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Comparative Study of Narrow-Band Imaging and i-scan for Predicting the Histology of Intermediate-to-Large Colorectal Polyps: A Prospective, Randomized Pilot Study
Joon Seop Lee, Seong Woo Jeon, Yong Hwan Kwon
Clin Endosc 2021;54(6):881-887.   Published online January 6, 2021
DOI: https://doi.org/10.5946/ce.2020.257
AbstractAbstract PDFPubReaderePub
Background
/Aims: To date, no reports have compared the diagnostic efficacy of narrow-band imaging (NBI) and i-scan for the histologic prediction of intermediate-to-large colorectal polyps. We aimed to compare the diagnostic accuracy of NBI and i-scan in predicting histology, and their inter-/intra-observer agreement.
Methods
We performed a prospective, randomized study that included 66 patients (NBI, n=33 vs. i-scan, n=33) with colorectal polyps (size >10 mm but <50 mm) who underwent colonoscopic resection. During the procedure, three endoscopists documented their prediction using the Japan NBI Expert Team (JNET) classification. Two months after study completion, the endoscopists reviewed still images and video clips for analysis.
Results
The overall diagnostic accuracies in the NBI and i-scan groups were 73.7% (73/99) and 75.8% (75/99), respectively, and there was no statistical significance between the two groups (p=0.744). The JNET classification as applied to NBI and i-scan showed substantial inter-observer agreement (NBI κ-value 0.612, p=0.001 vs. i-scan κ-value 0.662, p=0.002). Additionally, the κ-values of intra-observer agreement were in the range of 0.385–0.660 with NBI and 0.364–0.741 with i-scan.
Conclusions
NBI and i-scan have similar diagnostic accuracies for the histologic prediction of intermediate-to-large colorectal polyps. Furthermore, the inter-/intra-observer agreement was acceptable for both modalities when the JNET classification was applied.

Citations

Citations to this article as recorded by  
  • Ultra-minimally invasive endoscopic techniques and colorectal diseases: Current status and its future
    Nalini Kanta Ghosh, Ashok Kumar
    Artificial Intelligence in Gastrointestinal Endoscopy.2024;[Epub]     CrossRef
  • The Utility of Narrow-Band Imaging International Colorectal Endoscopic Classification in Predicting the Histologies of Diminutive Colorectal Polyps Using I-Scan Optical Enhancement: A Prospective Study
    Yeo Wool Kang, Jong Hoon Lee, Jong Yoon Lee
    Diagnostics.2023; 13(16): 2720.     CrossRef
  • Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
    Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
    Clinical Endoscopy.2023; 56(5): 553.     CrossRef
  • Classification and endoscopic diagnosis of colorectal polyps
    Ji Hyun Kim, Sung Chul Park
    Journal of the Korean Medical Association.2023; 66(11): 633.     CrossRef
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    Endoscopy International Open.2022; 10(04): E441.     CrossRef
  • Interventions to improve adenoma detection rates for colonoscopy
    Aasma Shaukat, Anne Tuskey, Vijaya L. Rao, Jason A. Dominitz, M. Hassan Murad, Rajesh N. Keswani, Fateh Bazerbachi, Lukejohn W. Day
    Gastrointestinal Endoscopy.2022; 96(2): 171.     CrossRef
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    V. A. Duvanskiy, A. V. Belkov
    Experimental and Clinical Gastroenterology.2022; (5): 154.     CrossRef
  • Mucosal imaging in colon polyps: New advances and what the future may hold
    Edward John Young, Arvinf Rajandran, Hamish Lachlan Philpott, Dharshan Sathananthan, Sophie Fenella Hoile, Rajvinder Singh
    World Journal of Gastroenterology.2022; 28(47): 6632.     CrossRef
  • Commentary on “Comparative Study of Narrow-Band Imaging and i-scan for Predicting the Histology of Intermediate-to-Large Colorectal Polyps: A Prospective, Randomized Pilot Study”
    Yunho Jung, Masayuki Kato
    Clinical Endoscopy.2021; 54(6): 781.     CrossRef
  • 5,739 View
  • 180 Download
  • 8 Web of Science
  • 9 Crossref
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Increased Detection of Colorectal Polyps in Screening Colonoscopy Using High Definition i-SCAN Compared with Standard White Light
Woo Jung Kim, Sang Young Park, Iksoo Park, Wook Jin Lee, Jaechan Park, Nuri Chon, Tak Geun Oh, Kwang Hyun Kim
Clin Endosc 2016;49(1):69-75.   Published online January 28, 2016
DOI: https://doi.org/10.5946/ce.2016.49.1.69
AbstractAbstract PDFPubReaderePub
Background
/Aims: The aim of this study was to evaluate the efficacy of high definition (HD) i-SCAN for colorectal polyp detection in screening colonoscopy.
Methods
We retrospectively analyzed the records of 501 patients who had undergone screening colonoscopy performed by three endoscopists with either HD i-SCAN (n=149) or standard white light (n=352) from January 2, 2014 through June 30, 2014. Patient information and inter-endoscopist variation as well as polyp number, endoscopic findings, and pathologic characteristics were reviewed.
Results
The detection rates of colorectal and neoplastic polyps were significantly higher using HD i-SCAN than standard white light colonoscopy (52% vs. 38.1%, p=0.004 for colorectal polyps; and 37.2% vs. 27.9%, p=0.041 for neoplastic polyps). Analysis of endoscopic findings revealed no difference in detected polyp size between HD i-SCAN and standard white light colonoscopy (4.59±2.35 mm vs. 4.82±2.81 mm, p=0.739), but non-protruding polyps were more commonly detected by i-SCAN than by standard white light colonoscopy (24.6% vs. 13.5%, p=0.007).
Conclusions
Colonoscopy using HD i-SCAN had a significantly higher detection rate of colorectal polyps, including neoplastic polyps, because of improved sensitivity for detecting non-protruding lesions.

