Fuji Intelligent Color Enhancement Research Articles

Endoscopic characterization of neoplastic and non-neoplastic lesions in inflammatory bowel disease: systematic review in the era of advanced endoscopic imaging.

Current guidelines strongly recommend the use of validated classifications to support optical diagnosis of lesions with advanced endoscopic imaging in the lower gastrointestinal tract. However, the optimal strategy in inflammatory bowel disease (IBD) is still a matter of debate. To analyze the accuracy of endoscopic classifications or single predictors for in vivo lesion characterization during endoscopic surveillance of IBD with advanced endoscopic imaging. Systematic review. Medline and PubMed were used to extract all studies which focused on lesion characterization of neoplastic and non-neoplastic lesions in IBD. The diagnostic accuracy of endoscopic classifications and single endoscopic predictors for lesion characterization were analyzed according to type of patients, lesions, and technology used. When available, the rates of true and false positives or negatives for neoplasia were pooled and the sensitivity (SE), specificity (SP), positive predictive value, and negative predictive value (NPV) were calculated. We included 35 studies (2789 patients; 5925 lesions - 1149 neoplastic). Advanced endoscopic imaging included dye-based chromoendoscopy, virtual chromoendoscopy (VCE), magnification and high-definition endoscopy, confocal laser endomicroscopy (CLE), endocytoscopy, and autofluorescence imaging. The Kudo classification of pit patterns was most frequently used, with pooled SE 83%, SP 83%, and NPV 95%. The endoscopic criteria with the highest accuracy, with minimum SE ⩾ 90%, SP ⩾ 80%, and NPV ⩾ 90% were: the Kudo-IBD classification used with VCE (Fuji Intelligent Color Enhancement and i-SCAN); combined irregular surface and vascular patterns used with narrow band imaging; the Mainz classification used with CLE. Multiple clinical and technical factors were found to influence the accuracy of optical diagnosis in IBD. No single endoscopic factor has yet shown sufficient accuracy for lesion characterization in IBD surveillance. Conventional classifications developed in the non-IBD setting have lower accuracy in IBD. The use of new classifications adapted for IBD (Kudo-IBD), and new technologies based on in vivo microscopic analysis show promise.

Video capsule endoscopy: pushing the boundaries with software technology

Video capsule endoscopy (VCE) has transformed imaging of the small bowel as it is a non-invasive and well tolerated modality with excellent diagnostic capabilities. The way we read VCE has not changed much since its introduction nearly two decades ago. Reading is still very time intensive and prone to reader error. This review outlines the evidence regarding software enhancements which aim to address these challenges. These include the suspected blood indicator (SBI), automated fast viewing modes including QuickView, lesion characterization tools such Fuji Intelligent Color Enhancement, and three-dimensional (3D) representation tools. We also outline the exciting new evidence of artificial intelligence (AI) and deep learning (DL), which promises to revolutionize capsule reading. DL algorithms have been developed for identifying organs of origin, intestinal motility events, active bleeding, coeliac disease, polyp detection, hookworms and angioectasias, all with impressively high sensitivity and accuracy. More recently, an algorithm has been created to detect multiple abnormalities with a sensitivity of 99.9% and reading time of only 5.9 minutes. These algorithms will need to be validated robustly. However, it will not be long before we see this in clinical practice, aiding the clinician in rapid and accurate diagnosis.

Rediscovering histology: what is new in endoscopy for inflammatory bowel disease?

