Inoue Ken, Yoshida Naohisa, Kobayashi Reo, Iwai Naoto, Hirose Ryohei, Dohi Osamu, Konishi Hideyuki
Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 6028566, Japan.
Dig Dis Sci. 2025 Aug 12. doi: 10.1007/s10620-025-09308-0.
Gel immersion endoscopy is a novel method that uses gel to enhance the visual field. This study aimed to analyze the efficacy of magnified endoscopy under gel immersion for optimal visualization and characterization of colorectal tumors.
We retrospectively examined 107 lesions observed with blue-laser/light imaging (BLI) or narrow-band imaging (NBI) between June 2022 and July 2023 using the Japan NBI Expert Team classification. The lesions underwent magnified endoscopy first with CO insufflation, then underwater, and finally under gel immersion. Visualization quality and diagnostic accuracy were evaluated. All colonoscopies were performed by three endoscopists (experienced: 2, less experienced: 1).
Among the 107 lesions, the mean tumor size was 22.7 ± 11.8 mm and 58 lesions were non-polypoid. Histopathology revealed 15 sessile serrated lesions, one sessile serrated lesion with dysplasia, 36 low-grade dysplasias, 37 high-grade dysplasias, 14 adenocarcinoma (≥ T1) cancers, and four others. Gel immersion resulted in significantly less halation compared to CO insufflation (p < 0.0001), fewer bubbles than underwater (p < 0.0001), and less intestinal fluid compared to both CO insufflation and underwater (p < 0.0001). Visualization quality was significantly better with gel immersion than with CO insufflation and underwater (p < 0.0001). No significant differences were observed in the accuracy of the tumor characterization among the three methods.
The reduced halation, bubbles, and internal fluid with gel immersion provided excellent visualization. The diagnostic accuracy for colorectal lesions using the gel immersion method was comparable to that of CO₂ insufflation and underwater methods.
凝胶浸入式内镜检查是一种利用凝胶增强视野的新方法。本研究旨在分析凝胶浸入式放大内镜检查对结直肠肿瘤的最佳可视化和特征描述的效果。
我们回顾性检查了2022年6月至2023年7月期间使用日本窄带成像专家团队分类法通过蓝激光/光成像（BLI）或窄带成像（NBI）观察到的107个病变。这些病变首先在二氧化碳充气状态下进行放大内镜检查，然后在水下进行，最后在凝胶浸入状态下进行。评估了可视化质量和诊断准确性。所有结肠镜检查均由三名内镜医师进行（经验丰富的：2名，经验较少的：1名）。
在107个病变中，平均肿瘤大小为22.7±11.8毫米，58个病变为非息肉样。组织病理学显示15个无蒂锯齿状病变、1个伴有发育异常的无蒂锯齿状病变、36个低级别发育异常、37个高级别发育异常、14个腺癌（≥T1期）癌以及其他4个病变。与二氧化碳充气相比，凝胶浸入导致的光晕明显更少（p<0.0001），与水下相比气泡更少（p<0.0001），与二氧化碳充气和水下相比肠液更少（p<0.0001）。凝胶浸入时的可视化质量明显优于二氧化碳充气和水下（p<0.0001）。三种方法在肿瘤特征描述的准确性方面未观察到显著差异。
凝胶浸入减少了光晕、气泡和内部液体，提供了出色的可视化效果。使用凝胶浸入法对结直肠病变的诊断准确性与二氧化碳充气法和水下法相当。
