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12 protocols using mb 46

1

Endoscopic Imaging Techniques Comparison

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All examinations were carried out with ME-BLI and ME-NBI. ME-BLI was performed using an EG-L590ZW endoscope (Fujifilm Co., Tokyo, Japan) with the LASEREO endoscopic system (Fujifilm Co.). ME-NBI was performed using a GIF-H260Z endoscope (Olympus Medical Systems, Tokyo, Japan) with the EVIS LUCERA SPECTRUM endoscopic system (Olympus Medical Systems). A black hood (MB-46, Olympus Medical Systems Co.) was attached to the tip of the endoscope to maintain the focal distance during the procedure. The same endoscopic system settings (BLI: image enhancement mode-A6 and color enhancement mode-C1, NBI: image enhancement mode-B8 and color enhancement mode-1) were used for all examinations. The image enhancement mode and color enhancement mode of the ME-BLI are similar to those of the ME-NBI.
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2

Magnifying Endoscopy for Colorectal Lesions

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The EVIS-LUCERA SPECTRUM system (CV-260, CV-290; Olympus, Tokyo, Japan) and magnifying video endoscope (GIF-H260Z, GIF-H290Z; Olympus) were used as video endoscopy systems. For obtaining a clear ME-NBI view, a soft hood (MB-46; Olympus) was attached to the distal tip of the endoscope to the proper focus distance. ME-NBI was performed by a single experienced endoscopist (G.H.K.), and all examinations were performed under conscious sedation with 2–5 mg midazolam. During endoscopy, the following endoscopic features were prospectively recorded for all lesions: (a) location; (b) macroscopic shape (Isp [subpedunculated], Is [sessile], IIa [slightly elevated]), according to the Paris classification of digestive tract lesions [10 (link)]; and (c) presence of central depression or ulceration. Subsequently, ME-NBI was performed to evaluate the MS and MV patterns and the presence of abnormally thickened subepithelial vessels (Figure 1).
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3

Endoscopic Imaging System for Mucosal Evaluation

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The endoscopy system used in the prospective trial consisted of a video processor (CV-260SL; Olympus Medical Systems, Tokyo, Japan) and a light source (CLV-260SL; Olympus Medical Systems) that worked in both the high resolution WLE and NBI modes. NBI uses narrow-band short-wavelength light (400 – 430 and 525 – 555 nm) to contrast vascular architecture and surface structure of the superficial mucosa 4 (link). Zoom videogastroscopy that can achieve a maximum of 80-fold optical magnification was used (GIF-Q240Z, GIF-H260Z and GIF-FQ260Z; Olympus Medical Systems). A soft black hood (MB162 or MB46; Olympus Medical Systems) was attached to the tip of the endoscope. The structure enhancement of the endoscopic video processor was set to B-mode level 4 or 6 for WLE and to B-mode level 8 for magnifying NBI. The color mode was set to level 1.
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4

Magnifying Endoscopy and NBI-Guided Iodine Staining

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A conventional magnifying endoscope (GIF-H260Z; Olympus Corporation, Tokyo, Japan) or Dual-Focus endoscope (GIF-HQ290; Olympus Corporation, Tokyo, Japan) was used in this study. We used a black rubber distal attachment (MB-46 [Olympus, Tokyo, Japan] for GIF-H260Z or MAJ-1989 [Olympus, Tokyo, Japan] for GIF-HQ290) on the tip of the endoscope to maintain the focal distance between the tip of the scope and it facilitated precise focusing during the magnification observation to inspect the esophagus in all eligible patients. All endoscopic examinations were performed under conscious sedation using intravenous flunitrazepam (0.2–0.8 mg, Rohypnol; Chugai Pharmaceutical, Tokyo, Japan) and pethidine hydrochloride (17.5–35 mg, Pethidine; Takeda Pharmaceutical, Osaka, Japan). Patients were initially examined by NBI. After observation of the stomach and duodenum, LCE was performed using 1.5% iodine solution. All procedures were performed by expert endoscopists, who were Japan Gastroenterological Endoscopy Society board-certified instructors with NBI examination experience of >1,000 cases.
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5

Esophageal Mucus Removal and Deep Sedation for Endoscopic Inspection

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All patients were orally administered with 20,000 U Pronase (Pronase MS; Kaken Pharmaceutical Products Inc., Tokyo, Japan) before the administration of pharyngeal anesthesia to eliminate mucus in the esophagus. All endoscopic inspections were performed under deep sedation through intravenous administration of pethidine hydrochloride (35–70 mg, Opystan; Mitsubishi Tanabe Pharma, Osaka, Japan) and flunitrazepam (0.2–0.8 mg, Rohypnol; Chugai Pharmaceutical, Tokyo, Japan).
NBI-ME and LCE-PS were performed by using a high-definition zoom endoscope (GIF-H260Z; Olympus Co., Tokyo, Japan) and a 19-in high-resolution liquid-crystal monitor (OEV191H; Olympus Co.) that enabled endoscopic observation at a 90-fold maximum magnification. A black rubber attachment (MB-46, Olympus Co.) was mounted on the tip of the zoom endoscope to maintain the focal distance between the tip of the scope and the lesion surface at 2 mm, and it facilitated precise focusing during the magnification observation.
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6