The potential of endoscopic evaluation in the management of inflammatory bowel diseases (IBD) has undoubtedly grown over the last few years. When dealing with IBD patients, histological remission (HR) is now considered a desirable target along with symptomatic and endoscopic remission, due to its association with better long-term outcomes. Consequently, the ability of endoscopic techniques to reflect microscopic findings in vivo without having to collect biopsies has become of upmost importance. In this context, a more accurate evaluation of inflammatory disease activity and the detection of dysplasia represent two mainstay targets for IBD endoscopists. New diagnostic technologies have been developed, such as dye-less chromoendoscopy, endomicroscopy, and molecular imaging, but their real incorporation in daily practice is not yet well defined. Although dye-chromoendoscopy is still recommended as the gold standard approach in dysplasia surveillance, recent research questioned the superiority of this technique over new advanced dye-less modalities [narrow band imaging (NBI), Fuji intelligent color enhancement (FICE), i-scan, blue light imaging (BLI) and linked color imaging (LCI)]. The endoscopic armamentarium might also be enriched by new video capsule endoscopy for monitoring disease activity, and high expectations are placed on the application of artificial intelligence (AI) systems to reduce operator-subjectivity and inter-observer variability. The goal of this review is to provide an updated insight on contemporary knowledge regarding new endoscopic techniques and devices, with special focus on their role in the assessment of disease activity and colorectal cancer surveillance.

Modified Kudo classification can improve accuracy of virtual chromoendoscopy with FICE in endoscopic surveillance of ulcerative colitis.

Background and study aims Virtual chromoendoscopy with Fuji Intelligent Color Enhancement (FICE) has never been studied in prospective trials of endoscopic surveillance for ulcerative colitis (UC). We compared FICE and white light endoscopy (WLE) in differentiation of visible lesions in UC. Patients and methods In a prospective parallel study, we compared consecutive outpatients with UC submitted to surveillance colonoscopy with FICE or WLE. At least one visible polypoid or non-polypoid lesion for each patient was required. Random biopsies from normal mucosa, targeted biopsies or removal of suspected neoplastic lesions and targeted biopsies of unsuspected lesions were performed. In the FICE arm, neoplasia was suspected according to a modified Kudo classification (FICE-KUDO/inflammatory bowel disease [IBD]). Sensitivity (SE), specificity (SP), positive and negative likelihood ratios (LR) and negative predictive value (NPV) were analyzed. Results One hundred patients were submitted to FICE (n = 46) or WLE (n = 54). Twenty-two patients (11 in WLE, 11 in FICE) had a least one neoplastic lesion. No neoplasia was found in random biopsies. Among 275 lesions, 17 of 136 by FICE and 27 of 139 by WLE were suspected neoplasia, but 28 (14 in each arm) were true neoplastic lesions. The accuracy of FICE-KUDO/IBD vs WLE (per lesion) was: SE 93 % vs 64 % ( P = 0.065), SP 97 % vs 86 % ( P = 0.002), positive-LR 28.3 vs 4.5 ( P = 0.001), negative-LR 0.07 vs 0.42 ( P = 0.092), NPV 99 % vs 96 % ( P = 0.083). FICE-KUDO/IBD detected more non-polypoid lesions than WLE ( P = 0.016). Conclusions Targeted biopsies of polypoid and non-polypoid lesions, using the modified Kudo classification with FICE are more accurate than WLE in UC surveillance.

Comparison of the detection of colorectal lesions in different endoscopic modalities: A network meta-analysis and systematic review.

