Flexible Spectral Imaging Color Enhancement Research Articles

Classification and endoscopic diagnosis of colorectal polyps

Background: Colorectal cancer is a common malignancy and a major health concern in Korea. The increased use of screening colonoscopies has led to improved survival of patients with colorectal cancer despite its high prevalence; this highlights the importance of early detection and removal of neoplastic polyps such as adenoma and sessile serrated lesions. Therefore, optical diagnosis of colorectal polyps is crucial in deciding whether the lesion requires removal and if endoscopic procedures can be used for its removal.Current Concepts: Several image-enhanced endoscopy (IEE) techniques and classifications can be used to improve the optical diagnosis of different polyps that match the histopathologic findings. Kudo’s pit pattern classification is based on features of pit patterns observed from different types of polyps via chromoendoscopy. The Narrow-Band Imaging (NBI) International Colorectal Endoscopic (NICE) classification is an international classification based on patterns observed from NBI findings. The Japan NBI Expert Team (JNET) classification identifies different patterns observed from magnified images with NBI. The Workgroup serrAted polypS and Polyposis (WASP) classification helps to differentiate hyperplastic polyps from sessile serrated lesions. Endoscopy manufacturers have also developed IEE techniques such as I-scan, flexible spectral imaging color enhancement, and blue laser imaging/linked color imaging to highlight, delineate, and differentiate various polyps.Discussion and Conclusion: Optical diagnosis of colorectal polyps using IEE such as NBI with different classifications such as NICE, JNET, and WASP is important for differentiating neoplastic polyps and removing them with an appropriate method.

A multifaceted comparative analysis of image and video technologies in gastrointestinal endoscope and their clinical applications.

This paper presents a comprehensive exploration of endoscopic technologies in clinical applications across seven tables, each focusing on a unique facet of the medical field. The discourse begins with a detailed analysis of pediatric endoscopes, highlighting their diagnostic capabilities in various conditions. It then delves into the specifications and applications of globally recognized capsule endoscopy devices. Additionally, the paper incorporates an analysis of advanced imaging techniques, such as Narrow Band Imaging (NBI), Flexible Spectral Imaging Color Enhancement (FICE), and i-scan, which are increasingly being integrated into ultrathin gastrointestinal (GI) endoscopes. Factors like technological capabilities, light source, camera technology, and computational constraints are evaluated to understand their compatibility with these advanced imaging techniques, each offering unique advantages and challenges in clinical settings. NBI, for instance, is lauded for its user-friendly, real-time enhanced imaging capabilities, making it effective for early detection of conditions like colorectal cancer and Barrett's esophagus. Conversely, FICE and i-scan offer high customizability and are compatible with a broader range of endoscope models. The paper further delves into innovative advances in movement control for Nasojejunal (NJ) feeding tube endoscopy, elucidating the potential of AI and other novel strategies. A review of the technologies and methodologies enhancing endoscopic procedure control and diagnostic precision follows, emphasizing image and video technologies in pediatric endoscopy, capsule endoscopes, ultrathin endoscopes, and their clinical applications. Finally, a comparative analysis of leading real-time video monitoring endoscopes in clinical practices underscores the continuous advancements in the field of endoscopy, ensuring improved diagnostics and precision in surgical procedures. Collectively, the comparative analysis presented in this paper highlights the remarkable diversity and continuous evolution of endoscopic technologies, underlining their crucial role in diagnosing and treating an array of medical conditions, thereby fostering advancements in patient care and clinical outcomes.

