Novel Endoscopic Findings as Visualized by Magnifying Endoscopy with Narrow-Band Imaging: White Opaque Substance Is Present in Colorectal Hyperplastic Polyps

Abstract Background and study aims A white opaque substance (WOS) has been observed in the epithelia of gastric, duodenal, and colorectal epithelial adenomas and carcinomas, using magnifying endoscopy (ME). The WOS has been reported to be derived from a dense accumulation of minute lipid droplets in the epithelium. This study aimed to investigate whether the WOS in colorectal hyperplastic polyps was derived from lipid droplets accumulated in the epithelium, as observed in the case of gastric, duodenal, and colorectal epithelial neoplasms. Patients and methods We analyzed 30 consecutive patients who were positive for the WOS, as visualized in colorectal hyperplastic polyps by ME with narrow-band imaging and 30 consecutive patients who were negative for the WOS. Biopsy specimens obtained from the polyps were immunostained with anti-adipophilin antibody to determine the correlation between the presence of the WOS and that of lipid droplets in the epithelium. Results In all patients, the epithelial cells were histologically positive for adipophilin. However, the area of adipophilin-positive epithelial cells in the WOS-positive group was significantly larger than that in the WOS-negative group (P < 0.001). The density of the WOS was strongly and positively correlated with the area of adipophilin-positive cells. Conclusions This study reveals that the WOS visualized in the superficial layers of colorectal hyperplastic polyps is produced by a dense accumulation of minute lipid droplets in the epithelia of the polyps.

Download Full-text

Barrett’s Esophageal Adenocarcinoma Involving a White Globe Appearance within the Long-Segment Barrett’s Esophagus

Case Reports in Gastroenterology ◽

10.1159/000508861 ◽

2020 ◽

Vol 14 (3) ◽

pp. 510-515

Author(s):

Yo Kubota ◽

Satoshi Tanabe ◽

Yohei Harada ◽

Seigo Nakatani ◽

Yasuaki Furue ◽

...

Keyword(s):

Barrett’S Esophagus ◽

Esophageal Adenocarcinoma ◽

Barrett's Esophagus ◽

Narrow Band ◽

Narrow Band Imaging ◽

Magnifying Endoscopy ◽

Endoscopic Findings ◽

Depressed Lesion ◽

Barrett’S Esophageal Adenocarcinoma ◽

Necrotic Debris

The diagnosis of Barrett’s esophageal adenocarcinoma (BEA) in patients with Barrett’s esophagus (BE) using endoscopy can be difficult and there are few specific endoscopic findings for BEA. However, white globe appearance (WGA) has been reported to be a specific endoscopic finding for early gastric cancer. We encountered a 51-year-old male patient with BEA exhibiting WGA. Esophagogastroduodenoscopy identified a red, depressed lesion of 10 mm within the long-segment BE (LSBE), while magnifying endoscopy with narrow-band imaging identified WGA. Endoscopic submucosal dissection (ESD) was performed based on our suspicion of BEA. Based on the ESD findings, we diagnosed adenocarcinoma accompanying LSBE histopathologically. WGA was identified, and intraglandular necrotic debris was discovered histologically at the same site. Therefore, WGA may be helpful in the diagnosis of BEA.

Download Full-text

EFFICACY OF THE DIAGNOSTIC ACCURACY USING MAGNIFYING ENDOSCOPY WITH NARROW-BAND IMAGING FOR PURE SIGNET RING CELL CARCINOMA AND POORLY DIFFERENTIATED-TYPE COMPONENT MIXED WITH UNDIFFERENTIATED-TYPE ADENOCARCINOMA

10.1055/s-0040-1704295 ◽

2020 ◽

Author(s):

M Inuyama ◽

Y Horiuchi ◽

J Fujisaki

Keyword(s):

Diagnostic Accuracy ◽

Narrow Band ◽

Narrow Band Imaging ◽

Signet Ring Cell Carcinoma ◽

Signet Ring Cell ◽

Magnifying Endoscopy ◽

Signet Ring ◽

Undifferentiated Type ◽

Poorly Differentiated ◽

Ring Cell

Download Full-text

Endoscopic submucosal dissection by using Clutch cutter and IT knife 2 for early gastric cancer with severe submucosal fibrosis: a case report

MedPharmRes ◽

10.32895/ump.mpr.2.3.17 ◽

2018 ◽

Vol 2 (3) ◽

pp. 17-21

Author(s):

Nhan Le ◽

Phuong Vien ◽

Nghia Le

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Narrow Band ◽

Narrow Band Imaging ◽

Magnifying Endoscopy ◽

Gastrointestinal Cancers ◽

Pathological Result ◽

Well Differentiated ◽

Submucosal Fibrosis

Introduction: Gastric cancer is one of the highly malignant gastrointestinal cancers and the third leading cause of cancer death. In the last decade, early gastric cancer (EGC) has been reported by using narrow-band imaging (NBI) magnifying endoscopy. Advances in endoscopic techniques, such as endoscopic submucosal dissection (ESD), have enabled the en bloc resection of these EGC. Although ESD is performed for early gastric cancer, there are still many difficult problems in technique of this procedure. The difficulty of gastric ESD depends on the size and location of a tumor, presence of severe submucosal fibrosis, presence of ulceration... We report a case of our successful ESD by using Clutch cutter and IT knife 2 in treatment of EGC with severe submucosal fibrosis. Case presentation: A 62-year-old man felt an epigastric discomfort two months ago. The narrow-band imaging (NBI) magnifying endoscopy revealed a suspected early gastric cancer type 0 - IIa + IIc (Japanese classification of early gastrointestinal cancers) at the incisura angularis, the size of this lesion was 15 mm in diameter, and pathological result of endoscopic biopsy was a well-differentiated adenocarcinoma. ESD was performed and we found there was severe submucosal fibrosis which was dissected safer and faster by using Clutch cutter and IT knife 2. There were no complications such as severe bleeding and perforation. The size of resected specimen was 60 x 35 mm and the time of procedure was 150 minutes. After ESD, the pathological result was a well differentiated adenocarcinoma, pT1a, UL(-), LY(-), V(-), no cancer cell in vertical and horizontal margins. The healing time of ESD-induced ulcer was 5 weeks without local recurrence. Conclusion: Through this case, we aim to emphasize the importance of using Clutch cutter and IT knife 2 as a modified technique which makes ESD a safe procedure in treatment of EGC with severe submucosal fibrosis.

Download Full-text