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【Objective】 To investigate the effects of 450 nm diode blue laser on the morphological changes and thermal damage of renal pelvis under different conditions. 【Methods】 An ex vivo study was conducted on a fresh porcine pelvis model (7 cm×5 cm×3 cm). The laser fiber was fixed on the mechanical arm perpendicular to the renal pelvis tissue, and the distance between them was 1-2 mm. The renal pelvis tissue was incised at a speed of 1-2 mm/s and power of 5-30 W. After the incised tissue was fixed in formalin (4%), the morphology, depth, width and coagulation thickness were observed with naked eyes and a microscope. 【Results】 The different powers had different vaporization and incision effects. When the operating distance was 2 mm, the speed was 2 mm/s and power was 5 W, the vaporization depth, width and coagulation thickness were approximately 0 9 mm, 0.25 mm and 0.35 mm, respectively. With the increase of power, the vaporization width and depth increased, and the coagulation thickness was 0.35-0.50 mm. When the power was more than 10 W, the renal pelvis tissue was easily penetrated. When the laser power was 20 W, the section of the renal pelvis showed an irregular shape of vaporization. When the operating distance was 1 mm, the whole renal pelvis tissue was easily vaporized. When it was 2 mm, a wide and safe energy treatment window was produced. 【Conclusion】 The 450 nm diode blue laser can vaporize and incise renal pelvis tissue safely and effectively, with high precision and little thermal damage. It is expected to be a new surgical tool in the treatment of renal pelvis lesions.
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【Objective】 To observe the efficacy of blue laser side light in the vaporization and enucleation of non-muscle invasive bladder cancer (NMIBC). 【Methods】 A retrospective analysis was performed on the data of NMIBC patients who received transurethral enucleation of bladder tumor (TURBT) using a 50 W blue laser treatment device. The efficacy and safety of surgery were evaluated by observing the application of blue laser in the treatment of bladder cancer in different locations, operation time, presence of bladder perforation and postoperative urine routine indicators. 【Results】 A total of 16 patients completed the surgery, including 5 cases with multiple bladder tumors, 9 with single bladder tumor, and 2 with lichenoid lesions. The postoperative pathological results showed all of them were NMIBC. The operation time was (10.4±4.7) min, postoperative urinalysis was (689.4±316.7)/μL, and no intraoperative bladder perforation occurred. 【Conclusion】 The lateral infusion mode of 50 W blue laser therapy device can be applied to the surgical treatment of NMIBC. The basal vaporization and enucleation of bladder cancer can be performed under direct vision conditions, and the multi-angle enucleation is suitable for bladder cancer in different positions. The tissue penetration depth of blue laser is shallow, which is conducive to the diagnosis and grading of pathological tissues.
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【Objective】 To investigate the feasibility and safety of semiconductor blue laser in the treatment of non-muscle invasive bladder cancer (NMIBC) in the day surgery model. 【Methods】 The clinical data of 22 NMIBC patients (average age 55.8 years and tumor size 1.4 cm) who underwent outpatient screening and accepted blue laser ambulatory surgery in our hospital during Jun.2022 and Sep.2022 were retrospectively analyzed. On the day of admission, transurethral resection of cancer was performed using blue laser en bloc enucleation. On the day of surgery or in the morning of next day, bladder irrigation was stopped, the catheter was removed, and patients were discharged. The baseline data, pre-hospital waiting time, operation time, length of hospital stay, hemoglobin decrease, complications and management, follow-up, medical costs, and patients’ satisfaction rate were recorded. 【Results】 The pre-hospital waiting time was 2 to 7 days, average (4.1±1.3)days. The operation time was 29 to 50 minutes, average (40.8±5.5)minutes. The length of hospital stay was 0.6 to 1.2 days, average (0.9±0.2)days. Hemoglobin decrease was 1 g/L to 8 g/L, average (3.8±1.8)g/L. The catheter was indwelt for 0.5 to 1 day, average (0.7±0.1)day. The medical costs were 13 790 to 16 811 Yuan, average (14 941.5±690.2) Yuan. Patients’ satisfaction rate was 100.0%. Mild intraoperative and postoperative complications occurred in 2 cases. One patient developed symptoms of cystitis which disappeared after 2 days of oral antibiotic cefixime, and another patient developed bladder spasm which was relieved after oral solifenacin succinate tablets. No adverse events such as obturator nerve reflex or bladder perforation occurred. After removal of the catheter, no urinary retention was observed. 【Conclusion】 This study was the first to apply blue laser ambulatory surgery in the treatment of bladder cancer, confirming that it is a safe, feasible, economical and efficient model for selected patients, which can be promoted in suitable hospitals.
