Virtual chromoendoscopy: Will it play a role in capsule endoscopy?

Abstract

Capsule endoscopy is an effective tool for the evaluation of small owel diseases, with a higher diagnostic yield when compared to ther small bowel imaging modalities. Virtual chromoendoscopy, .e., Narrow Band Imaging (NBI – Olympus, Tokyo, Japan), Fuji ntelligent Colour Enhancement (FICE, Fujinon Inc., Saitama, Japan) nd I-Scan (Pentax, Tokyo, Japan), is a well established technolgy that in combination with magnification and high resolution mage enables inspection of microvascular patterns and circuments some limitations of conventional chromoendoscopy. The ain advantage of virtual chromoendoscopy is the convenience of quick push-button switching between white light and chromoenoscopy modes, without the need for dye spraying. Moreover, dye praying would be unfeasible during capsule endoscopy. When compared to conventional endoscopy, virtual chromoenoscopy was initially reported to achieve an increased detection ate of neoplastic lesions, improving the overall accuracy of endocopic procedures. However, consistent evidence in the literature uggests that, at the moment, virtual chromoendoscopy fails to chieve this target [1,2]. Virtual chromoendoscopy has also been laimed to play a role in lesion characterisation (i.e., size evaluaion, limits of the lesions, and mucosal pattern) and, consequently, n the definition of therapeutic strategies. In this setting, several tudies have shown the feasibility of virtual chromoendoscopy in ccurately differentiating neoplastic from non-neoplastic colonic esions [3,4]. This resulted in the ‘resect and discard’ policy, ccording to which polyps classified as non-neoplastic at virtual hromoendoscopy were not to be sent out for pathology report. Similarly to conventional endoscopy, modified imaging with nhanced vascular and mucosal contrast might also improve detecion and characterisation of small bowel lesions with capsule ndoscopy. For this reason, virtual chromoendoscopy has been ranslated from conventional endoscopy to capsule endoscopy, ICE (Fuji Intelligent Colour Enhancement) software being now ncorporated into the Given Imaging workstation. FICE is a post proessing imaging technique: it takes an ordinary endoscopic image nd arithmetically processes the reflected photons to reconstiute virtual images of different wavelengths. With this technology, hysicians can easily select amongst “white light” images, “Blue