Fujinon Intelligent Color Enhancement Research Articles

A modified fujinon intelligent color enhancement (FICE) in the diagnostics of superficial epithelial neoplasms of the colon

Purpose . To assess the effectiveness of standard and modified settings of the fujinon intelligent color enhancement (FICE) technology in the differential diagnostics of colon epithelial formations including their morphological type. Description of clinical cases . The presented clinical cases demonstrate the effectiveness of FICE modified mode in the endoscopic diagnostics of superficial epithelial neoplasms of the colon. The proposed technique simplifies routine examination and allows to determine a malignization potential of colon epithelial neoplasms. It also allows to determine the morphological type of epithelial formations in the large intestine during endoscopic examination. Conclusion . Fujinon intelligent color enhancement (FICE) technique in a modified mode makes the diagnostics of epithelial formations and selection of curative tactics more precise.

Systematic review with network meta-analysis: endoscopic techniques for dysplasia surveillance in inflammatory bowel disease.

International guidelines recommend dysplasia surveillance in IBD. To compare endoscopic techniques for dysplasia surveillance METHODS: We searched MEDLINE, Embase, CENTRAL for randomised trials through May 2019. We estimated odds ratios (ORs) for binary and mean differences (MDs) for continuous outcomes, using frequentist random-effects network meta-analysis. We assessed study risk of bias and appraised evidence certainty using GRADE. Eighteen trials (2638 participants) were included. Standard definition white-light endoscopy (OR 0.44, 95% CI 0.26-0.73; high certainty) and i-SCAN (OR 0.47, 95% CI 0.25-0.90; moderate certainty) had lower odds of detecting neoplasia than chromoendoscopy. Fujinon intelligent colour enhancement (FICE), standard definition white-light endoscopy and i-SCAN had lower odds for this outcome than full spectrum high definition white-light endoscopy (ORs 0.02 to 0.15; low certainty). Standard definition white-light endoscopy had lower odds of detecting nonpolypoid neoplasia than full spectrum high definition white-light endoscopy, narrow band imaging, chromoendoscopy and high definition white-light endoscopy (ORs 0.01-0.14; moderate certainty). Full spectrum high definition white-light endoscopy ranked as the best technique for both outcomes (moderate certainty). Standard definition white-light endoscopy had lower odds of detecting neoplasia by target biopsy (OR 0.27, 95% CI 0.08-0.91) and had shorter procedure time (MD -14.81minutes, 95% CI -25.03, -4.06) than chromoendoscopy (moderate certainty). Chromoendoscopy, high definition white-light endoscopy, narrow band imaging, autofluorescence, FICE and full spectrum high definition white-light endoscopy may be comparable for dysplasia surveillance. Standard definition white-light endoscopy and i-SCAN probably provide lower yields for neoplasia identification. Full spectrum high definition white-light endoscopy may represent the first-line approach.

Gastric and duodenal polyps in familial adenomatous polyposis patients: Conventional endoscopy vs virtual chromoendoscopy (fujinon intelligent color enhancement) in dysplasia evaluation.

AIMTo test the fujinon intelligent color enhancement (FICE) in identifying dysplastic or adenomatous polyps in familial adenomatous polyposis (FAP) patients.METHODSSeventy-six consecutive FAP patients, already treated by colectomy and members of sixty-five families, were enrolled. A FICE system for the upper gastro-intestinal tract with an electronic endoscope system and a standard duodenoscope (for side-viewing examination) were used by two expert examiners. Endoscopic resection was performed with diathermic loop for polyps ≥ 6 mm and with forceps for polyps < 6 mm. Formalin-fixed biopsy specimens were analyzed by two expert gastrointestinal pathologists blinded to size, location and number of FAP-associated fundic gland polyps.RESULTSSixty-nine (90.8%) patients had gastric polyps (34 only in the corpus-fundus, 7 only in the antrum and 28 in the whole stomach) and 52 (68.4%) in duodenum (7 in the bulb, 35 in second/third duodenal portion, 10 both in the bulb and the second portion of duodenum). In the stomach fundus after FICE evaluation, 10 more polyps were removed from 10 patients for suspicious features of dysplasia or adenomas, but they were classified as cystic fundic gland after histology. In the antrum FICE identified more polyps than traditional endoscopy, showing a better tendency to identify adenomas and displastic areas. In the duodenum FICE added a significant advantage in identifying adenomas in the bulb and identified more polyps in the II/III portion.CONCLUSIONFICE significantly increases adenoma detection rate in FAP patients but does not change any Spigelman stage and thus does not modify patient’s prognosis and treatment strategies.

