Recently,image-enhanced endoscopy(IEE) has been used to diagnose gastrointestinal tumors.This method is a change from conventional white-light(WL) endoscopy without dyeing solution,requiring only the push of a button....Recently,image-enhanced endoscopy(IEE) has been used to diagnose gastrointestinal tumors.This method is a change from conventional white-light(WL) endoscopy without dyeing solution,requiring only the push of a button.In IEE,there are many advantages in diagnosis of neoplastic tumors,evaluation of invasion depth for cancerous lesions,and detection of neoplastic lesions.In narrow band imaging(NBI) systems(Olympus Medical Co.,Tokyo,Japan),optical filters that allow narrow-band light to pass at wavelengths of 415 and 540 nm are used.Mucosal surface blood vessels are seen most clearly at 415 nm,which is the wavelength that corresponds to the hemoglobin absorption band,while vessels in the deep layer of the mucosa can be detected at 540 nm.Thus,NBI also can detect pit-like structures named surface pattern.The flexible spectral imaging color enhancement(FICE) system(Fujifilm Medical Co.,Tokyo,Japan) is also an IEE but different to NBI.FICE depends on the use of spectral-estimation technology to reconstruct images at different wavelengths based on WL images.FICE can enhance vascular and surface patterns.The autofluorescence imaging(AFI) video endoscope system(Olympus Medical Co.,Tokyo,Japan) is a new illumination method that uses the difference in intensity of autofluorescence between the normal area and neoplastic lesions.AFI light comprises a blue light for emitting and a green light for hemoglobin absorption.The aim of this review is to highlight the efficacy of IEE for diagnosis of colorectal tumors for endoscopic treatment.展开更多
BACKGROUND Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer.However,whether image-enhanced endoscopy(IEE)further improves the adenoma detection rate(ADR)is controversial...BACKGROUND Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer.However,whether image-enhanced endoscopy(IEE)further improves the adenoma detection rate(ADR)is controversial.AIM To compare IEE with white-light imaging(WLI)endoscopy for the detection and identification of colorectal adenoma.METHODS This was a multicenter,randomized,controlled trial.Participants were enrolled between September 2019 to April 2021 from 4 hospital in China.Patients were randomly assigned to an IEE group with WLI on entry and IEE on withdrawal(n=2113)or a WLI group with WLI on both entry and withdrawal(n=2098).The primary outcome was the ADR.The secondary endpoints were the polyp detection rate(PDR),adenomas per colonoscopy,adenomas per positive colonoscopy,and factors related to adenoma detection.RESULTS A total of 4211 patients(966 adenomas)were included in the analysis(mean age,56.7 years,47.1%male).There were 2113 patients(508 adenomas)in the IEE group and 2098 patients(458 adenomas)in the WLI group.The ADR in two group were not significantly different[24.0%vs 21.8%,1.10,95%confidence interval(CI):0.99-1.23,P=0.09].The PDR was higher with IEE group(41.7%)than with WLI group(36.1%,1.16,95%CI:1.07-1.25,P=0.01).Differences in mean withdrawal time(7.90±3.42 min vs 7.85±3.47 min,P=0.30)and adenomas per colonoscopy(0.33±0.68 vs 0.28±0.62,P=0.06)were not significant.Subgroup analysis found that with narrowband imaging(NBI),between-group differences in the ADR,were not significant(23.7%vs 21.8%,1.09,95%CI:0.97-1.22,P=0.15),but were greater with linked color imaging(30.9%vs 21.8%,1.42,95%CI:1.04-1.93,P=0.04).the second-generation NBI(2G-NBI)had an advantage of ADR than both WLI and the first-generation NBI(27.0%vs 21.8%,P=0.01;27.0%vs 21.2.0%,P=0.01).CONCLUSION This prospective study confirmed that,among Chinese,IEE didn’t increase the ADR compared with WLI,but 2G-NBI increase the ADR.展开更多
