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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(12): E1528-E1536
DOI: 10.1055/a-1948-2910
Original article

Effect of adding acetic acid when performing magnifying endoscopy with narrow band imaging for diagnosis of Barrett’s esophageal adenocarcinoma

Yohei Ikenoyama‡
1   Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
2   Department of Endoscopy, Mie University Hospital, Tsu, Japan
,
Kyosuke Tanaka‡
1   Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
2   Department of Endoscopy, Mie University Hospital, Tsu, Japan
,
Yuhei Umeda
1   Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
2   Department of Endoscopy, Mie University Hospital, Tsu, Japan
,
Yasuhiko Hamada
1   Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
,
Hiroki Yukimoto
1   Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
,
Reiko Yamada
1   Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
,
Junya Tsuboi
1   Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
,
Misaki Nakamura
2   Department of Endoscopy, Mie University Hospital, Tsu, Japan
,
Masaki Katsurahara
2   Department of Endoscopy, Mie University Hospital, Tsu, Japan
,
Noriyuki Horiki
1   Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
,
Hayato Nakagawa
1   Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
2   Department of Endoscopy, Mie University Hospital, Tsu, Japan
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Abstract

Background and study aims Magnifying endoscopy with narrow band imaging (M-NBI) was developed to diagnose Barrett’s esophageal adenocarcinoma (BEA); however, this method remains challenging for inexperienced endoscopists. We aimed to evaluate a modified M-NBI technique that included spraying acetic acid (M-AANBI).

Patients and methods Eight endoscopists retrospectively examined 456 endoscopic images obtained from 28 patients with 29 endoscopically resected BEA lesions using three validation schemes: Validation 1 (260 images), wherein the diagnostic performances of M-NBI and M-AANBI were compared – the dataset included 65 images each of BEA and non-neoplastic Barrett’s esophagus (NNBE) obtained using each modality; validation 2 (112 images), wherein 56 pairs of M-NBI and M-AANBI images were prepared from the same BEA and NNBE lesions, and diagnoses derived using M-NBI alone were compared to those obtained using both M-NBI and M-AANBI; and validation 3 (84 images), wherein the ease of identifying the BEA demarcation line (DL) was scored via a visual analog scale in 28 patients using magnifying endoscopy with white-light imaging (M-WLI), M-NBI, and M-AANBI.

Results For validation 1, M-AANBI was superior to M-NBI in terms of sensitivity (90.8 % vs. 64.6 %), specificity (98.5 % vs. 76.9 %), and accuracy (94.6 % vs. 70.4 %) (all P < 0.05). For validation 2, the accuracy of M-NBI alone was significantly improved when combined with M-AANBI (from 70.5 % to 89.3 %; P < 0.05). For validation 3, M-AANBI had the highest mean score for ease of DL recognition (8.75) compared to M-WLI (3.63) and M-NBI (6.25) (all P < 0.001).

Conclusions Using M-AANBI might improve the accuracy of BEA diagnosis.



Publication History

Received: 19 May 2022

Accepted after revision: 20 September 2022

Accepted Manuscript online:
21 September 2022

Article published online:
15 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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