Magnifying Endoscopy with Narrow-Band Imaging

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The endoscopy system consisted of a video processor (CV-260SL; Olympus Co., Tokyo, Japan) and a light source (CLV-260SL; Olympus Co.) that worked in both the high-resolution white-light imaging and NBI modes. NBI illuminates narrow-banded short-wavelength light (400 – 430 and 525 – 555 nm) to contrast the vascular architecture and surface structure of the superficial mucosa
6 (link)
. Magnifying endoscopy that can achieve a maximum 80-fold optical magnification was used (GIF-Q240Z, GIF-H260Z, and GIF-FQ260Z; Olympus Co.). A soft black hood (MB162 or MB46; Olympus Co.) was attached to the tip of the endoscope to enable the endoscopist to maintain an adequate distance for maximal magnification of the endoscopic image. The structural enhancement of the endoscopic video processor was set to B-mode level 4 or 6 for white-light endoscopy and to B-mode level 8 for M-NBI. The color mode was set at level 1.
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7

Endoscopic Evaluation of Subepithelial Lesions

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The video endoscopy system used was the EVIS-LUCERA SPECTRUM system (Olympus, Tokyo, Japan),
which consisted of a light source (CLV-260SL), a processor (CV-260SL), and a magnifying video
endoscope (GIF-H260Z). To obtain a clear view for ME-NBI, a soft hood (MB-46; Olympus) was
fitted on the distal tip of the endoscope to maintain the focal distance. ME-NBI was performed
by a single experienced endoscopist (GHK) who had previously performed more than 100 ME-NBI
examinations. All examinations were performed under conscious sedation with 2 to 5 mg of midazolam. During conventional endoscopy for subepithelial lesions, the following endoscopic features were prospectively recorded for all lesions: (1) location; (2) macroscopic shape (Yamada classification
6 (link)
); and (3) presence of central dimpling, umbilication, or opening on the surface. Subsequently, ME-NBI was performed; during ME-NBI, presence of a microscopic opening on the surface, the status of microsurface structure, and presence of a thickened submucosal vessel were prospectively evaluated (
Fig. 1).
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8

High-resolution Endoscopic Procedures for Diagnostic Evaluation

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All the endoscopic diagnostic procedures were performed by two highly experienced endoscopists (certified by the Japan Gastroenterological Endoscopy Society) using a high-resolution upper gastrointestinal endoscope (GIF-H260, Olympus Medical Systems, Tokyo, Japan), a magnifying upper gastrointestinal endoscope (GIF-Q260Z, Olympus Medical Systems), and two electronic endoscopy systems (EVIS LUCERA Spectrum and EVIS LUCERA ELITE Spectrum; Olympus Medical Systems). NBI-ME was performed using a GIF-Q260Z endoscope fitted with a soft black hood (MB-46, Olympus Medical Systems) by the same endoscopist who performed ESD [22 (link)].
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9

Endoscopic Diagnosis of Gastric Cancer

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ME-NBI was performed at the time of the detailed examination before treatment, and EC-NBI was performed at the time of ESD. Both were taken at the utmost oral side of the cancerous tissue and the adjacent non-cancerous tissue. ME-NBI and EC-NBI were performed at the same site in each case. Figure 1 shows representative images of one case. In accordance with the gastric cancer treatment guidelines [19] (link), the cancerous and non-cancerous segments were confirmed in all cases using post-ESD pathological results as the gold standard.
The endoscopic procedure was performed as follows. ME-NBI was performed before treatment (on a different day). Before the examination, a soft hood (MB-46; Olympus Medical Systems) was mounted on the tip of the endoscope to enable the endoscopist to consistently fix the mucosa at a distance of approximately 2 mm. First, white-light endoscopy was performed. Second, ME-NBI was performed to diagnose the cancerous part and noncancerous segments. Finally, following indigo carmine spraying, chromoendoscopy was performed.
EC-NBI was performed immediately before treatment (on the same day). A soft hood was not mounted on the tip of the endoscope, since it is necessary to contact the mucosa directly for this technique. EC-NBI was performed to distinguish between the cancerous part and non-cancerous segments.
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10

Magnifying Endoscopy with Narrow-Band Imaging for Early Gastric Cancer

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The Evis Lucera Spectrum system (Olympus Co., Tokyo, Japan), comprising a light source (CLV-260SL), a processor (CV-260SL), and a magnifying video endoscope (GIF-H260Z), was used as the video endoscopy system. This system was equipped with both white light and NBI modes, which could be toggled using a button on the control head of the video endoscope. This system can reach zoom magnifications of ×80. To obtain a clear view for ME-NBI, a soft hood (MB-46; Olympus Co.) was fitted on the distal tip of the endoscope to maintain the focal distance.
ME-NBI was performed by a single experienced endoscopist (G.H.K.) who had previously performed over 100 ME-NBI examinations. All examinations were performed under conscious sedation with 2 to 5 mg of midazolam. After routine observation, ME-NBI examinations of EGC areas were performed to evaluate the MS and MV patterns. MS patterns were classified as oval and/or tubular, papillary, destructive, or absent, while MV patterns were classified as loop, fine network, or corkscrew (Fig. 1).2 (link),4 (link),20 (link) If lesions showed combined MS or MV patterns, the predominant pattern was used for classification.
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