Indian Journal of Gastroenterology

, Volume 37, Issue 2, pp 79–85 | Cite as

Efficacy of narrow-band imaging in detecting early esophageal cancer and risk factors for its occurrence

  • Wei Gai
  • Xi-Feng Jin
  • Ronglian Du
  • Ling Li
  • Tong-Hai Chai
Original Article



The aim of this study is to evaluate the efficacy of narrow-band imaging (NBI) in the detecting early esophageal cancer and precancerous lesions and to investigate the risk factors for its occurrence.


The esophagus was examined with ordinary endoscopy, NBI, and iodine staining. All the lesions were confirmed by histopathologically as the gold standard; NBI and intrapapillary capillary scale (IPCL) scale were compared with pathologic diagnosis. The accuracy, sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated. Subgroup analysis was performed between the elderly vs. younger group, and head and neck squamous cell cancer (HNSCC) vs. non-HNSCC patients.


Ninety lesions were detected with ordinary endoscopy, 108 with NBI, and 120 with iodine staining. All esophageal cancers were detected both by NBI and by iodine staining. Accuracy, sensitivity, and specificity for esophageal cancer and precancerous lesion were 67.8%, 58.1%, and 76.6%; 92%, 89.7%, and 96%; 93.4%, 93.4%, and 93.2%, respectively. NBI endoscopy and iodine staining were superior to ordinary endoscopy for detecting esophageal cancer and precancerous lesions (p < 0.05). NBI showed better detection of esophageal neoplasms in the elderly patients (p < 0.001). The incidence of multiple squamous cell cancers (SCCs) was significantly higher in non-elderly group (p = 0.009). NBI can also detect more esophageal neoplastic lesions in patients with head and neck cancers (p = 0.003).


NBI endoscopy appears as effective as Lugol staining to detect and screen the early esophageal cancer. NBI shows better detection of esophageal neoplasms in the elderly patients. The incidence of multiple SCCs was much higher in non-elderly patients.


Endoscopy Esophageal neoplasms Narrow band imaging Precancerous lesions 



This project was supported by China Scholarship Council.

Compliance with ethical standards

Conflicts statement

WG, XFJ, RD, LL, and THC declare that they have no conflict of interest.

Ethics statement

The authors declare that the study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008, concerning Human and Animal Rights. The protocol was approved by the Institutional Ethics Committee, and informed consent was obtained from the study subjects.