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【Objective】 To compare the efficacy and safety of blue laser en bloc enucleation and traditional plasmakinetic electrocautery in the treatment of non-muscle invasive bladder cancer (NMIBC). 【Methods】 A total of 50 NMIBC patients treated in our hospital during Oct.2018 and Dec.2019 were enrolled. A randomized, incomplete blinding, parallel control design and non-inferior test method was adopted. The control group (electrocautery group) used plasmakinetic electrocautery for transurethral resection, and the experimental group (blue laser group) used semiconductor blue laser for transurethral en bloc enucleation. The effective resection rate, operation time, postoperative catheter indwelling time, length of hospital stay, perioperative hemoglobin changes and obturator nerve reflex were compared. 【Results】 There were 24 patients in the blue laser group and 26 in the electrocautery group. The effective dissection rate and hemostasis rate in both groups reached 100%. The blue laser group had slightly longer operation time than the electrocautery group (55 min vs.42 min, P=0.009), but lesser hemoglobin decrease (5.7 g/L vs. 10.4 g/L, P=0.007). There were no significant differences in urinary catheter indwelling time, length of hospital stay and reoperation rate between the two groups. The electrocautery group had 3 cases of obturator nerve reflex, while the blue laser group had none. 【Conclusion】 Compared with the traditional electrocautery, blue laser has good vaporization cutting and coagulation hemostatic effects on bladder tumor tissue, and can completely enucleate tumors in a front-firing model with less bleeding and no obturator nerve reflex, which can be used as a new, efficient, safe and easy-to-learn method for NMIBC surgery. However, its effects on postoperative recurrence rate and progression rate still need further studies.
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【Objective】 To explore the effects of sexual function-preserving 450 nm blue laser vaporization of the prostate on the postoperative sexual function of patients with benign prostatic hyperplasia (BPH), and to evaluate the clinical efficacy, safety and feasibility of this procedure. 【Methods】 The clinical data of 20 BPH patients treated in our department during Jan. and Mar.2023 were analyzed. The International Prostate Symptom Score (IPSS), Quality of Life Scale (QoL) score, maximum urinary flow rate (Qmax), residual urine volume (PVR) and International Index of Erectile Function (IIEF-5) data were compared before and after the operation. The operation time, postoperative catheter indwelling time, and hospital stay were recorded. The ejaculation status 2 months after operation was followed up. 【Results】 All 20 patients completed the operation successfully. The operation time was (13.41±4.30) min, catheter indwelling time (1.2±0.4) d, and hospital stay (3.0±0.6) d. The IPSS, QoL, PVR and Qmax data 1 month after operation were significantly improved compared with those before operation (P0.05). 【Conclusion】 The modified 450 nm blue laser vaporization of the prostate can improve the urination symptoms of BPH patients while retaining sexual function. It is a safe and feasible technique for BPH patients who have sexual needs, and provides an alternative surgical approach for those looking to preserve sexual function.