Prospective study of diagnostic yields of flexible spectral imaging color enhancement installed in colon capsule endoscopy for colorectal polyps and tumors

Background and AimsWe prospectively aimed to determine the efficacy of flexible spectral imaging color enhancement (FICE) at second-generation colon capsule endoscopy (CCE) for colorectal polyps and tumors (CRTs). MethodsThis study included optical colonoscopy within four months after CCE. Two colonoscopists independently reviewed white light images (CCE-WL) and FICE images (CCE-FICE), respectively. Based on colonoscopic findings as the gold standard, the diagnostic accuracy for CRTs was compared between CCE-WL and CCE-FICE. ResultsOf 89 enrolled patients (65 men and 24 women; 75 with CRTs including 36 with serrated lesions, 63 with adenomas, and 9 with adenocarcinomas), the per-patient detectability of CCE-FICE for the representative CRT was significantly higher than that of CCE-WL: overall CRTs (CCE-WL,79%; CCE-FICE,88%, P=0.0001), 6-9 mm CRTs (63%; 94%, P=0.0055), ≥6mm CRTs (78%; 93%, P=0.0159), respectively. The per-lesion sensitivity of CCE-FICE was significantly higher than that of CCE-WL for CRTs: overall (61%; 79%, P<0.0001), <6 mm (53%; 69%, P<0.0001) and 6-9 mm CRTs (65%; 93%, P=0.0007), slightly elevated CRTs (53%; 75 %, P<0.0001), tubular adenomas (61%; 79%, P<0.0001), and serrated polyps (57%; 74%, P=0.0022), respectively. Both modes detected all adenocarcinomas. There were no significant differences of the per-lesion sensitivity for ≥10 mm or protruding CRTs between CCE-WL and CCE-FICE (81%; 94%, P=0.1138, 77%; 86%, P=0.0614, respectively). Kappa coefficients for overall CRTs at CCE-WL and CCE-FICE were 0.66 and 0.64, respectively, which indicated substantial agreement. ConclusionsCCE-FICE improved the detection rates for all CRTs except adenocarcinomas, ≥10 mm and protruding polyps, when compared to CCE-WL (UMIN 000021125).

Magnifying Chromoendoscopy with Flexible Spectral Imaging Color Enhancement, Indigo Carmine, and Crystal Violet in Predicting the Histopathology of Colorectal Polyps: Diagnostic Value in a Scare-Setting Resource.

Background and Aims Virtual magnifying chromoendoscopy with flexible spectral imaging color enhancement (FICE), image-enhanced endoscopy techniques, and dye-staining magnifying chromoendoscopy (with Indigo carmine and Crystal violet) have contributed to better visualization of the pit pattern and vascular structure of colorectal polyp. Therefore, magnifying chromoendoscopy is capable of predicting the histopathological results of colorectal polyp without biopsy and remains their diagnostic values over time, especially in scare-setting resources. This study compared the images of magnifying chromoendoscopy between FICE, Indigo carmine, and Crystal violet and then assessed their diagnostic values based on colorectal polyps' histopathology as a gold standard. Methods A total of 332 polyps of 266 patients were endoscopically evaluated from June 2016 to September 2019. After identified by white light endoscopy, polyps continued to be evaluated by virtual magnifying chromoendoscopy (×50-150 times) with FICE. The capillary-vessel pattern was divided into 5 subtypes according to the number, morphology, and distribution of the fine blood vessels according to Teixeira classification. Next, they were stained with Indigo carmine 0.2% and then Crystal violet 0.05% and were classified according to Kudo's pit pattern classification. Finally, polyps were resected by endoscopy or surgery and biopsy and compared with histopathological results of either neoplastic or nonplastic polyp. Results The number of neoplastic polyps was 278/332 with 231 adenoma polyps and 47 carcinoma polyps. Magnifying chromoendoscopy has high sensitivity and accuracy when compared with the histopathological results of colorectal polyps. The sensitivity, specificity, and accuracy of magnifying chromoendoscopy with Crystal violet are 97.2%, 72.2%, and 93.0%; with Indigo carmine are 96.0%, 72.2%, and 92.1%; and with FICE are 92.1%, 68.5%, and 88.3%.Conclusions Among the three methods, Crystal violet has the highest sensitivity and accuracy in predicting histopathological results of colorectal polyps. FICE has shown its diagnostic value with reliable sensitivity and accuracy and should still be a reasonable endoscopic choice for physicians in scare-setting resources regardless its moderate specificity. Physicians should base on their facility and capability to determine an appropriate endoscopy technique.