  1. 1.
    van Nistelrooij AM, Andrinopoulou ER, van Lanschot JJ, Tilanus HW, Wijnhoven BP. Influence of young age on outcome after esophagectomy for cancer. World J Surg. 2012;36:2612–21.Google Scholar
  2. 2.
    Wolfsen HC, Crook JE, Krishna M, et al. Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barretts esophagus. Gastroenterology. 2008;135:24–31.CrossRefPubMedGoogle Scholar
  3. 3.
    Ide E, Carneiro FO, Frazão MS, et al. Endoscopic detection of early esophageal squamous cell carcinoma in patients with achalasia: narrow-band imaging versus Lugol's staining. J Oncol. 2013;2013:736756.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Inoue H, Kaga M, Ikeda H, et al. Magnification endoscopy in esophageal squamous cell carcinoma: a review of the intrapapillary capillary loop classification. Ann Gastroenterol. 2015;28:41–8.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Shimizu Y, Takahashi M, Mizushima T, et al. Chromoendoscopy with iodine staining, as well as narrow-band imaging, is still useful and reliable for screening of early esophageal squamous cell carcinoma. Am J Gastroenterol. 2015;110:193–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Ebi M, Shimura T, Yamada T, et al. Multicenter, prospective trial of white-light imaging alone versus white-light imaging fllowed by magnifying endoscopy with narrow-band imaging for the real-time imaging and diagnosis of invasion depth in superficial esophageal squamous cell carcinoma. Gastrointest Endosc. 2015;81:1355–61.e2.CrossRefPubMedGoogle Scholar
  7. 7.
    Goda K, Dobashi A, Tajiri H. Perspectives on narrow-band imaging endoscopy for superficial squamous neoplasms of the orohypopharynx and esophagus. Dig Endosc. 2014;26 Suppl 1:1–11.CrossRefPubMedGoogle Scholar
  8. 8.
    Minami H, Isomoto H, Inoue H, et al. Significance of background coloration in endoscopic detection of early esophageal squamous cell carcinoma. Digestion. 2014;89:6–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Curvers WL, Alvarez Herrero L, Wallace MB, et al. Endoscopic tri-modal imaging is more effective than standard endoscopy in identifying early-stage neoplasia in Barrett's esophagus. Gastroenterology. 2010;139:1106–14.CrossRefPubMedGoogle Scholar
  10. 10.
    Curvers WL, van den Broek FJ, Reitsma JB, Dekker E, Bergman JJ. Systematic review of narrow-band imaging for the detection and differentiation of abnormalities in the esophagus and stomach (with video). Gastrointest Endosc. 2009;69:307–17.CrossRefPubMedGoogle Scholar
  11. 11.
    Schlemper J, Riddell RH, Kato Y, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–5.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ito S, Ohga T, Saeki H, et al. p53 mutation profiling of multiple esophageal carcinoma using laser capture microdissection to demonstrate field carcinogenesis. Int J Cancer. 2005;113:22–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Osta EH, Falchook G, Tsimberidou A, et al. BRAF mutations in advanced cancers: clinical characteristics and outcomes. Plos One. 2011;6:e25806.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Tsai WC, Chen PJ, Chao YC, Tsao YT. Chromoendoscopy with narrow band imaging for early stage multifocal squamous cell carcinoma of the esophagus. J Clin Gastroentero1. 2008;42:757.CrossRefGoogle Scholar
  15. 15.
    Curvers WL, Singh R, Song LM, et al. Endoscopic trimodal imaging for detection of early neoplasia in Barrett’s oesophagus: a multicentre feasibility study using high-resolution endoscopy, autofluorescence imaging and narrow band imaging incorporated in one endoscopy system. Gut. 2008;57:167–72.CrossRefPubMedGoogle Scholar
  16. 16.
    Inoue H, Kumagai Y, Yoshida T, et al. High magnification endoscopic diagnosis of superficial esophageal cancer. Digest Endosc. 2000;12:34.CrossRefGoogle Scholar
  17. 17.
    Yoshida T, Inoue H, Usui S, Satodate H, Fukami N, Kudo SE. Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions. Gastrointest Endosc. 2004;59:288–9.CrossRefPubMedGoogle Scholar
  18. 18.
    East JE, Guenther T, Kennedy RH, Saunders BP. Narrow band imaging avoids potential chromoendoscopy risks. Gut. 2007;56:1168–9.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Petit T, Georges C, Jung GM, et al. Systematic esophageal endoscopy screening in patients previously treated for head and neck squamous-cell carcinoma. Ann Oncol. 2001;12:643–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Morita M, Araki K, Saeki H, et al. Risk factors for multicentric occurrence of carcinoma in the upper aerodigestive tract: analysis with a serial histologic evaluation of the whole resected-esophagus including carcinoma. J Surg Oncol. 2003;83:216–21.CrossRefPubMedGoogle Scholar
  21. 21.
    Morita M, Kumashiro R, Kubo N, et al. Alcohol drinking, cigarette smoking, and the development of squamous cell carcinoma of the esophagus: epidemiology, clinical findings, and prevention. Int J Clin Oncol. 2010;15:126–34.CrossRefPubMedGoogle Scholar
  22. 22.
    Goda K, Dobashi A, Yoshimura N, et al. Clinicopathological features of narrow-band imaging endoscopy and immunohistochemistry in ultraminute esophageal squamous neoplasms. Dis Esophagus. 2014;27:267–75.CrossRefPubMedGoogle Scholar
  23. 23.
    East JE, Tan EK, Bergman JJ, et al. Meta-analysis: narrow band imaging for lesion characterisation in the colon, oesophagus, duodenal ampulla and lung. Aliment Pharmacol Ther. 2008;28:854–67.CrossRefPubMedGoogle Scholar
  24. 24.
    Wu IC, Zhao Y, Zhai R, et al. Association between polymorphisms in cancer-related genes and early onset of esophageal adenocarcinoma. Neoplasia. 2011;13:386–92.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Macfarlane TV, Macfarlane GJ, Oliver RJ, et al. The aetiology of upper aerodigestive tract cancers among young adults in Europe: the ARCAGE study. Cancer Causes Control. 2012;21:2213–21.CrossRefGoogle Scholar
  26. 26.
    Dawsey SP, Tonui S, Parker RK, et al. Esophageal cancer in young people: a case series of 109 cases and review of the literature. Plos One. 2010;5:e14080.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  • Wei Gai
    • 1
  • Xi-Feng Jin
    • 1
    • 2
  • Ronglian Du
    • 1
  • Ling Li
    • 1
  • Tong-Hai Chai
    • 1
  1. 1.Department of GastroenterologyTengzhou Central People’s HospitalTengzhouChina
  2. 2.Department of Internal MedicineUniversity-Hospital Campus Grosshadern, Ludwig-Maximilian University of MunichMunichGermany

Personalised recommendations