Diagnostic ability of magnification endoscope with narrow‐band imaging in screening esophagogastroduodenoscopy

Abstract

Objectives Magnifying endoscopy with narrow‐band imaging (M‐NBI) is useful for the optical diagnosis of gastrointestinal neoplasms. However, the utility of M‐NBI in screening esophagogastroduodenoscopy (EGD) is unclear. We aimed to evaluate the diagnostic ability of the magnification endoscope (ME) in screening EGD for a population with a low prevalence of upper gastrointestinal cancers. Methods Overall, 4887 asymptomatic examinees without a history of laryngopharyngeal and/or upper gastrointestinal neoplasms who underwent opportunistic screening EGD between April 2011 and December 2017 were enrolled in this retrospective study. The examinees were categorized into two groups depending on whether screening EGD was performed using ME (ME group) or not (non‐ME group). Using a propensity score‐matched analysis, the diagnostic ability of EGD was compared between the two groups. Results In total, 1482 examinees (30%) were allocated to the ME group and 3405 (70%) to the non‐ME group. Thirty‐five epithelial neoplasms were detected in 30 examinees (0.6%). The groups were matched for baseline characteristics (1481 pairs). Both groups showed no significant difference in the epithelial neoplasm detection rate (0.8% vs. 0.3%; P = 0.14). The biopsy rate was significantly lower in the ME group than in the non‐ME group (12% vs. 15%; P = 0.003). The positive predictive value (PPV) for biopsy was significantly higher in the ME group than in the non‐ME group (6.6% vs. 2.8%; P = 0.048). Conclusions Using an ME for screening EGD in an apparently healthy, asymptomatic population could reduce unnecessary biopsies by improving PPV for biopsy without decreasing the epithelial neoplasm detection rate.

Use of magnifying endoscopy with narrow‐band imaging can change the clinical practice of screening endoscopy for early upper gastrointestinal neoplasia

“…Takinami et al concluded that ME could reduce unnecessary biopsies in screening for upper early GI neoplasia in a healthy, asymptomatic population by improving the PPV for biopsy without compromising the epithelial neoplasm detection rate. 8 Although similar findings were described in previous studies, 6,9 this was the first study to compare the diagnostic performance of ME with that of non-ME in screening with upper GI endoscopy. A limitation of this study was that it was a retrospective study.…”

“…6,7 In this issue of Digestive Endoscopy, Takinami et al retrospectively investigated the diagnostic performance of magnifying endoscopy (ME) for upper GI screening in a population with low prevalence of upper GI cancers. 8 They determined the epithelial neoplasm detection rate, biopsy rate, and positive predictive value (PPV) between ME and non-ME groups using propensity score-matched analysis. The following results were obtained.…”

Utility of screening esophagogastroduodenoscopy performed sequentially with endoscopic ultrasonography

“…[27][28][29] A previous retrospective study on EGD screening showed that in opportunistic gastric cancer screening, magni cation endoscopy did not improve the detection rate of upper gastrointestinal epithelial neoplasms but reduced unnecessary biopsies by improving the positive predictive value. 30 Generally, when using a magni cation endoscope, white-light imaging detects epithelial abnormalities, and magneti ed endoscopic images combined with NBI are subsequently used to distinguish between benign and malignant lesions. However, some minor epithelial abnormalities may not be detectable with white-light imaging alone but possibly with magneti ed endoscopic imaging combined with NBI.…”

Current status of quality control in screening esophagogastroduodenoscopy and the emerging role of artificial intelligence

“…Narrow‐band imaging uses narrow‐bandwidth filters to enhance the contrast between the superficial mucosa and underlying blood vessels. It was reported to optimize the sensitivity and accuracy, although there is no evidence to demonstrate that it can benefit lesion detection during EGD 14,53–55 . Blue laser imaging uses blue laser light to enhance the visualization of mucosal and vascular structures.…”

“…It was reported to optimize the sensitivity and accuracy, although there is no evidence to demonstrate that it can benefit lesion detection during EGD. 14,[53][54][55] Blue laser imaging uses blue laser light to enhance the visualization of mucosal and vascular structures. In a recent perspective study, blue laser imaging showed a significantly higher detection rate of early gastric cancer than white light endoscopy (93.1% vs. 50.0%; P = 0.001) among patients with atrophic gastritis.…”