History, clinical application, and future perspective of narrow band imaging and blue laser imaging

History, clinical application, and future perspective of narrow band imaging and blue laser imaging

Advanced mucosal imaging in colonoscopy: technical details and clinical applications

Over the past decades, the significant development in endoscopic imaging has revolutionized digestive endoscopy. Real-time optical diagnosis has become possible using different tools and techniques (dye-based and virtual chromoendoscopy) such as narrow band imaging, flexible spectral imaging color enhancement, i-Scan, blue-laser imaging and linked-color imaging. Polyp detection and characterization, and prediction of depth of invasion of colorectal cancers have improved remarkably. Confocal laser endomicroscopy and endocytoscopy have allowed the evaluation of lesions on a cellular level. Not far from the horizon are newer technological innovations such as artificial intelligence and texture and color enhancement imaging that are now being studied for their potential to further improve mucosal visualization, optical diagnosis and virtual histology. This review gives an overview of image-enhanced endoscopy (IEE) and discusses its clinical applications and future directions in the lower gastrointestinal (GI) tract.

Electronic chromo-endoscopy: technical details and a clinical perspective.

Precise endoscopic assessment is necessary to detect neoplastic changes in an early stage. Electronic or virtual chromo-endoscopy (ECE) is an alternative to conventional dye-based chromo-endoscopy which markedly improves capillary pattern and hence can detect micro-vessel morphological changes of early neoplasia to target biopsies and aid in diagnosis. The clinical significance increased after the advent of endoscopic treatment modalities like ESD/EMR which requires precise delineation of extent and depth of lesion. Most of the studies have used narrow-band imaging (NBI) (Olympus Medical Systems Tokyo, Japan), although data from i-SCAN (PENTAX Endoscopy, Tokyo, Japan) and flexible spectral imaging color enhancement (FICE) (Fujinon, Fujifilm Medical Co, Saitama, Japan) are emerging. Electronic chromo-endoscopy is convenient compared to dye-based chromo-endoscopy in the sense that it is available at the push of a button in endoscope and reduces procedure time substantially with comparable efficacy. Scope of this review is to discuss available electronic chromo-endoscopy modalities and their role in the diagnosis, surveillance, and management of early GI neoplasia.

Evaluation of colon mucosa using screening colonoscopy and flexible spectral imaging color enhancement in patients with long lasting ulcerative colitis

AimTo determine which flexible spectral imaging color enhancement (FICE) channel best visualizes colon mucosa in ulcerative colitis (UC) and to compare FICE imaging with standard imaging.MethodsThe study enrolled patients with ulcerative colitis in remission who had inflammatory bowel disease for at least 8 years. All patients underwent screening colonoscopy. The entire colon, especially the suspicious areas in terms of dysplasia, were imaged with standard endoscopy and FICE. Random and target biopsies were obtained. Histopathological diagnosis was made and image patterns were evaluated. Seven endoscopists evaluated normal, colitis, and polyp images obtained with FICE.ResultsOne hundred and twenty-three colon segments were evaluated and 1831 images were obtained from 18 patients. A total of 1652 images were FICE and 179 were standard images. Separate FICE images were obtained for normal colon mucosa, polypoid lesions, and colitis areas. Normal colon mucosa was best visualized using the second, sixth, and ninth FICE channel; polyps using the third, seventh, and ninth channel; and colitis using the second, third, and ninth channel. When all images were analyzed, the second and ninth channel were significantly better than the other channels. A total of 584 biopsies were obtained, including 492 (84.2%) random biopsies and 92 (15.7%) target biopsies. Random biopsies detected no dysplasia, but target biopsies detected low-grade dysplasia in three diminutive polyps.ConclusionFICE was not significantly better at dysplasia screening than the standard procedure, but it effectively detected diminutive polyps and evaluated surface patterns without using magnification. FICE might contribute to the assessment of inflammation severity in patients with UC in clinical remission. However, more extensive studies are necessary to confirm these findings.

