title: Surveillance using trimodal imaging endoscopy after endoscopic submucosal dissection for superficial gastric neoplasia.
abstract: OBJECTIVE
  To evaluate the effectiveness of trimodal imaging endoscopy (TME) to detect another lesion after endoscopic submucosal dissection (ESD) for superficial gastric neoplasia (SGN).
  
  
  METHODS
  Surveillance esophagogastroduodenoscopy (EGD) using a TME was conducted in 182 patients that had undergone ESD for SGN. Autofluorescence imaging (AFI) was conducted after white-light imaging (WLI). When SGN was suspicious, magnifying endoscopy with narrow-band imaging (ME-NBI) was conducted. Final diagnoses were made by histopathologic findings of biopsy specimens. The detection rates of lesions in WLI, AFI, and NBI, and the characteristics of lesions detected by WLI and ones missed by WLI but detected by AFI were examined. The sensitivity, specificity, and accuracy of endoscopic diagnosis using WLI, AFI and ME-NBI were evaluated.
  
  
  RESULTS
  In 242 surveillance EGDs, 27 lesions were determined pathologically to be neoplasias. Sixteen early gastric cancers and 6 gastric adenomas could be detected by WLI. Sixteen lesions were reddish and 6 were whitish. Five gastric neoplasias were missed by WLI but were detected by AFI, and all were whitish and protruded gastric adenomas. There was a significant difference in color and pathology between the two groups (P = 0.006). Sensitivity, specificity and accuracy in ME-NBI were higher than those in both WLI and AFI. Specificity and accuracy in AFI were lower than those in WLI.
  
  
  CONCLUSIONS
  Surveillance using trimodal imaging endoscopy might be useful for detecting another lesion after endoscopic submucosal dissection for superficial gastric neoplasia.
authors.affiliation: Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Imaeda
authors.affiliation: Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Hosoe
authors.affiliation: Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kashiwagi
authors.affiliation: Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Ida
authors.affiliation: Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
authors.forename: Rieko
authors.initials: R
authors.lastname: Nakamura
authors.affiliation: Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
authors.affiliation: Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwao
authors.affiliation: Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.affiliation: Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
authors.affiliation: Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Ogata
authors.affiliation: Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
mesh_terms: D000368:Aged; D001706:Biopsy; D004210:Dissection / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D062048:Narrow Band Imaging / Q000379:methods*; D061848:Optical Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Autofluorescence imaging; Endoscopic submucosal dissection; Superficial gastric neoplasia