A colonoscopy is considered to be the standard diagnostic test used to detect early colorectal lesions. Detection rates are expected to improve with optimised visualisation. A systematic review and network meta-analysis was conducted to evaluate detection efficiency in several colonoscopic modalities. Relevant articles were identified in searches of the PubMed, EMBASE and Cochrane Library databases. The modalities, comprising of standard-definition white light (SDWL), high-definition white light (HDWL), narrow-band imaging (NBI), autofluorescence imaging (AFI), PENTAX image enhanced technology (i-SCAN), Fuji Intelligent Color Enhancement (FICE), dye-based chromoendoscopy and novel image enhanced systems, including blue laser imaging (BLI) and linked color imaging (LCI), were compared to identify the most efficient modalities that could be used to detect colorectal lesions. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. As a result, 40 studies fulfilled the inclusion criteria. Overall, in the network meta-analyses, NBI (OR, 1.29; 95% CI, 1.04-1.58), FICE (OR, 1.39; 95% CI, 1.11-1.77), chromoendoscopy (OR, 1.53; 95% CI, 1.22-1.93) and AFI (OR, 1.81; 95% CI, 1.07-2.87) were significantly better compared with SDWL at identifying adenoma in patients, and chromoendoscopy also proved significantly superior to HDWL (OR, 1.30; 95% CI, 1.06-1.60). In pairwise analyses, it was demonstrated that chromoendoscopy was significantly superior to HDWL at detecting the number of polyps (MD, -1.11; 95% CI, -1.46, -0.76) and flat lesions (MD, -0.30; 95% CI, -0.49, -0.10) per subject. Additionally, FICE detected a significantly greater number of subjects with polyps (OR, 0.78; 95% CI, 0.64-0.96) and NBI was significantly better at detecting the number of subjects with flat lesions (OR, 0.77; 95% CI, 0.60-0.99) compared with HDWL. Based on the meta-analysis, NBI, FICE and AFI were significantly better compared with SDWL at detecting patients with adenoma. Additionally, chromoendoscopy was significantly better than SDWL and HDWL at detecting the number of colorectal adenoma, however additional studies are needed to confirm these findings.

Virtual Chromoendoscopy With FICE for the Classification of Polypoid and Nonpolypoid Raised Lesions in Ulcerative Colitis.

The aim of this study was to analyze the performance of Fuji Intelligent Color Enhancement (FICE) using the classification of Kudo in the differentiation of neoplastic and non-neoplastic raised lesions in ulcerative colitis (UC). The Kudo classification of mucosal pit patterns is an aid for the differential diagnosis of colorectal polyps in the general population, but no systematic studies are available for all forms of raised lesions in UC. All raised, polypoid and nonpolypoid, lesions found during consecutive surveillance colonoscopies with FICE for long-standing UC were included. In the primary prospective analysis, the Kudo classification was used to predict the histology by FICE. In a post hoc analysis, further endoscopic markers were also explored. Two hundred and five lesions (mean size, 8 mm; range, 2 to 30 mm) from 59 patients (mean age, 56 y; range, 21 to 79 y) were analyzed. Twenty-three neoplastic (11%), 18 hyperplastic (9%), and 164 inflammatory (80%) lesions were found. Thirty-one lesions (15%), none of which were neoplastic, were unclassifiable according to Kudo. After logistic regression, a strong negative association resulted between endoscopic activity and neoplasia, whereas the presence of a fibrin cap was significantly associated with endoscopic activity. Using FICE, the sensitivity, specificity, and positive and negative likelihood ratios of the Kudo classification were 91%, 76%, 3.8, and 0.12, respectively. The corresponding values by adding the fibrin cap as a marker of inflammation were 91%, 93%, 13, and 0.10, respectively. FICE can help to predict the histology of raised lesions in UC. A new classification of pit patterns, based on inflammatory markers, should be developed in the setting of UC to improve the diagnostic performance.

Diagnostic value of Fuji intelligent color enhancement on vocal leukoplakia and esophageal diseases

Objective To study the clinical application of Fuji intelligent color enhancement (FICE) on the diagnosis of vocal leukoplakia and esophageal diseases. Methods A total of 50 patients suspected with vocal leukoplakia by electronic laryngoscopy were enrolled for undergoing meticulous examination of vocal cords and esophagus using FICE from January 2014 to January 2016. The diagnostic value of FICE for vocal leukoplakia were analyzed. Results Among the 50 patients, 50 lesions were found using laryngoscopy and 52 lesions were found using FICE. There were significant differences between FICE mode and white light mode on the capillary pattern score and lesion boundary resolution score (all P<0.05). The diagnostic coincidence rate of FICE mode with pathology was higher than that of white light mode[89.4% (42/47) VS 68.1% (32/47), P=0.01]. Among the 50 patients suspected with vocal leukoplakia, 31 combined with gastroesophageal reflux disease, and were given proton-pump inhibitor treatment. In the follow-up after three months, lesions of 16 cases alleviated, 13 cases disappeared, and 2 cases had no significant changes. Conclusion FICE has a higher clinical value than conventional laryngoscopy and white light endoscopy on the diagnosis of vocal leukoplakia. Key words: Endoscopy; Diagnosis; Fuji intelligent color enhancement; Vocal leukoplakia; Esophageal diseases

