Clinical Endoscopy

Original Articles

Optical diagnosis by near-focus versus normal-focus narrow band imaging colonoscopy in colorectal polyps based on combined NICE and WASP classification: a randomized controlled trial: Nisa Netinatsunton, Natcha Cheewasereechon, Tanawat Pattarapuntakul, Jaksin Sottisuporn, Kanet Kanjanapradit, Bancha Ovartlarnporn; Clin Endosc 2022;55(5):645-654. Published online September 8, 2022; DOI: https://doi.org/10.5946/ce.2022.048

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Background
/Aims: Narrow Band Imaging (NBI) International Colorectal Endoscopic (NICE) and Workgroup Serrated Polyps and Polyposis (WASP) classifications were developed for optical diagnosis of neoplastic and sessile serrated polyps, respectively. Near-focus NBI with NICE combined with WASP criteria for optical diagnosis of colonic polyps has not yet been evaluated. We aimed to compare the accuracy of near-focus NBI (group A) with normal-focus NBI (group B) in real-time optical diagnosis of colorectal polyps using combined NICE and WASP criteria.
Methods
Among 362 patients, 118 with 227 polyps were recruited. Groups A and B included 62 patients with 130 polyps (three lost polyps) and 56 patients with 106 polyps (six lost polyps), respectively. Optical diagnoses were compared with pathological reports.
Results
The accuracy of optical diagnosis of neoplastic polyps in groups A and B was not significantly different (76% vs. 71%, p=0.52). WASP criteria provided all false positive diagnoses of sessile polyps as serrated polyps in 31 (16.2%) patients.
Conclusions
Near-focus NBI was not superior to normal-focus NBI in optical diagnostics of neoplastic polyps using NICE criteria. In our study, WASP classification yielded all false positives in the diagnosis of sessile serrated adenomas/polyps. Routine real-life optical diagnosis of polyps is still unadvisable.

Citations

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Colonoscopy Quality, Innovation, and the Assessment of New Technology
Sanjay R.V. Gadi, Sriya S. Muralidharan, Jeremy R. Glissen Brown
Techniques and Innovations in Gastrointestinal Endoscopy.2024; 26(2): 177. CrossRef
Endoscopic characteristics and performance of WASP classification in the diagnosis of colorectal sessile‐serrated lesions in Vietnamese patients
Nhu Thi Hanh Vu, Huy Minh Le, Diem Thi‐Ngoc Vo, Nhan Quang Le, Dung Dang Quy Ho, Duc Trong Quach
JGH Open.2024;[Epub] 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
Understanding colorectal polyps to prevent colorectal cancer
Dong-Hoon Yang
Journal of the Korean Medical Association.2023; 66(11): 626. CrossRef
AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
Donghwan Kim, Eunsun Kim
Journal of the Korean Medical Association.2023; 66(11): 658. 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

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Artificial Intelligence-Based Colorectal Polyp Histology Prediction by Using Narrow-Band Image-Magnifying Colonoscopy: Istvan Racz, Andras Horvath, Noemi Kranitz, Gyongyi Kiss, Henriett Regoczi, Zoltan Horvath; Clin Endosc 2022;55(1):113-121. Published online September 23, 2021; DOI: https://doi.org/10.5946/ce.2021.149

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Background
/Aims: We have been developing artificial intelligence based polyp histology prediction (AIPHP) method to classify Narrow Band Imaging (NBI) magnifying colonoscopy images to predict the hyperplastic or neoplastic histology of polyps. Our aim was to analyze the accuracy of AIPHP and narrow-band imaging international colorectal endoscopic (NICE) classification based histology predictions and also to compare the results of the two methods.
Methods
We studied 373 colorectal polyp samples taken by polypectomy from 279 patients. The documented NBI still images were analyzed by the AIPHP method and by the NICE classification parallel. The AIPHP software was created by machine learning method. The software measures five geometrical and color features on the endoscopic image.
Results
The accuracy of AIPHP was 86.6% (323/373) in total of polyps. We compared the AIPHP accuracy results for diminutive and non-diminutive polyps (82.1% vs. 92.2%; p=0.0032). The accuracy of the hyperplastic histology prediction was significantly better by NICE compared to AIPHP method both in the diminutive polyps (n=207) (95.2% vs. 82.1%) (p<0.001) and also in all evaluated polyps (n=373) (97.1% vs. 86.6%) (p<0.001)
Conclusions
Our artificial intelligence based polyp histology prediction software could predict histology with high accuracy only in the large size polyp subgroup.

