Fujinon Intelligent Chromoendoscopy Research Articles

Impact of Electronic Chromoendoscopy on Adenoma Miss Rates During Colonoscopy: A Systematic Review and Meta-analysis

The impact of virtual chromoendoscopy such as narrow-band imaging, Fujinon intelligent chromoendoscopy, blue-light imaging, linked-color imaging, and i-SCAN on adenoma detection rate has been variable. However, adenoma miss rate (another measure suggested as a quality indicator) of electronic chromoendoscopy modalities has not been systematically evaluated. This study aimed to perform a systematic review and meta-analysis to examine the adenoma miss rate of white-light endoscopy compared with electronic chromoendoscopy. Medline, Embase, Scopus, Web of Knowledge, and Cochrane were the data sources for this study. The studies selected were tandem randomized controlled trials of electronic chromoendoscopy modalities compared with white-light endoscopy. Electronic chromoendoscopy compared with white light endoscopy was used to measure the adenoma miss rate. Primary outcome was the pooled adenoma miss rate of electronic chromoendoscopy techniques compared with white-light endoscopy. Secondary outcomes were subgroup analysis, adenoma size analysis, and adenoma detection rate. A total of 3507 patients were evaluated from 7 eligible tandem randomized control trials. A total of 1423 patients had white-light endoscopy as the first of the tandem examinations. The rest of the patients had electronic chromoendoscopy as the first of the tandem examination (narrow-band imaging, 988 patients; Fujinon intelligent chromoendoscopy, 728 patients; i-SCAN, 233 patients; blue-light imaging, 64 patients; and linked-color imaging, 71 patients). The pooled adenoma miss rate for electronic chromoendoscopy was not different than white-light endoscopy (17.9% vs 21%; OR, 0.72 (0.67-1.11); I 67%; p = 0.13). When only narrow-band imaging, blue-light imaging, and linked-color imaging were considered, the pooled rate was statistically significant (OR, 0.60 (0.37-0.98); p = 0.04). The pooled adenoma detection rate was not statistically different with electronic chromoendoscopy than white-light endoscopy (OR, 1.02 (0.88-1.19); p = 0.78). The small number of studies to assess the impact of each modality limited stratified conclusions. Electronic chromoendoscopy is not associated with a significant reduction in adenoma miss rate compared with white-light colonoscopy.

Specific computed virtual chromoendoscopy for detection of peritoneal carcinomatosis: an animal study.

Detection of an incipient Peritoneal Carcinomatosis (PC) is still challenging, and there is a crucial need for technological improvements in order to diagnose and to treat early this condition. The aim of this study was to create a murine model of incipient PC and to explore the PC with Fujinon Intelligent Chromo Endoscopy (FICE) in order to determine the wavelengths of the white light (WL) spectre that offer the highest contrast between PC nodules and surrounding peritoneum. Eighteen BALB/c mice had intraperitoneal injection of murine colonic cancer CT26 cells. Peritoneal exploration with FICE was performed at different times. For each PC nodule, 1 WL and 10 FICE images were recorded. Each image was then divided into its elementary red, green and blue band images. Depending on the FICE channel, each elementary image corresponds to a specific wavelength of the WL spectre. Through numerical analysis of these images, the value of the nodule and the background peritoneum were obtained, and the contrast value was calculated. Contrast values obtained with the different wavelengths were then compared. PC grew in all the mice. The number as well as the size of PC nodules was increasingly high depending on the day of exploration. Mean PCI was 1.6 ± 1.2 at day 5, 7.7 ± 2.6 at day 8 and 15.0 ± 7.3 at day 10. A total number of 1805 elementary images of PC nodules were analysed. The wavelength that offered the best contrast between PC nodules and background peritoneum was 460nm with a mean contrast value of 0.240 ± 0.151 (p < 0.0001). This murine model of incipient PC is effective, reliable and reproducible. A monochromatic light with a wavelength at 460nm offers the highest contrast between PC nodules and background peritoneum, allowing a better detection of PC.

A feasibility study of the use of computed virtual chromoendoscopy for laparoscopic evaluation of peritoneal metastases.