Tri-Scan: A Three Stage Color Enhancement Tool for Endoscopic Images.

Modern endoscopes play a significant role in diagnosing various gastrointestinal (GI) tract related diseases where the visual quality of endoscopic images helps improving the diagnosis. This article presents an image enhancement method for color endoscopic images that consists of three stages, and hence termed as "Tri-scan" enhancement: (1) tissue and surface enhancement: a modified linear unsharp masking is used to sharpen the surface and edges of tissue and vascular characteristics; (2) mucosa layer enhancement: an adaptive sigmoid function is employed on the R plane of the image to highlight micro-vessels of the superficial layers of the mucosa and submucosa; and (3) color tone enhancement: the pixels are uniformly distributed to create an enhanced color effect to highlight the subtle micro-vessels, mucosa and tissue characteristics. The proposed method is used on a large data set of low contrast color white light images (WLI). The results are compared with three existing enhancement techniques: Narrow Band Imaging (NBI), Fuji Intelligent Color Enhancement (FICE) and i-scan Technology. The focus value and color enhancement factor show that the enhancement level achieved in the processed images is higher compared to NBI, FICE and i-scan images.

Endoscopic Submucosal Dissection for Early Gastric Cancer Using Endoscopy With Fuji Intelligent Color Enhancement

Demarcation of early gastric cancers is sometimes unclear. Indigo carmine chromoendoscopy has usually been used as a diagnostic method for tumor margins as it enhances mucosal irregularities and differences in color. Fuji Intelligent Color Enhancement (FICE), a recently developed virtual chromoendoscopic system, can explore the entire mucosal surface (of structures and vessels). Here we report a case of a patient with early gastric cancer who underwent a successful endoscopic submucosal dissection (ESD) using endoscopy with FICE. A 58-year-old man with early gastric cancer underwent an ESD. Demarcation of the lesion was not clear through normal endoscopy. Therefore, an endoscopy was performed with FICE, which clearly revealed the demarcation. An ESD was carried out after spots were marked circumferentially. We identified the positional relationship between the demarcation and all markings on the magnifying model. A resection of the lesion was performed on the area outside the markings. Finally, the lesion was Histopathologically diagnosed as a well-differentiated adeno-carcinoma confined in the mucosal region, and the margins were free from carcinoma. FICE, especially combined with the magnifying model, is useful in the identification of the demarcation of early gastric cancer. This method may be useful in increasing the rate of complete resection by ESD for early gastric cancer.

Fuji intelligent color enhancement chromoendoscopy for diagnosis of early gastric cancer

