Comparison of the Imaging of Ultrathin Transnasal Endoscopy and Transoral Conventional Endoscopy in the Same Patient with Early Esophageal Cancer

AIM: The diagnostic value of ultrathin transnasal endoscopy (UT)for early esophageal cancers (EEC) remains controversial. Toevaluate the diagnostic utility of UT in detecting EEC, we comparedthe imaging of UT and transoral conventional endoscopy (CO) in thesame patient.METHODS: Nineteen consecutive patients with 20 lesions wereenrolled to this study. The endoscopic findings, sensitivity andaccuracy in the detection of mucosal findings, and the sensitivity ofdiagnosis were compared between UT and CO in the same subjects.The image density from each procedure was quantified and comparedwith the ImageJ software program.RESULTS: All 20 lesions could be detected using UT. Twelve of20 lesions (60.0%) could be diagnosed as cancerous by UT. Thesensitivities of the mucosal findings such as the fur white coat, thevessel irregularity and loss of glossy identified by CO were superiorto those obtained by UT. A combined examination by narrow-bandimaging (NBI) yielded the same detection rate of the brownish area.The quantitative analyses revealed that combination diagnosis withNBI was superior to optical imaging alone. There were no differencesin the calculated densities between UT and CO, thus demonstratingthat UT was not inferior to CO for detecting these lesions.CONCLUSIONS: The inherent shortcomings of UT includedits poor resolution, lower light source, and lack of magnification.The imaging qualities and diagnostic accuracy of UT in EEC werelower than those of CO. However, the combination of UT with NBIincreased the sensitivity, and UT with NBI could detect EEC.