For example, in a benign lesion that resembles cancer, even if glands are associated with intestinal metaplasia and inflammation, at a fixed distance, the cells are aligned at a tangent to the NBI afferent light, so whitish lines are clearly visible and the mucosal pattern

is retained. On the other hand, if for example the cancer glands are differentiated gastric cancer, distortion of the duct structure means few cells are aligned at a tangent to the NBI incoming rays, resulting in insufficient scattering of light to delineate the whitish lines, so the mucosal structural pattern is lost or unclear. Naturally, unlike a magnifying endoscopic examination, the vascular structure cannot be discerned, but it is of great significance that diagnostic ability is improved by observing the mucosal structure alone. With WLI

until now, diagnosis is based on the size and color of the lesion, and the characteristics of the lesion surface, selleck surrounding mucosa, and gastric rugae, making the experience of the endoscopist important and causing great variability in the findings. Furthermore, the diagnostic process involved the following histological and qualitative process: (i) close examination of the entire stomach; (ii) recognition (detection) of the presence of a lesion; and (iii) taking a biopsy of the lesion. A similar diagnostic process occurs with transnasal endoscopy. However, histological examination of the biopsy specimen often produces a benign diagnosis, so many biopsies are actually unnecessary. Sirolimus concentration In recent years, the efficacy of secondary preventative antiplatelet therapy, in particular low-dose aspirin, has been confirmed for a wide range of arteriosclerotic diseases, from myocardial infarction to stroke, by meta-analyses such as that conducted by the Antithrombotic Trialists’ Collaboration,[11] and prescriptions for antiplatelet agents

have increased rapidly. The proportion of patients undergoing endoscopic 上海皓元 examinations on antiplatelet therapy has also risen. Until recently, it was routine to suspend antiplatelet therapy for some time prior to an endoscopy, but it has been reported that the risk of a cardiac event increases 3.14 times when patients with coronary artery disease discontinue aspirin therapy.[12] In July 2012, the Japan Gastroenterological Endoscopy Society[13] published new guidelines regarding antiplatelet therapy, and it is now possible to perform biopsies without ceasing aspirin. However, there is a possibility of bleeding after the biopsy, so this is limited to cases where malignancy is strongly suspected. Accordingly, the use of nonmagnified close examination with NBI in screening endoscopies, as conducted in this study, is expected to become more important in the future. We anticipate that the diagnostic capability of ultrathin transnasal endoscopy in screening endoscopies will continue to improve in the future.