Objective To evaluate Fuji intelligent color enhancement （FICE） chromoendoscopy for diagnosis of early gastric cancer. Methods From February 2010 to March 2011, a total of 67 patients with suspected gastric mucosal lesions were enrolled in this study. The lesions were observed with magnifying endoscopy, FICE, magnifying chromoendoscopy and indigo-carmine-magnifying-chromoendoscopy. Suspected gastric mucosal pit patterns and microvascular morphology were compared. Targeted biopsy was performed on suspected locations. Sensitivity, specificity and pathological consistency were compared be- tween the 3 procedures. Results Out of 67 patients, 17 were diagnosed as having early gastric cancer. There was no difference among magnifying endoscopy, FICE magnifying chromoendoscopy and indigo-carmine-magnifying-chromoendoscopy in pit pattern findings, however, FICE magnifying chromoendoscopy was superior to other 2 procedures in displaying capillary loop. The sensibility, specificity and pathological accordance rate of FICE magnifying chromoendoscopy were 94. 1% （16/17）, 98.0% （49/50）and 97.0% （65/67）, which were higher than those of the magnifying endoscopy [ 58.8% （10/17）, 84% （42/50） and 77.6% （52/67） ] （P 〈0. 05）, and were not different from those of indigo-carmine-magnifying-chromoendoscopy [ 88.2% （ 15/17）, 96% （48/50） and 94.0% （63/67） ] （P 〉 0. 05 ）. Conclusion FICE magnifying chromoendoscopy provides rather clear images of gastric mucosa and intrapapillary capillary, thereby improving the accuracy of endoscopic biopsy and then imporving the diagnosis rate of early gastric cancer. Key words: Magnifying endoscopy; Indigo-carmine-magnifying-chromoendoscopy; Early gastriccancer; Fuji intelligent color enhancement magnifying chromoendoscopy

A study on the diagnosis of minimal endoscopic lesions in nonerosive reflux esophagitis using computed virtual chromoendoscopy (FICE)

Gastroesophageal reflux disease is very prevalent in the world. Endoscopically it can be classified as nonerosive when there is no mucosal erosive lesion on endoscopy. The presence of endoscopic minimal lesions is included in the Los Angeles classification for reflux disease. Virtual chromoendoscopy Fuji Intelligent Color Enhancement (FICE) is an endoscopic technique that enhances detection of small lesions of the digestive tract. To evaluate whether the use of FICE improves the diagnosis of minimal lesions on endoscopy, and to assess the association of symptoms with minimal lesions in patients with nonerosive reflux disease. One hundred fifty-five patients were enrolled, 62 with typical reflux symptoms and 93 without esophageal symptoms. The patients had normal esophageal endoscopy or minimal lesions. Each patient was examined initially by conventional video endoscopy and then using FICE. Among 155 patients, 113 had a normal conventional endoscopy and 42 had minimal lesions. Sixty-two patients had typical reflux symptoms, and 93 other symptoms unrelated to reflux. In 104 patients, the esophageal mucosa was normal for both conventional endoscopy and FICE, in 42 patients both techniques showed minimal lesions, in 9 patients conventional endoscopy was normal and minimal lesions were shown by FICE. The height and circumference of minimal lesions were greater using FICE than that measured by conventional endoscopy. There was a significant association of the presence of minimal lesions with male gender, but not with alcoholism, smoking, anti-inflammatory drugs and age. The diagnosis of minimal lesions was observer-dependent, both in conventional endoscopy as using FICE. The use of FICE improves the diagnosis of minimal lesions as compared to conventional videoendoscopy, although this diagnosis remains observer-dependent. There was no association between the presences of minimal lesions with reflux symptoms.

Differentiating Small Polyp Histologies Using Real-Time Screening Colonoscopy With Fuji Intelligent Color Enhancement

There are limited data describing the performance of Fuji Intelligent Color Enhancement (FICE, EC 590 ZW; Fujinon Inc, Saitama, Japan) for differentiating polyp histologies during screening colonoscopy. We evaluated the ability of an endoscopist to diagnose small polyp histology during a screening colonoscopy using FICE. A prospective study was performed on 763 consecutive, asymptomatic subjects who were undergoing screening colonoscopy. Pit patterns and vascular patterns were used to predict the histology of 525 polyps (mean size, 4.5 ± 2.2 mm, 315 adenomas) of less than 10 mm using FICE with high magnification and without. The performances of the FICE analyses were calculated and compared with the results from the histopathology. The overall accuracy achieved by FICE with high magnification in the diagnosis of adenomas of less than 10 mm (87.0%) was significantly greater than that achieved without high magnification (80.4%; P < .05). Moreover, the improvement of accuracy attained when using high-magnification FICE was most pronounced and significant compared without using high-magnification FICE in the diagnosis for diminutive polyps (≤5 mm; 85.4% vs 79.1%; P < .05). Among all types of adenomas, the sensitivity of FICE was lowest for sessile serrated adenomas (38.5% vs 89.4%; P < .01), even when FICE was used with high magnification. FICE with high magnification is better for differentiating the histology of small polyps during screening colonoscopy than FICE without high magnification, especially for diminutive polyps. Large-scale studies are needed to improve the identification of serrated adenomas and small diminutive polyps using FICE.

