1. Endoscopic Diagnosis Of Chronic Gastritis By Image Enhancement Observation Method Number:4a02c073 Name:Chen,Chia-Sheng Professor:Wang,Ming-Shyan Date:2015/05/21 Noriya Uedo, Gastrointestinal cancer (esophagus, stomach, large intestine) and endoscopic diagnosis and treatment UICC, Osaka Medical Center for Cancer and Cardiovascular Disease

2. Outline  Basic policy  Image enhanced endoscopy for diagnosis of chronic gastritis and carcinoma  Pathogenesis of gastric cancer  H. pylori-associated gastritis  Chromoendoscopy  Autofluorescence imaging  Narrow band imaging

3. Basic policy  Many endoscopists, particularly in the West, considered the Japanese classification, with its numerous divisions for esophagus, stomach, and colon, to be a "botanical hobby", too complex for practical use.  Lambert R, GIE 2003;58 (SUPPL)  I ain't looking to compete with you…classify you… All I really want to do is be friends with you  Dylan B, 1964

4. Image Enhanced Endoscopy  Dye-based IEE 染料基於圖像增強內鏡 (chromoendoscopy 色素 ):  Absorptive dye 吸收染料  Lugol’s solution 盧戈氏液  Methylene blue 亞甲藍  Contrast dye 造影劑  Indigo carmine 靛藍胭脂紅  Equipment-based IEE 設備基於圖像增強內鏡 :  Optical 光學  Narrow band imaging 窄頻成像  Electronic 電子  Spectral estimation technology 光譜估計技術 : FICE 富士智能 色彩增強技術  Surface enhancement technology 表面增強技術  Autofluorescence imaging 自體螢光成像

5. Image Enhanced Endoscopy (tri-modal imaging):WLI,NBI,AFI ( 三模態成像 )

6. Chronic gastritis as a cancer precursor H. Pylori infection( 感染 ) ↓ Acute gastritis( 急性胃炎 ) ↓ Chronic gastritis( 慢性胃炎 ) ↓ Atrophic gastritis( 萎縮性胃炎 ) ↓ Intestinal metaplasia( 腸上皮化生 ) ↓ Dysplasia( 發育異常 ) ↓ Carcinoma

7. Relationship of gastroscopic feature to histological findings in gastritis and Helicobacter pylori infection in a general population sample H. pylori (-) normal mucosa 陰性反應正常的黏膜 Chronic atrophic gastritis 慢性萎縮性胃炎 Sensitivity (%)Specificity 差異性 (%) Visible vessels 可見血管 48 (26-70)87 (84-90) Absence of rugae67 (43-85)85 (82-88) 有無皺褶

8. Chromoendoscopic observations on extension and develoment of fundal gastritis and intestinal metaplasia

9. Color difference in autofluorescence image 自體螢光的顏色差異 0 0.1 0.2 480580680 780 Background mucosa Gastric cancer Fluoroph ores Mucosal thickening 黏膜增厚 Increased blood flow 增加血流 量 (Hb) Different tissue structure 不 同的組織結構 etc…

10. Color difference of background mucosa in AFI image AFI 圖像背景粘膜色差 H. pylori Negative(-) Atrophic fundic gastritis 萎縮性胃體 胃炎

11. Diagnostic accuracy of green mucosa in gastric body by AFI for gastritis 由 AFI 胃炎的診斷綠色胃體黏膜的準確性

12. Narrow band imaging,NBI 窄頻成像 Xeno n Lamp NBI filter RGB Rotary Filter ON OFF 400 500 600 nm White light image (RGB broad band) Hb absorption curve Narrow band image

13. Diagnostic accuracy of LBC for histological IM 88 recorded images by three endoscopists

14. Thanks for listening