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Usefulness of Acetic Acid Spray with Narrow-Band Imaging for Identifying the Margin of Sessile Serrated Lesions

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Abstract

Background

Sessile serrated lesions (SSLs) are precursors of colon cancer, especially in cases of large, right colon. However, they are difficult to not only detect, but only clarify the margin of the lesion, which can lead to the poor endoscopic treatment outcomes.

Aims

This study evaluated the usefulness of acetic acid spray with narrow-band imaging (A-NBI) for the better visualization of the margin of SSLs.

Methods

From January 2013 to March 2022, patients with superficial elevated polyps suspected of being SSLs ≥ 10 mm with an endoscopic diagnosis that had been endoscopically resected at Hiroshima City Hiroshima Citizens Hospital were enrolled. Endoscopic images with white-light imaging (WLI), narrow-band imaging (NBI), indigo-carmine (IC), and A-NBI were recorded in each lesion and were randomly arranged and assessed by 10 endoscopists. We compared the visibility score (1 to 4) and color differences (ΔE) between inside and outside of the lesions among WLI, NBI, IC, and A-NBI.

Results

Forty-one lesions in 33 cases were included, and a total of 164 images were evaluated. As for the visibility score, most of the lesions were scored as 1 or 2 on WLI, whereas most were scored 4 on A-NBI. The median ΔE of A-NBI was also significantly higher than that of WLI, NBI, or IC (20.5 vs. 8.3 vs. 8.2 vs. 12.3, P < 0.01). A significant correlation was observed between the color difference and visibility score (r = 0.53, P < 0.01).

Conclusions

A-NBI may be a useful modality for identifying the margin of SSLs.

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Authors and Affiliations

  1. Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-Machi, Naka-ku, Hiroshima, 730-8518, Japan

    Yoshiyasu Kono, Reiji Higashi, Hidetaka Mizushima, Daisuke Shimizu, Tetsuya Katayama, Masanari Kosaka, Issei Hirata, Tetsu Hirata, Tatsuhiro Gotoda, Koji Miyahara, Yuki Moritou & Masaki Kunihiro

  2. Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Yoshiyasu Kono & Hiroyuki Okada

  3. Department of Gastroenterology, Ichinomiyanishi Hospital, 1 Kaimeihira, Ichinomiya, 494-0001, Japan

    Reiji Higashi

  4. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Daisuke Shimizu, Masanari Kosaka & Issei Hirata

  5. Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Tetsuya Katayama

  6. Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan

    Tatsuhiro Gotoda

  7. Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-machi, Naka-ku, Hiroshima, 730-8518, Japan

    Masahiro Nakagawa

  8. Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-machi, Naka-ku, Hiroshima, 730-8518, Japan

    Koichi Ichimura

  9. Department of Internal Medicine, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, 670-8540, Japan

    Hiroyuki Okada

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  1. Yoshiyasu Kono
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  2. Reiji Higashi
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Contributions

KY: conception and design of the work and drafting the manuscript; MH, SD, KT, KM, HI, HT, MK, MY, KM, and IK: acquisition, analysis, or interpretation of data for the work; HR: revising it critically for important intellectual content; NM and OH: final approval of the version to be published.

Corresponding author

Correspondence to Yoshiyasu Kono.

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Conflict of interest

Kono Y, Higashi R, Mizushima H, Shimizu D, Katayama T, Kosaka M, Hirata I, Hirata T, Gotoda T, Miyahara K, Moritou Y, Kunihiro M, Nakagawa M, Ichimura K, and Okada H declare that they have no conflict of interest.

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Kono, Y., Higashi, R., Mizushima, H. et al. Usefulness of Acetic Acid Spray with Narrow-Band Imaging for Identifying the Margin of Sessile Serrated Lesions. Dig Dis Sci 68, 2553–2560 (2023). https://doi.org/10.1007/s10620-022-07816-x

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