Comparison of the imaging of ultrathin transnasal endoscopy and transoral conventional endoscopy in the same patient with early esophageal cancer

Abstract

AIM: The diagnostic value of ultrathin transnasal endoscopy (UT) for early esophageal cancers (EEC) remains controversial. To evaluate the diagnostic utility of UT in detecting EEC, we compared the imaging of UT and transoral conventional endoscopy (CO) in the same patient.

METHODS: Nineteen consecutive patients with 20 lesions were enrolled to this study. The endoscopic findings, sensitivity and accuracy in the detection of mucosal findings, and the sensitivity of diagnosis were compared between UT and CO in the same subjects. The image density from each procedure was quantified and compared with the ImageJ software program.

RESULTS: All 20 lesions could be detected using UT. Twelve of 20 lesions (60.0%) could be diagnosed as cancerous by UT. The sensitivities of the mucosal findings such as the fur white coat, the vessel irregularity and loss of glossy identified by CO were superior to those obtained by UT. A combined examination by narrow-band imaging (NBI) yielded the same detection rate of the brownish area. The quantitative analyses revealed that combination diagnosis with NBI was superior to optical imaging alone. There were no differences in the calculated densities between UT and CO, thus demonstrating that UT was not inferior to CO for detecting these lesions.

CONCLUSIONS: The inherent shortcomings of UT included its poor resolution, lower light source, and lack of magnification. The imaging qualities and diagnostic accuracy of UT in EEC were lower than those of CO. However, the combination of UT with NBI increased the sensitivity, and UT with NBI could detect EEC.