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【Objective】 To evaluate the efficacy and safety of 450 nm semiconductor blue laser combined with triamcinolone acetonide injection in the treatment of bladder neck contracture (BNC). 【Methods】 A 61-year-old male patient with BNC and urethral stricture was treated with 450 nm semiconductor blue laser vaporization combined with triamcinolone acetonide injection. The surgery was performed with a small-caliber laser resectoscope of F22. The follow-up results 3 months after surgery were reported. 【Results】 The operation was successful, the operation time was 30 minutes, and the patient was discharged the next day after operation. Follow-up 3 months after operation showed the maximum urinary flow rate (Qmax) was 22.1 mL/s, the International Prostate Symptom Score (IPSS) was 2, the Quality of Life Scale (QoL) was 0, and no recurrence was observed. 【Conclusion】 It is safe and feasible to use 450 nm semiconductor blue laser combined with triamcinolone acetonide injection to treat bladder neck contracture through a small-caliber laser resectoscope of F22, especially for patients with urethral stricture. The short-term efficacy is satisfactory.
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【Objective】 To evaluate the clinical efficacy of 200 W blue laser vaporization of prostate and the possibility of developing such surgery into day surgery. 【Methods】 The clinical data of 30 patients treated during Aug. and Sep.2022 were retrospectively reviewed. The residual urine volume, urine flow rate, International Prostate Symptom Score (IPSS) and Quality of Life Scale(QoL) score before and after surgery were compared. The operation time and postoperative routine urinary red blood cell count were recorded. 【Results】 All surgeries were successful and the catheter was moved 1 day after surgery. The operation time was (12.2±5.1) min, postoperative bladder irrigation time (20.0±4.2) h, and urinary red blood cell count (806.2±16.3)/μL. Recatheter was needed in 1 patient. The urinary flow rate before surgery, immediately and 1-month after surgery were (10.6±3.5) mL/s, (24.2±5.6) mL/s, and (27.2±3.1) mL/s, respectively. The residual urine was (57.3±3.2) mL before surgery and (5.6±3.1) mL 1-month after surgery. The average preoperative IPSS and QoL scores were (25.1±1.6) and (5.4±0.7), and were (9.5±1.4) and (2.9±0.6), respectively, 3-months after surgery. 【Conclusion】 Transurethral 200 W blue laser vaporization of the prostate is a practical and feasible surgical technique for the treatment of benign prostatic hyperplasia. It is effective, rapid and safe, and can greatly shorten the length of hospital stay and improve perioperative safety. With the improvement of clinical application technology, it can be a choice of prostatic day surgery.
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【Objective】 To investigate the clinical efficacy and safety of transurethral blue laser vaporescetion of the prostate in the treatment of benign prostatic hyperplasia (BPH). 【Methods】 The clinical data of 100 BPH patients undergoing the surgery in our hospital during May and Sep.2022 were retrospectively analyzed. The observations included operation time, bladder irrigation duration, postoperative catheter indwelling time, hospital stay, complications, as well as changes in hemoglobin, International Prostate Symptom Score (IPSS), Quality of Life Scale (QoL) score, maximum urinary flow rate (Qmax), bladder residual urine volume (PVR), and other related indicators before and 3 months after surgery. 【Results】 All 100 procedures were successfully completed without turning to transurethral resection of the prostate and/or open surgery. No blood transfusion was needed. The operation time was (37.8±19.6) min, bladder irrigation time (1.3±0.5) d, catheter indwelling time (12.7±0.4) d, hospital stay (3.4±0.7) d, hemoglobin drop (4.1±7.1) g/L. The postoperative IPSS and QoL score were significantly lower than those before surgery (P<0.05); postoperative Qmax was higher than that before surgery (P<0.05); postoperative PVR was smaller than that before surgery (P<0.05). Urinary retention occurred in 4 cases (4%) after removal of the catheter; carnal hematuria and bladder clot formation occurred in 3 cases (3%); mixed urinary incontinence occurred in 2 cases (2%); stenosis of the external urethra occurred in 2 cases (2%). All complications were cured after symptomatic treatment. There were no serious perioperative complications, no intraoperative complications such as ureteral orifice injury or bladder perforation, and no serious postoperative complications such as transurethral resection syndrome (TURS), permanent urinary incontinence or bladder neck contracture. 【Conclusion】 The blue laser surgical system had satisfactory effects of vaporization and hemostasia. Transurethral blue laser vaporesection of the prostate is safe and effective in the treatment of BPH.