Bile pigment in small-bowel water content may reflect bowel habits: a retrospective analysis of a capsule endoscopy imaging series

BackgroundPigmented bile salts darken the small-bowel lumen and are present with bile acid, which is involved in the development of bowel habits. The small-bowel water content (SBWC) in the ileum could represent the colonic environment, but no studies have focused on this feature. However, measurement of crude SBWC can be challenging because of the technical difficulty of the endoscopic approach without preparation. Our aim was to evaluate optically active bile pigments in the SBWC of patients with abnormal bowel habits using capsule endoscopy (CE) to investigate the impact of bile acid on bowel habits.MethodsThe study population included 37 constipated patients, 20 patients with diarrhea, and 77 patients with normal bowel habits who underwent CE between January 2015 and May 2018. Patients with secondary abnormal bowel habits were excluded. In addition to conventional imaging, we used flexible spectral imaging color enhancement (FICE) setting 1 imaging, in which the effects of bile pigments on color are suppressed. Intergroup color differences of SBWC in the ileum (ΔE) were evaluated from conventional and FICE setting 1 images. Color values were assessed using the CIE L*a*b* color space. Differences in SBWC lightness (black to white, range 0–100) were also evaluated.ResultsThe ΔE values from the comparison of conventional images between patients with constipation and with normal bowel habits and between patients with diarrhea and with normal bowel habits were 12.4 and 11.2, respectively. These values decreased to 4.4 and 3.3, respectively, when FICE setting 1 images were evaluated. Patients with constipation and diarrhea had significantly brighter (34.4 versus 27.6, P < .0001) and darker (19.6 versus 27.6, P < .0001) SBWC lightness, respectively, than patients with normal bowel habits. The FICE setting 1 images did not reveal significant differences in SBWC lightness between those with constipation and with normal bowel habits (44.1 versus 43.5, P = .83) or between those with diarrhea and with normal bowel habits (39.1 versus 43.5, P = .20).ConclusionsDifferences in SBWC color and darkness in the ileum appear to be attributable to bile pigments. Therefore, bile pigments in SBWC may reflect bowel habits.

Serum iron and vitamin B 12 deficiency could indicate celiac disease by flexible spectral imaging color enhancement.

INTRODUCTION Celiac disease (CeD) is an autoimmune disease that can be delayed in diagnosis due to the presence of atypical and asymptomatic cases in adulthood. Herein we aimed to study the frequency of CeD and evaluate whether magnified endoscopy and magnified/FICE (flexible spectral imaging color enhancement) techniques contribute to the diagnosis in patients with serum iron and vitamin B12 deficiency. METHODS We evaluated 50 adult patients (10 males and 40 females) who had serum iron and vitamin B12 deficiency, prospectively. All the patients had undergone upper gastrointestinal system endoscopy by the same endoscopist. The second part of the duodenum was evaluated with white light, magnified, and magnified/FICE endoscopy. Biopsy specimens were evaluated by the same pathologist. The specimens diagnosed as CeD were classified according to the Modified Marsh-Oberhuber criteria. RESULTS 10 of 50 patients (20%) were diagnosed as CeD. The average age was 41±11 years (20-67 years). Thirty percent of CeD diagnosed patients had typical CeD symptoms. Six of 10 patients (60%) who were diagnosed as CeD had typical endoscopic images under white lighted endoscopy. All of these 10 patients (100%) showed villous irregularity, partial villous atrophy, or total villous atrophy consistent with CeD with magnified and magnified/FICE endoscopy. CONCLUSION The practical use of magnified/FICE endoscopy allows us to differentiate mucosal abnormalities of the duodenum and minimize false-negative results that indicate normal mucosal findings with conventional endoscopy.

