treatment in ulcerative colitis were in crytal opening 80% (8/10), submucosal vascularity 60% (6/10), mucosal denudation (microscopic erosion) 30% (3/10), and in mucosal unevenness 40% (4/10). CONCLUSIONS: It is suggested that magnifying chromoscopic findings in ulcerative colitis may be useful in initial diagnosis and confirmation of remnant lesion, but, not in prediction of clinical severity.

Usefulness of Chromoscopy Using Lugol Solution for Detection of Superficial Esophageal Cancer / 대한소화기내시경학회지

Background/Aims: Esophageal cancer is not an uncommon cancer in Korea, however, the prognosis still remains very poor with a 5 year survival rate bemg less than l0% mainly becauae of the delayed diagnosis. Although chromoscopy with lugol solution has been received to diagnose the esophageal cancer in an early stage without difficulty, its clinical use has not been popular yet in Korea. This study was performed prospectively to evaluate the usefulness of the chromoscopy for the detection of superficial esophageal cancer in risk patients for esophageal cancer. Methods: Ninety-five patients were selected among persons who received gasiroscopy at Asan Medical Center between Jan. 1996 and May 1996 and were prospectively included for chromoscopy. Inclusion criteria for the chromoscopy were patients older than 60 years of age with smoking history of more than 30 packyears, and/or past or family history of cancers. After conventional endoscopic examination, lugol solution was sprayed to stain the glycogen granules in the epithelial cells. The size of unstained lesion was measured and stainability was classified into 5 grades. All lesions unstained were biopsied for histological diagnosis.(continue...)