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Usefulness of magnifying endoscopy with acetic acid and narrow-band imaging for the diagnosis of duodenal neoplasms: proposal of a diagnostic algorithm

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Abstract

Background

This study aimed to clarify the features of superficial non-ampullary duodenal epithelial tumors (SNADETs) on magnifying endoscopy with narrow-band imaging (M-NBI) and magnifying endoscopy with acetic acid and narrow-band imaging (M-AANBI), and evaluate the efficacy of M-NBI/M-AANBI to distinguish high-grade adenomas or adenocarcinomas (HGA/AC) from low-grade adenomas (LGA).

Methods

Clinicopathological data on 62 SNADETs in 58 patients who underwent preoperative M-NBI/M-AANBI and endoscopic resection were retrospectively reviewed. The pathological results were classified into two categories, LGA and HGA/AC. We evaluated microvascular patterns (MVPs) and microsurface patterns (MSPs) observed by M-NBI and MSPs observed by M-AANBI for characterizing LGA and HGA/AC. The kappa value was calculated to assess the interobserver and intraobserver agreements of evaluation of M-AANBI images.

Results

Pathologically, 38 lesions (61.3%) were LGA and 24 lesions (38.7%) were HGA/AC. HGA/AC tended to have irregular MVP and/or MSP on M-NBI. M-NBI diagnostic performance to distinguish HGA/AC from LGA showed 62.5% sensitivity, 68.4% specificity, and 66.1% accuracy. SNADETs had irregular MSP on M-AANBI. Three irregularity grades (iG) of MSP were observed by M-AANBI as follows: iG1, mild; iG2, moderate; iG3, significant. HGA/AC lesions had a significantly higher rate of iG3 than LGA lesions (p < 0.001). The iG2 was associated with HGA/AC in elevated lesions and LGA in depressed lesions. The diagnostic performance of M-AANBI was as follows: 95.8% sensitivity, 97.4% specificity, and 96.8% accuracy. The diagnostic accuracy of M-AANBI was significantly higher than that of M-NBI (p < 0.001). The kappa value for interobserver agreement on the diagnosis and irregularity grading of M-AANBI images was 0.742 and 0.719, respectively. These data indicate substantial interobserver agreement. Based on the above-mentioned results, we developed a M-AANBI diagnostic algorithm for SNADETs.

Conclusion

The diagnostic algorithm for SNADETs using M-AANBI may be useful for differentiating between LGA and HGA/AC.

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References

  1. Alwmark A, Andersson A, Lasson A (1980) Primary carcinoma of the duodenum. Ann Surg 191:13–18

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Qubaiah O, Devesa SS, Platz CE, Huycke MM, Dores GM (2010) Small intestinal cancer: a population-based study of incidence and survival patterns in the United States, 1992 to 2006. Cancer Epidemiol Biomarkers Prev 19:1908–1918

    Article  PubMed  PubMed Central  Google Scholar 

  3. Schottenfeld D, Beebe-Dimmer JL, Vigneau FD (2009) The epidemiology and pathogenesis of neoplasia in the small intestine. Ann Epidemiol 19:58–69

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bojesen RD, Andersson M, Riis LB, Nielsen OH, Jess T (2016) Incidence of, phenotypes of and survival from small bowel cancer in Denmark, 1994–2010: a population-based study. J Gastroenterol 51:891–899

    Article  PubMed  Google Scholar 

  5. Legue LM, Bernards N, Gerritse SL, van Oudheusden TR, de Hingh IH, Creemers GM, Ten Tije AJ, Lemmens VE (2016) Trends in incidence, treatment and survival of small bowel adenocarcinomas between 1999 and 2013: a population-based study in The Netherlands. Acta Oncol 55:1183–1189

    Article  CAS  PubMed  Google Scholar 

  6. Lu Y, Frobom R, Lagergren J (2012) Incidence patterns of small bowel cancer in a population-based study in Sweden: increase in duodenal adenocarcinoma. Cancer Epidemiol 36:e158–e163

    Article  PubMed  Google Scholar 

  7. Goda K, Kikuchi D, Yamamoto Y, Takimoto K, Kakushima N, Morita Y, Doyama H, Gotoda T, Maehata Y, Abe N (2014) Endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors in Japan: Multicenter case series. Dig Endosc 26(Suppl 2):23–29