Efficacy of computed virtual chromoendoscopy on colorectal cancer screening: a prospective, randomized, back-to-back trial of Fuji Intelligent Color Enhancement versus conventional colonoscopy to compare adenoma miss rates

Colonoscopy is the criterion standard for screening of colorectal neoplasms. Nonetheless, a substantial miss rate with conventional, white-light colonoscopy (WL) remains a challenge. To assess whether Fuji Intelligent Color Enhancement (FICE) can detect more adenomas than WL in screening colonoscopy. Prospective, randomized trial of tandem colonoscopy adjusted for withdrawal time and lavage effect. Seoul National University Hospital Healthcare System Gangnam Center, Korea. This study involved 359 average-risk adults undergoing screening colonoscopy. Patients were randomized to the first withdrawal with either FICE (FICE-WL group) or WL (WL-FICE group). The primary end point measure was the difference in adenoma miss rates, and the secondary outcome measure was the adenoma detection rate. We enrolled 359 patients (mean age 50.6 years, male 66.9%) and randomly assigned 181 to the WL-FICE group and 178 to the FICE-WL group. The number of adenomas detected by FICE and WL was 123 and 107, respectively. The adenoma miss rate with FICE showed no significant difference compared with that of WL (6.6% vs 8.3%, P = .59). Characteristics of lesions missed by use of FICE were similar to those missed by use of WL; 93% of overall missed polyps were < or =5 mm, and none were > or =1 cm. All missed adenomas were low grade and nonpedunculated. There was no significant difference between FICE and WL in adenoma detection rate (mean 0.64 vs 0.55 per patient, P = .65) nor percentage of patients with > or =1 adenoma (33.7% vs 30.4%, P = .74). Single-center study. FICE at screening colonoscopy did not improve the adenoma miss rate or detection rate compared with WL.

M1534: Efficacy of Computed Virtual Chromoendoscopy on Colorectal Cancer Screening: A Prospective Randomized Back-to-Back Trial of Fuji Intelligent Color Enhancement vs Conventional Colonoscopy to Compare Adenoma Miss Rates

M1534: Efficacy of Computed Virtual Chromoendoscopy on Colorectal Cancer Screening: A Prospective Randomized Back-to-Back Trial of Fuji Intelligent Color Enhancement vs Conventional Colonoscopy to Compare Adenoma Miss Rates

Preliminary Study of Ultraslim Endoscopy with Fuji Intelligent Color Enhancement (FICE) for Diagnosis of Superficial Upper Gastrointestinal Neoplasms

Preliminary Study of Ultraslim Endoscopy with Fuji Intelligent Color Enhancement (FICE) for Diagnosis of Superficial Upper Gastrointestinal Neoplasms

Estudo comparativo entre MBI (FICE®) e a magnificação com índigo-carmin no diagnóstico diferencial de lesões neoplásicas e não-neoplásicas de cólon e reto

