Fuji Intelligent Chromo Endoscopy Research Articles

A Review of New and Emerging Techniques For Optical Diagnosis of Colonic Polyps.

Endoscopic imaging is a rapidly progressing field and benefits from miniaturization of advanced imaging technologies, which may allow accurate real-time characterization of lesions. The concept of the "optical biopsy" to predict polyp histology has gained prominence in recent years and may become clinically applicable with the advent of new imaging technology. This review aims to discuss current evidence and examine the emerging technologies as applied to the optical diagnosis of colorectal polyps. A structured literature search and review has been carried out of the evidence for diagnostic accuracy of image-enhanced endoscopy and emerging endoscopic imaging technologies. The image-enhanced endoscopy techniques are reviewed, including their basic scientific principles and current evidence for effectiveness. These include the established image-enhancement technologies such as narrow-band imaging, i-scan, and Fuji intelligent chromoendoscopy. More recent technologies including optical enhancement, blue laser imaging, and linked color imaging are discussed. Adjunctive imaging techniques in current clinical use are discussed, such as autofluorescence imaging and endocytoscopy. The emerging advanced imaging techniques are reviewed, including confocal laser endomicroscopy, optical coherence tomography, and Raman spectroscopy. Large studies of the established image-enhancement techniques show some role for the optical diagnosis of polyp histology, although results have been mixed, and at present only the technique of narrow-band imaging is appropriate for the diagnosis of low-risk polyps when used by an expert operator. Other image-enhancement techniques will require further study to validate their accuracy but show potential to support the use of a "resect-and-discard" approach to low-risk polyps. New technologies show exciting potential for real-time diagnosis, but further clinical studies in humans have yet to be performed.

Application of Digestive Endoscopy in Diagnosis of Helicobacter Pylori Infection

Helicobacter pylori (Hp),a proven pathogen of digestive disease,is closely associated with gastrointestinal diseases including peptic ulcer,chronic active gastritis,stomach cancer,and stomach-associated lymphoid tissue lymphoma. Thus,precise and timely diagnosis of Hp is of great significance. In addition to 13C or 14C breath test,rapid urease test,and other commonly used Hp diagnosis methods,some new endoscopic techniques such as magnifying endoscopy,narrow-band imaging,confocal laser endomicroscopy,Fuji intelligent chromoendoscopy,and I scanning have been used for the direct observation of the fine-structure of stomach with Hp infection or for the identification of living Hp. This article reviews the application of digestive endoscopy in the diagnosis of Hp infection.

Detection and characterization of colorectal polyps using high-definition white light and i-Scan: Evidence-based consensus recommendations using a modified Delphi process.

i-Scan is an image enhancement modality, which provides enhanced views of mucosal structures and vascular patterns. A modified Delphi process was used to develop a series of evidence-based statements on the role of high-definition white light (HDWL) and i-Scan for the detection and diagnosis of colorectal neoplasms. Each statement was voted to achieve consensus (i.e. >80% agreement). Seven proposed statements achieved consensus: (1) HDWL is recommended rather than standard definition (SD) for detection and diagnosis of colorectal neoplasms; (2) HDWL colonoscopy with i-Scan improves polyp and adenoma detection rates when compared with SD colonoscopy; (3) HDWL + i-Scan is superior to HDWL alone for the optical diagnosis of colorectal neoplasms; (4) HDWL + i-Scan in expert hands meets American Society for Gastrointestinal Endoscopy (ASGE) in the Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) standards for optical diagnosis of diminutive neoplasms; (5) HDWL + i-Scan in non-expert hands does not meet ASGE PIVI standards for optical diagnosis of diminutive neoplasms; (6) optical diagnosis of polyps with i-Scan has a learning curve and needs systematic training; and (7) the performance of i-Scan for the invivo diagnosis of colorectal neoplasms is similar to Narrow Band Imaging (NBI) and Fuji Intelligent Chromo Endoscopy (FICE). Seven proposed statements on the use of HDWL and i-Scan for the detection and diagnosis of colorectal neoplasms achieved consensus.

Fuse and image enhancement.