    Article  PubMed  Google Scholar 

  8. Kakushima N, Kanemoto H, Tanaka M, Takizawa K, Ono H (2014) Treatment for superficial non-ampullary duodenal epithelial tumors. World J Gastroenterol 20:12501–12508

    Article  PubMed  PubMed Central  Google Scholar 

  9. Nonaka S, Oda I, Tada K, Mori G, Sato Y, Abe S, Suzuki H, Yoshinaga S, Nakajima T, Matsuda T, Taniguchi H, Saito Y, Maetani I (2015) Clinical outcome of endoscopic resection for nonampullary duodenal tumors. Endoscopy 47:129–135

    PubMed  Google Scholar 

  10. Hoteya S, Furuhata T, Takahito T, Fukuma Y, Suzuki Y, Kikuchi D, Mitani T, Matsui A, Yamashita S, Nomura K, Kuribayashi Y, Iizuka T, Kaise M (2017) Endoscopic submucosal dissection and endoscopic mucosal resection for non-ampullary superficial duodenal tumor. Digestion 95:36–42

    Article  PubMed  Google Scholar 

  11. Kinoshita S, Nishizawa T, Ochiai Y, Uraoka T, Akimoto T, Fujimoto A, Maehata T, Goto O, Kanai T, Yahagi N (2017) Accuracy of biopsy for the preoperative diagnosis of superficial nonampullary duodenal adenocarcinoma. Gastrointest Endosc 86:329–332

    Article  PubMed  Google Scholar 

  12. Kakushima N, Ono H, Takao T, Kanemoto H, Sasaki K (2014) Method and timing of resection of superficial non-ampullary duodenal epithelial tumors. Dig Endosc 26(Suppl 2):35–40

    Article  PubMed  Google Scholar 

  13. Kikuchi D, Hoteya S, Iizuka T, Kimura R, Kaise M (2014) Diagnostic algorithm of magnifying endoscopy with narrow band imaging for superficial non-ampullary duodenal epithelial tumors. Dig Endosc 26(Suppl 2):16–22

    Article  PubMed  Google Scholar 

  14. Tsuji S, Doyama H, Tsuji K, Tsuyama S, Tominaga K, Yoshida N, Takemura K, Yamada S, Niwa H, Katayanagi K, Kurumaya H, Okada T (2015) Preoperative endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors, including magnifying endoscopy. World J Gastroenterol 21:11832–11841

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mizumoto T, Sanomura Y, Tanaka S, Kuroki K, Kurihara M, Yoshifuku Y, Oka S, Arihiro K, Shimamoto F, Chayama K (2017) Clinical usefulness of magnifying endoscopy for non-ampullary duodenal tumors. Endosc Int Open 5:E297–E302

    Article  PubMed  PubMed Central  Google Scholar 

  16. Nakayama A, Kato M, Takatori Y, Shimoda M, Mizutani M, Tsutsumi K, Kiguchi Y, Akimoto T, Sasaki M, Mutaguchi M, Takabayashi K, Maehata T, Ochiai Y, Kanai T, Yahagi N (2020) How I do it: Endoscopic diagnosis for superficial non-ampullary duodenal epithelial tumors. Dig Endosc 32:417–424

    Article  PubMed  Google Scholar 

  17. Tanaka Y, Fujii S, Oiwa Y, Kusaka T, Shibuya S, Kokuryu H (2021) Efficacy of magnifying narrow band imaging with acetic acid spray in diagnosing superficial non-ampullary duodenal epithelial tumors. Digestion 102:572–579

    Article  CAS  PubMed  Google Scholar 

  18. Yamasaki Y, Takeuchi Y, Kanesaka T, Kanzaki H, Kato M, Ohmori M, Tonai Y, Hamada K, Matsuura N, Iwatsubo T, Akasaka T, Hanaoka N, Higashino K, Uedo N, Ishihara R, Okada H, Iishi H (2020) Differentiation between duodenal neoplasms and non-neoplasms using magnifying narrow-band imaging - Do we still need biopsies for duodenal lesions? Dig Endosc 32:84–95

