High-resolution Magnification Endoscopy Research Articles

In vivo pilot study into superficial microcirculatory characteristics of colorectal adenomas using novel high-resolution magnifying endoscopy with blue laser imaging

BACKGROUND No studies have yet been conducted on changes in microcirculatory hemodynamics of colorectal adenomas in vivo under endoscopy. The microcirculation of the colorectal adenoma could be observed in vivo by a novel high-resolution magnification endoscopy with blue laser imaging (BLI), thus providing a new insight into the microcirculation of early colon tumors. AIM To observe the superficial microcirculation of colorectal adenomas using the novel magnifying colonoscope with BLI and quantitatively analyzed the changes in hemodynamic parameters. METHODS From October 2019 to January 2020, 11 patients were screened for colon adenomas with the novel high-resolution magnification endoscope with BLI. Video images were recorded and processed with Adobe Premiere, Adobe Photoshop and Image-pro Plus software. Four microcirculation parameters: Microcirculation vessel density (MVD), mean vessel width (MVW) with width standard deviation (WSD), and blood flow velocity (BFV), were calculated for adenomas and the surrounding normal mucosa. RESULTS A total of 16 adenomas were identified. Compared with the normal surrounding mucosa, the superficial vessel density in the adenomas was decreased (MVD: 0.95 ± 0.18 vs 1.17 ± 0.28 μm/μm2, P < 0.05). MVW (5.11 ± 1.19 vs 4.16 ± 0.76 μm, P < 0.05) and WSD (11.94 ± 3.44 vs 9.04 ± 3.74, P < 0.05) were both increased. BFV slowed in the adenomas (709.74 ± 213.28 vs 1256.51 ± 383.31 μm/s, P < 0.05). CONCLUSION The novel high-resolution magnification endoscope with BLI can be used for in vivo study of adenoma superficial microcirculation. Superficial vessel density was decreased, more irregular, with slower blood flow.

Current technologies for the endoscopic assessment of duodenal villous pattern in celiac disease

Currently, standard endoscopy is not considered enough reliable for the evaluation of celiac disease, neither to drive biopsy sampling. The diagnostic reliability of the endoscopic assessment of celiac disease has been increased by the recent advancement of software and hardware technologies. Several endoscopic technologies have been investigated so far for the diagnostic evaluation of celiac disease, including: water-immersion techniques, dye-based and dye-less chromoendoscopy techniques (Narrow band imaging; Fujinon Intelligeng Chromo Endoscopy; I-scan); optical coherence tomography; confocal laser endomicroscopy; high-resolution magnification endoscopy; videocapsule endoscopy; enteroscopy.Such a technologic improvement brought us to higher diagnostic possibilities in the evaluation and management of CD. A wider application of advanced diagnostic endoscopic techniques is therefore warranted to decrease the number of misdiagnoses and related healthcare costs of celiac disease.

Endoscopic diagnosis and management of type I neuroendocrine tumors

Type I gastric neuroendocrine tumors (TI-GNETs) are related to chronic atrophic gastritis with hypergastrinemia and enterochromaffin-like cell hyperplasia. The incidence of TI-GNETs has significantly increased, with the great majority being TI-GNETs. TI-GNETs present as small (< 10 mm) and multiple lesions endoscopically and are generally limited to the mucosa or submucosa. Narrow band imaging and high resolution magnification endoscopy may be helpful for the endoscopic diagnosis of TI-GNETs. TI-GNETs are usually histologically classified by World Health Organization criteria as G1 tumors. Therefore, TI-GNETs tend to display nearly benign behavior with a low risk of progression or metastasis. Several treatment options are currently available for these tumors, including surgical resection, endoscopic resection, and endoscopic surveillance. However, debate persists about the best management technique for TI-GNETs.

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.

Evaluation of patients with endoscopically suspected esophageal metaplasia (ESEM) by trimodal – High resolution magnifying endoscopy (HRME), endoscopic autofluorescence (AFI) and narrow band imaging (NBI) endoscopic technique – Initial Hungarian experience

Background: Trimodal imaging endoscopy – HRME, AFI, and NBI – is a new promising technique for the detection of early neoplasias in patients with ESEM. In contrast to the conventional endoscopy this new technique may allow us to obtain targeted biopsies from suspicious lesions.

