Dense‐type crypt opening seen on magnifying endoscopy with narrow‐band imaging is a feature of gastric adenoma

BACKGROUND: Magnifying endoscopy with narrow-band imaging (ME-NBI) can visualize crypt openings (CO) as slit-like structures in gastric epithelial neoplasia. Visualization of numerous CO is characteristic of low-grade adenoma (LGA). The aim of the present study was to investigate whether visualization of CO by ME-NBI is useful for discriminating between LGA and early gastric cancer (EGC). PATIENTS AND METHODS: Fifty-one superficial elevated-type gastric neoplasias (10 LGA and 41 EGC) were retrospectively evaluated. The presence of CO and the number of CO were evaluated in endoscopic photos obtained at high-power endoscopic magnification by ME-NBI. The optimal cut-off value for the number of CO visualized to discriminate between LGA and EGC was determined by receiver operating characteristic curve analysis. RESULTS: The mean number of CO visualized was significantly larger in the LGA group than in the EGC group (31.2, 95% confidence interval [CI] 16.3-46.1 vs 6.3, 95% CI 3.6-9.0; P < 0.001). When the cut-off for the number of CO visualized was set at 20, the sensitivity, specificity, and accuracy of dense-type CO for discriminating between LGA and EGC were 90.0%, 87.8%, and 88.2%, respectively. CONCLUSION: Determining the number of CO visualized in superficial elevated-type gastric neoplasias by ME-NBI appears to be a useful method for discriminating between LGA and EGC.