Multiband imaging (MBI)/Fuji Intelligent Color Enhancement (FICE) is a spectral image processing technology that helps in vivo diagnosis of colorectal neoplasias. To compare the diagnostic accuracy of the magnification with either the electronic chromoendoscopy or indigo carmine dye in the differential diagnosis of neoplastic and non-neoplastic colorectal lesions. Seventy five patients with 157 colorectal lesions were prospectively evaluated. The capillary pattern, as well as the pit pattern according to the Kudo classification, of colorectal lesions were evaluated by means of the FICE system. Absence and presence of meshed capillary networks were labeled as non-neoplastic and neoplastic lesions, respectively. Afterwards, indigo carmine 0.8% was instilled and a new evaluation of the pit pattern was carried out. One hundred and sixteen of the 157 lesions were classified as positive meshed capillary network, 115 of them were confirmed histologically as neoplasia. Other 32 lesions out of 41 with negative meshed capillary network were non-neoplastic. Sensitivity, specificity and accuracy were, respectively, 92.7%, 97% and 93.6%. Pit patterns I and II were confirmed as non-neoplastic lesions, and patterns III to V were confirmed as neoplasias. Sensitivity, specificity and accuracy for the electronic chromoendoscopy were, respectively, 94.4%, 97% and 94.9%. Meanwhile, the figures for the magnification with indigo carmine were, respectively, 97.6%, 93.9% and 96.8%. Both methods, either the MBI/FICE system or the use of indigo carmine dye with magnification, achieved a high accuracy for the differential diagnosis between neoplastic and non-neoplastic colorectal lesions.

Optimal band imaging system: a new tool for enhancing the duodenal villous pattern in celiac disease

The optimal band imaging (OBI) system is a new technology that can select better spectral images decomposed from ordinary endoscopic images. This technology, first introduced as "FUJI Intelligent Color Enhancement," enhances the contrast of the mucosal surface without the use of dyes. This study aimed to evaluate the potential of OBI for predicting the duodenal villous morphologic characteristics in patients with suspected celiac disease. This study was designed as an open, prospective, single-center trial. Duodenoscopy was performed with a high-resolution magnification view, in association with OBI spectral processing. Duodenal villous patterns were evaluated and classified as normal, partially atrophic, or markedly atrophic. The endoscopic results were then compared with the histologic diagnosis. Endoscopy unit at the A. Gemelli University Hospital of Rome, Italy. Sixty-one patients undergoing upper endoscopy for clinical history of malabsorption or serologic suspicion for celiac disease were included in the study. From OBI sets using red, green, and blue wavelength combinations that ranged from 400 to 580 nm, the endoscopist was able to find marked villous atrophy of the duodenum in 16 subjects, partial villous atrophy in 9 subjects, and normal villi in the remaining 36 subjects. The sensitivity, specificity, and positive and negative predictive values of the OBI-based duodenoscopy were 100% accurate in the evaluation of villous patterns. High-resolution magnification endoscopy with OBI allows clear visualization of the duodenal villous pattern. The OBI system may play a potential role in optimizing the diagnostic accuracy of endoscopy in celiac disease.

Evaluation and Validation of Fuji Intelligent Color Enhancement in Superficial-Type Early Gastric Cancer

