Tecnicas de imagen avanzada para patologia gastrica

1. ENDOSCOPIA
DE IMAGEN
AVANZADA
GÁSTRICA Dra. Luz A. Lizcano Carreño.
Residente de segundo año de postgrado Gastroenterología.
San Cristóbal, 05 de mayo de 2020

3. VIDEOENDOSCOPIA
LUZ BLANCA
Estandar
Alta definición
CROMOENDOSCOPIA
VIRTUAL
2005
MAGNIFICACIÓN
ENDOSCOPICA
1996
CROMOENDOSCOPIA
CON TINCIÓN
1970

4. ENDOMICROSCOPÍA
LÁSER CONFOCAL
ENDOCITOSCOPIA
2003

5. ENDOSCOPIO DE
FIBRA ÓPTICA
1. Haycock A et cols. Cottons and Williams Practical gastrointestinal endoscopy The fundamentals. Seventh Edition. Wiley Blackwell. 2014
Jang J. The Past, present and future of Image-Enhanced Endoscopy. Clin Endosc 2015;48:466-475
1957, Hirchwitz

6. CCD
Estandar: 100,000 – 400,000 pixeles.
Alta resolución: 850,000 – 1,000,000 pixeles. (2000)
VIDEOENDOSCOPIA 1983
1. Jang J. The Past, present and future of Image-Enhanced Endoscopy. Clin Endosc 2015;48:466-475

7. CROMOENDOSCOPIA
CON TINCIÓN 1970
Absorbibles/Vitales
Contraste
Reactivos
Tatuaje
Azul de metileno y toluidina, acido acético
Índigo carmín
Rojo congo, rojo fenol
Tinta negra

8. CROMOENDOSCOPIA
CON TINCIÓN
Cáncer gástrico precoz

9. CROMOENDOSCOPIA
CON TINCIÓN
Metaplasia intestinal.
1. Ho S, Uedo N Aso A Yao K. Development of Imagen-enhanced endoscopy of gastrointestinal tract. A review of history and current evidences. J Clin Gastroenterol Volume 00, Number 00, ’’ 2017

10. 10-71 micras
MAGNIFICACIÓN
ENDOSCOPICA
1996
1. Ho S, Uedo N Aso A Yao K. Development of Imagen-enhanced endoscopy of gastrointestinal tract. A review of history and current evidences. J Clin Gastroenterol Volume 00, Number 00, ’’ 2017
Imagen microscópica en tiempo real.
1,5-150x
6,4- 71 micras.
Combinación con otras técnicas.
MEJORA
CARACTERIZACIÓN
NO DETECCIÓN

11. MAGNIFICACIÓN
ENDOSCOPICA
1. M. Muto et al. (eds.), Atlas of Endoscopy with Narrow Band Imaging. DOI 10.1007/978-4-431-54243-8_9. Springer Japan 2015
Técnica irrigación de agua
Técnica inmersión en agua

12. NBI
FICE
BLI
LCI
I-SCAN
AFI
CROMOENDOSCOPIA
ELECTRÓNICA

13. NARROW BAND IMAGING (NBI)
Olympus
415 nm AZUL
540 nm VERDE
LUZ BLANCA NBI
1. Gono K. Narrow Band Imaging: Technology Basis and Research and Development History. Clin Endosc 2015;48:476-480.
2. Muto M, Yao K, Sano Y. Atlas of endoscopy with Narrow band imaging. Springer. 2015

14. FLEXIBLE SPECTRAL IMAGING COLON ENHANCEMENT (FICE)
Fujinon
1. Gono K. Narrow Band Imaging: Technology Basis and Research and Development History. Clin Endosc 2015;48:476-480

15. FLEXIBLE SPECTRAL IMAGING COLON ENHANCEMENT (FICE)
Fujinon
1. Centro de Control de Cancer Gastrointestinal “Dr. Luis E. Anderson

16. BLUE LASER IMAGING (BLI)
Fujinon
1. Dohi O et cols. Diagnostic ability of magnifying endoscopy with blue laserimaging for early gastric cancer: a prospective study. Gastric Cancer (2017) 20:297–303. DOI 10.1007/s10120-016-0620-6

17. LINKED COLOR IMAGING (LCI)
Fujinon
1. Shinozaki S et cols. Linked color imaging for the detection of early gastrointestinal neoplasmsTher Adv Gastroenterol 2019, Vol. 12: 1–10 DOI: 10.1177/https://doi.org/10.1177/175628

18. I- SCAN DIGITAL CONTRAST
Pentax
Surface Enhancement (SE) Contrast Enhancement (SE) Tone Enhancement (SE)
Agudeza de la imagen Áreas deprimidas Imágenes espectrales
TE-p TE-v TE-b TE-c TE-e TE-g
I-SCAN 1 : SE
I-SCAN 2 : SE + TE-c
I-SCAN 3 : SE + TE-c + CE
1. Jang J. The Past, Present, and Future of Image-Enhanced Endoscopy. Clin Endosc 2015;48:466-475. http://dx.doi.org/10.5946/ce.2015.48.6.466

19. AUTOFLUORESCENCE IMAGING (AFI)
Olympus
1. Uedo N et cols. Autofluoresce Imaging Video-Endoscopy System for diagnosis of superficial gastric neoplasia. Nwe Challenges in Gastrointestinal Endoscopy. Springer.

