Esophagus : official journal of the Japan Esophageal Society · 2026
Efficacy of combined use of magnifying narrow-band imaging/blue laser imaging and Lugol chromoendoscopy for tumor extent delineation in esophageal squamous cell carcinoma.
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Kitagawa Daiki, Yoshii Shunsuke, Ishihara Ryu, Mori Hitoshi, Tani Yasuhiro, Okubo Yuki, Asada Yuya, Ueda Tomoya, Kizawa Atsuko, Ninomiya Takehiro, Ando Yoshiaki, Tanabe Gentaro, Fujimoto Yuta, Kato Minoru, Shichijo Satoki, Kanesaka Takashi, Yamamoto Sachiko, Higashino Koji, Uedo Noriya, Kitamura Masanori, Honma Keiichiro, Michida Tomoki, Fujiwara Yasuhiro
Аннотация
BACKGROUND AND AIM: Accurate delineation of tumor extent is essential for curative endoscopic resection of esophageal squamous cell carcinomas (ESCCs). This study aimed to clarify the efficacy of the combined use of magnifying narrow-band imaging (NBI)/blue laser imaging (BLI) observation with Lugol chromoendoscopy (LCE) for evaluating the extent of ESCCs during endoscopic resection.
METHODS: This prospective, single-center study enrolled patients with ESCCs scheduled for endoscopic resection (ER). Tumor margins were initially assessed using NBI/BLI with magnification, followed by LCE. ER was performed based on the combined diagnosis. The primary outcome was the proportion of lesions demonstrating a positive effect, defined as a decrease in either overestimation or underestimation of tumor extent when using the combined diagnostic strategy compared to LCE alone.
RESULTS: A total of 62 patients with 82 ESCCs underwent endoscopic treatment. After excluding two lesions due to inadequate pathological evaluation, 80 lesions in 60 patients were analyzed. R0 resection was achieved in 96.3% (77/80). A positive effect was observed in 8.8% (7/80; 95% confidence interval [CI] 3.6-17.2%), all associated with multiple Lugol-voiding lesions (LVLs), in which overestimation by LCE was mitigated using the combined diagnostic strategy. Among lesions with multiple LVLs, the positive effect rate was 18.9% (7/37; 95% CI 8.0-35.2%). Overestimation by magnifying NBI/BLI occurred in one lesion, while LCE-added areas contained SCC in 3 lesions and intraepithelial neoplasia in two lesions.
CONCLUSIONS: Combined use of magnifying NBI/BLI and LCE is a simple and effective strategy during ER for ESCCs, particularly in cases with multiple LVLs.
METHODS: This prospective, single-center study enrolled patients with ESCCs scheduled for endoscopic resection (ER). Tumor margins were initially assessed using NBI/BLI with magnification, followed by LCE. ER was performed based on the combined diagnosis. The primary outcome was the proportion of lesions demonstrating a positive effect, defined as a decrease in either overestimation or underestimation of tumor extent when using the combined diagnostic strategy compared to LCE alone.
RESULTS: A total of 62 patients with 82 ESCCs underwent endoscopic treatment. After excluding two lesions due to inadequate pathological evaluation, 80 lesions in 60 patients were analyzed. R0 resection was achieved in 96.3% (77/80). A positive effect was observed in 8.8% (7/80; 95% confidence interval [CI] 3.6-17.2%), all associated with multiple Lugol-voiding lesions (LVLs), in which overestimation by LCE was mitigated using the combined diagnostic strategy. Among lesions with multiple LVLs, the positive effect rate was 18.9% (7/37; 95% CI 8.0-35.2%). Overestimation by magnifying NBI/BLI occurred in one lesion, while LCE-added areas contained SCC in 3 lesions and intraepithelial neoplasia in two lesions.
CONCLUSIONS: Combined use of magnifying NBI/BLI and LCE is a simple and effective strategy during ER for ESCCs, particularly in cases with multiple LVLs.