FICE in Predicting Colorectal Flat Lesion Histology.

Background and Objectives:Colonoscopy is the gold standard for detection of polyps and is preventive against colorectal cancers. Flat adenomas are small, superficial lesions and have a high rate of going undetected during conventional white-light endoscopy. This article adds to the scant body of literature in English regarding in vivo detection and diagnosis of flat adenomas using Fujinon intelligent color enhancement (FICE) system. In this study, we investigated the diagnosis of flat lesions via the FICE endoscopy system and in vivo histologic diagnostic estimations of flat lesions.Methods:This prospective study was conducted in patients who underwent colonoscopy that found flat adenomas. Lesions were classified morphologically with regard to the Paris Classification and sent for histopathologic examination after in vivo histologic diagnostic estimations were made according to Kudo's pit pattern classification. The positive predictive value (PPV), negative predictive value (NPV), specificity, sensitivity, and accuracy of in vivo endoscopic diagnostic estimations of flat lesions with the FICE system were analyzed.Results:A total of 217 flat lesions were identified in 137 patients. Of the lesions, 85.7% were Paris type 0-IIa, and 59.4% were Kudo pit pattern type III. When the FICE diagnostic estimations of flat lesions and final pathology results were considered, PPV was 68.5%, NPV value was 89.6%, sensitivity was 94.7%, specificity was 50.9%, and accuracy was 74.2%.Conclusions:Biologic importance of flat lesions is obscure, as they are usually missed during colonoscopy. The use of novel endoscopic techniques may improve their detection and diagnosis rates.

Advanced Endoscopic Imaging Techniques for the Study of Colonic Mucosa in Patients with Inflammatory Bowel Disease.

Crohn's disease and ulcerative colitis are inflammatory bowel diseases (IBD) associated with colorectal cancer risk in long-standing diseases. In order to assess the colonic mucosa and to discover dysplastic or neoplastic lesions, advanced endoscopic techniques are needed. Such techniques are detailed in this review: chromoendoscopy, autofluorescence imaging (AFI), narrow band imaging (NBI), i-SCAN, Fujinon Intelligent Color Enhancement (FICE) and confocal laser endomicroscopy (CLE). The aim of the review is to describe and establish the clinical impact of advanced endoscopic techniques, that could be used in IBD patients'examination in order to assess mucosal healing, microscopic inflammation, dysplasia or neoplasia. A literature research about new endoscopic approaches of patients with IBD was made. A lot of studies have been performed to reveal which imaging technique might be used for IBD surveillance. Regarding dysplasia or neoplasia detection and mucosal healing or inflammation assessment, CE proved to be superior to white light endoscopy (WLE), while NBI and AFI did not show an encouraging result. I-SCAN did not improve the colonoscopy quality while FICE has been used in a few studies. CLE could be used to characterize a lesion, providing the same results as conventional histology. At the moment, CE is the only technique which has been included in guidelines for IBD surveillance. CLE can be used to assess any lesion detected with WLE during surveillance, while the other imaging techniques require.more studies to determine their efficacy or inefficacy.

Is virtual chromoendoscopy useful in the evaluation of subtle ulcerative small-bowel lesions detected by video capsule endoscopy?

