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. 2022 Apr;19(2):278-286.
doi: 10.1007/s10388-021-00894-2. Epub 2021 Nov 13.

Blue laser imaging identifies endoscopic findings corresponding to metachronous esophageal squamous cell carcinoma

Yuka Azuma  1 , Osamu Dohi  2 , Yuji Naito  1   3 , Takeshi Yasuda  1 , Takuma Yoshida  1 , Tsugitaka Ishida  1 , Hiroaki Kitae  1 , Shinya Matsumura  1 , Toshihumi Doi  1 , Ryohei Hirose  1 , Ken Inoue  1 , Naohisa Yoshida  1 , Kazuhiro Kamada  1 , Kazuhiko Uchiyama  1 , Tomohisa Takagi  1 , Takeshi Ishikawa  1 , Hideyuki Konishi  1 , Ayako Nishimura  4 , Mitsuo Kishimoto  4 , Yoshito Itoh  1
Affiliations

Blue laser imaging identifies endoscopic findings corresponding to metachronous esophageal squamous cell carcinoma

Yuka Azuma et al. Esophagus. 2022 Apr.

Abstract

Background and study aim: This study aimed to evaluate endoscopic findings using non-magnifying blue laser imaging (BLI) to determine the risk factors for metachronous esophageal squamous cell carcinoma (ESCC).

Patients and methods: All consecutive patients who underwent endoscopic submucosal dissection (ESD) for primary superficial ESCC (SESCC) without a history of ESCC between January 2013 and January 2016 were enrolled. Three highly experienced endoscopists investigated seven endoscopic findings using non-magnifying BLI as follows: (1) a brownish area with unclear margin, (2) white flat deposits, (3) multiple foci of dilated vessels, (4) low capillary permeability, (5) multiple glycogenic acanthosis, (6) horizontal lines, and (7) a nonuniform color tone. Furthermore, Lugol-voiding lesions (LVLs) were graded according to the number of LVLs per endoscopic view (A, no lesions; B, 1-9 lesions; C, ≥ 10 lesions).

Results: A total of 102 SESCC patients who underwent ESD were included. Multivariate analyses showed that multiple foci of dilated vessels, low capillary permeability, and a nonuniform color tone were significantly associated with metachronous ESCC (hazard ratio [HR] 2.30; 95% confidence interval [CI] 1.01-5.46; P = 0.049, HR 5.25; 95% CI 1.86-15.01; P = 0.002 and HR 3.17; 95% CI 1.11-9.43; P = 0.032, respectively). The three-year cumulative incidence of metachronous ESCC was significantly higher in patients with low capillary permeability and a nonuniform color tone than in patients without these findings. (41.1% vs. 6.0%, 45.0% vs. 12.7%, respectively, P < 0.001 for both).

Conclusion: BLI findings of multiple foci of dilated vessels, low capillary permeability, and a nonuniform color tone in the background esophageal mucosa were risk factors for patients with metachronous ESCC after ESD.

Keywords: Blue laser imaging; Endoscopic submucosal dissection; Metachronous esophageal squamous cell carcinoma.

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