20. TÉCNICAS DE HISTOLOGÍA
VIRTUAL

21. CONFOCAL LASER ENDOMICROSCOPIA (CLE)
Pentax, Cellvizio endomicroscopy System
1. Jang J. The Past, Present, and Future of Image-Enhanced Endoscopy. Clin Endosc 2015;48:466-475. http://dx.doi.org/10.5946/ce.2015.48.6.466
2. Lee JWJ, Lim LG, Yeoh KG, et al. BMJ Open Gastro 2017;4:e000105. doi:10.1136/bmjgast-2016-000105
3. Cho W et cols. Recent Advances in Image-enhanced Endoscopy. Clin Endosc 2011;44:65-75
ANTROCUERPO

22. ENDOCITOSCOPIA
1. Angeli M et cols. Endocytoscopy: technology and clinical application in upper gastrointestinal tract. Transl Gastroenterol Hepatol 2020;5:28 | http://dx.doi.org/10.21037/tgh.2019.11.12
2. Sato H, Inoue H et cols . vivo gastric mucosal histopathology using endocytoscopy. World J Gastroenterol 2015 April 28; 21(16): 5002-5008
Olympus

23. Identificar individuos de
alto riesgo
de desarrollo de Cancer
Diferenciar
lesiones neoplásicas
De las no neoplásicas
Determinar
márgenes laterales
de la lesión
1. Uedo N, Yao K. Endoluminal Diagnosis of Early Gastric Cancer and Its Precursors: Bridging the Gap Between Endoscopy and Pathology. Springer International Publishing Switzerland 2016
2. The endoscopic diagnosis of early gastric cancer. Yao K. Ann Gastroenterol 2013; 26 (1): 11-22

24. Cuerpo, fundus.
FÚNDICA
PILÓRICA
Cardias, Antro.

25. MUCOSA
FÚNDICA
PATRON VASCULAR
PATRON MUCOSAL
Capilares subepiteliales (SEC)
Bucle cerrado poligonal Panal de abejas.
Vénulas colectoras (RAC)
Epitelio marginal de la cripta
Apertura de la cripta “Foveolar”.
Intervening part
ME-NBI
1. Uedo N, Yao K. Endoluminal Diagnosis of Early Gastric Cancer and Its Precursors: Bridging the Gap Between Endoscopy and Pathology. Springer International Publishing Switzerland 2016
2. Yao K. The endoscopic diagnosis of early gastric cancer.. Ann Gastroenterol 2013; 26 (1): 11-22
PATRON VS: EPITELIO DENTRO DEL VASO

26. MUCOSA
PILÓRICA
PATRON VASCULAR
PATRON MUCOSAL
Capilares subepiteliales en bucle
abierto espiralado.
Vénulas colectoras (RAC).
Epitelio marginal de la cripta
Velloso/Crestas
Apertura de la cripta.
Intervening part.
.1. Uedo N, Yao K. Endoluminal Diagnosis of Early Gastric Cancer and Its Precursors: Bridging the Gap Between Endoscopy and Pathology. Springer International Publishing Switzerland 2016
2. Yao K. The endoscopic diagnosis of early gastric cancer.. Ann Gastroenterol 2013; 26 (1): 11-22
ME-NBI
PATRON VS: VASOS DENTRO DEL EPITELIO

27. GASTRITIS CRÓNICA
ASOCIADA A
H. Pylori
1. Uedo N, Yao K. Endoluminal Diagnosis of Early Gastric Cancer and Its Precursors: Bridging the Gap Between Endoscopy and Pathology. Springer International Publishing Switzerland 2016
Mucosa fúndica
AUSENCIA DE VÉNULAS
COLECTORAS 90%
Atrofia severa