Colorectal cancer (CRC) is the most devastating consequence of long-standing colitis in inflammatory bowel disease (IBD) patients. In a population-based study, the cumulative prevalence rates of CRC were 1%, 3%, and 7% after 10, 20, and 30 years of disease activity, respectively.1 The higher than expected rate of CRC underlies the importance of dysplasia surveillance programs in this population. However, one of the challenges faced by endoscopists is that the dysplasia seen in this cohort is mostly flat and subtle, which can be easily missed in the midst of mucosal inflammation and pseudopolyps. In addition, the use of low-definition, standard white-light colonoscopy and traditional practice of random quadrantic biopsy that only sample < 0.05% of the entire colonic mucosa lacks acceptable sensitivity and specificity in dysplasia identification and is associated with high rate of interval colitis-associated cancers.2 There is compelling evidence to support chromoendoscopy (CE) in dysplasia detection in long-standing IBD patients, and this technique has been endorsed for surveillance colonoscopy by all major guidelines including American Gastroenterological Association, American College of Gastroenterology, Crohn's and Colitis Foundation of America, European Crohn's and Colitis Organization, British Society of Gastroenterology, American Society for Gastrointestinal Endoscopy, the Australian National Health and Medical Research Council, and the Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendations. However, despite guideline recommendations, CE has not been widely adopted into clinical practice, mainly related to the cumbersome and time-consuming technique.3 Many endoscopists prefer to use non-dye-based digital image enhancement, such as narrow band imaging, although there is currently a lack of evidence that narrow band imaging improves the detection of dysplasia over and above CE in IBD patients.4 Recent innovations, such as confocal laser endomicroscopy and autofluorescence imaging, have been evaluated in dysplasia surveillance in IBD and appear promising in improving neoplasia detection.5-7 However, studies performed to date are small, and larger studies are clearly needed to evaluate the accuracy of these new technologies to determine their role in dysplasia screening algorithm for IBD patients. Other new imaging modalities in development are Fuji Intelligent Chromoendoscopy and i-scan that utilize surface and tone enhancement via a digital image processing algorithm, which avoids the use of contrast to better define and outline mucosal structures in real time. However, there is no study to date on the use of such technology in dysplasia surveillance in IBD patients.8 Optical coherence tomography is another new innovative imaging modality that has mainly been evaluated in Barrett's surveillance and not yet in dysplasia detection in IBD. This technology utilizes an optical probe that is balloon-centered that can be placed endoscopically to provide radial imaging scan using infrared light, capturing 1200 images over 90 s. However, given the limited performance data currently available, this technology is mainly assessed in research setting.9 Recently, a new imaging modality became available in Australia known as full spectrum endoscopy (FUSE) that maintains the capability of an adult colonoscope but has additional camera lenses to the right and left sides of the tip of the scope providing a near-panoramic 330-degree endoscopic view of the mucosa as opposed to the restricted 170-degree endoscopic view from conventional forward viewing colonoscopes. Improved visualization of the side walls, blind spots, and behind mucosal folds allows more colonic lesions to be identified, hence reducing polyp miss rates. A recent tandem back-to-back screening colonoscopy study of a non-IBD population demonstrated a significant reduction in sporadic colonic adenoma miss rates from 41% to 7% using forward viewing colonoscopes versus FUSE, respectively.10 FUSE colonoscopy has yet to be evaluated for IBD dysplasia and the benefit of FUSE in comparison against the current gold standard technique of dye-spray CE also remains unknown. In summary, improvements in the optics of endoscopes and the use of CE have improved our ability to detect dysplasia. However, the current strategies used still remains inadequate, and the development of CRC continues to fuel ongoing research in advanced endoscopic imaging techniques to improve the efficacy of dysplasia surveillance. These emerging modalities appear promising and may change our traditional approach to dysplasia screening in IBD patients in the years ahead. A major hurdle continues to be the low uptake of CE in IBD surveillance.

The good lies so near - invivo diagnosis of colonic polyps.

The good lies so near - invivo diagnosis of colonic polyps.

Advanced bronchoscopic techniques in diagnosis and staging of lung cancer.