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Introdução: Imagem endoscópica aprimorada permite o diagnóstico diferencial das lesões colorretais em tempo real através do estudo da microvasculatura. Objetivo: Revisar o uso do Blue Laser Imaging (BLI) na análise do padrão dos capilares para o diagnóstico diferencial entre lesões neoplásicas e não neoplásicas. Métodos: Esta é revisão integrativa da literatura que colheu informações publicadas em plataformas virtuais em português e inglês. A busca para leitura e análise foi realizada nas plataformas SciELO Scientific Electronic Library Online, Google Scholar, Pubmed e Scopus. Os descritores retirados do DeCS/MESH foram: "Blue laser imaging. Endoscopia. Cromoendoscopia, Pólipos colorretais. Magnificação" e seus correspondentes em inglês "Blue laser imaging. Image-enhanced endoscopy. Chromoendoscopy. Colorectal polyps. Magnification" com busca AND ou OR, considerando o título e/ou resumo. Foram incluídos somente os que tivessem maior correlação ao tema, e neles foi baseada a revisão com leitura, na íntegra, dos textos. Resultados: Ao final resultaram 22 artigos que compuseram esta revisão. Conclusão: BLI associada à magnificação mostrou bons resultados no diagnóstico histológico preditivo em tempo real para as lesões de cólon e reto.
Introduction: Improved endoscopic imaging allows the differential diagnosis of colorectal lesions in real time through the study of the microvasculature. Objective: To review the use of Blue Laser Imaging (BLI) in analyzing the capillary patern for the differential diagnosis between neoplastic and nonneoplastic lesions. Methods: This is an integrative review of the literature that collected information published on virtual platforms in Portuguese and English. The search for reading and analysis was carried out on the SciELO Scientific Electronic Library Online, Google Scholar, Pubmed and Scopus platforms. The descriptors taken from DeCS/MESH were: "Blue laser imaging. Endoscopy. Chromoendoscopy, Colorectal polyps. Magnification" and its English counterparts "Blue laser imaging. Image-enhanced endoscopy. Chromoendoscopy. Colorectal polyps. Magnification" with AND or OR search, considering the title and/or abstract. Only those that had the greatest correlation to the topic were included, and the review was based on them, with reading, in full, of the texts. Results: In the end, 22 articles resulted that made up this review. Conclusion: BLI associated with magnification showed good results in real-time predictive histological diagnosis for colon and rectal lesions.
