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Linked Color Imaging and Blue Laser Imaging for Upper Gastrointestinal Screening
Hiroyuki Osawa,Yoshimasa Miura,Takahito Takezawa,Yuji Ino,Tsevelnorov Khurelbaatar,Yuichi Sagara,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.6
White light imaging (WLI) may not reveal early upper gastrointestinal cancers. Linked color imaging (LCI) produces bright imagesin the distant view and is performed for the same screening indications as WLI. LCI and blue laser imaging (BLI) provide excellentvisibility of gastric cancers in high color contrast with respect to the surrounding tissue. The characteristic purple and green colorof metaplasias on LCI and BLI, respectively, serve to increase the contrast while visualizing gastric cancers regardless of a history ofHelicobacter 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 inmucosal color before the appearance of morphological changes in various gastric lesions. BLI is superior to LCI in the detection ofearly esophageal cancers and abnormal findings of microstructure and microvasculature in close-up views of upper gastrointestinalcancers. Excellent images can also be obtained with transnasal endoscopy. Using a combination of these modalities allows one to obtainimages 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.
Blue Laser Imaging with a Small-Caliber Endoscope Facilitates Detection of Early Gastric Cancer
Haruo Takahashi,Yoshimasa Miura,Hiroyuki Osawa,Takahito Takezawa,Yuji Ino,Masahiro Okada,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.3
Conventional endoscopy often misses early gastric cancers with minimal red discoloration because they cannot be distinguished frominflamed mucosa. We treated a patient with a small early gastric cancer that was diffcult to diagnose using conventional endoscopy. Conventional endoscopy using a small-caliber endoscope showed only subtle red discoloration of the gastric mucosa. However, bluelaser imaging showed a clearly discolored area measuring 10 mm in diameter around the red lesion, which was distinct from thesurrounding inflamed mucosa. Irregular vessels on the tumor surface (suspicious for early gastric cancer) were observed even withsmall-caliber endoscopy. Biopsy revealed a well-moderately differentiated tubular adenocarcinoma, and endoscopic submucosaldissection was performed. Histopathological examination of the specimen confirmed well-moderately differentiated adenocarcinomalocalized to the mucosa with slight depression compared to the surrounding mucosa, consistent with the endoscopic findings. Thissmall early gastric cancer became clearly visible with blue laser imaging using small-caliber endoscopy.
Chihiro Iwashita,Yoshimasa Miura,Hiroyuki Osawa,Takahito Takezawa,Yuji Ino,Masahiro Okada,Alan K. Lefor,Hironori Yamamoto 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.1
Barrett’s adenocarcinoma may occur in multiple sites, and recurrence and metachronous lesions are the major problems with endoscopic resection. Therefore, early detection of such lesions is ideal to achieve complete resection and obtain improved survival rates with minimally invasive treatment. Laser imaging systems allow multiple modalities of endoscopic imaging by using white light laser, flexible spectral imaging color enhancement (FICE), blue laser imaging (BLI), and linked color imaging even at a distant view. However, the usefulness of these modalities has not been sufficiently reported regarding Barrett’s adenocarcinoma. Here, we report on a patient with three synchronous lesions followed by one metachronous lesion in a long segment with changes of Barrett’s esophagus, all diagnosed with this new laser endoscopic imaging system and enhanced by using FICE and/or BLI with high contrast compared with the surrounding mucosa. Laser endoscopic imaging may facilitate the detection of malignancies in patients with early Barrett’s adenocarcinoma.
Yoshikazu Hayashi,Masahiro Okada,Takaaki Morikawa,Tatsuma Nomura,Hisashi Fukuda,Takahito Takezawa,Alan Kawarai Lefor,Hironori Yamamoto 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.3
Superficial colonic neoplasms sometimes extend into a diverticulum. Conventional endoscopic mucosal resection of these lesionsis considered challenging because colonic diverticula do not have a muscularis propria and are deeply inverted. Even if the solutionis carefully injected below the mucosa at the bottom of the diverticulum, the mucosa is rarely elevated from the diverticular orifice,and it is usually just narrowed. Although endoscopic submucosal dissection or full-thickness resection with an over-the-scope clipdevice enables the complete resection of these lesions, it is still challenging, time consuming and expensive. Underwater endoscopicmucosal resection without submucosal injection (UEMR) is an innovative technique enabling en bloc resection of superficial colonlesions. We report three patients with colon adenomas extending into a diverticulum treated with successful UEMR. UEMR enabledrapid and safe en bloc resection of colon lesions extending into a diverticulum.