Surveillance in inflammatory bowel disease: is chromoendoscopy the only way to go? A systematic review and meta-analysis of randomized clinical trials.

Background and study aims Ulcerative colitis (UC) and Crohn’s disease (CD) have higher risk of colorectal cancer (CRC). Guidelines recommend dysplasia surveillance with dye-spraying chromoendoscopy (DCE). The aim of this systematic review and meta-analysis was to review all randomized clinical trials (RCTs) available and compare the efficacy of different endoscopic methods of surveillance for dysplasia in patients with UC and CD. Methods Databases searched were Medline, EMBASE, Cochrane and SCIELO/LILACS. It was estimated the risk difference (RD) for dichotomous outcomes (number of patients diagnosed with one or more dysplastic lesions, total number of dysplastic lesions diagnosed and number of dysplastic lesions detected by targeted biopsies) and mean difference for continuous outcomes (procedure time). Results This study included 17 RCTs totaling 2,457 patients. There was superiority of DCE when compared to standard-definiton white light endoscopy (SD-WLE). When compared with high-definition (HD) WLE, no difference was observed in all outcomes (number of patients with dysplasia (RD 0.06; 95 % CI [–0.01, 0.13])). Comparing other techniques, no difference was observed between DCE and virtual chromoendoscopy (VCE – including narrow-band imaging [NBI], i-SCAN and flexible spectral imaging color enhancement), in all outcomes except procedure time (mean difference, 6.33 min; 95 % CI, 1.29, 11.33). DCE required a significantly longer procedure time compared with WLE (mean difference, 7.81 min; 95 % CI, 2.76, 12.86). Conclusions We found that dye-spraying chromoendoscopy detected more patients and dysplastic lesions than SD-WLE. Although no difference was observed between DCE and HD-WLE or narrow-band imaging, the main outcomes favored numerically dye-spraying chromoendoscopy, except procedure time. Regarding i-SCAN, FICE and auto-fluorescence imaging, there is still not enough evidence to support or not their recommendation.

Design of Multiband Switching Illumination With Low-Concentration Lugol Stain for Esophageal Cancer Detection

Narrowband imaging (NBI), flexible spectral imaging color enhancement (FICE), and Lugol chromoendoscopy (LCE) are used in endoscopy of head and neck cancers and esophageal cancers. The NBI and FICE techniques enhance the capillary pattern in cancerous areas, whereas in LCE, normal and cancerous areas are differentiated using Lugol solution. Although invasive, LCE is more sensitive than NBI and FICE for this purpose. In this study, we propose a relatively less invasive and highly sensitive technique for detecting cancerous areas that combines low-concentration Lugol stain and narrowband illumination. This combined technique requires the use of an endoscopic system that can acquire RGB images synchronized with narrowband illumination switching. This technique produces a large number of images that can potentially discriminate smaller differences in color than is possible with conventional RGB imaging. Experiments to predict the performance of the proposed method were performed using four resected specimens, including esophageal cancer, and promising results were obtained.

Improving Diagnostic Yield of Capsule Endoscopy in Coeliac Disease: Can Flexible Spectral Imaging Colour Enhancement Play a Role?

Introduction: Flexible spectral imaging colour enhancement (FICE) is a form of virtual chromoendoscopy that is incorporated in the capsule reading software and that can be used by reviewers to enhance the delineation of lesions in the small bowel. This has been shown to be useful in the detection of pigmented (ulcers, angioectasias) lesions. However, its application to coeliac disease (CD) images from small bowel capsule endoscopies (SBCEs) has rarely been studied. Methods: This was a European, multicentre study that included 5 expert capsule reviewers who were asked to evaluate a number of normal and abnormal de-identified images from SBCEs of patients with CD to determine whether the use of FICE and blue light can improve the detection of CD-related changes. Results: Sensitivity and specificity of conventional white light in the delineation of CD-related changes were 100%. The next best image modification was FICE 1 with a sensitivity of 80% and a specificity of 100%. There was no difference between conventional white light, FICE and blue light for the identification of CD-related changes. There was a low agreement (Fleiss kappa 0.107; p = 0.147) between expert reviewers in selecting the best image modification that detected CD-related changes. Conclusions: FICE and blue light were not found to be superior to conventional white light in the delineation of macroscopic changes related to CD on SBCEs.

