The efficacy of high-magnification endoscopy for evaluation of high-risk patients in a western cohort

Aims Cancers of the upper gastrointestinal (GI) tract, including esophageal squamous cell carcinoma (SCC), esophageal adenocarcinoma (EAC), and gastric adenocarcinoma, present significant challenges due to high case-fatality rates. Screening for early neoplastic lesions in predisposing conditions such as Barrett’s esophagus (BE) and gastric atrophy with gastric intestinal metaplasia (GIM) is crucial. Image-Enhanced Endoscopy (IEE) has improved neoplasia recognition and high magnification endoscopy, previously limited to Japan and East-Asian countries, is now available in the West. We report the efficiency of high-magnification IEE in a large, western, tertiary center for a cohort of high-risk patients.

Methods Single center, retrospective analysis, of patients undergoing high-magnification IEE (Zoom X135) for known neoplasia or due to high predisposing risk factors. Endoscopic diagnosis was obtained and classified as non-neoplastic, superficial neoplasia or deeply invasive carcinoma. The endoscopic diagnosis was then correlated to histology. Patients negative for neoplasia were followed for 1-year to discern missed lesions.

Results A total of 171 patients (Male, 105) were examined for esophageal (n=112) and gastric (n=59) lesions. 109 (64%) patients were referred due to neoplasia. IEE Neoplasia was suspected in 63 patients and concordance to histology was 85% (Sensitivity 73%, Specificity 83%, PPV 59%, NPV 89%). In cases of disconcordance, endoscopic over-diagnosis was more common than under-diagnosis (33% vs 7.9%). Of 101 patients without neoplasia, two were found to have superficial neoplasia after 1-year follow up.

Conclusions : In a high risk, western cohort, high-magnification IEE can reliably diagnose neoplasia. A high negative predictive value coupled with low incidence of neoplasia on 1-year follow-up is useful to rule-out neoplasia, even in a high risk population.

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025