The role of advanced brochoscopic diagnostic techniques in detection and staging of lung cancer has steeply increased in recent years. Bronchoscopic imaging techniques became widely available and easy to use. Technical improvement led to merging in technologies making autofluorescence or narrow band imaging incorporated into one bronchoscope. New tools, such as autofluorescence imagining (AFI), narrow band imaging (NBI) or fuji intelligent chromo endoscopy (FICE), found their place in respiratory endoscopy suites. Development of endobronchial ultrasound (EBUS) improved minimally invasive mediastinal staging and diagnosis of peripheral lung lesions. Linear EBUS proven to be complementary to mediastinoscopy. This technique is now available in almost all high volume centers performing bronchoscopy. Radial EBUS with mini-probes and guiding sheaths provides accurate diagnosis of peripheral pulmonary lesions. Combining EBUS guided procedures with rapid on site cytology (ROSE) increases diagnostic yield even more. Electromagnetic navigation technology (EMN) is also widely used for diagnosis of peripheral lesions. Future development will certainly lead to new improvements in technology and creation of new sophisticated tools for research in respiratory endoscopy. Broncho-microscopy, alveoloscopy, optical coherence tomography are some of the new research techniques emerging for rapid technological development.

Flexible spectral imaging color enhancement for diagnosis of early esophageal carcinomas and pre- cancerous lesions

Objective To evaluate the flexible spectral imaging color enhancement （FICE） system in the diagnosis of early esophageal carcinoma and precancerous lesions. Methods A total of 257 patients with suspicious esophageal lesions were examined successively by FICE, magnifying FICE, iodine dyeing en- doscopy and magnifying iodine dyeing endoscopy. Findings were compared with the pathologic diagnosis. Re- suits The positive rates of early esophageal carcinoma by FICE （92. 6%, 25/27） and iodine dyeing endos- copy （88. 9%, 24/27） were not significantly different （P =0. 642）, nor were those of magnifying FICE （96. 3 %, 26/27 ） and magnifying iodine dyeing endoscopy （92. 6%, 25/27 ）, （ P = 0. 556）. The magnif- ying FICE could reveal the IPCL of early esophageal carcinoma clearly. Early esophageal carcinoma and ad- vanced neoplasia were mainly type Ⅳ ＋ Ⅴ, low-level neoplasia and esophagitis were type Ⅱ ＋ Ⅲ, and nor- mal esophagus was type I. However, the magnifying iodine dyeing endoscopy was not able to reveal IPCL. There was no adverse reaction in FICE, but the adverse reaction rate was 12. 8% （33/257） in iodine dyeing endoscopy. Conclusion Magnifying FICE can accurately determine the pathological types of early esopha- geal carcinoma, which is an effective complement to iodine dyeing endoscopy. Key words: Early esophageal carcinoma; Fuji intelligent chromo endoscopy; Intraepithelial pa- pillary capillary loop

Intestinal mantle cell lymphoma observed by double-balloon endoscopy with Fuji Intelligent Chromo Endoscopy

Title Intestinal mantle cell lymphoma observed by double-balloon endoscopy with Fuji Intelligent Chromo Endoscopy. Author(s) Norimura, Daisuke; Isomoto, Hajime; Niino, Daisuke; Akazawa, Yuko; Yamaguchi, Naoyuki; Ohnita, Ken; Shikuwa, Saburo; Takeshima, Fuminao; Nakao, Kazuhiko Citation Endoscopy, 43(2), pp.E26-E27; 2011 Issue Date 2011-03 URL http://hdl.handle.net/10069/27389 Right © Georg Thieme Verlag KG Stuttgart · New York NAOSITE: Nagasaki University's Academic Output SITE

Value of Fuji intelligent chromo endoscopy under different channel settings in the diagnosis of colorectal polyps

Value of Fuji intelligent chromo endoscopy under different channel settings in the diagnosis of colorectal polyps

Magnified endoscopic observation with Fuji Intelligent Chromo Endoscopy of primary duodenal follicular lymphoma

Follicular lymphoma occurs rarely in the gastrointestinal tract, comprising only 1 % – 3 % of all B-cell non-Hodgkin lymphomas of the gastrointestinal tract [1]. Prior reports have described cases of follicular lymphoma by using advanced endoscopic imaging [1] [2] [3] [4]. With narrow-band imaging (NBI) and magnification, follicular lymphoma is reported to show as enhanced whitish areas within enlarged villi and with a coiled vascular pattern [1] [2]. According to a previous case report [1], the lesion was also identified as whitish small nodules in the jejunum by using Fuji Intelligent Chromo Endoscopy (FICE). However, FICE in combination with magnified endoscopy in follicular lymphoma has not been reported to date.