Detection of an incipient peritoneal carcinomatosis (PC) is still challenging, and there is a crucial need for technological improvements in order to diagnose and to treat early this condition. Fujinon Intelligent Chromo Endoscopy (FICE) is a spectral image processing technology that enhances the contrast of the target tissue. The aim of this study is to investigate the usefulness of FICE system during peritoneal endoscopy and to establish the optimal FICE preset(s) for peritoneal exploration and PC detection. A total of 561 images corresponding to 51 different areas of PC nodules and normal peritoneum were recorded during peritoneal endoscopies (For each area, one white light endoscopy (WLE) image and 10 FICE images). Three groups of 5 evaluators each: senior surgeons, surgical residents and medical students assessed these images. In a first questionnaire, the evaluators gave a score ranging from 1 to 10 to each image, and the three best FICE channels were determined. In a second questionnaire, five criteria were studied specifically: contrast, brightness, vascular architecture, differentiation between organs and detection of PC. The evaluators ranked the WLE and the three best FICE channel images according to these criteria. The three best FICE channels were channels 6, 2 and 9 with mean scores of 6.21±1.59, 6.17±1.48 and 6.06±1.52, respectively. FICE Channel 2 was superior to WLE and other FICE channels, in terms of contrast (p<10-4), visualization of vascular architecture (p<10-4), differentiation between organs (p<10-4) and detection of PC (p<10-4); and ranked first in 38.8, 41.5, 31 and 46.9% of the cases, respectively. FICE system provides adequate illumination of the abdominal cavity and a unique contrast that enhances the vascular architecture. FICE Channel 2 is the optimal channel for peritoneal exploration and could be a useful tool for the diagnosis of PC during peritoneal explorations.

Endoscopic evaluation of celiac disease.

Although serology-based diagnosis of celiac disease (CD) in children recently has been legitimized 1, small bowel biopsy remains the gold standard for diagnosis of the condition 2 3. Upper endoscopy, therefore, takes on paramount importance in management of CD for several reasons, including serendipitous discovery of endoscopic markers of CD, assessment of “patchy” villous atrophy, targeting of biopsy sampling, and evaluation of CD-related complications. Macroscopic markers of CD, estimable with white light endoscopy, include the “scalloped” appearance of duodenal folds, nodular pattern of the mucosa (the so-called “mosaicism”), evidence of submucosal vessels, and epithelial fissurations 4. The diagnostic accuracy of these findings is largely variable, according to different reports 5 6, and they are associated with a significant rate of underdiagnosis of CD 7 8. Because standard endoscopy is unreliable, other endoscopic tools have been investigated for diagnosis opf CD, which fall into two categories based on their working principle: machine-independent techniques and machine-dependent techniques; the latter include software- and hardware-dependent techniques 9 10. The water-immersion technique (WIT) and dye-staining chromoendoscopy and machine-independent. Software-dependent techniques include Narrow-Band Imaging (optical dye-less chromoendoscopy), Fujinon Intelligent Chromo Endoscopy (virtual dye-less chromoendoscopy) and i-SCAN, which are dyeless chromoendoscopy tools. Hardware-dependent techniques such as optical coherence tomography, confocal laser endomicroscopy, video capsule endoscopy, and enteroscopy can be performed only with dedicated tools that are different from regular gastroscopes, or with the use of probes 9 10. The combination of these techniques has been suggested to improve the detection of duodenal villous abnormalities 11. In this issue of Endoscopy International Open, Iacucci et al 12 present a retrospective cohort study of 58 patients with clinical suspicion of CD and positive serology testings who underwent upper endoscopy and duodenal evaluation with both white light endoscopy (WLE) and a combination of i-SCAN and WIT (iSCAN-HDWI). The duodenal view was respectively classified as normal, reduction of folds, mosaic pattern, scalloping and atrophy with visible vessels with WLE, and as normal, mild, moderate, patchy or severe villous atrophy with iSCAN-HDWI. The authors found a significant correlation between the endoscopic grade evaluated by iSCAN-HDWI and the histology score. Assessment with WLE showed a lower but significant grade of correlation. In particular, iSCAN-HDWI achieved 96 % sensitivity, 63 % specificity, and 100 % accuracy for predicting duodenal damage (excluding Marsh I lesions), whereas WLE showed 78 % sensitivity, 50 % specificity, and 72 % accuracy for the same gold standard. Respectively, WLE identified no abnormalities in 55.6 % of patients diagnosed with patchy villous atrophy and in 33.3 % of patients diagnosed with mild villous atrophy after iSCAN-HDWI evaluation. WIT is an easy technique that allows real-time enhancement of duodenal villous pattern during upper endoscopy. After aspiration of air from the duodenal lumen, the operator injects 100 mL to 150 mL of water to highlight villi 13. WIT achieved high levels of accuracy in diagnosing total villous atrophy (TVA), with only slightly less accurate results in identifying partial villous atrophy (PVA) 14 15 16 17. i-SCAN is a digital tool developed by Pentax Medical. It enhances images through three different modalities: contrast enhancement, which highlights mucosal abnormalities, particularly those of depressed areas; surface enhancement, which increases contrast between light and dark; and tone enhancement, which groups and recombines blue, red, and green components of images. i-SCAN produced results similar to WIT in assessment of TVA and PVA 18. The combination of iSCAN technology with WIT both highlights vascular and mucosal pattern and allows direct visualization of villi. Such a “joint-venture” can be of help in evaluating the duodenal villous pattern, especially in the case of partial or patchy villous atrophy, and in targeting biopsy sampling; therefore, it is advocated to decrease the number of CD misdiagnoses and related unnecessary costs. Further studies, combining other modalities for imaging enhancement, are therefore welcome to improve our knowledge of the diagnostic potential of endoscopic tools in CD.