Background: The identification of subtle small-bowel mucosal lesions by video capsule endoscopy (VCE) can be challenging. Virtual chromoendoscopy techniques, based on narrowing the bandwidth of conventional white light endoscopic imaging (WLI), were developed to improve the analysis of mucosal patterns. However, data on the already-implemented Flexible spectral Imaging (or Fujinon Intelligent) Color Enhancement (FICE) software application in VCE are limited. Materials and methods: An evaluation of 250 difficult-to-interpret small-bowel ulcerative and 50 artifact lesions selected from 64 VCE recordings was conducted by four experienced VCE readers in two steps: initially as WLI, then with the addition of all available virtual chromoendoscopy pre-sets (FICE 1, 2, and 3 and Blue mode). The readers labeled them as real or false ulcerative lesions and rated the usefulness of each of the pre-sets. Results: Between the first (WLI-only) and second (virtual chromoendoscopy-aided) readings, in terms of accuracy there was a global 16.5 % (95 % confidence interval [95 %CI] 13.6 – 19.4 %) improvement (P < 0.001), derived from a 22 % [95 %CI 18.9 – 25.1 %] improvement in the evaluation of true ulcerative images (P < 0.001) and an 11 % (95 %CI 4.1 – 17.7 %) decrease in the evaluation of false ulcerative ones (P = 0.003). The FICE 1 and 2 pre-sets were rated as most useful. Conclusion: The application of virtual chromoendoscopy for VCE is useful to better categorize difficult-to-interpret small-bowel mucosal ulcerative lesions. However, care must be taken, and individual images should be evaluated only as part of a sequence in a recording because the technology can also mistakenly guide to the incorrect interpretation of artifacts as ulcerative lesions.

ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps

In vivo real-time assessment of the histology of diminutive (≤5 mm) colorectal polyps detected at colonoscopy can be achieved by means of an “optical biopsy” by using currently available endoscopic technologies. This systematic review and meta-analysis was performed by the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee to specifically assess whether acceptable performance thresholds outlined by an ASGE Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) document for clinical adoption of these technologies have been met. We conducted direct meta-analyses calculating the pooled negative predictive value (NPV) for narrow-band imaging (NBI), i-SCAN, and Fujinon Intelligent Color Enhancement (FICE)–assisted optical biopsy for predicting adenomatous polyp histology of small/diminutive colorectal polyps. We also calculated the pooled percentage agreement with histopathology when assigning postpolypectomy surveillance intervals based on combining real-time optical biopsy of colorectal polyps 5 mm or smaller with histopathologic assessment of polyps larger than 5 mm. Random-effects meta-analysis models were used. Statistical heterogeneity was evaluated by means of I2 statistics. Our meta-analyses indicate that optical biopsy with NBI, exceeds the NPV threshold for adenomatous polyp histology, supporting a “diagnose-and-leave” strategy for diminutive predicted nonneoplastic polyps in the rectosigmoid colon. The pooled NPV of NBI for adenomatous polyp histology by using the random-effects model was 91% (95% confidence interval [CI], 88–94). This finding was associated with a high degree of heterogeneity (I2 = 89%). Subgroup analysis indicated that the pooled NPV was greater than 90% for academic medical centers (91.8%; 95% CI, 89-94), for experts (93%; 95% CI, 91-96), and when the optical biopsy assessment was made with high confidence (93%; 95% CI, 90-96). Our meta-analyses also indicate that the agreement in assignment of postpolypectomy surveillance intervals based on optical biopsy with NBI of diminutive colorectal polyps is 90% or greater in academic settings (91%; 95% CI, 86-95), with experienced endoscopists (92%; 95% CI, 88-96) and when optical biopsy assessments are made with high confidence (91%; 95% CI, 88-95). Our systematic review and meta-analysis confirms that the thresholds established by the ASGE PIVI for real-time endoscopic assessment of the histology of diminutive polyps have been met, at least with NBI optical biopsy, with endoscopists who are expert in using this advanced imaging technology and when assessments are made with high confidence.

Equipment-based image-enhanced endoscopy for differentiating colorectal polyps.

