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Curative treatment of patients with gastric cancer requires reliable detection of early gastric cancer. Magnifying endoscopy with narrow-band imaging (M-NBI) is useful for the accurate preoperative diagnosis of early gastric cancer. However, the role of M-NBI in screening endoscopy has not been established. The aims of this study were to determine the feasibility and limitations of M-NBI in screening endoscopy. We conducted a multicenter prospective uncontrolled trial of patients undergoing routine screening endoscopy patients. We determined the diagnostic accuracy, sensitivity and specificity of M-NBI according to the degree of certainty and need for biopsy, as assessed using the VS (vessel plus surface) classification system. We analyzed the endoscopic and histopathological characteristics of both false negative and false positive high confidence M-NBI diagnoses. We then developed a provisional diagnostic strategy based on the diagnostic performance and limitations identified in this study. A total of 1097 patients were enrolled in the study. We analyzed 371 detected lesions (20 cancers and 351 non-cancers). The accuracy, sensitivity and specificity of high confidence M-NBI diagnoses were 98.1, 85.7 and 99.4 %, respectively. The false negative case was a pale mucosal lesion with tissue diagnosis of signet-ring cell carcinoma. Exclusion of pale mucosal lesions increased the accuracy, sensitivity and specificity of high confidence M-NBI diagnoses to 99.4, 100 and 99.4 %, respectively. We therefore propose a practical strategy targeting non-pale mucosal lesions. With a refined strategy considering its limitations, M-NBI can act as an “optical biopsy” in screening endoscopies.

In recent years, various endoscopic treatments have become available to treat gastroesophageal reflux disease (GERD) in Western countries. The Stretta procedure, which uses radiofrequency energy, is one type of safe and effective endoluminal treatment for GERD. However, the feasibility, safety, and efficacy of the Stretta procedure in Japanese patients with GERD, who differ from Western peoples in their physiological characteristics, are not known. In 2006, we imported a Stretta system from the United States and investigated important clinical aspects of the system in Japanese patients with GERD. This study was an open-label trial that enrolled patients with GERD who desired to undergo the Stretta procedure. Heartburn scores, medication use, overall satisfaction with the procedure, and adverse events were evaluated. Nine patients received the Stretta treatment between February and September 2006. Esophagogastroduodenoscopy just after treatment revealed a remarkable reduction in the expansion of the gastric cardia and small erosions in all patients. At 3 or 6 months after treatment, heartburn scores were significantly improved compared with pretreatment scores (5.0 ± 1.7 pretreatment vs. 0.7 ± 1.4 posttreatment, P = 0.007). In six of nine patients (66.7%), treatment significantly (P = 0.009) decreased medication use. There were no major adverse events. All patients were satisfied with this treatment. The Stretta procedure safely reduced GERD symptoms and decreased medication use in Japanese patients with GERD. This treatment may thus be very useful for such patients, and it is hoped that a nationwide trial will be undertaken in Japan to obtain more extensive data.

men. Seventeen patients were diagnosed as gastric cancer and 45 patients were diagnosed as adenoma after ESD. The diameter of the lesions was 16.9mm (range, 5-51mm). Depressed type, mucosal ulceration and size were significant variables for predicting carcinomas. In the multivariate analysis, more than 3cm (p 0.027) and mucosal ulceration (p 0.017) were significant predicting factors suggesting early gastric cancer. Conclusion/ Our result suggested that, in patient with HGD at initial forceps biopsies, adenoma with mucosal ulceration or more than 3cm should be considered a candidate for more endoscopic extended dissection to obtain safety resection margin.

Usefulness of Narrow Band Imaging for the Diagnosis of Early Gastric Cancer: A Comparison Study with Conventional Endoscopy Hirohisa Machida, Kazuhide Higuchi, Masahiko Tabuchi, Satoshi Sugimori, Natsuhiko Kameda, Tomoko Wada, Hirotoshi Okazaki, Masatsugu Shiba, Toshio Watanabe, Kazunari Tominaga, Yasuhiro Fujiwara, Tetsuo Arakawa Background and Study Aims: Importance of angiogenesis in the development of malignant disease is well recognized, and the morphologic changes in microvascular structure were useful in the diagnosis of early gastric cancer. The NBI system (NBI) is based on narrowing the bandwidth of spectral transmittance of optical filters, enables to clearly observe the surface and microvascular structure in the superficial lesion. The aim of this study is to evaluate the usefulness of NBI for the diagnosis of early gastric cancer. Patients and Methods: Twenty patients with 22 lesions underwent endoscopic examination for superficial gastric lesion. All lesions, which were confirmed as early gastric cancer, were investigated twice each by magnifying endoscopy with and without NBI, and recorded on digital video. Endoscopic evaluation focused on two findings which are specific for early gastric cancer, 1) irregular microvascular pattern (IMP), defined as irregularity of subepithelial microvascular structure, and 2) demarcation line (DL), defined as the border line between normal mucosa and cancerous lesion. Two endoscopists (one was well-experienced for NBI and magnifying endoscopy and another had no experience for both) assessed the digital video, and assigned to 3 grades for delineation of IMP and DL, visible or not for detectability of DL, according to the quality of visualization. These findings of NBI endoscopy were compared with those of conventional magnifying endoscopy. Results: For the IMP delineation, NBI endoscopy was superior to conventional endoscopy (p ! 0.0001). In NBI endoscopy, IMP was visualized clearly and differentiated easily from collecting venules of normal mucosa. The DL detectability was similar among NBI and conventional endoscopy (87.9% vs. 81.0%), but NBI endoscopy was superior to conventional endoscopy for the DL delineation (p ! 0.0001), resulting in the margin of the lesion being clear. With conventional endoscopy, well-experienced endoscopist was superior to not-experienced endoscopist in identifying the DL delineation, but it became to be similar with NBI endoscopy without significant difference. Conclusions: NBI endoscopy visualized the surface and microvascular structure evident, therefore it might be useful for the diagnosis of early gastric cancer, independent of experience. To estimate the usefulness using the NBI system for the diagnosis of early gastric cancer, randomized control trials should be conducted in the future.