Original Articles
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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
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Joon Seop Lee, Seong Woo Jeon, Yong Hwan Kwon
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Clin Endosc 2021;54(6):881-887. Published online January 6, 2021
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DOI: https://doi.org/10.5946/ce.2020.257
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Abstract
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- 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.
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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
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Sergio Sobrino-Cossío, Oscar Teramoto-Matsubara, Fabian Emura, Raúl Araya, Vítor Arantes, Elymir S. Galvis-García, Marisi Meza-Caballero, Blanca Sinahi García-Aguilar, Arturo Reding-Bernal, Noriya Uedo
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
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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
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Increased Detection of Colorectal Polyps in Screening Colonoscopy Using High Definition i-SCAN Compared with Standard White Light
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Woo Jung Kim, Sang Young Park, Iksoo Park, Wook Jin Lee, Jaechan Park, Nuri Chon, Tak Geun Oh, Kwang Hyun Kim
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Clin Endosc 2016;49(1):69-75. Published online January 28, 2016
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DOI: https://doi.org/10.5946/ce.2016.49.1.69
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Abstract
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- 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.
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Citations
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Focused Review Series: Image Enhanced Endoscopys
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Advanced Imaging Technology Other than Narrow Band Imaging
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Jun-Hyung Cho
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Clin Endosc 2015;48(6):503-510. Published online November 30, 2015
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DOI: https://doi.org/10.5946/ce.2015.48.6.503
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- 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
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Jae-Young Jang
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Clin Endosc 2015;48(6):466-475. Published online November 30, 2015
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DOI: https://doi.org/10.5946/ce.2015.48.6.466
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- 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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Recent Advances in Image-enhanced Endoscopy
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Won Young Cho, Jae Young Jang, Don Haeng Lee, The Endoscopic Technology and Investigation Study Group
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Clin Endosc 2011;44(2):65-75. Published online December 31, 2011
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DOI: https://doi.org/10.5946/ce.2011.44.2.65
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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
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Efficacy of I-scan Endoscopy in the Diagnosis of Gastroesophageal Reflux Disease with Minimal Change
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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
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Clin Endosc 2011;44(1):27-32. Published online September 30, 2011
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DOI: https://doi.org/10.5946/ce.2011.44.1.27
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Abstract
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ePub
- 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.
MethodsThe 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.
ResultsA 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).
ConclusionsThe use of i-scan endoscopy significantly improves the identification of minimal change and helps to identify more precisely
the type of minimal change.
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Citations
Citations to this article as recorded by

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The Current Status of Virtual Chromoscopy
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Jin-Oh Kim, M.D. and Tae Hee Lee, M.D.
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Korean J Gastrointest Endosc 2009;38(6):309-322. Published online June 30, 2009
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Abstract
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- 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)