A study of Fuji Intelligent Chromo Endoscopy in the diagnosis of colonrectal neoplasia

Objective To investgate the value of Fuji Intelligent Chromo Endoscopy(FICE)for the diagnosis of colonrectal polympus.Methods 197 patients who had colon polypoid lesion examined with ordinary colonoscopy from March 2009 to January 2010 were enrolled in this study.The patients were examined with magnifying conventional colonoscopy,magnifying FICE technique and magnifying chromoendoscopy technique,the pit pattern and blood capillary form.The endoscopic diagnosis was made,and compared with pathologic diagnosis.Results 359 neoplasms were detected in the197 patients,among those 91.2% were detected with magnifying conventional endoscopy,97.8% were detected with FICE technique ,there was significant difference between the two methods.the structure and form of mucosal blood capillary saw mere clearly in FICE than that in chromoendoscopy technique,(P ＜ 0.01),there was no significant difference between the two methods for showing the pit pattern.The coincident rate of FICE for the diagnosis of tumor and non-tumor polynpus was 90.3%,which was significant higher than that of chromoendoscopy 82.5% (P ＜ 0.01).Conclusion Magnifying FICE endoscopy could show mucosal microstructure and blood capillary form.It hav the superiority of high coincident rate in distinguishing neoplastic from non-neoplastic colorectal polympus compared with conventional magnifying colonoscopy and magnifying chromoendoscopy.The detected rate of early carcinoma of colon is dramatically increased with FICE.FICE could be easily operated,and hare satisfactory clinical practical value. Key words: Fuji Intelligent Chromo Endoscopy; Colon polympus; Diagnosis

Era of Barrett’s surveillance: Does equipment matter?

Barrett's esophagus is a consequence of long standing gastro-esophageal reflux disease and predisposes to the development of esophageal adenocarcinoma. Regular surveillance endoscopies can detect curable early neoplasia in asymptomatic patients, which in turn could improve the prognosis compared to symptomatic cancer. Early neoplastic lesions, which are amenable for local therapy, could be treated endoscopically, avoiding a major surgery. However, in the absence of obvious mucosal lesions, random four quadrant biopsies are done, which is associated with significant sampling error. Newer imaging modalities, such as autofluorescence endoscopy, are helpful in detecting subtle lesions that could be examined in detail with narrow band imaging to characterize and target biopsies. This has the potential benefit of reducing the number of random biopsies with a better yield of dysplasia. Confocal endomicroscopy provides "optical biopsies" and is a valuable tool in targeting biopsies to improve dysplasia detection; however, this is technically challenging. Fuji intelligent chromoendoscopy and I-Scan are recent additions to the imaging armamentarium that have produced notable early results. While all these additional new imaging techniques are promising, a thorough examination by high resolution white light endoscopy after clearing the mucosa with mucolytics should be the minimum standard to improve dysplasia detection during Barrett's surveillance.

Advanced imaging of the gastrointestinal tract: research vs. clinical tools?

Diagnostic endoscopy has moved forward considerably in the recent years. Still, three major needs have to be satisfied: endoscopy should be able to detect a lesion, characterize the lesion, and then its nature should be confirmed. These steps should ideally translate into an immediate therapeutic decision. High definition endoscopy has optimized our endoscopic view onto the mucosa and can be combined with digital surface enhancement modalities. Chromoendoscopy still holds a place to detect especially flat lesions in high-risk patients such as ulcerative colitis. Digital chromoendoscopy techniques such as narrow band imaging, i-scan, or Fuji intelligent chromo endoscopy offer new possibilities of easily and reversibly obtaining enhanced tissue contrast. Autofluorescence imaging uses tissue function to yield a pseudocolored image, and has potential to serve as a red flag technique for the detection of neoplastic lesions. Confocal laser endomicroscopy has for the first time provided real time microscopy. In addition to visualizing morphology, functional and molecular imaging open new horizons for the gastroenterologist. Advanced imaging techniques have provided the endoscopist with an armamentarium of novel modalities for detection, characterization and microscopy of lesions during endoscopy. In addition, functional and molecular imaging give insight into dynamic processes of tissues in their natural surroundings.