The use of colonoscopy for the screening and surveillance of colorectal cancer has increased. However, the miss rate of advanced colorectal neoplasm is known to be 2% to 6%, which could be affected by the image intensity of colorectal lesions. Image-enhanced endoscopy (IEE) is capable of highlighting lesions, which can improve the colorectal adenoma detection rate and diagnostic accuracy. Equipment-based IEE methods, such as narrow band imaging (NBI), Fujinon intelligent color enhancement (FICE), and i-Scan, are used to observe the mucosal epithelium of the microstructure and capillaries of the lesion, and are helpful in the detection and differential diagnosis of colorectal tumors. Although NBI is similar to chromoendoscopy in terms of adenoma detection rates, NBI can be used to differentiate colorectal polyps and to predict the submucosal invasion of malignant tumors. It is also known that FICE and i-Scan are similar to NBI in their detection rates of colorectal lesions. Through more effective and advanced endoscopic equipment, diagnostic accuracy could be improved and new treatment paradigms developed.

Colorectal cancer surveillance in inflammatory bowel disease: A critical analysis.

Colonoscopic surveillance is advocated in patients with inflammatory bowel disease (IBD) for detection of dysplasia. There are many issues regarding surveillance in IBD: the risk of colorectal cancer seems to be decreasing in the majority of recently published studies, necessitating revisions of surveillance strategy; surveillance guidelines are not based on concrete evidence; commencement and frequency of surveillance, cost-effectiveness and adherence to surveillance have been issues that are only partly answered. The traditional technique of random biopsy is neither evidence-based nor easy to practice. Therefore, highlighting abnormal areas with newer technology and biopsy from these areas are the way forward. Of the newer technology, digital mucosal enhancement, such as high-definition white light endoscopy and chromoendoscopy (with magnification) have been incorporated in guidelines. Dyeless chromoendoscopy (narrow band imaging) has not yet shown potential, whereas some forms of digital chromoendoscopy (i-Scan more than Fujinon intelligent color enhancement) have shown promise for colonoscopic surveillance in IBD. Other techniques such as autofluorescence imaging, endomicroscopy and endocytoscopy need further evidence. Surveillance with genetic markers (tissue, serum or stool) is at an early stage. This article discusses changing epidemiology of colorectal cancer development in IBD and critically evaluates issues regarding colonoscopic surveillance in IBD.

Advanced Endoscopic Imaging

Advanced Endoscopic Imaging

Digital Chromoendoscopy for Diagnosis of Diminutive Colorectal Lesions

Introduction. To compare the accuracy of digital and real-time chromoendoscopy for the differential diagnosis of diminutive (<5 mm) neoplastic and nonneoplastic colorectal lesions. Materials and Methods. This is a prospective randomized study comparing the Fujinon intelligent color enhancement (FICE) system (65 patients/95 lesions) and indigo carmine (69 patients/120 lesions) in the analysis of capillary meshwork and pit pattern, respectively. All lesions were less than 5 mm in diameter, and magnification was used in both groups. Histopathology was the gold standard examination. Results. Of 215 colorectal lesions, 153 (71.2%) were adenomas, and 62 were hyperplastic polyps (28.8%). Morphological analysis revealed 132 (61.4%) superficial lesions, with 7 (3.3%) depressed lesions, and 83 (38.6%) protruding lesions. Vascular meshwork analysis using FICE and magnification resulted in 91.7% sensitivity, 95.7% specificity, and 92.6% accuracy in differentiating neoplastic from nonneoplastic lesions. Pit pattern analysis with indigo carmine and magnification showed 96.5% sensitivity, 88.2% specificity, and 94.2% accuracy for the same purpose. Conclusion. Both magnifying virtual chromoendoscopy and indigo carmine chromoendoscopy showed high accuracy in the histopathological diagnosis of colorectal lesions less than 5 mm in diameter.