AIM: To assess the risk of failing to detect diminutive and small colorectal cancers with the "resect and discard" policy.METHODS: Patients who received colonoscopy and polypectomy were recruited in the retr...AIM: To assess the risk of failing to detect diminutive and small colorectal cancers with the "resect and discard" policy.METHODS: Patients who received colonoscopy and polypectomy were recruited in the retrospective study. Probable histology of the polyps was predicted by six colonoscopists by the use of NICE classification. The incidence of diminutive and small colorectal cancersand their endoscopic features were assessed. RESULTS: In total, we found 681 cases of diminutive(1-5 mm) lesions in 402 patients and 197 cases of small(6-9 mm) lesions in 151 patients. Based on pathology of the diminutive and small polyps, 105 and 18 were non-neoplastic polyps, 557 and 154 were low-grade adenomas, 18 and 24 were high-grade adenomas or intramucosal/submucosal(SM) scanty invasive carcinomas, 1 and 1 were SM deeply invasive carcinoma, respectively. The endoscopic features of invasive cancer were classified as NICE type 3 endoscopically.CONCLUSION: The risk of failing to detect diminutive and small colorectal invasive cancer with the "resect and discard" strategy might be avoided through the use of narrow-band imaging observation with the NICE classification scheme and magnifying endoscopy.展开更多
BACKGROUND Red dichromatic imaging(RDI)is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point.However,it has not been thoroughly investigated.CASE SUMMARY A 91-year-old man develo...BACKGROUND Red dichromatic imaging(RDI)is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point.However,it has not been thoroughly investigated.CASE SUMMARY A 91-year-old man developed a sudden massive hematochezia and underwent emergent colonoscopy.An ulcer with pulsatile bleeding was found on the lower rectum.Due to massive bleeding,the exact location of the bleeding point was not easy to detect with white light imaging(WLI).Upon switching to RDI,the bleeding point appeared in deeper yellow compared to the surrounding blood.Thus,RDI enabled us for easier recognition of the bleeding point,and hemostasis was achieved successfully.Furthermore,we reviewed endoscopic images and evaluated the color difference between the bleeding point and surrounding blood for WLI and RDI.In our case,the color difference of RDI was greater than that of WLI(9.75 vs 6.61),and RDI showed a better distinguished bleeding point from the surrounding blood.CONCLUSION RDI may improve visualization of the bleeding point by providing better contrast in color difference relative to surrounding blood.展开更多
文摘Recently,image-enhanced endoscopy(IEE) has been used to diagnose gastrointestinal tumors.This method is a change from conventional white-light(WL) endoscopy without dyeing solution,requiring only the push of a button.In IEE,there are many advantages in diagnosis of neoplastic tumors,evaluation of invasion depth for cancerous lesions,and detection of neoplastic lesions.In narrow band imaging(NBI) systems(Olympus Medical Co.,Tokyo,Japan),optical filters that allow narrow-band light to pass at wavelengths of 415 and 540 nm are used.Mucosal surface blood vessels are seen most clearly at 415 nm,which is the wavelength that corresponds to the hemoglobin absorption band,while vessels in the deep layer of the mucosa can be detected at 540 nm.Thus,NBI also can detect pit-like structures named surface pattern.The flexible spectral imaging color enhancement(FICE) system(Fujifilm Medical Co.,Tokyo,Japan) is also an IEE but different to NBI.FICE depends on the use of spectral-estimation technology to reconstruct images at different wavelengths based on WL images.FICE can enhance vascular and surface patterns.The autofluorescence imaging(AFI) video endoscope system(Olympus Medical Co.,Tokyo,Japan) is a new illumination method that uses the difference in intensity of autofluorescence between the normal area and neoplastic lesions.AFI light comprises a blue light for emitting and a green light for hemoglobin absorption.The aim of this review is to highlight the efficacy of IEE for diagnosis of colorectal tumors for endoscopic treatment.