Citations

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Colon polyps: updates in classification and management
David Dornblaser, Sigird Young, Aasma Shaukat
Current Opinion in Gastroenterology.2024; 40(1): 14. CrossRef
Employing deep learning for predicting the thermal properties of water and nano-encapsulated phase change material
Saihua Xu, Ali Basem, Hasan A Al-Asadi, Rishabh Chaturvedi, Gulrux Daminova, Yasser Fouad, Dheyaa J Jasim, Javid Alhoee
International Journal of Low-Carbon Technologies.2024; 19: 1453. CrossRef
Endoscopic Artificial Intelligence for Image Analysis in Gastrointestinal Neoplasms
Ryosuke Kikuchi, Kazuaki Okamoto, Tsuyoshi Ozawa, Junichi Shibata, Soichiro Ishihara, Tomohiro Tada
Digestion.2024; : 1. 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
AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
Donghwan Kim, Eunsun Kim
Journal of the Korean Medical Association.2023; 66(11): 658. CrossRef
Artificial Intelligence-Based Colorectal Polyp Histology Prediction: High Accuracy in Larger Polyps
Naoki Muguruma, Tetsuji Takayama
Clinical Endoscopy.2022; 55(1): 45. CrossRef
Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
Ji Young Chang
Clinical Endoscopy.2022; 55(5): 699. CrossRef
Response to Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
Istvan Racz, Andras Horvath, Zoltán Horvath
Clinical Endoscopy.2022; 55(5): 701. CrossRef

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White Opaque Substance, a New Optical Marker on Magnifying Endoscopy: Usefulness in Diagnosing Colorectal Epithelial Neoplasms: Kazutomo Yamasaki, Takashi Hisabe, Kenshi Yao, Hiroshi Ishihara, Kentaro Imamura, Tatsuhisa Yasaka, Hiroshi Tanabe, Akinori Iwashita, Toshiharu Ueki; Clin Endosc 2021;54(4):570-577. Published online January 13, 2021; DOI: https://doi.org/10.5946/ce.2020.205

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Background
/Aims: A white substance that is opaque to endoscopic light is sometimes observed in the epithelium during narrowband imaging with magnifying endoscopy of gastric or colorectal epithelial neoplasms. This prospective observational study aimed to determine whether the morphology of the white opaque substance (WOS) allows differential diagnosis between colorectal adenoma and carcinoma.
Methods
A consecutive series of patients with colorectal adenomas or early carcinomas who underwent endoscopic resection or surgical excision were studied. The morphology of the WOS was determined based on endoscopic images before the histopathological diagnosis was performed. The primary outcome was the diagnostic performance of an irregular WOS as a marker of colorectal carcinoma.
Results
The study analyzed 125 lesions. A total of 33 lesions showed an irregular WOS, and 92 lesions showed a regular WOS. Among the 33 lesions found to show an irregular WOS, 30 were carcinomas. Among the 92 lesions showing a regular WOS, 79 were adenomas. With irregular WOS as a marker of carcinoma, the diagnostic accuracy was 87%, sensitivity was 91%, and specificity was 86%.
Conclusions
This study demonstrated the potential usefulness of the morphology of the WOS as a marker for the differential diagnosis between adenoma and carcinoma in cases of colorectal epithelial neoplasms.