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Humains , Tumeurs du côlonRésumé
Objective:To develop early gastric cancer (EGC) detection system of magnifying blue laser imaging (ME-BLI) model and magnifying narrow-band imaging (ME-NBI) model based on deep convolutional neural network, to compare the performance differences of the two models and to explore the effects of training methods on the accuracy.Methods:The images of benign gastric lesions and EGC under ME-BLI and ME-NBI were respectively collected. A total of five data sets and three test sets were collected. Data set 1 included 2 024 noncancerous lesions and 452 EGC images under ME-BLI. Data set 2 included 2 024 noncancerous lesions and 452 EGC images under ME-NBI. Data set 3 was the combination of data set 1 and 2 (a total of 4 048 noncancerous lesions and 904 EGC images under ME-BLI and ME-NBI). Data set 4: on the basis of data set 2, another 62 noncancerous lesions and 2 305 EGC images under ME-NBI were added (2 086 noncancerous lesions and 2 757 EGC images under ME-NBI). Data set 5: on the basis of data set 3, another 62 noncancerous lesions and 2 305 EGC images under ME-NBI were added(4 110 noncancerous lesions and 3 209 EGC images under ME-NBI and ME-BLI). Test set A included 422 noncancerous lesions and 197 EGC images under ME-BLI. Test set B included 422 noncancerous lesions and 197 EGC images under ME-NBI. Test set C was the combination of test set A and B (844 noncancerous and 394 EGC images under ME-BLI and ME-NBI). Five models were constructed according to these five data sets respectively and their performance was evaluated in the three test sets. Per-lesion video was collected and used to compare the performance of deep convolutional neural network models under ME-BLI and ME-NBI for the detection of EGC in clinical environment, and compared with four senior endoscopy doctors. The primary endpoint was the diagnostic accuracy of EGG, sensitivity and specificity. Chi-square test was used for statistical analysis.Results:The performance of model 1 was the best in test set A with the accuracy, sensitivity and specificity of 76.90% (476/619), 63.96% (126/197) and 82.94% (350/422), respectively. The performance of model 2 was the best in test set B with the accuracy, sensitivity and specificity of 86.75% (537/619), 92.89% (183/197) and 83.89% (354/422), respectively. The performance of model 3 was the best in test set B with the accuracy, sensitivity and specificity of 86.91% (538/619), 84.26% (166/197) and 88.15% (372/422), respectively. The performance of model 4 was the best in test set B with the accuracy, sensitivity and specificity of 85.46% (529/619), 95.43% (188/197) and 80.81% (341/422), respectively. The performance of model 5 was the best in test set B, with the accuracy, sensitivity and specificity of 83.52% (517/619), 96.95% (191/197) and 77.25% (326/422), respectively. In terms of image recognition of EGC, the accuracy of models 2 to 5 was higher than that of model 1, and the differences were statistically significant ( χ2=147.90, 149.67, 134.20 and 115.30, all P<0.01). The sensitivity and specificity of models 2 and 3 were higher than those of model 1, the specificity of model 2 was lower than that of model 3, and the differences were statistically significant ( χ2=131.65, 64.15, 207.60, 262.03 and 96.73, all P < 0.01). The sensitivity of models 4 and 5 was higher than those of models 1 to 3, and the specificity of models 4 and 5 was lower than those of models 1 to 3, and the differences were statistically significant ( χ2=151.16, 165.49, 71.35, 112.47, 132.62, 153.14, 176.93, 74.62, 14.09, 15.47, 6.02 and 5.80, all P<0.05). The results of video test based on lesion showed that the average accuracy of doctors 1 to 4 was 68.16%. And the accuracy of models 1 to 5 was 69.47% (66/95), 69.47% (66/95), 70.53% (67/95), 76.84% (73/95) and 80.00% (76/95), respectively. There were no significant differences in the accuracy among models 1 to 5 and between models 1 to 5 and doctors 1 to 4 (all P>0.05). Conclusions:ME-BLI EGC recognition model based on deep learning has good accuracy, but the diagnostic effecacy is sligntly worse than that of ME-NBI model. The effects of EGC recognition model of ME-NBI combined with ME-BLI is better than that of a single model. A more sensitive ME-NBI model can be obtained by increasing the number of ME-NBI images, especially the images of EGG, but the specificity is worse.
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@#Introduction: Staphylococcus aureus biofilm is a major mediator of infection. The light based therapy is still not adequate to eradicate biofilm caused by Extracellular Polymeric Substances (EPS). The Ultra Violet (UV) irradiation has high energy and sufficient to penetrate a tissue. This study aims to investigate the effect of combination of UV LED irradiation and blue laser on the biofilm. Methods: The pure culture of Staphylococcus aureus ATCC 25923 approximated 108 CFU/mL or 1.0 McFarland Standard was used for this study. The biofilm sample was placed onto micro plate for 48 hours. The treatment group was divided into 3 groups, which were blue laser group, UV LED group and UV-Blue laser group. Results: The results showed that the highest biofilm reduction (80.57 ± 0.77) % was treated by blue laser irradiation for 4 minutes and UV irradiation for 20 s. Conclusion: Thus, the combination UV LED and Blue laser is the best choice to eradicate more biofilm.