Dieulafoy's lesion: new diagnosis using high-definition endoscopy and treatment with isoamyl-2-cyanoacrylate (Amcrylate)

Dieulafoy's lesion (DL) is a rare but important cause of gastrointestinal (GI) bleeding, accounting for up to 6% of the cases of nonvariceal bleeding in the upper GI tract and 1–2% of all GI hemorrhages. Mortality rates are similar to those of other causes for GI bleeding. Following our strategy, an expert endoscopist with a skilled assistant should have a high rate of successful DL diagnosis when an obscured GI lesion is suspected. In our seven-case study, we think it was feasible to use high-definition Fujinon intelligent chromoendoscopy to diagnose DL. Isoamyl-2-cyanoacrylate (Amcrylate) was effective and safe for treating DL as well as were other strategies, including ethanolamine oleate, band ligation, and n -butyl-2-cyanoacrylate. Surgical wedge resection of the lesion should be considered as a therapeutic option if endoscopic therapy fails.

A mobile medical QR-code authentication system and its automatic FICE image evaluation application

This paper presents an adaptive imaging technique run on a mobile service system for endoscopic image enhancement by using color transform and Gray Level Co-occurrence Matrices (GLCM) for a single input endoscopy image. The method is simply deal with the color image channels combination which chose the maximum scalar values of red, green and blue channel images, respectively. The GLCM subsequently applied for selecting the highest contrast and entropy images of the expanding image series. The enhanced endoscopy image is generated by fusing of the color, contrast and entropy images. We also proposed a service system with medical image retrieval application via quick response code authentication based on the Android operating system, which helps clinicians convenient in using mobile phone and reviewing images of the patient with cost efficiency. For the mobile technologies are growing rapidly, the mobile service system is installed to connect a Picture Archive and Communication Systems (PACS) system in hospital and applied for automatic evaluation of colon images screening. The experimental results show the proposed system is efficient for observing gastrointestinal tract polyp. The performance is evaluated and compared with Fujinon intelligent chromo endoscopy enhanced method. All Rights Reserved © 2015 Universidad Nacional Autonoma de Mexico, Centro de Ciencias Aplicadas y Desarrollo Tecnologico. This is an open access item distributed under the Creative Commons CC License BY-NC-ND 4.0.

