title: Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (with video).
abstract: BACKGROUND
  Magnifying endoscopy (ME) with narrow-band imaging (NBI) may allow reliable delineation of the horizontal extent of early gastric cancers before endoscopic submucosal dissection (ESD). However, the advantages of ME with NBI over standard endoscopy with dye spraying (chromoendoscopy [CE]) have yet to be elucidated.
  
  
  OBJECTIVE
  To investigate the usefulness and limitations of ME with NBI when CE is unsuccessful for determining the horizontal extent of early gastric cancer.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Single tertiary referral center.
  
  
  METHODS
  Series of 350 consecutive early gastric cancers resected en bloc using ESD.
  
  
  METHODS
  ME with NBI for cancers with unclear margins by CE.
  
  
  METHODS
  The rate of successful delineation by ME with NBI for cancers that had demonstrated unclear margins using CE.
  
  
  RESULTS
  The proportion of cancers showing unclear margins using CE was 18.9% (66/350). Of these, 62 of 66 cancers were examined using ME with NBI, with the entire margins successfully delineated in 72.6% (45/62) of the lesions that had shown unclear margins using CE. The success rate was 0% for undifferentiated cancers, significantly lower than that for differentiated lesions (P < .00001).
  
  
  CONCLUSIONS
  Even by using ME with NBI, endoscopic delineation remains difficult for undifferentiated lesions.
  
  
  CONCLUSIONS
  ME with NBI is an excellent modality for identifying the entire margin of early gastric cancers, when the margins are unclear using CE.
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nagahama
authors.forename: Kenshi
authors.initials: K
authors.lastname: Yao
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Maki
authors.forename: Motochika
authors.initials: M
authors.lastname: Yasaka
authors.forename: Yashuhiro
authors.initials: Y
authors.lastname: Takaki
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Matsui
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanabe
authors.forename: Akinori
authors.initials: A
authors.lastname: Iwashita
authors.forename: A
authors.initials: A
authors.lastname: Ota
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis*; D013997:Time Factors