Citations

Citations to this article as recorded by  
  • Mucosal imaging in colon polyps: New advances and what the future may hold
    Edward John Young, Arvinf Rajandran, Hamish Lachlan Philpott, Dharshan Sathananthan, Sophie Fenella Hoile, Rajvinder Singh
    World Journal of Gastroenterology.2022; 28(47): 6632.     CrossRef
  • Técnicas colonoscópicas para la detección de pólipos: un estudio egipcio
    M. Abdelbary, S. Hamdy, H. Shehab, N. ElGarhy, M. Menesy, R. Marzaban
    Revista de Gastroenterología de México.2021; 86(1): 36.     CrossRef
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    Revista de Gastroenterología de México (English Edition).2021; 86(1): 36.     CrossRef
  • Effect of I-scan Electronic Chromoendoscopy on Detection of Adenomas During Colonoscopy
    Trilokesh D. Kidambi, Jonathan P. Terdiman, Najwa El-Nachef, Aparajita Singh, Michael G. Kattah, Jeffrey K. Lee
    Clinical Gastroenterology and Hepatology.2019; 17(4): 701.     CrossRef
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    Yun Nah Lee, Jong Ho Moon, Hyun Jong Choi
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  • Enhanced flat adenoma detection rate with high definition colonoscopy plus i-scan for average-risk colorectal cancer screening
    Antonio Rodríguez-D´Jesus, Esteban Saperas
    Revista Española de Enfermedades Digestivas.2016;[Epub]     CrossRef
  • 8,001 View
  • 106 Download
  • 7 Web of Science
  • 8 Crossref
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Focused Review Series: Image Enhanced Endoscopys
Advanced Imaging Technology Other than Narrow Band Imaging
Jun-Hyung Cho
Clin Endosc 2015;48(6):503-510.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.503
AbstractAbstract PDFPubReaderePub
To improve the detection rate of gastrointestinal tumors, image-enhanced endoscopy has been widely used during screening and surveillance endoscopy in Korea. In addition to narrow band imaging (NBI) with/without magnification, various types of electronic chromoendoscopies have been used, including autofluorescence imaging, I-scan, and flexible spectral imaging color enhancement. These technologies enable the accurate characterization of tumors because they enable visualization of microvascular and microsurface patterns. The present review focuses on understanding the principle and clinical applications of advanced imaging technologies other than NBI.

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The Past, Present, and Future of Image-Enhanced Endoscopy
Jae-Young Jang
Clin Endosc 2015;48(6):466-475.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.466
AbstractAbstract PDFPubReaderePub
Despite the remarkable progress recently made to enhance the resolution of white-light endoscopy, detection, and diagnosis of premalignant lesions, such as adenomas and subtle early-stage cancers, remains a great challenge. As for example, although chromoendoscopy, such as endoscopy using indigo carmine, is useful for the early diagnosis of subtle lesions, the technique presents various disadvantages ranging from the time required for spray application of the dye and suctioning of excess dye to the increased difficulty in identifying lesions in the presence of severe inflammation and obstruction of visual field due to the pooling of solution in depressed-type lesions. To overcome these diagnostic problems associated with chromoendoscopy, research has focused on the development of endoscopes based on new optical technologies. Several types of image-enhanced endoscopy methods have recently been presented. In particular, image-enhanced endoscopy has emerged as a new paradigm for the diagnosis of gastrointestinal disorders. Image-enhanced endoscopes provide high-contrast images of lesions by means of optical or electronic technologies, including the contrast enhancement of the mucosal surface and of blood vessels. Chromoendoscopy, narrow-band imaging, i-SCAN, and flexible spectral imaging color enhancement are representative examples of image-enhanced endoscopy discussed in this paper.