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A laser endoscopy system was developed in 2012. The system allows blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI) to be performed as modes of narrow-band light observation; these modes have been reported to be useful for tumor detection and characterization. Furthermore, an innovative endoscopy system using four-light emitting diode (LED) multilight technology was released in 2016 to 2017 in some areas in which laser endoscopes have not been approved for use, including the United States and Europe. This system enables blue light imaging (this is also known as BLI) and LCI with an LED light source instead of a laser light source. Several reports have shown that these modes have improved tumor detection. In this paper, we review the efficacy of BLI and LCI with laser and LED endoscopes in tumor detection and characterization.
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Tumeurs colorectales , Endoscopes , Endoscopie , Europe , États-UnisRésumé
A 62-year-old man with a flat early esophageal cancer was referred for endoscopic treatment. White light imaging revealed a pale red lesion, whereas linked color imaging (LCI) and blue laser imaging (BLI) yielded purple and brown images, respectively. Iodine staining demonstrated a large unstained area with a homogenous but very weak pink-color sign. This area appeared more clearly as purple and green on LCI and BLI, respectively; however, a different colored portion was observed at the 4 o'clock position inside the iodine-unstained area. Histopathology findings of the resected specimen revealed squamous intraepithelial neoplasia at the 4 o'clock position and an esophageal squamous cell carcinoma in the remaining iodine-unstained area. LCI and BLI combined with iodine staining produce characteristic images that overcomes the pink-color sign, reflecting the histological features of a flat esophageal neoplasm. This new method is useful for detailed evaluation of early flat squamous cell neoplasms.
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Humains , Adulte d'âge moyen , Carcinome épidermoïde , Cellules épithéliales , Tumeurs de l'oesophage , Iode , Méthodes , Tumeurs épidermoïdesRésumé
Conventional endoscopy often misses early gastric cancers with minimal red discoloration because they cannot be distinguished from inflamed mucosa. We treated a patient with a small early gastric cancer that was difficult to diagnose using conventional endoscopy. Conventional endoscopy using a small-caliber endoscope showed only subtle red discoloration of the gastric mucosa. However, blue laser imaging showed a clearly discolored area measuring 10 mm in diameter around the red lesion, which was distinct from the surrounding inflamed mucosa. Irregular vessels on the tumor surface (suspicious for early gastric cancer) were observed even with small-caliber endoscopy. Biopsy revealed a well-moderately differentiated tubular adenocarcinoma, and endoscopic submucosal dissection was performed. Histopathological examination of the specimen confirmed well-moderately differentiated adenocarcinoma localized to the mucosa with slight depression compared to the surrounding mucosa, consistent with the endoscopic findings. This small early gastric cancer became clearly visible with blue laser imaging using small-caliber endoscopy.
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Humains , Adénocarcinome , Biopsie , Dépression , Endoscopes , Endoscopie , Muqueuse gastrique , Muqueuse , Tumeurs de l'estomacRésumé
?At present, the diagnosis and treatment of early cancer in digestive tract is a hot topic, which is defined as cancer confined to the mucosa layer and submucosa, including early esophageal cancer, early gastric cancer and early colorectal cancer. For gastrointestinal cancer early diagnosis technology has been from a single common white light endoscopy, endoscopic gradually transition to the pigment dyeing narrow-band imaging technology, electronic (narrow band imaging, NBI), intelligent electronic spectroscopic techniques (flexible spectral imaging color enhancement, FICE), magnifying endoscopy, endoscopic confocal optical microscopy, confocal laser endomicroscopy, CLE), etc., so as to improve the early cancer detection rate, can even provide lesions in depth and scope, histopathology, and blue laser endoscope is introduced by the Fuji company blue laser endoscopic system (LASEREO), the more possibility for accurate diagnosis of early carcinoma of digestive tract. In this paper, the progress of blue laser imaging technology (blue laser imaging, BLI) in the accurate diagnosis of early carcinoma of digestive tract was overviewed.
