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Gastric Case 10

Dr. Ashutosh Mohapatra

Sai Institute of Gastroenterology & Liver Sciences

India

Disclaimer:

NBI™ and TXI™ Technologies are not intended to replace histopathological sampling as a means of diagnosis
The positions and statements made herein by Dr. Mohapatra are based on Dr. Mohapatra’s experiences, thoughts and opinions. As with any product, results may vary, and the techniques, instruments, and settings can vary from facility to facility. The content hereof should not be considered as a substitute for carefully reading all applicable labeling, including the Instructions for Use. Please thoroughly review the relevant user manual(s) for instructions, risks, warnings, and cautions. Techniques, instruments, and setting can vary from facility to facility. It is the clinician’s decision and responsibility in each clinical situation to decide which products, modes, medications, applications, and settings to use.
The EVIS X1™ endoscopy system is not designed for cardiac applications. Other combinations of equipment may cause ventricular fibrillation or seriously affect the cardiac function of the patient. Improper use of endoscopes may result in patient injury, infection, bleeding, and/or perforation. Complete indications, contraindications, warnings, and cautions are available in the Instructions for Use (IFU)a

Procedure information

Scope: GIF-EZ1500

Case: Patient endoscopy finding include scattered gastric atrophy in areas of intestinal metaplasia. In areas of Intestinal Metaplasia there are several lesions and out of that one lesion is neoplastic having demarcation line with irregular, heterogeneous, densely distributed micro-vessels suggestive of high grade of dysplasia

Organ: Stomach

Patient Information: M, 50s, belongs to eastern India, non-vegetarian presented with dyspepsia

1. WLI Image

On white‑light endoscopy, a 10‑mm reddish, superficially depressed lesion (Paris IIa+IIc) was seen on the posterior wall of the incisura, on a background of severely atrophic mucosa with scattered areas of intestinal metaplasia.

#WL #B5

2. TXI™ Technology - Mode 1 Image

TXI™ technology mode 1 was applied that enhanced color contrast between the depressed neoplastic center and the surrounding mucosa and slightly accentuated surface/texture details that make the depression and its borders more conspicuous compared with standard white light.

#TXI-1 #Low level enhancement

3. TXI™ Technology - Mode 2 Image

TXI™ technology mode 2 is designed to keep an overall natural appearance very close to white light while subtly enhancing brightness and texture, but without the stronger color contrast you see in TXI™ technology mode 1.

#TXI-1 #low level enhancement

4. NBI™ Technology

NBI™ technology revealed a clear demarcation line with irregular, heterogeneous, densely distributed micro-vessels along the left side of the lesion border, together with irregular micro-surface epithelium, findings highly suggestive of high‑grade dysplasia.

#NBI #B8

5. NBI™ Technology in Near Mode

With dual focus using EDOF™ technology and optical magnification, NBI™ technology demonstrated a sharply defined demarcation line and irregular, heterogeneous, densely packed micro-vessels, some of which traversed the crypt epithelium, a pattern highly suggestive of high‑grade dysplasia.

#NBI #B8

6. NBI™ Technology in Near Mode with 1.6X optical zoom

#NBI #B8

Case Video

Video shows the scattered atrophy with Intestinal Metaplasia which is enhanced in TXI™ technology modes ( both 1 and 2) and on an NBI™ technology image of posterior wall of incisura has a lesion with sharply defined demarcation line and irregular, heterogeneous, densely packed micro-vessels, some of which traversed the crypt epithelium, a pattern highly suggestive of high‑grade dysplasia.

Overall Comment

A male in his 50’s with no significant past medical history presented with dyspepsia and underwent upper GI endoscopy. White-light imaging revealed an approximately 20 mm superficially elevated lesion with a depressed component (Paris IIa+IIc).

Using NBI™ technology, the depressed component revealed a clear demarcation line with irregular, heterogeneous microvascular architecture and an irregular micro-surface pattern, raising concern for a neoplastic lesion.

* Specifications, design and accessories are subject to change without any notice or obligation on the part of the manufacturer.

Case 9: Duodenal second part tubular adenoma with high grade dysplasia
Prof. Dr. Fatih Aslan

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Imaging Atlas