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Three-dimensional flexible endoscopy enables more accurate endoscopic recognition and endoscopic submucosal dissection marking for superficial gastric neoplasia: a pilot study to compare two- and three-dimensional imaging

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Abstract

Background

Three-dimensional (3D) visualization offers better depth recognition than two-dimensional (2D) imaging, thus helping to provide more useful information. We compared 3D and 2D endoscopy with regard to endoscopic recognition and endoscopic submucosal dissection (ESD) marking for superficial gastric neoplasia.

Methods

ESD marking was performed on half of a neoplasia margin under 2D observation and the on other half under 3D observation for 28 gastric lesions (26 early gastric cancers and 2 adenomas). The accuracy of ESD marking was evaluated based on the distance between the pathological and endoscopic neoplasia margins measured on histology sections of ESD specimens. The technical ease of ESD marking and endoscopic lesion recognition (lesion morphology, lesion extent, and comprehensive endoscopic cognition) were assessed using visual analog scale (VAS) questionnaires.

Results

The mean distance between the pathological and endoscopic margins under 3D observation (1.03 ± 0.80 mm) was significantly (p = 0.002) shorter than that under 2D observation (1.94 ± 1.96 mm). The VAS for technical ease of ESD marking under 3D observation was significantly better (p < 0.01) than that under 2D observation. The VAS for all aspects of endoscopic recognition under 3D observation was significantly better (p < 0.01) than under 2D observation.

Conclusions

3D flexible endoscopy achieved more accurate endoscopic recognition and ESD marking for superficial gastric neoplasia than a 2D approach in a clinical setting of ESD.

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Abbreviations

3D:

Three-dimensional

2D:

Two-dimensional

ESD:

Endoscopic submucosal dissection

NBI:

Narrow-band imaging

WLI:

White-light imaging

M-NBI:

Magnifying endoscopy combined with NBI

VAS:

Visual analog scale

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Authors and Affiliations

  1. Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Kazutoshi Higuchi, Mitsuru Kaise, Hiroto Noda, Kumiko Kirita, Eriko Koizumi, Takamitsu Umeda, Teppei Akimoto, Jun Omori, Naohiko Akimoto, Osamu Goto, Atsushi Tatsuguchi & Katsuhiko Iwakiri

  2. Department of Analytic Human Pathology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan

    Atsushi Tatsuguchi

Authors
  1. Kazutoshi Higuchi
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  2. Mitsuru Kaise
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  3. Hiroto Noda
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  4. Kumiko Kirita
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  5. Eriko Koizumi
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  6. Takamitsu Umeda
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  7. Teppei Akimoto
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  9. Naohiko Akimoto
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  10. Osamu Goto
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  11. Atsushi Tatsuguchi
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  12. Katsuhiko Iwakiri
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Corresponding author

Correspondence to Kazutoshi Higuchi.

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Disclosures

The 3D endoscopy system used in this study was provided by Olympus Co., Ltd. Kaise Mitsuru received lecture fees from Olympus Co., Ltd. Osamu Goto received lecture and consultant fees from Olympus Co., Ltd. Kazutoshi Higuchi, Hiroto Noda, Kumiko Kirita, Eriko Koizumi, Takamitsu Umeda, Teppei Akimoto, Jun Omori, Naohiko Akimoto, Atsushi Tatsuguchi, and Katsuhiko Iwakiri have no conflict of interest or financial ties to disclose.

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Higuchi, K., Kaise, M., Noda, H. et al. Three-dimensional flexible endoscopy enables more accurate endoscopic recognition and endoscopic submucosal dissection marking for superficial gastric neoplasia: a pilot study to compare two- and three-dimensional imaging. Surg Endosc 35, 6244–6250 (2021). https://doi.org/10.1007/s00464-020-08124-z

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  • DOI: https://doi.org/10.1007/s00464-020-08124-z

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