Colonoscopy technologies for diagnostics and drug delivery

AbstractWith a global increase of colorectal cancer, inflammatory bowel disease and other colon‐related illnesses, advanced technologies are needed for imaging of the colon and localized drug delivery. Optical colonoscopy is the gold standard for imaging of the colon. However, existing colonoscopy approaches have a high adenoma misdiagnosis rate, which can be lethal for patients. This article reviews the emergence of virtual colonoscopy, dye‐based chromoendoscopy, electronic chromoendoscopy and capsule endoscopy in diagnosis. Flexible spectral imaging colour enhancement, the use of second‐generation capsule endoscopy and i‐scan were described. Moreover, a drug delivery system using capsule endoscopy was discussed. Finally, this review includes market analyses of commercial products, clinical trials and future prospects of colonoscopy devices.

Advanced endoscopic methods in gastrointestinal diseases: a systematic review.

Endoscopic imaging is the main method for detecting gastrointestinal diseases, which adversely affect human health. White light endoscopy (WLE) was the first method used for endoscopic examination and is still the preliminary step in the detection of gastrointestinal diseases during clinical examination. However, it cannot accurately diagnose gastrointestinal diseases owing to its poor correlation with histopathological diagnosis. In recent years, many advanced endoscopic methods have emerged to improve the detection accuracy by endoscopy. Chromoendoscopy (CE) enhances the contrast between normal and diseased tissues using biocompatible dye agents. Narrow band imaging (NBI) can improve the contrast between capillaries and submucosal vessels by changing the light source acting on the tissue using special filters to realize the visualization of the vascular structure. Flexible spectral imaging color enhancement (FICE) technique uses the reflectance spectrum estimation technique to obtain individual spectral images and reconstructs an enhanced image of the mucosal surface using three selected spectral images. The i-Scan technology takes advantage of the different reflective properties of normal and diseased tissues to obtain images, and enhances image contrast through post-processing algorithms. These abovementioned methods can be used to detect gastrointestinal diseases by observing the macroscopic structure of the digestive tract mucosa, but the ability of early cancer detection is limited with low resolution. However, based on the principle of confocal imaging, probe-based confocal laser endomicroscopy (pCLE) can enable cellular visualization with high-performance probes, which can present cellular morphology that is highly consistent with that shown by biopsy to provide the possibility of early detection of cancer. Other endoscopic imaging techniques including endoscopic optical coherence tomography (EOCT) and photoacoustic endoscopy (PAE), are also promising for diagnosing gastrointestinal diseases. This review focuses on these technologies and aims to provide an overview of different technologies and their clinical applicability.

The Significance of a Pale Area Via Flexible Spectral Imaging Color Enhancement in the Diagnosis of Esophageal Precancerous Lesions and Early-stage Squamous Cancer.

Goals:The main aim of this study was to investigate the significance of a pale area via flexible spectral imaging color enhancement (FICE) in the diagnosis of esophageal dysplasia and cancer.Background:The early diagnosis of esophageal squamous cancer is challenging, and the indication of Lugol’s chromoendoscopy has not yet been well established.Study:The esophageal mucosa of patients at our endoscopic center were sequentially evaluated with white-light endoscopy and FICE during insertion of the endoscope, followed by staining with Lugol’s solution during withdrawal. Patients were divided into 2 groups depending on whether esophageal leukoplakia was detected by white-light endoscopy and 2 groups depending on whether a pale area was detected by FICE. We compared cases of patients with abnormal iodine staining, and cases of dysplasia or cancer in esophageal leukoplakia—or pale area—positive and negative groups.Results:Cases of abnormal staining in the esophageal leukoplakia—or pale area—positive group were far more numerous than cases without esophageal leukoplakia or pale area, respectively (P=0.000). Cases of esophageal dysplasia and cancer in the esophageal leukoplakia—or pale area—positive group were far more numerous than cases without esophageal leukoplakia or pale area, respectively (P=0.000).Conclusions:Iodine staining should be performed in patients with esophageal leukoplakia or pale areas. Esophageal dysplasia and early-stage cancer were more easily detected in those with esophageal leukoplakia or pale areas.

