Electronic chromoendoscopy

Abstract

We read with interest the status evaluation of electronic chromoendoscopy.1Manfredi M.A. Abu Dayyeh B.K. Bhat Y.M. et al.ASGE Technology CommitteeElectronic chromoendoscopy.Gastrointest Endosc. 2015; 81: 249-261Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar The article was heavily focused toward narrow-band imaging (NBI), reflecting its market penetration and the volume of published research. However, we were confused regarding the author’s examination of flexible spectral imaging color enhancement (FICE). The article correctly stated that there are fewer publications examining the technology. However, they omitted from review several significant articles. Our research group published two reports examining FICE for characterization of colonic polyps. The first study examined FICE for in vivo diagnosis, keeping the ASGE preservation and incorporation of valuable endoscopic innovations (PIVI) standards in mind.2Longcroft-Wheaton G.R. Higgins B. Bhandari P. Flexible spectral imaging color enhancement and indigo carmine in neoplasia diagnosis during colonoscopy: a large prospective UK series.Eur J Gastroenterol Hepatol. 2011; 23: 903-911Crossref PubMed Scopus (33) Google Scholar Accuracy, sensitivity, and specificity of 86%, 88%, and 82% were achieved. The PIVI standard for resect and discard was met. However, with a negative predictive value of 78%, it was insufficient for leaving polyps in situ. This improved to 90% with the additional use of indigo carmine, meeting the standard. This showed that FICE on its own meets some PIVI standards but, when complemented by indigo carmine, meets all PIVI standards. The study by Longcroft-Wheaton et al3Longcroft-Wheaton G. Brown J. Cowlishaw D. et al.High-definition vs. standard-definition colonoscopy in the characterization of small colonic polyps: results from a randomized trial.Endoscopy. 2012; 44: 905-910Crossref PubMed Scopus (47) Google Scholar was the first report evaluating the effect of high-definition endoscopes on the accuracy of in vivo characterization of polyps. FICE with high-definition endoscopes demonstrated high sensitivity (93%) compared with standard-definition endoscopes (83%). This affected accuracy for setting the re-scope interval by use of both ASGE (100% vs 91%) and British Society of Gastroenterology (BSG) (100% vs 88%) guidelines. Although this work was only conducted with FICE, it may well also apply to NBI, although no studies have investigated this. Both of these articles are MEDLINE listed. If such a review is to have meaning, it is vital that technologies are evaluated in a thorough and comprehensive manner. We believe that in omitting these articles, the strengths and weaknesses of FICE for colonic in vivo diagnosis have been inadequately reviewed. Electronic chromoendoscopyGastrointestinal EndoscopyVol. 81Issue 2PreviewThe ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, performing a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported adverse events of a given technology. Both are supplemented by accessing the “related articles” feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Full-Text PDF Response:Gastrointestinal EndoscopyVol. 82Issue 4PreviewWe thank Drs Longcroft-Wheaton and Bhandari for their comments on the ASGE Technology Committee Status Evaluation Report on Electronic Chromoendoscopy. Although the committee tries to be as comprehensive as possible while drafting manuscripts, we acknowledge the possibility of occasional inadvertent omission of relevant articles. Our search strategy is outlined in the preamble to all our reports. Full-Text PDF