Comparison of High Resolution Magnifying Endoscopy and Standard Videoendoscopy for the Diagnosis of Helicobacter pylori Gastritis in Routine Clinical Practice: A Prospective Study

It has been shown that standard endoscopic features often labeled as gastritis has a poor correlation with histopathology. Recently, high resolution magnifying endoscopy has been reported to be an effective method to diagnose gastritis. The aim of the present study was to compare standard endoscopy with magnifying endoscopy for the diagnosis of Helicobacter pylori gastritis, and to determine whether gastritis can be diagnosed based on findings at magnification endoscopy. A total of 129 patients were enrolled into the study. Erythema, erosions, prominent area gastrica, nodularity, and regular arrangement of collecting venules (RAC) were investigated by standard endoscopy. Standard endoscopy was followed by magnifying endoscopy in all patients, and repeated in 55 patients after indigo carmine spraying. None of the standard endoscopic features showed a sensitivity of more than 70% for H. pylori gastritis, except RAC pattern analysis. Absence of a corporal RAC pattern had 85.7% sensitivity and 82.8% specificity for predicting H. pylori infection. Under magnification, the sensitivity and specificity of regular corporal pattern (regular collecting and capillary vascular structures with gastric pits resembling pinholes) for predicting normal histology were 90.3% and 93.9%, respectively. Loss of collecting venules, or both collecting and capillary structures was correlated with chronic inflammation and activity. With the progression of mucosal atrophy, irregular collecting venules became visible. The values for irregularly arranged antral ridge pattern for the prediction of antral gastritis were 89.3% and 65.2%, respectively. Indigo carmine staining increased sensitivity and specificity up to 97.6% and 100% for corporal gastritis, and up to 88.4% and 75.0% for antral gastritis, respectively. Indigo carmine staining significantly increases the detection of intestinal metaplasia. High resolution magnifying is superior to standard endoscopy for the diagnosis of H. pylori gastritis, and identification of specific histopathologic features such as atrophy and intestinal metaplasia seems possible.

Emerging technologies in upper gastrointestinal endoscopy and celiac disease

Despite advances in our knowledge of celiac disease, the most current and authoritative recommendations conclude that diagnosis requires at least four biopsy specimens to be taken from the duodenal area. These recommendations are based on the perception that classic endoscopic markers are not adequate to target biopsy sampling to sites of villous damage in the duodenum. In the past few years, newly developed procedures and technologies have improved endoscopic recognition of the duodenum. These advances make possible the real-time recognition of the duodenal villous pattern during an upper endoscopy procedure, and thereby have the potential to optimize diagnostic accuracy. It is, therefore, reasonable to hypothesize that upper endoscopy might have a more incisive role in the diagnosis of celiac disease than merely providing a means of obtaining biopsy specimens for histological analysis. This Review highlights the new technologies in the field of upper endoscopy that could be helpful for the diagnosis of celiac disease, including the water-immersion technique, chromoendoscopy, high-resolution magnification endoscopy, optimal band imaging, optical coherence tomography and confocal endomicroscopy.

The Detection of Flat and Depressed Colorectal Lesions: Which Endoscopic Imaging Approach?

The secondary prevention of colorectal cancer (CRC) assumes that early detection and resection of precursor lesions disrupts the adenoma– carcinoma sequence and halts progression to invasive neoplastic disease. The adenoma– carcinoma sequence has until now formed the rationale for endoscopic therapies directed at reducing the incidence of CRC. The fact that snare polypectomy of exophytic lesions fails to prevent progression to carcinoma in up to 24% of cases has prompted reevaluation of the prevalence and clinicopathologic significance of flat and depressed colorectal lesions in Western population cohorts. Such lesions, although well-described in the Japanese literature, have only recently been reported in Western population cohorts. Debate has continued regarding their prevalence, anatomic localization, histopathologic characteristics, and proposed imaging modality of choice. Within this perspective, we summarize the key data pertinent to recently described endoscopic diagnostic modalities and detail their clinical applicability both for the detection of flat neoplastic lesions occurring in the “sporadic” patient cohort, familial polyposis syndromes, and chronic ulcerative colitis.