Citations

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Emergence of a New Optical Marker for Colorectal Neoplasms: To What Extent Should We Accept It?
Han Hee Lee
Clinical Endoscopy.2022; 55(2): 315. CrossRef

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Focused Review Series: Current Status of Image-Enhanced Endoscopy (IEE)

Usefulness of Narrow-Band Imaging in Endoscopic Submucosal Dissection of the Stomach: Jung-Wook Kim; Clin Endosc 2018;51(6):527-533. Published online November 19, 2018; DOI: https://doi.org/10.5946/ce.2018.186

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There have been many advances in endoscopic imaging technologies. Magnifying endoscopy with narrow-band imaging is an innovative optical technology that enables the precise discrimination of structural changes on the mucosal surface. Several studies have demonstrated its usefulness and superiority for tumor detection and differential diagnosis in the stomach as compared with conventional endoscopy. Furthermore, magnifying endoscopy with narrow-band imaging has the potential to predict the invasion depth and tumor margins during gastric endoscopic submucosal dissection. Classifications of the findings of magnifying endoscopy with narrow-band imaging based on microvascular and pit patterns have been proposed and have shown excellent correlations with invasion depth confirmed by microscopy. In terms of tumor margin prediction, magnifying endoscopy with narrow-band imaging offers superior delineation of gastric tumor margins compared with traditional chromoendoscopy with indigo carmine. The limitations of narrow-band imaging, such as the need for considerable training, long procedure time, and lack of studies about its usefulness in undifferentiated cancer, should be resolved to confirm its value as a complementary method to endoscopic submucosal dissection. However, the role of magnifying endoscopy with narrow-band imaging is expected to increase steadily with the increasing use of endoscopic submucosal dissection for the treatment of gastric tumors.

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Francesca Boscolo Nata, Giancarlo Tirelli, Vincenzo Capriotti, Alberto Vito Marcuzzo, Erica Sacchet, Azzurra Nicole Šuran-Brunelli, Nicolò de Manzini
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Journal of Gastroenterology and Hepatology.2020; 35(11): 1930. CrossRef
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Chang Seok Bang, Jae Jun Lee, Gwang Ho Baik
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Review

Raman Spectroscopy for the Endoscopic Diagnosis of Esophageal, Gastric, and Colonic Diseases: Neel Sharma, Nobuyoshi Takeshita, Khek Yu Ho; Clin Endosc 2016;49(5):404-407. Published online September 22, 2016; DOI: https://doi.org/10.5946/ce.2016.100

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Globally white-light endoscopy with biopsy sampling is the gold standard diagnostic modality for esophageal, gastric, and colonic pathologies. However, there is overwhelming evidence to highlight the deficiencies of an approach based predominantly on eyeball visualization. Biopsy sampling is also problematic due in part to excessive sampling and hence attendant cost. Various innovations are currently taking place in the endoscopic domain to aid operators in diagnosis forming. These include narrow band imaging which aims to enhance the surface anatomy and vasculature, and confocal laser endomicroscopy which provides real time histological information. However, both of these tools are limited by the skill of the operator and the extensive learning curve associated with their use. There is a gap therefore for a new form of technology that relies solely on an objective measure of disease and reduces the need for biopsy sampling. Raman spectroscopy (RS) is a potential platform that aims to satisfy these criteria. It enables a fingerprint capture of tissue in relation to the protein, DNA, and lipid content. This focused review highlights the strong potential for the use of RS during endoscopic gastroenterological examination.

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Original Article

A Randomized Controlled Clinical Study Comparing the Diagnostic Accuracy of the Histologic Prediction for Colorectal Polyps Depending on the Use of Either Magnified or Nonmagnified Narrow Band Imaging: Jin Joo Kim, Kyoung Sup Hong, Joo Sung Kim, Hyun Chae Jung; Clin Endosc 2015;48(6):528-533. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.528

