Review
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World J Gastroenterol. Mar 28, 2012; 18(12): 1295-1307
Published online Mar 28, 2012. doi: 10.3748/wjg.v18.i12.1295
Magnifying endoscopy in upper gastroenterology for assessing lesions before completing endoscopic removal
Ning-Li Chai, En-Qiang Ling-Hu, Yoshinori Morita, Daisuke Obata, Takashi Toyonaga, Takeshi Azuma, Ben-Yan Wu
Ning-Li Chai, Ben-Yan Wu, Department of Gastroenterology, Division of South Building, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
En-Qiang Ling-Hu, Department of Gastroenterology, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Yoshinori Morita, Daisuke Obata, Takashi Toyonaga, Takeshi Azuma, Department of gastroenterology and endoscopy, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
Author contributions: Chai NL and Ling-Hu EQ contributed towards the conception and designed the review with final editing; Obata D contributed to collect part of the pictures; Wu BY, Morita Y, Toyonaga T and Azuma T contributed equally to the supportive work and supervision.
Supported by The fund of National Natural Science Foundation Financial of China, No. 81072913
Correspondence to: Ning-Li Chai, MD, PhD, Department of Gastroenterology, Division of South Building, Chinese People’s Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, China. csxlily@hotmail.com
Telephone: +86-10-66876225 Fax: +86-10-66939565
Received: November 2, 2011
Revised: January 10, 2012
Accepted: March 9, 2012
Published online: March 28, 2012
Abstract

Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at diagnosis. Endoscopic submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as curative treatments for many early-stage GI lesions in recent years. The technologies have been widely accepted in many Asian countries because they are minimally invasive and supply thorough histopathologic evaluation of the specimens. However, before engaging in endoscopic therapy, an accurate diagnosis is a precondition to effecting the complete cure of the underlying malignancy or carcinoma in situ. For the past few years, many new types of endoscopic techniques, including magnifying endoscopy with narrow-band imaging (ME-NBI), have emerged in many countries because these methods provide a strong indication of early lesions and are very useful in determining treatment options before ESD or EMR. However, to date, there is no comparable classification equivalent to “Kudo’s Pit Pattern Classification in the colon”, for the upper GI, there is still no clear internationally accepted classification system of magnifying endoscopy. Therefore, in order to help unify some viewpoints, here we will review the defining optical imaging characteristics and the current representative classifications of microvascular and microsurface patterns in the upper GI tract under ME-NBI, describe the accurate relationship between them and the pathological diagnosis, and their clinical applications prior to ESD or en bloc EMR. We will also discuss assessing the differentiation and depth of invasion, defying the lateral spread of involvement and targeting biopsy in real time.

Keywords: Magnifying endoscopy with narrow-band imaging, Upper gastroenterology, Assessment, Endoscopic submucosal dissection, Endoscopic mucosal resection