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Objective To explore the nursing measures in blue laser endoscopy. Methods Endoscopy was performed in 102 patients. The nursing was done including preoperative preparation, nurse's coordination for different mode of endoscpy, postoperative nursing and so on. Result The endoscopy for the 102 patients was successfully done,the time ranging between 10~25 min,averaged 13.85 min.No complications were found. Conclusion The nursing measures including careful preoperative preparation,intraoperative cooperation and postoperative nursing are key to the successful detection and diagnosis of diseases by blue laser endoscopy.
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Objective To study the clinical and pathological characteristics of early gastric cancer ( EGC) and to evaluate the value of blue laser imaging combined with magnification endoscopy ( BLI-ME) in the diagnosis of EGC. Methods A retrospective study was conducted on data of 255 patients with EGC diagnosed in Huashan Hospital from January 2014 to January 2017, including 33 cases of preoperative BLI-ME intensive examination. According to the Japanese classification of gastric carcinoma of Japanese Gastric Cancer Association, the EGCs were histopathologically divided into differentiated and undifferentiated subtypes. Clinical characteristics, endoscopic features, pathological type, lymph node metastasis, and lesion characteristics of BLI-ME were analyzed. Results Among the 255 cases of EGC, 164 cases ( 63. 31％) were male, 242 cases ( 94. 90％) were over 40 years old, 182 cases ( 71. 37％) belonged to differentiated type, 93 cases ( 36. 47％) were located in gastric antrum, 92 cases ( 36. 08％) were type 0-Ⅱc under endoscopy, and 37 cases (14. 51％) had lymph node metastasis. Comparative analysis showed that the lymph node metastasis rate was significantly lower in mucosal carcinoma compared to submucosal carcinoma[ 5. 04％(7/139) VS 25. 86％ (30/116),χ2=22. 109, P=0. 000], lower in differentiated carcinoma compared to undifferentiated carcinoma[9. 89％ (18/182) VS 26. 03％ (19/73), χ2=10. 938, P=0. 002], and lower in tumors with maximum diameter of lesion≤2. 0 cm compared to maximum diameter of lesion>2. 0 cm [ 9. 88％ ( 16/162 ) VS 22. 58％ ( 21/93 ) , χ2 =7. 687, P=0. 009 ] . Among the 33 cases undergoing BLI-ME, differentiated EGC was mainly fine-network pattern (13. 64％, 3/22), intralobular loop pattern (ILL)-1 (59. 09％, 13/22) and ILL-2 (22. 73％, 5/22), whereas undifferentiated subtype patients were characterized as ILL-2 ( 45. 45％, 5/11 ) and corkscrew pattern ( 54. 55％, 6/11 ) . Conclusion The incidence of EGC is higher in male with age over 40 years. Gastric lesions occur most frequently in the antrum, and the most common microscopic morphology is 0-Ⅱc type. Tumor>2. 0 cm or invasion of submucous layer, and undifferentiated carcinoma are prone to lymph node metastasis. The assessment of mucosal microvascular pattern and micro surface structure under BLI-ME facilitate to determine the pathological type of EGC.