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Background
/Aims: The aim of this study was to compare the diagnostic capabilities of narrow band imaging (NBI) colonoscopy with and without optical magnification in differentiating neoplastic from nonneoplastic colorectal polyps.
Methods
Between April 2012 and March 2013, 122 patients with colorectal polyps detected by using diagnostic conventional colonoscopy were prospectively enrolled. A total of 236 polyps were evaluated with NBI, in vivo in real time during therapeutic colonoscopy, by one experienced endoscopist. Whether magnification was used or not was determined by randomization. After an in vivo real-time endoscopic prediction of histology, all lesions were endoscopically excised. Surgical pathologic reports were used as the criterion standards. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of identifying neoplastic polyps were calculated.
Results
A total of 236 lesions with an average size of 5.6 mm in 122 patients were assessed (159 neoplastic, 77 nonneoplastic). The Sn, Sp, PPV, and NPV in differentiating neoplastic from nonneoplastic lesions with the magnified NBI were 97.5%, 83.3%, 94.0%, and 92.6%, respectively, whereas those of the nonmagnified NBI group were 97.5%, 85.1%, 91.7%, and 95.2%, respectively.
Conclusions
Nonmagnified NBI colonoscopy distinguishes neoplastic from nonneoplastic colorectal polyps as accurately as does magnified NBI colonoscopy.

Citations

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Utility of the narrow-band imaging international colorectal endoscopic classification for optical diagnosis of colorectal polyp histology in clinical practice: a retrospective study
Yasuhiko Hamada, Kyosuke Tanaka, Masaki Katsurahara, Noriyuki Horiki, Reiko Yamada, Tomomi Yamada, Yoshiyuki Takei
BMC Gastroenterology.2021;[Epub] CrossRef
Feasibility of using narrow band imaging international colorectal endoscopic classification for diagnosing colorectal neoplasia in China: A multicenter pilot observational study
Qing Wei Zhang, Jing Jing Zhang, Ai Ming Yang, Jian Qiu Sheng, Yu Lan Liu, Zhao Shen Li, Hai Ying Chen, Nan Feng, Qing Wei Jiang, Peng Jin, Li Ming Zhang, Hong Yu Fu, Yun Jie Gao, Zhi Zheng Ge, Xiao Bo Li
Journal of Digestive Diseases.2020; 21(2): 88. CrossRef
Narrow-Band Imaging: Clinical Application in Gastrointestinal Endoscopy
Sandra Barbeiro, Diogo Libânio, Rui Castro, Mário Dinis-Ribeiro, Pedro Pimentel-Nunes
GE - Portuguese Journal of Gastroenterology.2019; 26(1): 40. CrossRef
The value of narrow band imaging in diagnosis of head and neck cancer: a meta-analysis
Hui Zhou, Jing Zhang, Linghong Guo, Ji Nie, Chenjing Zhu, Xuelei Ma
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Comparison of narrow-band imaging and confocal laser endomicroscopy for the detection of neoplasia in Barrett's esophagus: A meta-analysis
Yi-Quan Xiong, Shu-Juan Ma, Hao-Yue Hu, Jing Ge, Li-Zhi Zhou, Shu-Ting Huo, Min Qiu, Qing Chen
Clinics and Research in Hepatology and Gastroenterology.2018; 42(1): 31. CrossRef
Endoscopic classification for colorectal tumors using narrow‐band imaging
Gian Eugenio Tontini, Helmut Neumann
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Narrow Band Imaging as an Efficient and Economical Tool in Diagnosing Colorectal Polyps
Naoki Muguruma, Tetsuji Takayama
Clinical Endoscopy.2015; 48(6): 461. CrossRef

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Focused Review Series: Image Enhanced Endoscopys

Polyp Detection, Characterization, and Management Using Narrow-Band Imaging with/without Magnification: Takahiro Utsumi, Mineo Iwatate, Wataru Sano, Hironori Sunakawa, Santa Hattori, Noriaki Hasuike, Yasushi Sano; Clin Endosc 2015;48(6):491-497. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.491

