ENDOSCOPIC FINDINGS USING WHITE LIGHT IMAGING AND NON-MAGNIFYING NARROW BAND IMAGING THAT CAN PREDICT THE PRESENCE OF MULTIPLE LUGOL-VOIDING LESIONS IN THE ESOPHAGUS

Abstract

Background & Aim: The Lugol dye-staining method is useful for detecting squamous cell carcinoma (SCC) and multiple Lugol-voiding lesions (MLVL) in the esophagus. However, it often induces unpleasant side effects. We examined the endoscopic findings on white light imaging (WL) and non-magnifying narrow band imaging (NBI) that can predict the presence of MLVL in the esophagus.

Methods: An endoscopist (T.K.) reviewed the esophageal background mucosa in WL and NBI images from patients with SCC and explored the five endoscopic findings on WL and NBI for predicting MLVL: white protrusions, horizontal lines, low permeability of capillary, brownish area with unclear margin, dot-shaped vessels. Three endoscopists judged the presence of each finding in WL and NBI images of 136 patients with SCC and classified Lugol dye-staining findings to grades A, B and C. We evaluated the sensitivity/specificity for “Grade C” of each finding and various combinations of findings (derivation study). Using the selected finding, they judged another 125 patients with SCC and validated the results (validation study).

Results: In the derivation study, the finding of “horizontal lines or low permeability of capillary” was selected, because the sensitivity /specificity (%) for “Grade C” of 78/47(WL)and 82/43(NBI)were most reasonable. In the validation study, the sensitivity /specificity (%) for “Grade C” was 72/70 (WL)and 78/59(NBI).

Conclusion: The finding of “horizontal lines or low permeability of capillary” on WL and non-magnifying NBI may be able to predict the presence of MLVL in the esophagus. It might be an indication of Lugol dye-staining.