This Month in Gastroenterology

This Month in Gastroenterology

Microcarcinoid tumor diagnosed with high-resolution magnification endoscopy and narrow band imaging

Microcarcinoid tumor diagnosed with high-resolution magnification endoscopy and narrow band imaging

Chromoendoscopy and Narrow-Band Imaging Compared With High-Resolution Magnification Endoscopy in Barrett’s Esophagus

The aim of this study was to compare magnified still images obtained with high-resolution white light endoscopy, indigo carmine chromoendoscopy, acetic acid chromoendoscopy, and narrow-band imaging to determine the best technique for use in Barrett's esophagus. We obtained magnified images from 22 areas with the 4 aforementioned techniques. Seven endoscopists with no specific expertise in Barrett's esophagus or advanced imaging techniques and 5 international experts in this field evaluated these 22 areas for overall image quality, mucosal image quality, and vascular image quality. In addition, the regularity of mucosal and vascular patterns and the presence of abnormal blood vessels were evaluated, and this was correlated with histology. The interobserver agreement for the 3 features of mucosal morphology with white light images ranged from kappa = 0.51 (95% confidence interval [CI]: 0.46-0.55) to kappa = 0.53 (95% CI: 0.50-0.57) for all observers, from kappa = 0.43 (95% CI: 0.33-0.54) to kappa = 0.53 (95% CI: 0.41-0.64) for experts, and from kappa = 0.51 (95% CI: 0.15-0.33) to kappa = 0.64 (95% CI: 0.58-0.70) for nonexperts. The interobserver agreement in these groups did not improve by adding one of the enhancement techniques. The yield for identifying early neoplasia with white light images was 86% for all observers, 90% for experts, and 84% for nonexperts. The addition of enhancement techniques did not improve the yield neoplasia. The addition of indigo carmine chromoendoscopy, acetic acid chromoendoscopy, or narrow-band imaging to white light images did not improve interobserver agreement or yield identifying early neoplasia in Barrett's esophagus.

Novel endoscopic observation in Barrett’s oesophagus using high resolution magnification endoscopy and narrow band imaging

High resolution magnification endoscopy with narrow band imaging (NBI) may improve the detection of specialised intestinal metaplasia (SIM) and dysplasia in Barrett's oesophagus. To describe the magnified endoscopic features with the use of NBI in Barrett's oesophagus. Three hundred and forty-four areas from 50 patients with Barrett's oesophagus were studied using high resolution magnification endoscopy (HRME) with NBI and targeted biopsies were obtained. The sensitivity, specificity, predictive values of the various patterns for the prediction of SIM and dysplasia were calculated. The magnified endoscopic features of Barrett's oesophagus with the use of NBI consist of microstructural/microvascular patterns. The yield of SIM according to the patterns was: (i) Regular microstructural pattern with tubular/linear/villous pattern 90.6% and with circular pattern 0%; and (ii) Absent microstructural pattern 98.9%. The sensitivity, specificity, positive and negative predictive values of the combination of regular microstructural pattern (tubular/villous/linear) and absent microstructural pattern to detect SIM were 100%, 78.8%, 93.5% and 100%, respectively. The sensitivity, specificity, positive and negative predictive values of the irregular microvascular/microstructural pattern for the prediction of high grade dysplasia were 90%, 100%, 99.2% and 100%, respectively. High resolution magnification endoscopy with NBI allows clear visualisation of microstructural and microvascular patterns within Barrett's oesophagus, and allows targeted biopsy with a high yield of SIM and high grade dysplasia.

Endoscopic Diagnosis of Autoimmune Gastritis Is Feasible with High Resolution Magnification Endoscopy

Endoscopic Diagnosis of Autoimmune Gastritis Is Feasible with High Resolution Magnification Endoscopy

Use of Fujinon FICE and High Resolution Magnification Endoscopy in the Confirmation of Eradication of Helicobacter Pylori in Patients with Previously Treated Duodenal Or Gastric Ulcer

Background: The Fujinon Company has recently developed FICE (Fujinon Intelligent Color Enhancement). This technology allows the combination of spectral images generated from a color image decomposed according to specific wavelengths. The combination of FICE with high resolution-magnification in the Fujinon EG 590 ZW gastroscope gives an advantage in the evaluation of the characteristics of the gastrointestinal mucosa and its pathological variations. Aim: To determine the convenience of FICE technology in the recognition of a mucosal pattern that predicts the presence of Helicobacter pylori (Hp) in patients that were previously eradicated.

