The Relationship Between White Substance Under White Light Endoscopy And Flat Esophageal Mucosal Neoplastic Lesions

Goals: Some papers have reported that the white globe appearance and white opaque substance were associated with esophageal cancer,but their findings need high-quality endoscopic techniques and most of these papers were case studies for esophageal adenocarcinoma.White substance attachment was often found in white light endoscopy,and it is not clear whether the white substance can indicate the flat esophageal mucosal neoplastic lesions.The goal of this study is to further determine the relationship between white substance and flat esophageal mucosal neoplastic lesions.Study: After retrospective analysis of pathological and clinical data of patients undergoing upper gastrointestinal endoscopy from 2012 to 2017,we identified all patients with flat esophageal mucosal lesions on white light endoscopic images.Images were re-evaluated by two experienced endoscopists and the prevalence of white substance recorded.Patients were divided into non-neoplastic and neoplastic groups,based on pathology.The difference in the prevalent rate of white substance in each group and the diagnostic values of white substance for flat esophageal mucosal neoplastic lesions were statistically analyzed.Results: Of the 352 patients enrolled in the study,the white substance was present in 3.5%(5/144)of non-neoplastic and 14.9%(31/208)of neoplastic cases(P < 0.05).The diagnostic sensitivity and specificity of the white substance for neoplastic lesions diagnosis were 14.9% and 96.5%,respectively.The white substance was more prevalent in males(75%),in the middle third of the esophagus(66.7%)and in patients aged 60-69 years(52.8%).But there was no significant correlation between the presence of the white substance and sex,age,or lesion location(P > 0.05).Conclusions: The white substance,which is easily detected by white light endoscopy,prevalence in neoplastic lesions is significantly higher than that in non-neoplastic lesions.Because white substance is highly specific for neoplastic lesions,the presence of white substance is useful to diagnose the flat esophageal mucosal neoplastic lesions,irrespective of sex,age,and lesion location.Early esophageal cancer and precancerous lesions are typically flat esophageal mucosal lesions,so,we speculate that the white substance is also of certain significance in the diagnosis of these lesions.Nevertheless,further prospective studies are necessary to determine the relationship between them.