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Brown slits for colorectal adenoma crypts on conventional magnifying endoscopy with narrow band imaging using the X1 system

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World Journal of Gastroenterology 2022年第24期28卷 2748-2757页

作者： Osamu Toyoshima Toshihiro Nishizawa Shuntaro Yoshida Hidenobu Watanabe Nariaki Odawara Kosuke Sakitani Toru Arano Hirotoshi Takiyama Hideyuki Kobayashi Hirofumi Kogure Mitsuhiro Fujishiro Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalChiba 286-8520Japan Department of Pathology Pathology and Cytology Laboratory JapanTokyo 166-0003Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology Sakitani Endoscopy ClinicChiba 275-0026Japan Department of Gastroenterology The Fraternity Memorial HospitalTokyo 130-8587Japan Department of Surgical Oncology The University of TokyoTokyo 113-8655Japan Department of Internal Medicine Umegaoka Ekimae ClinicTokyo 154-0022Japan

BACKGROUND Accurate diagnosis of colorectal premalignant polyps,including adenomas,is vital in clinical practice.AIM To investigate the diagnostic yields of novel findings of brown slits for adenomas.METHODS Patients who underwent colonoscopy at the Toyoshima Endoscopy Clinic were enrolled.polyps sized≥5 mm suspected of adenomas or clinically significant Serrated polyps were included in the study.We defined the surface structures of colorectal polyps,which were brown curves inside and along the tubular glands identified using a combination of a new X1 system(Olympus Corporation)and a conventional magnifying colonoscope with non-staining narrow band imaging(NBI),as brown slits.The brown slits corresponded to slit-like lumens on endocytoscopy and histological crypt openings of an adenoma.We evaluated the diagnostic performance of brown slits for adenoma.RESULTS A total of 108 Lesions from 62 patients were eligible.The average age was 60.4 years and 41.9%were male.The mean polyp size was 7.45±2.83 mm.Fifty-seven lesions were positive for brown slits.Histopathological diagnosis comprised 59 low-grade tubular adenomas,16 sessile serrated lesions,and 33 hyperplastic polyps.Among 59 adenomas,56(94.9%)were positive for brown slits.Among 16 sessile serrated lesions,0(0%)was positive for brown slits.Among 33 hyperplastic polyps,1(3.0%)was positive for brown slits.The sensitivity,specificity,and accuracy of brown slits for adenoma were 94.9%,98.0%,and 96.3%,respectively.The positive predictive value and negative predictive value of brown slits for adenoma were also excellent for 98.2%,and 94.1%,respectively.CONCLUSION Brown slits on conventional magnifying endoscopy with non-staining NBI using the X1 system were useful for diagnosing colorectal adenoma.The new endoscopy system could be examined using new standards.

关键词： Adenoma Colonoscopy Narrow band imaging Magnifying endoscopy X1 Serrated polyp Colorectal neoplasm Endocytoscopy

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Impact of looping on premalignant polyp detection during colonoscopy

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World Journal of Gastrointestinal Endoscopy 2022年第11期14卷 694-703页

作者： Osamu Toyoshima Toshihiro Nishizawa Shuntaro Yoshida Tatsuya Matsuno Toru Arano Ryo Kondo Kazunori Kinoshita Yuki Yasumi Yosuke Tsuji Mitsuhiro Fujishiro Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Obstetrics and Gynecology Seijo Kinoshita HospitalTokyo 157-0066Japan Department of Internal Medicine Yasumi HospitalMorioka 028-4125Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan

BACKGROUND The presence of premalignant polyps on colonoscopy is an indicator of metachronous colorectal cancer.Looping during colonoscopy is associated with old age,female sex,and colonoscopy insertion time.However,the clinical significance of looping is not fully understood.We aimed to clarify the effect of looping on colorectal premalignant polyp detection.AIM To assess the effects of looping on premalignant polyp detection using logistic regression analyses.METHODS We retrospectively investigated patients who underwent colonoscopy at Toyoshima Endoscopy Clinic between May,2017 and October,2020.From the clinic’s endoscopy database,we extracted data on patient age,sex,endoscopist-assessed looping,colonoscopy duration,endoscopist experience,detection rate,and number of premalignant polyps.RESULTS We assessed 12259 patients(mean age,53.6 years;men,50.7%).Looping occurred in 54.3%of the patients.Mild and severe looping were noted in 4399 and 2253 patients,respectively.The detection rates of adenomas,advanced adenomas,high-risk adenomas,clinically significant Serrated polyps(CSSPs),and sessile serrated lesions(SSLs)were 44.7%,2.0%,9.9%,8.9%and 3.5%,respectively.The mean numbers of adenomas and SSLs were 0.82 and 0.04,respectively.The detection rates of adenomas,high-risk adenomas,and CSSPs increased with looping severity(all Ppolyps.Therefore,looping may predict the risk of metachronous colorectal cancer.Endoscopists should carefully examine the colorectum of patients with looping.

关键词： Looping Colorectal polyp Colonoscopy Adenoma Serrated polyp Colorectal neoplasm

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