Use of Fujinon FICE and High Resolution Magnification Endoscopy to Identify Chemical Gastritis Vs. Helicobacter Pylori Related Gastritis

Background: The Fujinon Company has recently added FICE (Fujinon Intelligent Color Enhancement), to the new processor EPX-4400. This technology allows the combination of spectral images generated from a color image decomposed according to specific wavelengths. The system presets 10 different options that can be freely changed. The combination of FICE with high resolution-magnification in the Fujinon EG 590 ZW gastroscope gives a potential advantage in the evaluation by electronic chromoendoscopy of the characteristics of the gastrointestinal mucosa. Aim: To determine the presence of specific endoscopic patterns for normal mucosa, mucosa with inflammation and the patterns that suggests the presence or absence of Helicobacter pylori (Hp). Methods: This study includes 251 patients who underwent Upper GI endoscopy for dyspeptic symptoms. The results were classified in 3 different patterns: (1) Increased superficial vascular pattern, discrete separation of crypts, “empty” aspect of the crypts (pinhole or “halo” aspect) viewed with FICE (set 4 and 6). (2) Decreased superficial vascular pattern, “filled” aspect of the crypts plus enlargement and increased opacity viewed with FICE (set 4 and 6). (3) Indeterminate pattern were crypt arrangement is irregular and discrete segmentation of mucosa with or without vascular superficial pattern present. Biopsies were taken in all patients for HPFAST and 20% of the cases were correlated with histopathological analysis. The endoscopy was performed with Fujinon gastroscope EG-590 ZW5. The pathologist was not aware of the type of pattern observed on each patient. Results: 251 patients were enrolled (136 males, mean age 49.9, median 51). Hp was present in 93 patients (37.1%). In 132 patients a type 1 pattern was identified, 9% of these patients were Hp. In 87 patients type 2 pattern was recognized, 81% Hp. Thirty-two patients had type 3 pattern, 31% Hp positive. The correlation of histological findings revealed chemical gastropathy as a common finding in type 1 pattern and chronic active gastritis in most patients with type 2 pattern. The type 3 pattern patients had marked inflammatory process and atrophy in some cases. The FICE system was efficient for the easy recognition of the patterns. The most representative observation was performed at the gastric body. Conclusion: Fujinon FICE technology associated with high-resolution magnification endoscopy can help identify mucosal patterns and predict the presence of Hp. This system helps choosing the most representative place to biopsy. Further studies will help clarify the relevance of the details observed in the presence or absence of Hp.

Magnification Endoscopy with Narrow Band Imaging in the Cardia Shows a High Prevalence of Intestinal Metaplasia Which Has Identical Microstructural and Microvascular Patterns with Barrett's Epithelium