Su1412 Comparison of Narrow Band Imaging (NBI) and Fujinon Intelligent Color Enhancement (FICE) in Predicting Colon Polyp Histology During a Screening Colonoscopy: A Prospective Randomized Study

Su1412 Comparison of Narrow Band Imaging (NBI) and Fujinon Intelligent Color Enhancement (FICE) in Predicting Colon Polyp Histology During a Screening Colonoscopy: A Prospective Randomized Study

Tu1565 Efficacy of Computed Image Modification at Capsule Endoscopy in the Examination of Patients With Obscure Gastrointestinal Bleeding

Computed virtual chromoendoscopy with the Fujinon intelligent color-enhancement (FICE) system has been reported to improve visualization of the lesions in the gastrointestinal tract and clarify the difference between neoplastic and non-neoplastic tissue. But it remains unclear whether FICE system can improve the diagnostic yield at capsule endoscopy (CE) for obscure gastro-intestinal bleeding (OGIB). The aim of this study was to assess whether FICE system can improve the diagnostic yield more than standard CE in the examination of OGIB and to decide the most suitable set of wavelength in FICE for determining the cause of OGIB.

Su1531 Narrow Band Imaging Versus I-Scan for Real-Time Histologic Prediction of Diminutive Colonic Polyps: A Prospective Comparative Study

Several recent studies have indicated that digital chromoendoscopy, such as narrow band imaging (NBI), Fujinon intelligent color enhancement, and I-Scan, can be useful for differentiating adenomatous from hyperplastic colonic polyps. However, there are no data demonstrating superiority of one system over another.

Advances in endoscopic visualization of colorectal polyps

Conventional white-light endoscopy is currently the gold standard for the detection and treatment of colorectal polyps. However, up to a fifth of polyps may be missed on initial examination, especially flat and small mucosal lesions. This study reviews the literature reporting on the use of new advances in endoscopic visualization. Literature searches were performed on PubMed using the terms 'chromoendoscopy', 'narrow-band imaging' (NBI), 'autofluorescence imaging' (AFI), 'Fujinon Intelligent Colour Enhancement' (FICE), 'i-Scan colonoscopy', 'zoom colonoscopy' and 'confocal laser endomicroscopy' (CLE). We focused on systematic reviews, national guidelines and randomized controlled trials written in English. Studies were assessed for methodological quality using QUADAS. Prospective studies assessing new technology were also reviewed. Further publications were identified from reference lists. Chromoendoscopy increases the detection of neoplastic polyps compared with conventional colonoscopy. NBI avoids the use of additional dyes and enhances the vascular network of capillaries surrounding the crypts, increasing the adenoma detection rate and the ability to distinguish between neoplastic and non-neoplastic lesions. FICE, AFI and i-Scan are new developments that improve tissue contrast. Zoom endoscopy may be combined with different modalities to help further characterize colonic lesions. CLE provides live in vivo high-resolution optical sections of tissue and may be particularly useful in the surveillance of patients with long-standing ulcerative colitis, reducing the number of random biopsies. Although there is mounting evidence that these new technologies are superior to conventional endoscopy, current guidelines are limited. Further large-scale randomized controlled trials comparing these modalities in different patient subpopulations are warranted.

Computerized virtual chromoendoscopy versus indigo carmine chromoendoscopy combined with magnification for diagnosis of small colorectal lesions

Magnifying colonoscopy with indigo carmine dye and the analysis of the capillary and the pit patterns by computed virtual chromoendoscopy (Fujinon Intelligent Color Enhancement, FICE) with magnification are effective for the differential diagnosis of neoplastic and non-neoplastic lesions. This study aimed to compare the accuracy of virtual and real chromoendoscopy in differentiating neoplastic and non-neoplastic colorectal lesions. A prospective randomized trial of magnification colonoscopy with targeted FICE (Group I - 72 patients/111 lesions) versus magnification colonoscopy with targeted indigo carmine dye (Group II - 72 patients/137 lesions) was performed in consecutive patients with lesions 1 cm or less. Histopathology of the specimens was regarded as the gold standard. In group I, 86 (77.5%) lesions showed an intense vascular pattern (positive capillary meshwork), of which 80 (93%) were histologically confirmed as adenomas. From 25 lesions with negative capillary meshwork, 23 (92%) were non-neoplastic. Sensitivity, specificity, accuracy, positive and negative predictive values of the capillary meshwork for the differential diagnosis of these lesions was 97.8, 79.3, 92.8, 93 and 92%, respectively. The same parameters for pit pattern analysis by FICE were 92.7, 82.3, 90.1, 93.8 and 80%, respectively. Indigo carmine magnified chromoscopy showed sensitivity, specificity, accuracy, positive and negative predictive values of 97, 88.9, 94.9, 96.1 and 91.4%, respectively in the discrimination between neoplastic and non-neoplastic lesions. Magnified virtual chromoendoscopy is as accurate as indigo carmine magnified chromoendoscopy in distinguishing between neoplastic from non-neoplastic small colorectal lesions.