Value of magnifying endoscopy combined with Fujinon intelligent chromoendoscopy in diagnosis of flat gastric lesions

Value of magnifying endoscopy combined with Fujinon intelligent chromoendoscopy in diagnosis of flat gastric lesions

Colonic polyps: is it useful to characterize them with advanced endoscopy?

There have been major developments in endoscopic imaging techniques in recent years. Endoscopes with high definition and magnification can provide high quality images that allow for the histological estimation of lesions in vivo and in situ when combined with ancillary enhancement techniques such as chromoendoscopy (CE) and virtual CE (narrow band imaging fujinon intelligent chromoendoscopy, or i-Scan). Despite the enormous potential for these advanced techniques, their value and feasibility in the clinic are still doubted, particularly in cases of colonic polyps that are slated for removal, where in vivo characterization may be deemed unnecessary. However, there are several advantages offered by such advanced endoscopic imaging. CE with or without magnification demonstrates highly accurate histology and invasion depth prediction, and virtual CE is a feasible and less cumbersome alternative to CE in terms of histological estimation, though not sufficiently accurate for depth invasion prediction. Furthermore, the supplementary information provided by advanced imaging systems can assist the endoscopist in the selection of a strategic approach, such as in deciding whether a colonic lesion should be resected, left in situ, or requires more intensive surgical treatment. Lastly, advanced high-resolution imaging techniques may be more cost effective, such that histopathology of low-risk lesions following resection can be eliminated. The results of these evaluations and comparisons with traditional CE are presented and discussed. Taken together, the benefits provided by these advanced capabilities justify their development, and advocates their use for the treatment and management of colonic polyps.

Diagnostic performance of narrowed spectrum endoscopy, autofluorescence imaging, and confocal laser endomicroscopy for optical diagnosis of colonic polyps: a meta-analysis

Novel endoscopic technologies could allow optical diagnosis and resection of colonic polyps without histopathological testing. Our aim was to establish the sensitivity, specificity, and real-time negative predictive value of three types of narrowed spectrum endoscopy (narrow-band imaging [NBI], image-enhanced endoscopy [i-scan], and Fujinon intelligent chromoendoscopy [FICE]), confocal laser endomicroscopy (CLE), and autofluorescence imaging for differentiation between neoplastic and non-neoplastic colonic lesions. We identified relevant studies through a search of Medline, Embase, PubMed, and the Cochrane Library. Clinical trials and observational studies were eligible for inclusion when the diagnostic performance of NBI, i-scan, FICE, autofluorescence imaging, or CLE had been assessed for differentiation, with histopathology as the reference standard, and for which a 2 × 2 contingency table of lesion diagnosis could be constructed. We did a random-effects bivariate meta-analysis using a non-linear mixed model approach to calculate summary estimates of sensitivity and specificity, and plotted estimates in a summary receiver-operating characteristic curve. We included 91 studies in our analysis: 56 were of NBI, ten of i-scan, 14 of FICE, 11 of CLE, and 11 of autofluorescence imaging (more than one of the investigated modalities assessed in eight studies). For NBI, overall sensitivity was 91·0% (95% CI 88·6-93·0), specificity 85·6% (81·3-89·0), and real-time negative predictive value 82·5% (75·4-87·9). For i-scan, overall sensitivity was 89·3% (83·3-93·3), specificity 88·2% (80·3-93·2), and real-time negative predictive value 86·5% (78·0-92·1). For FICE, overall sensitivity was 91·8% (87·1-94·9), specificity 83·5% (77·2-88·3), and real-time negative predictive value 83·7% (77·5-88·4). For autofluorescence imaging, overall sensitivity was 86·7% (79·5-91·6), specificity 65·9% (50·9-78·2), and real-time negative predictive value 81·5% (54·0-94·3). For CLE, overall sensitivity was 93·3% (88·4-96·2), specificity 89·9% (81·8-94·6), and real-time negative predictive value 94·8% (86·6-98·1). All endoscopic imaging techniques other than autofluorescence imaging could be used by appropriately trained endoscopists to make a reliable optical diagnosis for colonic lesions in daily practice. Further research should be focused on whether training could help to improve negative predictive values. None.