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Narrow-band imaging (NBI) is a new imaging technology that was developed in 2006 and has since spread worldwide. Because of its convenience, NBI has been replacing the role of chromoendoscopy. Here we review the efficacy of NBI with/without magnification for detection, characterization, and management of colorectal polyps, and future perspectives for the technology, including education. Recent studies have shown that the next-generation NBI system can detect significantly more colonic polyps than white light imaging, suggesting that NBI may become the modality of choice from the beginning of screening. The capillary pattern revealed by NBI, and the NBI International Colorectal Endoscopic classification are helpful for prediction of histology and for estimating the depth of invasion of colorectal cancer. However, NBI with magnifying colonoscopy is not superior to magnifying chromoendoscopy for estimation of invasion depth. Currently, therefore, chromoendoscopy should also be performed additionally if deep submucosal invasive cancer is suspected. If endoscopists become able to accurately estimate colorectal polyp pathology using NBI, this will allow adenomatous polyps to be resected and discarded; thus, reducing both the risk of polypectomy and costs. In order to achieve this goal, a suitable system for education and training in in vivo diagnostics will be necessary.

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Clinical Application of Magnifying Endoscopy with Narrow-Band Imaging in the Stomach: Kenshi Yao; Clin Endosc 2015;48(6):481-490. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.481

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Magnifying endoscopy with narrow-band imaging (M-NBI) can visualize superficial microanatomies in the stomach. The normal morphology of the microanatomy visualized by M-NBI differs according to the part of the stomach. The gastric fundic glandular mucosa appears as a regular honeycomb-like subepithelial capillary network (SECN) pattern with a regular collecting venule pattern and regular oval crypt opening with circular marginal crypt epithelium (MCE) pattern. The gastric pyloric glandular mucosa displays a regular coil-shaped SECN pattern and regular polygonal or curved MCE pattern. For a diagnosis of early gastric cancer using M-NBI, the vessel plus surface classification system was developed. This system is clinically useful for the differential diagnosis of focal gastritis and small depressed cancer and for determining the horizontal extent of early gastric cancer for successful endoscopic resection. Advantages of M-NBI over conventional endoscopic imaging techniques with white light include accurate diagnosis and cost effectiveness. This technique is a breakthrough in the endoscopic diagnostic field.

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Narrow Band Imaging: Technology Basis and Research and Development History: Kazuhiro Gono; Clin Endosc 2015;48(6):476-480. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.476

Abstract PDF PubReader ePub

The first launch of narrow band imaging (NBI) was in 2005. Since then, in most countries where gastrointestinal endoscopies are performed, NBI is the most commonly used optical digital method of performing image-enhanced endoscopy. Thanks to the outstanding efforts of many endoscopists, many clinical studies have been performed and clinical evidence has been gathered. In Japan, since 2010, NBI has been reimbursed under the Japanese national health insurance system. This is owing to the establishment of clinical evidence by physicians. However, even though endoscope systems with NBI function have been widely used outside of Japan, dissemination of knowledge on how to use NBI is insufficient. In this review paper, the technology basis of NBI and its research and development history are described. I hope this information will be helpful for updating physicians’ knowledge of 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

Abstract PDF PubReader ePub

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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Original Article

Light-Emitting Diode-Assisted Narrow Band Imaging Video Endoscopy System in Head and Neck Cancer: Hsin-Jen Chang, Wen-Hung Wang, Yen-Liang Chang, Tzuan-Ren Jeng, Chun-Te Wu, Ludovic Angot, Chun-Hsing Lee, Pa-Chun Wang; Clin Endosc 2015;48(2):142-146. Published online March 27, 2015; DOI: https://doi.org/10.5946/ce.2015.48.2.142

Abstract PDF PubReader ePub

Background/Aims

To validate the effectiveness of a newly developed light-emitting diode (LED)-narrow band imaging (NBI) system for detecting early malignant tumors in the oral cavity.

Methods

Six men (mean age, 51.5 years) with early oral mucosa lesions were screened using both the conventional white light and LED-NBI systems.