Introduction: Fuji Intelligent Color Enhancement (FICE) (Fujinon, Saitama, Japan) spectral estimation technology allows selection of spectral reflectance of a dedicated wavelength and is based on arithmetical processing by a spectral estimation matrix processing circuit of ordinary images taken from a video endoscope. The aim of this study was to investigate the usefulness of FICE in the assessment of superficial-type early gastric cancer. Methods: During the period September 2005 through December 2006, a total of 100 patients with superficial-type early gastric cancer who underwent endoscopic or surgical resection at Hiroshima University Hospital were analyzed. The instruments used in this study were a video endoscope system (VP-4400 and EG-590WR/ZW: Fujinon). The FICE process was performed at the following wavelengths: R, 530 nm; G, 455 nm; B, 455 nm. After the white-light endoscopic examination, we performed FICE endoscopic examination of a similar visual field. We scored the demarcation between cancer and normal mucosa for white-light and FICE observation, both without magnification, as follows: 1, demarcation between cancer and normal mucosa is unclear; 2, between 1 and 3; and 3, demarcation between cancer and normal mucosa is clear. Results: Observation of gastric cancer by FICE was improved from that of white-light endoscopy in 46 (46%) cases, was unchanged in 54 (54%) cases, and there was no decrement cases (0%). According to color of cancer, FICE improved observation from that of white-light endoscopy in 40% of whitish cases, 33.3% of same color cases, and 54.4% of reddish cases (Table 1). According to histologic type, FICE improved observation from that of white-light endoscopy in 48.7% of differentiated and 36.4% of undifferentiated cases (Table 2). Conclusion: FICE delineates superficial gastric cancer more easily than does white-light endoscopy and facilitates detection of changes in superficial type-gastric cancer. Table 1Change of endoscopic image with use of the FICE according to color of cancer Improvement Unchanged Decrement Whitish 4 (40%) 6 (60%) 0 (0%) Same 11 (33.3%) 22 (66.7%) 0 (0%) Reddish 31 (54.4%) 26 (45.6%) 0 (0%) Open table in a new tab Table 2Change of endoscopic image with use of the FICE according to histologic type Improvement Unchanged Decrement Differentiated 38 (48.7%) 40 (51.3%) 0 (0%) Undifferentiated 8 (36.4%) 22 (63.6%) 0 (0%) Open table in a new tab

Computed virtual chromoendoscopy system (FICE): A new tool for upper endoscopy?

A newly developed computed virtual chromoendoscopy system, Fuji Intelligent Color Enhancement (FICE) technology, decomposes images by wavelength, then directly produces reconstructed images with enhanced mucosal surface contrast. The aims of the present study were to determine the quality of information provided by computed virtual chromoendoscopy for detecting gastrointestinal polyps and to identify the best channel setting for imaging. Thirty-one upper endoscopy procedures were performed in 31 patients using Fujinon 1.3-million-pixel endoscopes with zoom. A polyp was diagnosed in 45% of the patients. Six experienced endoscopists, who had never used the computed virtual chromoendoscopy system before, analysed the 31 endoscopy reports. Each endoscopy report included 11 images (one conventional image and one image for each FICE channel). The endoscopists used a 10-cm analog visual scale to determine the three best FICE channels, and to evaluate the quality and pit pattern of the chromoendoscopy images. Channel 4 (red: 520; green: 500; blue: 405) was considered the best channel in 39.7% of the reports (p<0.0001) and was among the best three in 77%. For 94.1% of the reports, the best FICE channel image was considered superior to the conventional image (p<0.0001). Median pit pattern score was 9.43 for computed virtual chromoendoscopy and 7.08 for conventional endoscopy (p<0.001). Fuji Intelligent Color Enhancement (FICE) channel 4 images were significantly better than conventional images. Computed virtual chromoendoscopy enabled better analysis of the pit pattern and the normal-pathological mucosal junction. Computed virtual chromoendoscopy can be used to identify gastroduodenal polyps and to assist in complete polypectomy.

Magnifying endoscopy in the diagnosis of Barrett's esophagus and Barrett's adenocarcinoma

Magnifying endoscopy with dye or acetic acid is useful for evaluating mucosal surface patterns in patients with Barrett's epithelium. Barrett's epithelium can be diagnosed on the basis of the presence of translucent longitudinal vessels. Specialized intestinal metaplasia frequently occurs in villous- or gyrus-type mucosa. Superficial Barrett's adenocarcinoma is associated with irregularities or destruction of mucosal surface patterns. Magnifying endoscopy combined with optical chromoendoscopy by new techniques for enhancement of vascular images, such as narrow-band imaging (NBI) and Fuji intelligent color enhancement (FICE), may further improve diagnostic accuracy. Irregularly arranged abnormal vessels appear in cancerous lesions. However, classification systems for characteristic vascular patterns have not been established. Whether vascular patterns are useful for diagnosing cancers with mild atypia remains an open question.