Real-Time Endoscopic Pathology Assessment of Colorectal Polyps

Determining the pathology of colorectal polyps in real-time has been the subject of many studies. Polyp pathology has been estimated using white light endoscopy, narrow band imaging with and without optical magnification, the Fujinon Intelligent Chromo Endoscopy system, the Pentax i-scan, confocal laser microscopy, autofluorescence, and the endocytoscopy system. Nearly all the technologies have had a substantial degree of success, with the largest number of studies performed using narrow band imaging. The persistent and nagging question is whether the use of these technologies can have an impact on everyday clinical practice, because, althoughtheyhavebeenavailableinsomecasesfor morethan a decade, they currently do not have a meaningful role in routine endoscopic practice. Numerous obstacles to the implementation of real-time pathology in practice are still present. These include lack of reimbursement, and consequently a lack of motivation for many endoscopists. Second, in many locations, all surgically removedtissuemustbesentforpathologicevaluation.Finally,

Endoscopic tools for the diagnosis and evaluation of celiac disease

Celiac disease (CD) is an autoimmune disease of the small bowel induced by ingestion of wheat, rye and barley. Current guidelines indicate histological analysis on at least four duodenal biopsies as the only way to diagnose CD. These indications are based on the conception of the inability of standard endoscopy to make diagnosis of CD and/or to drive biopsy sampling. Over the last years, technology development of endoscopic devices has greatly ameliorated the accuracy of macroscopic evaluation of duodenal villous pattern, increasing the diagnostic power of endoscopy of CD. The aim of this paper is to review the new endoscopic tools and procedures proved to be useful in the diagnosis of CD, such as chromoendoscopy, Fujinon Intelligent Chromo Endoscopy, Narrow Band Imaging, Optical Coherence Tomography, Water-Immersion Technique, confocal laser endomicroscopy, high-resolution magnification endoscopy, capsule endoscopy and I-Scan technology.

Small-bowel capsule endoscopy: a ten-point contemporary review.

The introduction of capsule endoscopy (CE) in clinical practice increased the interest for the study of the small-bowel. Consequently, in about 10 years, an impressive quantity of literature on indications, diagnostic yield (DY), safety profile and technical evolution of CE has been published as well as several reviews. At present time, there are 5 small-bowel capsule enteroscopy (SBCE) models in the worldwide market. Head-to-head trials have showed in the great majority of studies comparable results in terms of DY, image quality and completion rate. CE meta-analyses formed the basis of national/international guidelines; these guidelines place CE in a prime position for the diagnostic work-up of patients with obscure gastrointestinal bleeding, known and/or suspected Crohn's disease and possible small-bowel neoplasia. A 2-L polyethylene glycol-based purge, administered the day before the procedure, is the most widely practiced preparation regimen. Whether this regimen can be further improved (i.e., by further decreasing its volume, changing the timing of administration, coupling it with prokinetics and/or other factors) or if it can really affect the DY, is still under discussion. Faecal calprotectin has been used in SBCE studies in two settings: in patients taking non-steroidal anti-inflammatory drugs, to evaluate the type and extent of mucosal damage and, more importantly from a clinical point of view, in patients with known or suspected Crohn's disease for assessment of inflammation activity. Although there is still a lot of debate around the exact reasons of SBCE poor performance in various small-bowel segments, it is worth to remember that the capsule progress is non-steerable, hence more rapid in the proximal than in lower segments of the small-bowel. Capsule aspiration, a relatively unexpected complication, has been reported with increasing frequency. This is probably related with the increase in the mean age of patients undergoing CE. CE video review is a time-consuming procedure. Therefore, several attempts have been made to develop technical software features, in order to make CE video analysis easier and shorter (without jeopardizing its accuracy). Suspected Blood Indicator, QuickView and Fujinon Intelligent Chromo Endoscopy are some of the software tools that have been checked in various clinical studies to date.