Utility of Kudo Pit Pattern for Distinguishing Adenomatous from Non Adenomatous Colonic Lesions In Vivo: Meta-Analysis of Different Endoscopic Techniques

Background: The pit pattern classification system proposed by Kudo is being increasingly utilized as a tool to predict histology of colorectal lesions with sensitivities of over 90% reported in expert hands. Chromoendoscopy, magnification endoscopy, narrow band imaging (NBI) and Fuji intelligent chromoendoscopy (FICE) are all techniques adopted to improve pit pattern determination. Accurate colonoscopic assessment in vivo has been advocated to avoid the need for histopathology and reduce costs. Aims: To do a meta-analysis of the utility of Kudo pit pattern classification in distinguishing adenomatous and non adenomatous colorectal lesions.

Characterization of Follicular Lymphoma in the Small Intestine Using Double-Balloon Endoscopy

Follicular lymphomas occur rarely in the gastrointestinal tract, representing only 1–3% of all gastrointestinal tract B-cell non-Hodgkin lymphomas. We describe endoscopic analysis of 3 cases of follicular lymphoma in the small intestine using double-balloon endoscopy. Double-balloon endoscopy revealed multiple nodular lesions and elevated white patches, multiple polypoid lesions, and scattered white polypoid and nodular lesions in the duodenum and small intestine. Fuji Intelligent Chromo Endoscopy demonstrated small, whitish nodules, and narrow-band imaging showed a coiled, elongated vascular pattern within the elevated lesions. These cases are the first follicular lymphomas in the small intestine evaluated using narrow-band imaging or Fuji Intelligent Chromo Endoscopy to be reported.

Fuji Intelligent Chromo Endoscopy and staining technique for the diagnosis of colon tumor

Colon cancer is a common malignant tumor in the clinic with an incidence rate that is increasing in recent years. The key point for improving the survival rate is the diagnosis and treatment at an early stage. The purpose of this study was to compare the difference of the Fuji Intelligent Chromo Endoscopy (FICE) and staining technique for the diagnosis of colon tumors and non-tumor lesions. From March to November 2007, 654 patients were examined with ordinary colonoscopy. Among them 223 patients with colon neoplasm or polypoid lesion were included. The patients were examined with a magnifying ordinary colonoscopy, a magnifying FICE technique and magnifying staining technique. The pit pattern and blood capillary form of the lesion were examined, an endoscopic diagnosis was made and it was compared with the pathologic diagnosis. Four hundred and fifty-one neoplasms were detected in the 223 patients, among those 91.1% (411/451) were detected with the magnifying ordinary endoscopy while 99.1% (447/451) were detected with the FICE technique; there was a significant difference between the two methods. FICE could clearly show the structure and form of mucosal blood capillaries (P < 0.01) but there was no significant difference between the two methods for showing the pit pattern. The coincident rate of FICE for the diagnosis of tumor and non-tumor lesions was 91.6% (413/451), that of the magnifying staining technique was 82.0% (370/451) (P < 0.05). Magnifying FICE could show the mucosal microstructure and blood capillary form and it had a superiority of high coincident rate, high sensitivity and specificity when compared with ordinary magnifying colonoscopy and magnifying staining endoscopy. In addition, it was easy to operate and a biopsy could be taken from the target, so it has a satisfactory clinical practical value.

Role of Fuji intelligent chromo endoscopy in observation of pit pattern and blood capillary form of colonic lesions

Role of Fuji intelligent chromo endoscopy in observation of pit pattern and blood capillary form of colonic lesions