Results

Small elevated or ulcerative lesions were found under the white light view, and typical scattered brown spots were identified after shifting to the LED-NBI view for all six patients. Histopathological examination confirmed squamous cell carcinoma. The clinical stage was early malignant lesions (T1), and the patients underwent wide excision for primary cancer. This is the pilot study documenting the utility of a new LED-NBI system as an adjunctive technique to detect early oral cancer using the diagnostic criterion of the presence of typical scattered brown spots in six high-risk patients.

Conclusions

Although large-scale screening programs should be established to further verify the accuracy of this technology, its lower power consumption, lower heat emission, and higher luminous efficiency appear promising for future clinical applications.

Citations

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LED-Based Light Source Combined with Quantum Dot for Spectral Imaging
Young Min Bae, Dong-Goo Kang, Ki Young Shin, Wonju Lee, Dong-Wook Yoo
Journal of Nanomaterials.2019; 2019: 1. CrossRef

6,753 View
67 Download
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Review

Equipment-Based Image-Enhanced Endoscopy for Differentiating Colorectal Polyps: Ja Seol Koo; Clin Endosc 2014;47(4):330-333. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.330

Abstract PDF PubReader ePub

The use of colonoscopy for the screening and surveillance of colorectal cancer has increased. However, the miss rate of advanced colorectal neoplasm is known to be 2% to 6%, which could be affected by the image intensity of colorectal lesions. Image-enhanced endoscopy (IEE) is capable of highlighting lesions, which can improve the colorectal adenoma detection rate and diagnostic accuracy. Equipment-based IEE methods, such as narrow band imaging (NBI), Fujinon intelligent color enhancement (FICE), and i-Scan, are used to observe the mucosal epithelium of the microstructure and capillaries of the lesion, and are helpful in the detection and differential diagnosis of colorectal tumors. Although NBI is similar to chromoendoscopy in terms of adenoma detection rates, NBI can be used to differentiate colorectal polyps and to predict the submucosal invasion of malignant tumors. It is also known that FICE and i-Scan are similar to NBI in their detection rates of colorectal lesions. Through more effective and advanced endoscopic equipment, diagnostic accuracy could be improved and new treatment paradigms developed.

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Focused Review Series: Optical Diagnosis and New Management Strategys of Colorectal Polyps

Endoscopic Assessment of Colorectal Cancer with Superficial or Deep Submucosal Invasion Using Magnifying Colonoscopy: Shinji Tanaka, Nana Hayashi, Shiro Oka, Kazuaki Chayama; Clin Endosc 2013;46(2):138-146. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.138

Abstract PDF PubReader ePub

Among early colorectal carcinoma, endoscopic treatment is generally indicative for cases with intramucosal to submucosal (SM) superficial invasion, because cases with SM deep invasion should be treated surgically due to the risk of lymph node metastasis. It is important, therefore, to distinguish between superficial and deep SM invasion in early colorectal carcinoma prior to treatment. In this review we assessed the clinical usefulness and knack of pit pattern and narrow band imaging (NBI) diagnosis using magnifying observation. V_N type pit pattern, type C3 in NBI Hiroshima classification and NBI type 3 in NBI international colorectal endoscopic (NICE) classification are useful predictors of SM deep invasion. In NBI magnifying observation evaluation of both the vascular pattern and surface pattern are important. We have to use pit pattern diagnosis and NBI magnifying diagnosis as the situation demands with the knowledge of both advantage and disadvantage in each diagnostic method.

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New Paradigms for Colonoscopic Management of Diminutive Colorectal Polyps: Predict, Resect, and Discard or Do Not Resect?: Cesare Hassan, Alessandro Repici, Angelo Zullo, Prateek Sharma; Clin Endosc 2013;46(2):130-137. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.130