基金Supported by the National Key R&D Program of China,No. 2018YFC1315005National Natural Science Foundation of China,No. 82002515+1 种基金Shanghai Sailing Program,No. 20YF1407200China Postdoctoral Science Foundation,No. 2020M681177
文摘BACKGROUND Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer.However,whether image-enhanced endoscopy(IEE)further improves the adenoma detection rate(ADR)is controversial.AIM To compare IEE with white-light imaging(WLI)endoscopy for the detection and identification of colorectal adenoma.METHODS This was a multicenter,randomized,controlled trial.Participants were enrolled between September 2019 to April 2021 from 4 hospital in China.Patients were randomly assigned to an IEE group with WLI on entry and IEE on withdrawal(n=2113)or a WLI group with WLI on both entry and withdrawal(n=2098).The primary outcome was the ADR.The secondary endpoints were the polyp detection rate(PDR),adenomas per colonoscopy,adenomas per positive colonoscopy,and factors related to adenoma detection.RESULTS A total of 4211 patients(966 adenomas)were included in the analysis(mean age,56.7 years,47.1%male).There were 2113 patients(508 adenomas)in the IEE group and 2098 patients(458 adenomas)in the WLI group.The ADR in two group were not significantly different[24.0%vs 21.8%,1.10,95%confidence interval(CI):0.99-1.23,P=0.09].The PDR was higher with IEE group(41.7%)than with WLI group(36.1%,1.16,95%CI:1.07-1.25,P=0.01).Differences in mean withdrawal time(7.90±3.42 min vs 7.85±3.47 min,P=0.30)and adenomas per colonoscopy(0.33±0.68 vs 0.28±0.62,P=0.06)were not significant.Subgroup analysis found that with narrowband imaging(NBI),between-group differences in the ADR,were not significant(23.7%vs 21.8%,1.09,95%CI:0.97-1.22,P=0.15),but were greater with linked color imaging(30.9%vs 21.8%,1.42,95%CI:1.04-1.93,P=0.04).the second-generation NBI(2G-NBI)had an advantage of ADR than both WLI and the first-generation NBI(27.0%vs 21.8%,P=0.01;27.0%vs 21.2.0%,P=0.01).CONCLUSION This prospective study confirmed that,among Chinese,IEE didn’t increase the ADR compared with WLI,but 2G-NBI increase the ADR.
基金Supported by Institute of Minimally Invasive Endoscopic Care(iM EC),Sano Hospital,No.2014-02
文摘AIM: To assess the risk of failing to detect diminutive and small colorectal cancers with the "resect and discard" policy.METHODS: Patients who received colonoscopy and polypectomy were recruited in the retrospective study. Probable histology of the polyps was predicted by six colonoscopists by the use of NICE classification. The incidence of diminutive and small colorectal cancersand their endoscopic features were assessed. RESULTS: In total, we found 681 cases of diminutive(1-5 mm) lesions in 402 patients and 197 cases of small(6-9 mm) lesions in 151 patients. Based on pathology of the diminutive and small polyps, 105 and 18 were non-neoplastic polyps, 557 and 154 were low-grade adenomas, 18 and 24 were high-grade adenomas or intramucosal/submucosal(SM) scanty invasive carcinomas, 1 and 1 were SM deeply invasive carcinoma, respectively. The endoscopic features of invasive cancer were classified as NICE type 3 endoscopically.CONCLUSION: The risk of failing to detect diminutive and small colorectal invasive cancer with the "resect and discard" strategy might be avoided through the use of narrow-band imaging observation with the NICE classification scheme and magnifying endoscopy.
文摘BACKGROUND Red dichromatic imaging(RDI)is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point.However,it has not been thoroughly investigated.CASE SUMMARY A 91-year-old man developed a sudden massive hematochezia and underwent emergent colonoscopy.An ulcer with pulsatile bleeding was found on the lower rectum.Due to massive bleeding,the exact location of the bleeding point was not easy to detect with white light imaging(WLI).Upon switching to RDI,the bleeding point appeared in deeper yellow compared to the surrounding blood.Thus,RDI enabled us for easier recognition of the bleeding point,and hemostasis was achieved successfully.Furthermore,we reviewed endoscopic images and evaluated the color difference between the bleeding point and surrounding blood for WLI and RDI.In our case,the color difference of RDI was greater than that of WLI(9.75 vs 6.61),and RDI showed a better distinguished bleeding point from the surrounding blood.CONCLUSION RDI may improve visualization of the bleeding point by providing better contrast in color difference relative to surrounding blood.