High-resolution magnified endoscopy combined with flexible spectral imagining colour enhancement techniques in the diagnosis of Helicobacter pylori disease.

AimTo evaluate the efficiency of the flexible spectral imaging colour enhancement (FICE) procedure added to high-resolution magnified endoscopy (HRME) for the evaluation of structural changes in gastric mucosa infected with Helicobacter pylori (H. pylori).Material and methodsA total of 104 patients were included in the study. First HRME and then HRME + FICE methods were used for the evaluation of the gastric mucosal structure, and examined areas were studied histopathologically. Mucosal appearance was evaluated with the modified Yagi classification. Images were shown to five endoscopists in order to examine inter- and intra-observer variability in image assessment.ResultsSensitivity and specificity of the image pattern noted with HRME in the antrum in the detection of H. pylori were 67.9% and 84.6%, respectively, while these were 93.5% and 92.3%, respectively, with HRME + FICE. Type 5 pattern in the antrum, which we thought to be associated with intestinal metaplasia, was not observed in any patient with HRME. Sensitivity and specificity values of type 5 pattern noted with HRME + FICE technique for intestinal metaplasia were 50% and 98.8%, respectively.ConclusionsThe results show that HRME + FICE as a digital chromoendoscopic method provided an additional diagnostic contribution to HRME for showing the presence of H. pylori and intestinal metaplasia and is a method with higher sensitivity and specificity. The “patchy appearance” (type 5) observed in the antrum not previously described in the evaluations with FICE can be a guiding sign especially for the diagnosis of intestinal metaplasia.

Compared Abilities of Endoscopic Techniques to Increase Colon Adenoma Detection Rates: A Network Meta-analysis

Adenoma detection rate (ADR) is a quality metric for colorectal cancer screening. We performed a systematic review and network meta-analysis to assess the overall and comparative efficacies of different endoscopic techniques in adenoma detection. We performed a systematic review of published articles and abstracts, through March 15, 2018, to identify randomized controlled trials of adults undergoing colonoscopy that compared the efficacy of different devices in detection of adenomas. Our final analysis included 74 2-arm trials that comprised 44948 patients. These studies compared efficacies of add-on devices (cap, endocuff, endo-rings, G-EYE), enhanced imaging techniques (chromoendoscopy, narrow-band imaging, flexible spectral imaging color enhancement, blue laser imaging), new scopes (full-spectrum endoscopy, extra-wide-angle-view colonoscopy, dual focus), and low-cost optimizing existing resources (water-aided colonoscopy, second observer, dynamic position change), alone or in combination with high-definition colonoscopy or each other. Primary outcome was increase in ADR. We performed pairwise and network meta-analyses, and appraised quality of evidence using GRADE. Low-cost optimizing existing resources (odds ratio [OR], 1.29; 95% CI,1.17-1.43), enhanced imaging techniques (OR,1.21; 95% CI, 1.09-1.35), and add-on devices (OR,1.18; 95% CI, 1.07-1.29) were associated with a moderate increase in ADR compared with high-definition colonoscopy; there was low to moderate confidence in estimates. Use of newer scopes was not associated with significant increases in ADR compared with high-definition colonoscopy (OR, 0.98; 95% CI, 0.79-1.21). In our comparative efficacy analysis, no specific technology for increasing ADR was superior to others. We did not find significant differences between technologies in detection of advanced ADR, polyp detection rate, or mean number of adenomas/patient. In a network meta-analysis of published trials, we found that low-cost optimization of existing resources to be as effective as enhanced endoscopic imaging, or add-on devices, in increasing ADR during high-definition colonoscopy.