Abstract PDF PubReader ePub

The possibility to predict in vivo the histology of colorectal polyps by advanced endoscopic imaging has resulted in the implementation of a more conservative management for diminutive lesions detected at colonoscopy. In detail, a predict-and-do-not-resect strategy has been proposed for diminutive lesions located in the rectosigmoid tract, whilst a predict-resect-and-discard policy has been advocated for nonrectosigmoid diminutive polyps. Recently, the American Society for Gastrointestinal Endoscopy set required thresholds to be met, before allowing the adoption of these policies in the clinical field. The ability of current endoscopic imaging in reaching these thresholds would depend on a complex interaction among the accuracy of advanced endoscopic imaging in differentiating between adenomatous and hyperplastic lesions, the prevalence of (advanced) neoplasia within diminutive lesions, and the type of surveillance intervals recommended. Aim of this review is to summarize the data supporting the application of both a predict-and-do-not-resect and a predict-resect-and-discard policies, also addressing the potential pitfalls associated with these strategies.

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Optical Diagnosis of Small Colorectal Polyp Histology with High-Definition Colonoscopy Using Narrow Band Imaging: Amit Rastogi; Clin Endosc 2013;46(2):120-129. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.120

Abstract PDF PubReader ePub

Optical diagnosis of polyp histology can potentially result in enormous cost savings by way of the "resect and discard" strategy for diminutive polyps and the "do not resect" strategy for diminutive hyperplastic polyps in the distal colon. Narrow Band Imaging (NBI) highlights the surface mucosal and vascular pattern on polyps and has been shown to accurately characterize adenomatous and hyperplastic polyps by experts. However, the results have been a little discouraging amongst lesser experienced endoscopists. Studies have also shown that using the NBI diagnosis of diminutive polyp histology, experts can accurately define the future surveillance colonoscopy intervals. However nonexperts in academic or community setting have as yet failed to achieve the recommended thresholds. The subjectivity in assessment by endoscopists leads to the variable accuracy rates and can be circumvented by computer based automated tools. Although initial experience with a few computer based algorithms have shown accuracies comparable to experts, further refinement and validation will be required before these can be implemented in clinical practice. Incorporation of optical diagnosis of diminutive polyps into clinical practice is bound to face several hurdles. But the potential for enormous cost saving makes it an attractive strategy that can make colonoscopy more cost effective.

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Introduction: What Are New Roles of Current Colonoscopy?: Hyung Wook Kim; Clin Endosc 2013;46(2):118-119. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.118

Abstract PDF PubReader ePub

The recent advances in endoscopic imaging technologies make great changes in the management of colorectal polyps. These changes include optical histologic diagnosis with high definition colonscopy, new management strategies such as resect and discard or do not resect, and differentiation of depth of submucosal invasion. In this focused review series, these new paradigms in management of colorectal polyps are discussed by three, world famous authors. First, Amit Rastogi explained optical diagnosis of small colorectal polyp with high definition colonoscopy using narrow band imaging. Second, Cesare Hassan explained new paradigms for colonoscopic management of diminutive colorectal polyps: resect and discard or do not resect. In the last, Shinji Tanaka described, in detail, endoscopic assessment of invasive colorectal cancer: slight vs. deep submucosal invasion. These focused review series introduce the new roles of current colonoscopy to readers and will help the readers to know how to use the new imaging technologies and paradigms in clinical practices.

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Review

Endoscopic Imaging in Barrett's Oesophagus: Applications in Routine Clinical Practice and Future Outlook: Sam Costello, Rajvinder Singh; Clin Endosc 2011;44(2):87-92. Published online December 31, 2011; DOI: https://doi.org/10.5946/ce.2011.44.2.87

Abstract PDF PubReader ePub

The practice for endoscopic surveillance of Barrett's oesophagus has evolved from "blind" or random 4 quadrant biopsies (Seattle protocol) to a more "intelligent" targeted biopsy approach. This evolution has been possible due to the rapid advances in endoscopic imaging technology and expertise in the last decade. Previous endoscopes had relatively poor image resolution that often did not allow the subtle mucosal changes associated with dysplastic Barrett's mucosa to be identified. Newer endoscopic imaging techniques available today may allow endoscopists to identify areas of dysplasia or malignancy and target biopsies accordingly. These modalities which include narrow band imaging, chromoendoscopy, autofluorescence imaging, and confocal endomicroscopy as well as a few novel imaging modalities on the horizon will be discussed further.