Helpfulness of the combination of acetic acid and FICE in the detection of Barrett's epithelium and Barrett's associated neoplasias

To investigate the mucosal morphology in Barrett's oesophagus by chromo and magnifying endoscopy. A prospective pilot study at a tertiary medical centre was conducted to evaluate the use of acetic acid pulverisation combined with virtual chromoendoscopy using Fujinon intelligent chromoendoscopy (FICE) for semiological characterization of the mucosal morphology in Barrett's oesophagus and its neoplastic complications. Upper endoscopy using high definition white light, 2% acid acetic pulverisation and FICE with high definition videoendoscopy were performed in 20 patients including 18 patients who presented with aspects of Barrett's oesophagus at endoscopy examination. Two patients used as controls had normal endoscopy and histological results. Prospectively, videos were watched blind from histological results by three trained FICE technique endoscopists. The videos of patients with high-grade dysplasia showed an irregular mucosal pattern in 14% using high definition white light endoscopy and in 100% using acid acetic-FICE combined. Videos did not identify irregular vascular patterns using high definition white light endoscopy, while acid acetic-FICE combined visualised one in 86% of cases. Combined acetic acid and FICE is a promising method for screening high-grade dysplasia and early cancer in Barrett's oesophagus.

Evolving techniques in colonoscopy

This review summarizes recent clinical studies of colonoscopy technique and new technologies. Water immersion reduces pain and sedation doses in unsedated and lightly sedated colonoscopy. Cap-fitted colonoscopy makes insertion faster and improves detection of lesions behind folds, but the latter effect is operator-dependent. A single controlled trial showed improved detection with the Third Eye Retroscope, but the two arms of the study were not controlled for withdrawal time. Chromoendoscopy increases detection of diminutive adenomas, but adds time to the colonoscopy procedure. Electronic chromoendoscopy methods (narrow band imaging, Fujinon Intelligent ChromoEndoscopy, i-scan, and autofluorescence) have been either unsuccessful in improving detection or require more study. However, these methods and several other methods (chromoendoscopy with magnification, confocal laser microscopy, and endocytoscopy) allow accurate real time determination of polyp histology. Water immersion is a clear advance in unsedated colonoscopy. Cap-fitted colonoscopy is a promising method for both practical and effective visualization of the proximal sides of haustral folds. Electronic chromoendoscopy has been largely ineffective at improving polyp detection, but is effective (as are confocal laser microscopy and endocytoscopy) for diagnosis of polyp histology.

Diagnosis of Nonerosive Reflux Disease: High Resolution Magnified Endoscopy and Fujinon Intelligent Chromo Endoscopy (FICE)

Diagnosis of Nonerosive Reflux Disease: High Resolution Magnified Endoscopy and Fujinon Intelligent Chromo Endoscopy (FICE)

Evaluation of Fujinon intelligent chromo endoscopy-assisted capsule endoscopy in patients with obscure gastroenterology bleeding

To investigate the potential benefit of Fujinon intelligent chromo endoscopy (FICE)-assisted small bowel capsule endoscopy (SBCE) for detection and characterization of small bowel lesions in patients with obscure gastroenterology bleeding (OGIB). The SBCE examinations (Pillcam SB2, Given Imaging Ltd) were retrospectively analyzed by two GI fellows (observers) with and without FICE enhancement. Randomization was such that a fellow did not assess the same examination with and without FICE enhancement. The senior consultant described findings as P0, P1 and P2 lesions (non-pathological, intermediate bleed potential, high bleed potential), which were considered as reference findings. Inter-observer correlation was calculated using kappa statistics. Sensitivity and specificity for P2 lesions was calculated for FICE and white light SBCE. In 60 patients, the intra-class kappa correlations between the observers and reference findings were 0.88 and 0.92 (P2), 0.61 and 0.79 (P1), for SBCE using FICE and white light, respectively. Overall 157 lesions were diagnosed using FICE as compared to 114 with white light SBCE (P = 0.15). For P2 lesions, the sensitivity was 94% vs 97% and specificity was 95% vs 96% for FICE and white light, respectively. Five (P2 lesions) out of 55 arterio-venous malformations could be better characterized by FICE as compared to white light SBCE. Significantly more P0 lesions were diagnosed when FICE was used as compared to white light (39 vs 8, P < 0.001). FICE was not better than white light for diagnosing and characterizing significant lesions on SBCE for OGIB. FICE detected significantly more non-pathological lesions. Nevertheless, some vascular lesions could be more accurately characterized with FICE as compared to white light SBCE.