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Review
Recent Advances in Image-enhanced Endoscopy
Won Young Cho, Jae Young Jang, Don Haeng Lee, The Endoscopic Technology and Investigation Study Group
Clin Endosc 2011;44(2):65-75.   Published online December 31, 2011
DOI: https://doi.org/10.5946/ce.2011.44.2.65
AbstractAbstract PDFPubReaderePub

The desire to better recognized such malignancies, which may be difficult to distinguish from inflammation or trauma, has accelerated the development of endoscopy with new optical technologies. Narrow-band imaging is a novel endoscopic technique that may enhance the accuracy of diagnosis using narrow-bandwidth filters in a red-green-blue sequential illumination system. Autofluorescence imaging is based on the detection of natural tissue fluorescence emitted by endogenous molecules. I-scan technology using a digital filter that modifies normal images through software functions, is the newly developed image-enhanced endoscopic technology from PENTAX. Flexible spectral imaging color enhancement enhances the visualization of mucosal structure and microcirculation by the selection of spectral transmittance with a dedicated wavelength. Confocal laser endomicroscopy images were collected with an argon beam with a scanning depth of 0 (epithelium) to 250 µm (lamina propria) and analyzed using the reflected light.

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Original Article
Efficacy of I-scan Endoscopy in the Diagnosis of Gastroesophageal Reflux Disease with Minimal Change
Min Sik Kim, Seok Reyol Choi, Myung Hwan Roh, Jong Hun Lee, Jin Seok Jang, Byung Geun Kim, Sang Ock Kim, Ji Sun Han, Chien Ter Hsing
Clin Endosc 2011;44(1):27-32.   Published online September 30, 2011
DOI: https://doi.org/10.5946/ce.2011.44.1.27
AbstractAbstract PDFPubReaderePub
Background/Aims

The aim of the study was to evaluate the efficacy of i-scans for the diagnosis of gastroesophageal reflux disease, especially where only minimal change is involved.

Methods

The esophageal mucosa was inspected using an i-scan following conventional white light endoscopy. The examination with iscan was performed under tone enhancement (TE) esophagus (e) mode. Patients with subtle distal esophageal mucosal changes without definite mucosal breaks, such as blurring of Z-line (B), mucosal coarseness (C), hyperemic or purplish discoloration (D), erythema (E), ectopic gastric mucosal islet (I) and mixed type were classified as minimal change.

Results

A total of 156 patients were included. Using i-scan endoscopy, the number of minimal change was found to further increase from 94 (conventional endoscopy; 19B, 9C, 29D, 13E, 5I, 19 mixed type) to 109 (i-scan; 15B, 8C, 29D, 16E, 5I, 36 mixed type). And 14 patients who had single type by conventional endoscopy were converted to mixed type after i-scan. Therefore, 29 of 156 patients were upgraded after i-scan, they were account for 19% (p<0.0001; 95% confidence interval, 0.13 to 0.25).

Conclusions

The use of i-scan endoscopy significantly improves the identification of minimal change and helps to identify more precisely the type of minimal change.

Citations

Citations to this article as recorded by  
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    Journal of Voice.2024; 38(6): 1439.     CrossRef
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    DEN Open.2022;[Epub]     CrossRef
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    Ni-Na Zhang, Yi-Min Ma, Qi Sun, Liang-Liang Shi, Yin Xie, Xiao-Ping Zou
    Journal of Clinical Gastroenterology.2022; 56(5): 405.     CrossRef
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    Amrit K. Kamboj, Allon Kahn, Cadman L. Leggett
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  • 16 Crossref
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The Current Status of Virtual Chromoscopy
Jin-Oh Kim, M.D. and Tae Hee Lee, M.D.
Korean J Gastrointest Endosc 2009;38(6):309-322.   Published online June 30, 2009
AbstractAbstract PDF
Virtual chromoscopy is a novel technology that enhances endoscopic visualization of superficial mucosal surfaces and microvascular architecture. Currently available virtual chromoscopy techniques include narrow band imaging, Fujinon intelligent color enhancement and I-scan. Refinements are expected to improve detection of the lesions, which will lead to further insight into the pathological processes, in turn, providing guidance in selecting the optimal treatment. Presently, we review the currently available literature regarding virtual chromoscopy and provide technical principles, clinical usefulness, and limitations. (Korean J Gastrointest Endosc 2009;38:309-322)
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