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Objective To evaluate the diagnostic value of VS classification of magnifying endoscopy with blue laser imaging ( ME-BLI) for gastric precancerous lesion and early gastric cancer. Methods A retrospective study was performed on the data of 313 patients ( 322 lesions) with gastric mucosal lesions undergoing ME-BLI in digestive endoscopy center of Renmin Hospital of Wuhan University from January 2014 to January 2017. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of VS classification by ME-BLI in diagnosis of gastric precancerous lesion and early cancer were analyzed. Results Among the 322 lesions, 57 were pathologically diagnosed as cancerous lesions and 265 were non-cancerous lesions. According to VS classification of ME-BLI, 98. 2%(56/57) VS structures of the cancerous lesions were irregular or disappearing, and 100. 0%( 57/57 ) cancerous lesions had clear demarcation. Taking the pathological diagnosis as the gold standard, the accuracy of VS classification of ME-BLI was 93. 8%(302/322), with a good consistency with pathological diagnosis(Kappa＝0. 810). The sensitivity, specificity, positive predictive value, and negative predictive value were 98. 2%( 56/57), 92. 8%( 246/265 ), 74. 7%( 56/75 ) and 99. 6%( 246/247 ), respectively. Conclusion The VS classification of ME-BLI is an effective method with high accuracy, sensitivity and specificity for diagnosis of gastric precancerous lesion and early gastric cancer.
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Objective To evaluate the magnifying endoscopy with blue laser imaging( M-BLI) for early esophageal cancers. Methods A total of 153 focal esophageal lesions detected with conventional white light endoscopy (WLE) based on changes of mucosal shape and color were enrolled in this study. Patients were examined with WLE, M-BLI, and 1. 25% Lugol′s iodine chromoendoscopy between April 2015 and December 2016. Diagnostic consistency of M-BLI and Lugol′s iodine chromoendoscopy were evaluated with pathology as a golden standard. Results Pathological diagnosis showed there were 19 lesions of esophagitis or chronic mucosal inflammation,92 of low grade intraepithelial neoplasia,and 42 high grade intraepithelial neoplasia or early cancer. Diagnostic sensitivities of WLE, M-BLI and Lugol′s iodine chromoendoscopy of screening early cancer were 66. 7%( 28/42 ), 95. 2%( 40/42 ), and 95. 2%( 40/42 ) respectively, the specificities were 57. 7%( 64/111 ), 91. 9%( 102/111 ), and 92. 8%( 103/111 ) respectively. The consistency rate between endoscopy and pathological examination were 60. 1%( 92/153 ), 92. 8%(142/153), and 93. 5%(143/153) respectively,and the Kappa values were 0. 565, 0. 891, and 0. 906 respectively. The detection rate of M-BLI was higher than that of WLE alone ( χ2 ＝9. 166, P＝0. 002). Conclusion The diagnostic value of M-BLI for early esophageal cancer is similar to that of Lugol′s iodine chromoendoscopy. However, M-BLI is easier to operate, and superior to Lugol′s iodine staining endoscopy in the absence of iodine allergy, long operating time and patients′intolerance.
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White light imaging (WLI) may not reveal early upper gastrointestinal cancers. Linked color imaging (LCI) produces bright images in the distant view and is performed for the same screening indications as WLI. LCI and blue laser imaging (BLI) provide excellent visibility of gastric cancers in high color contrast with respect to the surrounding tissue. The characteristic purple and green color of metaplasias on LCI and BLI, respectively, serve to increase the contrast while visualizing gastric cancers regardless of a history of Helicobacter pylori eradication. LCI facilitates color-based recognition of early gastric cancers of all morphological types, including flat lesions or those in an H. pylori-negative normal background mucosa as well as the diagnosis of inflamed mucosae including erosions. LCI reveals changes in mucosal color before the appearance of morphological changes in various gastric lesions. BLI is superior to LCI in the detection of early esophageal cancers and abnormal findings of microstructure and microvasculature in close-up views of upper gastrointestinal cancers. Excellent images can also be obtained with transnasal endoscopy. Using a combination of these modalities allows one to obtain images useful for establishing a diagnosis. It is important to observe esophageal cancers (brown) using BLI and gastric cancers (orange) surrounded by intestinal metaplasia (purple) and duodenal cancers (orange) by LCI.