Confocal Laser Endomicroscopy: Technical Advances and Clinical Applications

Since its introduction in 2004, confocal laser endomicroscopy (CLE) has emerged as a valuable tool for gastrointestinal endoscopic imaging. Endomicroscopy enables the endoscopist to obtain real time in vivo histology during ongoing endoscopy thereby creating “optical biopsies.” To date, numerous studies have shown potential applications of endomicroscopy in the clinical setting, including in vivo diagnosis of esophageal squamous cell carcinoma, Barrett’s esophagus, celiac disease, and colonic polyps. Moreover, recent data suggest the potential application of endomicroscopy in the field of molecular imaging. Additionally, in recent months new applications and developments in the field of confocal imaging were introduced including endomicroscopy of the liver, pancreatic, and bile ducts. Furthermore, by introducing a new needle-based confocal imaging system, which is small enough to be introduced through a 22gauge puncture needle, a wide field for new applications of endomicroscopic imaging has been opened. Currently, 2 CE- and US Food and Drug Administration (FDA)approved devices for endomicroscopy are available (Figures 1 and 2; Supplementary Table 1). In this review, we introduce both systems and discuss new technical advances and clinical applications of CLE.

Initial observations with computed chromoendoscopy (Fujinon intelligent color enhancement) system in colonoscopy

Introduction: Conventional white-light colonoscopy (WLC) is currently the gold standard for detection and treatment of colorectal lesions. The Fujinon intelligent color enhancement system (FICE) is a real-time, on-demand endoscopic multi-band imaging technique designed to enhance visualization of vascular network and surface texture of the mucosa. There is few information available about the optimal selection among the ten factory-determined wavelength-enhanced presets of FICE for detection of colorectal lesions. The aim was to overview our initial observations.

Computed image modification for enhancement of small-bowel surface structures at video capsule endoscopy

Computed virtual chromoendoscopy with the Fujinon intelligent color-enhancement (FICE) system was reported to improve visualization of neoplastic and non-neoplastic lesions at gastroscopy and colonoscopy. The technique is based on narrowing the bandwidth of the conventional endoscopic image arithmetically by a spectral estimation technology. Implementation of the FICE software in the video capsule workstation might also allow for contrast-enhanced assessment of nature and extent of small-bowel mucosal lesions. Here we propose this novel technique and report on 10 consecutive patients who underwent small-bowel video capsule endoscopy that was evaluated with FICE-enhanced imaging.

Endoscopic Imaging for the Detection of Esophageal Dysplasia and Carcinoma

Numerous endoscopic imaging modalities have been developed and introduced into clinical practice to enhance diagnostic capabilities. In the past, detection of dysplasia and carcinoma of the esophagus has been dependent on biopsies taken during standard white-light endoscopy. Recent important developments in biophonotics have improved visualization of these subtle lesions sufficiently for cellular details to be seen in vivo during endoscopy. These improvements allow diagnosis to be made in gastrointestinal endoscopy units, thereby avoiding the cost, risk, and time delay involved in tissue biopsy and resection. Chromoendoscopy, narrow-band imaging, high-yield white-light endoscopy, Fujinon intelligent color enhancement, and point enhancement such as confocal laser endomicroscopy are examples of enhanced imaging technologies that are being used in daily practice. This article reviews endoscopic-based imaging techniques for the detection of esophageal dysplasia and carcinoma from the perspective of routine clinical practice.