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Original Article

Correlation of Narrow Band Imaging with Magnifying Colonoscopy and Histology in Colorectal Tumors: Hee Yong Yoo, Moon Sung Lee, Bong Min Ko, Hee Kyung Kim, Hyung Su Ahn, Seung Hyo Han, Jun Yong Bae, Seul Ki Min, Jong Chan Lee, Chang Beom Ryu; Clin Endosc 2011;44(1):44-50. Published online September 30, 2011; DOI: https://doi.org/10.5946/ce.2011.44.1.44

Abstract PDF PubReader ePub

Background/Aims

Narrow band imaging (NBI) is a new technique that uses optical filters for imaging of mucosal morphology. The aim of this study was to correlate findings of NBI with magnifying colonoscopy and histology for prediction of neoplastic colorectal lesion.

Methods

Between September 2005 and December 2007, 107 colon polyps from 68 patients were detected by conventional colonoscopy and subsequently evaluated by NBI with magnifying colonoscopy and analyzed for a pit pattern and a capillary pattern. More analysis was done regarding thickness and irregularity of capillary features.

Results

Pit pattern with NBI magnification to discriminate between neoplastic and non-neoplastic lesions had a sensitivity of 88.9% and a specificity of 87.5%; capillary pattern yielded test performance characteristics of 91.9% and 87.5%. In respect of capillary thickness, invisible capillaries were found significantly more often in hyperplastic lesions. All thick capillaries were found in neoplastic polyps, and found significantly more often in carcinomas with submucosal massive invasion (sm-m) (p<0.01). In respect of capillary irregularity, invisible capillaries were found significantly more often in hyperplasic lesions, and severely irregular capillaries were found significantly more often in sm-m lesions (p<0.01).

Conclusions

Observation of capillary thickness and irregularity by NBI magnification is useful for correlating histological grade with carcinoma, especially with depth of submucosal invasion.

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Narrow Band Imaging and White Light Colonoscopy for Detection of Polyps: Seok Jae Han, M.D., Eun Young Kim, M.D., Jae Bum Park, M.D., Jong Woon Cheon, M.D., Ka Young Kim, M.D., Young Kook Shin, M.D., Jang Seok Oh, M.D., Byung Seok Kim, M.D., Jimin Han, M.D., Jin Tae Jung, M.D., Joong Goo Kwon, M.D., Chang Hyeong Lee, M.D. and; Korean J Gastrointest Endosc 2011;42(3):152-156. Published online March 28, 2011

Abstract PDF

Background/Aims: Narrow band imaging (NBI) is a new technique that is expected to improve the detection rate of colorectal polyps, but results have been inconsistent. The aim of this study was to compare the polyp miss rate and the characteristics of missed colorectal polyps using white light (WL) and NBI.

Methods: 62 patients were randomized into two groups. In the first group (NBI first, NBIF), a colonoscopic examination of each segment (cecum-ascending, transverse, descending, and rectosigmoid colons) was performed first with NBI followed by a re-examination of the same segment using WL. An opposite sequence was applied for the other group (white light first, WLF).

Results: 67 polyps were found in the first examination, and 31 polyps were found on the re-examination, resulting in a polyp miss rate of 31.6%. The polyp miss rate was 39% for WLF and 23% for NBIF (p＞0.05). Seventy-four small polyps (＜5 mm) were found, and miss rates for NBIF and WLF were 20% and 46%, respectively (p=0.01). The polyp miss rate at the rectosigmoid was 11% for NBIF and 54% for WLF (p=0.01).

Conclusions: The polyp miss rate was not significantly different between NBI or WL when a colonoscopy was performed. NBI resulted in a lower polyp miss rate for small (＜5 mm) and rectosigmoid polyps than WL. (Korean J Gastrointest Endosc 2011;42:152-156)

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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

Abstract 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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