Enhanced mucosal imaging

The continued application of innovative imaging systems to endoscopic procedures has vastly improved the detection of indiscriminant tissue anomalies. This article describes the fundamental principles of these technologies and reviews the advances of each over the past 18 months, considering their utility in the diagnosis and surveillance of various gastrointestinal diseases. Through a combination of novel optics, processors and filters, real-time high-resolution contrast endoscopy provides increased visual data without greater procedure duration or difficulty. Optical contrast techniques incorporated into endoscopes, such as narrow band imaging (Olympus), i-Scan (Pentax), and Fujinon Intelligent Chromo Endoscopy, have become standard of care for many endoscopists. These technologies, as well as autofluorescence imaging, potentially improve detection of mucosal abnormalities, serving as 'red flag' tools for the evaluation of wide areas of mucosa. In addition, a number of promising devices allow virtual histology and in-vivo diagnosis, thereby directing biopsies and potentially guiding concurrent interventions. One such technology, confocal laser endomicroscopy, continues to establish its role in clinical practice. Because of inherent shortcomings affecting each modality's sensitivity and specificity, the coupling of various devices, as with endoscopic trimodal imaging, has shown great promise; however, most are not widely available and not definitively proven to be superior to more established techniques. Emerging technologies, including in-vivo molecular tagging, provide a powerful means of detecting disease without reliance on morphologic diagnostic criteria. Endoscopy continues to evolve from a field that previously allowed only macroscopic imaging dependent on subsequent pathology to one that allows real-time in-vivo diagnosis. Although the promise of enhanced endoscopic technologies seems limitless, practical and technological considerations slow their adoption into the standard of care.

Live Image Processing Does Not Increase Adenoma Detection Rate During Colonoscopy: A Randomized Comparison Between FICE and Conventional Imaging (Berlin Colonoscopy Project 5, BECOP-5)

Fujinon intelligent chromoendoscopy (FICE) is a post-processing imaging technique for increasing contrast of mucosa and mucosal lesions that might lead to improvement in colonic adenoma detection during colonoscopy. Previous studies on similar contrast-enhancing techniques as well as on dye staining have yielded variable and conflicting results. This large randomized trial was undertaken to determine whether FICE technology enhances adenoma detection rate (ADR). In a prospective study performed in a multicenter private practice and hospital setting, involving 8 examiners with substantial lifetime experience (>10,000 colonoscopies each), 1,318 patients (men 46.7%, women 53.3%; mean age 59.05 years) were randomly assigned to colonoscopy with either FICE or white light imaging on instrument withdrawal. Of the colonoscopies, 68% were screening and 32% were diagnostic examinations. The primary outcome measure was the ADR (i.e., number of adenomas/total number of patients). There was no difference between the two groups in terms of general ADR (0.28 in both groups), the total number of adenomas (184 vs. 183), or detection of subgroups of adenomas. The rate of identification of hyperplastic polyps was also the same in both groups (127 vs. 121; P=0.67). The results were the same for both the screening and the diagnostic colonoscopy subgroups. Withdrawal time was the same in both groups (8.4 vs. 8.3 min, P=0.55). This large randomized trial could not show any objective advantage of the FICE technique over conventional high-resolution endoscopy in terms of improved ADR.

Role of Multiband Imaging [Fujinon Intelligent Chromoendoscopy (FICE)] in Patients with Inflammatory Bowel Disease (IBD) and Other Colorectal Lesions: A Pilot Study

Role of Multiband Imaging [Fujinon Intelligent Chromoendoscopy (FICE)] in Patients with Inflammatory Bowel Disease (IBD) and Other Colorectal Lesions: A Pilot Study

Advanced Colon Polypectomy

Advanced Colon Polypectomy