Diagnostics and methods of endoscopic treatment of post-caustic esophageal strictures

The article deals with stricture subsequent to esophageal corrosive injury and describes endoscopic treatment results and diagnostic methods. Etiologic and pathogenetic aspects of the esophageal corrosive injury development depending on damaging substance were reported and steroid endotherapy results considering modern classification were given. Clinical peculiarities of the disease were singled out according to endoscopic treatment results. Individual approaches to endoscopic and drug therapy in patients with caustic esophageal injury were covered depending on damaging substance and exposure time as well as postoperative follow-up of these patients. The aim of the study was to evaluate the results of endoscopic treatment of post corrosive esophageal strictures using pneumatic balloon and hydro-balloon dilatation with subsequent glucocorticosteroid drug submucosal injection. Material and methods. High-technology video endoscope system FUJINON EPX 4450 with HDTV imaging and digital chromoendoscopy Flexible spectral Imaging Color Enhancement (FICE) were used. Endoscopic examination included a detailed assessment of the esophageal mucosa condition (the presence of erosions, ulcers), centric or eccentric narrowing of the esophagus, the diameter of stricture determination, the possibility, feasibility and the staged manner of endoscopic treatment. Result and discussion. All patients underwent pneumatic balloon and then hydro-balloon dilatation without the balloon removing, but only changing air and water supply. The synthetic hormone Flosteron (2 ml) was injected into the submucosal layers of the fracture sites after dilatation in order to inhibit and decrease fibroblasts formation, which reduced the risk of the esophagus mucous membrane severe scarring. Conclusions: Endoscopic combined balloon dilatation in post corrosive esophageal strictures based on developed indications and technical aspects of performance is an effective and sufficiently safe method of treatment.

Clinical Significance of Diminutive Colonic Polyps in Elderly Patients.

Background and Objectives:Colorectal cancer is the third leading cause of cancer-related death. Excision of premalignant polyps has a significant impact on reducing colorectal cancer mortality and morbidity. Colonoscopy is considered to be the gold standard for the diagnosis and affords an opportunity for treatment of colonic polyps. In recent years, serious debates have taken place because of the biological characteristics of diminutive polyps (DPs), polypectomy complications, and serious costs. There has not yet been a consensus on the management of DPs. The objectives of this study were to demonstrate the real clinical importance of DPs smaller than 5 mm in diameter, which are frequently seen in geriatric patients by new endoscopic techniques, and to help in determining screening and surveillance programs.Methods:The patients who underwent colonoscopy and were found to have a diminutive colorectal polyp (<5 mm from September 1, 2016 through September 1, 2017), were classified into 3 groups according to the imaging method used: flexible spectral imaging color enhancement (FICE), narrow band imaging (NBI), or I-SCAN. In all groups, demographic data were compared according to Paris classification (morphologic) and Kudo classification (correlation between the prediction of endoscopic diagnosis and final pathological examination) in terms of sensitivity, specificity, and negative and positive predictive values.Results:Two hundred sixty-seven patients were included in the study: 97 in the NBI group, 83 in the FICE group, and 87 in the I-SCAN group. There were no statistically significant differences between NBI, FICE, and I-SCAN in differentiating neoplastic and nonneoplastic polyps, according to the Kruskal-Wallis test (P = .809).Conclusions:The estimated progression rates of DPs to advanced adenomas or colorectal cancer (CRC) are very low. Missing these polyps or not excising them may lead to failure to diagnose some cancers. There is a need for further comprehensive studies of removing all polyps to determine whether non–high-risk lesions require further pathologic examination and to re-examine routine surveillance programs.