    Article  PubMed  Google Scholar 

  19. Tanaka K, Toyoda H, Inoue H, Hamada Y, Aoki M, Kosaka R, Takamura M, Imoto I (2007) Depressed-type early duodenal carcinoma (carcinoma in situ) observed by enhanced magnification endoscopy. Endoscopy 39(Suppl 1):E125–E126

    Article  PubMed  Google Scholar 

  20. Kadowaki S, Tanaka K, Toyoda H, Kosaka R, Imoto I, Hamada Y, Katsurahara M, Inoue H, Aoki M, Noda T, Yamada T, Takei Y, Katayama N (2009) Ease of early gastric cancer demarcation recognition: a comparison of four magnifying endoscopy methods. J Gastroenterol Hepatol 24:1625–1630

    Article  PubMed  Google Scholar 

  21. Shibagaki K, Amano Y, Ishimura N, Taniguchi H, Fujita H, Adachi S, Kakehi E, Fujita R, Kobayashi K, Kinoshita Y (2016) Diagnostic accuracy of magnification endoscopy with acetic acid enhancement and narrow-band imaging in gastric mucosal neoplasms. Endoscopy 48:16–25

    PubMed  Google Scholar 

  22. Tanaka K, Toyoda H, Jaramillo E (2008) Magnifying endoscopy in combination with narrow-band imaging and acetic acid instillation in the diagnosis of Barrett’s esophagus. In: Tajiri H, Nakajima M, Yasuda K (eds) New challenges in gastrointestinal endoscopy. Springer, Tokyo, pp 153–160

    Chapter  Google Scholar 

  23. Okada K, Fujisaki J, Kasuga A, Omae M, Kubota M, Hirasawa T, Ishiyama A, Inamori M, Chino A, Yamomoto Y, Tsuchida T, Nakajima A, Hoshino E, igarashi M, (2011) Sporadic nonampullary duodenal adenoma in the natural history of duodenal cancer: a study of follow-up surveillance. Am J Gastroenterol 106:357–364

    Article  PubMed  Google Scholar 

  24. Maruoka D, Matsumura T, Kasamatsu S, Ishigami H, Taida T, Okimoto K, Nakagawa T, Katsuno T, Arai M (2017) Cold polypectomy for duodenal adenomas: a prospective clinical trial. Endoscopy 49:776–783

    Article  PubMed  Google Scholar 

  25. Irino T, Nunobe S, Hiki N, Yamamoto Y, Hirasawa T, Ohashi M, Fujisaki J, Sano T, Yamaguchi T (2015) Laparoscopic-endoscopic cooperative surgery for duodenal tumors: a unique procedure that helps ensure the safety of endoscopic submucosal dissection. Endoscopy 47:349–351

    PubMed  Google Scholar 

  26. Binmoeller KF, Shah JN, Bhat YM, Kane SD (2013) “Underwater” EMR of sporadic laterally spreading nonampullary duodenal adenomas (with video). Gastrointest Endosc 78:496–502

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the medical staff members of the Departments of Endoscopy, Gastroenterology and Pathology of Mie University Hospital, for their contribution to this work. We also thank NAI Inc. (Yokohama, Japan) for reviewing the English.

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Author notes

  1. Hiroshi Miura and Kyosuke Tanaka contributed equally as first authors.

Authors and Affiliations

  1. Department of Endoscopy, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Hiroshi Miura, Kyosuke Tanaka, Junya Tsuboi, Masaki Katsurahara & Hayato Nakagawa

  2. Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan

    Hiroshi Miura, Kyosuke Tanaka, Yuhei Umeda, Yohei Ikenoyama, Hiroki Yukimoto, Yasuhiko Hamada, Reiko Yamada, Misaki Nakamura, Noriyuki Horiki & Hayato Nakagawa

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  1. Hiroshi Miura
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Correspondence to Kyosuke Tanaka.

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Miura, H., Tanaka, K., Umeda, Y. et al. Usefulness of magnifying endoscopy with acetic acid and narrow-band imaging for the diagnosis of duodenal neoplasms: proposal of a diagnostic algorithm. Surg Endosc 36, 8086–8095 (2022). https://doi.org/10.1007/s00464-022-09239-1

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  • DOI: https://doi.org/10.1007/s00464-022-09239-1

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