28. 2, Yao K. Clinical Application of Magnifying Endoscopy with Narrow-Band Imaging in the Stomach. Clin Endosc 2015;48:481-490
3. Uedo N et cols. A new method of diagnosing gastric intestina metaplasia: narrow−band imaging with magnifying Endoscopy. Endoscopy 2006; 38 (8): 819±824 Georg Thieme Verlag KG Stuttgart ´ New York ´
4. Yao K et cols. Nature of white opaque substance in gastric epithelial neoplasia as visualized by magnifying endoscopy with narrow-band imaging. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society
LIGHT BLUE CREST WHITE OBSCURE SUBSTANCE
S: 83% E: 93%

30. CLASIFICACIÓN
VS
(VESSEL PLUS SURFACE)
YAO K et cols.

31. REGULAR AUSENTEIRREGULAR
MICROVASCULAR (MV)
MICROSUPERFICIAL (MS)
MICROVASCULATURA IRREGULAR
PATRON ENTRELAZADO FINO PATRON SACACORCHO
1. Muto M, Yao K et colsMagnifying endoscopy simple diagnostic algorithm for early gastric cáncer. Digestive Endoscopy 2016; 28: 379–393 doi: 10.1111/den.12638
2, Yao K. Clinical Application of Magnifying Endoscopy with Narrow-Band Imaging in the Stomach. Clin Endosc 2015;48:481-490
Sensibilidad: : 85,7% Especificidad: 99,4%

32. 1. Yoshida N et cols. White globe appearance is a novel specific endoscopic marker for gastric cancer: A prospective study. Digestive Endoscopy 2016; 28: 59–66
2. Doyama H et cols The “white globe appearance” (WGA): a novel marker for a correct diagnosis of early gastric cancer by magnifying endoscopy with narrow-band imaging (M-NBI). Endoscopy International Open 2015; 03: E120–E124

33. Estrategia de abordaje endoscópico para diagnóstico
de CANCER GÁSTRICO PRECOZ
1. Uedo N, Yao K. Endoluminal Diagnosis of Early Gastric Cancer and Its Precursors: Bridging the Gap Between Endoscopy and Pathology. Springer International Publishing Switzerland 2016
2. Yao K. The endoscopic diagnosis of early gastric cancer. Ann Gastroenterol 2013; 26 (1): 11-22

34. Algoritmo diagnóstico magnificación endoscópica
simple para cáncer gástrico
(MESDA-G) Lesión sospechosa
Línea de demarcación
Benigna MV o MS irregular
CANCER
AUSENTE PRESENTE
PRESENTE
AUSENTE
YAO K et cols.
1. Muto M, Yao K, Uedo N. Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G). Digestive Endoscopy 2016; 28: 379–393 doi: 10.1111/den.12638
2. 2, Yao K. Clinical Application of Magnifying Endoscopy with Narrow-Band Imaging in the Stomach. Clin Endosc 2015;48:481-490
LIMITACIONES
-ADC difuso.
-Sangrado
-Cubierta de moco

35. Criterios diagnósticos
cáncer gástrico
PRECOZ
Patrón MV irregular + línea de demarcación
Patrón MS irregular + línea de demarcación
y/o
1, Yao K. Clinical Application of Magnifying Endoscopy with Narrow-Band Imaging in the Stomach. Clin Endosc 2015;48:481-490

36. MAPEO GÁSTRICO
SSS: Systematic screening protocol for the Stomach (22 fotos)
INHIBIR PERISTÁLSIS
Butil-Bromuro Escopolamina 10-20 mg
Glucagón 1 mg
LIMPIAR MUCOSA
Japon: 100cc agua + 20 000 U pronase + 1g Bicarbonato de sodio + 10
cc dimetilpolisiloxano
Alternativa: 100 cc agua + 2 cc acetilcisteina + 0,5 cc dimeticona activa.
1. Uedo N, Yao K. Endoluminal Diagnosis of Early Gastric Cancer and Its Precursors: Bridging the Gap Between Endoscopy and Pathology. Springer International Publishing Switzerland 2016

37. Decoloración de la mucosa (Eritema/Palidez)
Sangrado espontáneo
Área elevada/deprimida
Pliegues gástricos interrumpidos
Pérdida del brillo
Opacidad localizada
1. Muto M, Yao K, Uedo N. Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G). Digestive Endoscopy 2016; 28: 379–393 doi: 10.1111/den.12638

38. CÁNCER
LUZ BLANCA ME-NBICROMOENDOSCOPIA
CON TINCIÓN
ADC pobremente diferenciado intramucosal
1. Muto M, Yao K, Uedo N. Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G). Digestive Endoscopy 2016; 28: 379–393 doi: 10.1111/den.12638

39. CÁNCERADC bien-moderadamente diferenciado intramucosal
LUZ BLANCA CROMOENDOSCOPIA
CON TINCIÓN
ME-NBI
1. Muto M, Yao K, Uedo N. Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G). Digestive Endoscopy 2016; 28: 379–393 doi: 10.1111/den.12638

40. CARCINOMA
Gástritis focal Vs Carcinoma precoz
GASTRITIS FOCAL
LESIÓN PLANA ERITEMATOSA EN ANTRO
Yao K et al. Magnifying endoscopy for diagnosing and delineating early gastric cancer… Endoscopy 2009; 41: 462–467

41. ME - NBI
ADENOMA TUBULAR
LESIÓN SUPERFICIALMENTE ELEVADA PARED POSTERIOR ANTRO
LUZ BLANCA HISTOLOGÌA

42. La ME-NBI es recomendado para la mejor caracterización de las lesiones neoplásicas
superficiales pequeñas planas y deprimidas (Sensibilidad 95% Especificidad 96,6%)
La endoscopia de imagen avanzada ofrece una nueva forma de observar y clasificar la
mucosa en una base histopatológica.
La endoscopia con luz blanca convencional sigue teniendo un rol importante en la detección
del cáncer gástrico precoz.
CONCLUSIONES
La endoscopia de imagen avanzada permite disminuir la brecha que existía entre los
hallazgos endoscópicos con luz blanca y el análisis patológico.

43. MUCHAS
GRACIAS

45. 24h 37m 23s
earths is the Sun’s mass
Identificar indiviudos de alto riesgo

46. CROMOENDOSCOPIA
CON TINCIÓN
Cateter spray
Preparar mucosa: Agente mucolítico
Esperar por mecanismo de acción
Remover exceso de tinción. No aplica para
los de contraste.

47. CROMOENDOSCOPIA
CON TINCIÓN
Cáncer gástrico precoz

48. 1. Pimentel-Nunes Pedro et al. NBI for the diagnosis of gastric lesions… Endoscopy, 2016
CLASIFICACIÓN SIMPLIFICADA NBI
Aa
Ab
Ab+
B C
B

49. IMAGEN AUTO-
FLUORESCENCIA
ENDOMICROSCOPÍA
LÁSER CONFOCAL
INTELIGENCIA
ARTIFICIAL
ENDOCITOSCOPIA
2003

50. Algoritmo diagnóstico magnificación endoscópica
simple para cáncer gástrico
(MESDA-G) Lesión sospechosa
Línea de demarcación
Benigna MV o MS irregular
CANCER
AUSENTE PRESENTE
PRESENTE
AUSENTE
YAO K et cols.
1. Muto M, Yao K, Uedo N. Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G). Digestive Endoscopy 2016; 28: 379–393 doi: 10.1111/den.12638
2. 2, Yao K. Clinical Application of Magnifying Endoscopy with Narrow-Band Imaging in the Stomach. Clin Endosc 2015;48:481-490
LIMITACIONES
-ADC difuso.
-Sangrado
-Cubierta de moco

51. PÓLIPO HIPERPLÁSICO
PÓLIPO DE GLÁNDULAS FÚNDICAS
1. M. Muto et al. (eds.), Atlas of Endoscopy with Narrow Band Imaging. DOI 10.1007/978-4-431-54243-8_9. Springer Japan 2015

52. CÁNCERADC bien diferenciado intramucosal
LUZ BLANCA CROMOENDOSCOPIA
CON TINCIÓN
ME-NBI
1. Muto M, Yao K, Uedo N. Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G). Digestive Endoscopy 2016; 28: 379–393 doi: 10.1111/den.12638

53. LUZ BLANCA ME-NBI
NEGATIVO PARA MALIGNIDAD
1. Muto M, Yao K, Uedo N. Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G). Digestive Endoscopy 2016; 28: 379–393 doi: 10.1111/den.12638

54. CONFOCAL LASER ENDOMICROSCOPIA (CLE)
DISPLASIA
BAJO GRADO
DISPLASIA
ALTO GRADO Wang et cols. Diagnosis of gastric intraepithelial neoplasia by narrowband imaging and confocal laser endomicroscopy World J Gastroenterol 2012 September 14; 18(34): 4771-4780

55. 2, Yao K. Clinical Application of Magnifying Endoscopy with Narrow-Band Imaging in the Stomach. Clin Endosc 2015;48:481-490
3. Uedo N et cols. A new method of diagnosing gastric intestina metaplasia: narrow−band imaging with magnifying Endoscopy. Endoscopy 2006; 38 (8): 819±824 Georg Thieme Verlag KG Stuttgart ´ New York ´
4. Yao K et cols. Nature of white opaque substance in gastric epithelial neoplasia as visualized by magnifying endoscopy with narrow-band imaging. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society
LIGHT BLUE CREST WHITE OBSCURE SUBSTANCE
S: 83% E: 93%