Background: Gastric cardia has been defined as an area which occupies few mms distal to the gastroesophageal junction (GEJ). It is unclear whether cardia is a normal structure, and whether it lines the esophagus or the proximal stomach. Cardia intestinal metaplasia (CIM) is a premalignant condition with a prevalence of 5-34% on ‘blind biopsies’. Since no endoscopic features exist that can distinguish CIM from normal cardia, biopsy specimens are randomly obtained with potential sampling errors. Our aim was to assess the value of high resolution magnification (HRME) endoscopy with Narrow Band Imaging (NBI) in the detection of CIM. Patients–Methods: Consecutive patients undergoing upper gastrointestinal (GI) endoscopy due to dyspeptic symptoms were included in the study. Patients were included if the squamocolumnar junction and the GEJ were at the same level. Endoscopy was performed using the GIF-Q160Z/ and GIF Q240-Z (Olympus, Japan) magnifying endoscopes (× 115). with a black hood mounted on the tip of the scope. Twenty minutes before the endoscopy, all patients drank a mixture consisting of 150 mL of water with acetylcysteine and simethicone. The cardiac area (5 mm below the GEJ) was scrutinized with HRME with NBI. Targeted biopsies were obtained from different microstructural/microvascular patterns. The H. pylori status was examined by histology (biopsies from body and antrum) and by the magnified endoscopic findings in the body mucosa. Results: 157 areas from 50 patients (24 male, mean age 54 years, range 24-72) were studied. Cardiac epithelium was classified into 4 types: type I, round type; type II, tubular type; type III, villous type and type IV flat type. Interestingly, these magnified endoscopic types are the same types described by the Kansas/Amsterdam groups in Barrett's esophagus (BE). The overall frequency of CIM was 76%. The yield of CIM according to the types was: round 0/52 (0%), tubular 42/50 (84%), villous 43/48 (89.6%), and flat type 4/7 (57%). H. pylori infection was detected in 13 patients (26%). 9/13 patients with H. Pylori infection had CIM while 29/37 patients without H. pylori infection had also CIM (p = ns). The specificity/PPV of type 2 and type 3 for the prediction of CIM were 86.7% (78-92.7/84% (73.7-91.3), and 91.2 (82.9-96.1)/89.6% (79.7-95.3) respectively. The sensitivity and NPV of the combination of types 2-3 for the prediction of CIM was 95.5% (90.7-98.1) and 92.9% (85.4-97). Conclusion: HRME with NBI in the cardia shows a high prevalence of IM which has identical magnified endoscopic patterns with BE. Larger studies from other centers involving also control groups are needed in order to validate our findings.

High-resolution magnification endoscopy can reliably identify normal gastric mucosa, Helicobacter pylori-associated gastritis, and gastric atrophy

The aims of the study were to describe the magnified endoscopic findings in the gastric body, correlate these with histology, and evaluate their reproducibility in the assessment of the magnified endoscopic patterns seen. A total of 95 consecutive dyspeptic patients underwent upper gastrointestinal endoscopy with a magnifying endoscope. The endoscopists classified the magnified endoscopic patterns and correlated them with the histological findings. In the second part of the study, 200 images were shown to five endoscopists in order to examine inter- and intraobserver variability in image assessment. The magnified endoscopic findings in the gastric body were categorized into four types: type 1, honeycomb-type subepithelial capillary network (SECN) with regular arrangement of collecting venules and regular, round pits; type 2, honeycomb-type SECN with regular, round pits, but loss of collecting venules; type 3, loss of normal SECN and collecting venules, with enlarged white pits surrounded by erythema; and type 4, loss of normal SECN and round pits, with irregular arrangement of collecting venules. The sensitivity, specificity, and positive and negative predictive values of the type 1 pattern for predicting normal gastric mucosa were 92.7% (95% confidence interval [CI] 93.2-97.3%), 100% (95% CI 83.9-100%), 100% (95% CI 92.9-100%), and 83.8% (95% CI 65.5-93.9%). The sensitivity, specificity, and positive and negative predictive values of types 2 and 3 patterns for predicting a Helicobacter pylori-infected stomach were 100% (95% CI 83.9-100%), 92.7% (95% CI 93.2-97.3%), 83.8% (95% CI 65.5-93.9%), and 100% (95% CI 92.9-100%). The sensitivity, specificity, and positive and negative predictive values of a type 4 pattern for predicting gastric atrophy were 90% (95% CI 66.8-98.2%), 96% (95% CI 87.9-98.9%), 85.7% (95% CI 62.6-96.2%), and 97.3% (95% CI 89.6-99.5%. The kappa values for inter- and intraobserver agreement in predicting normal gastric mucosa, H. pylori gastritis, and gastric atrophy were 0.864 and 0.913 respectively. High-resolution magnification endoscopy can reliably identify the normal gastric mucosa, H. pylori-associated gastritis, and gastric atrophy in a Western population.

High Resolution Magnification Endoscopy with Narrow Band Imaging in Patients with Barrett's Esophagus

Background: Chromoscopy either as a vital or contrast stain has been shown to be useful to detect specialized intestinal metaplasia (SIM) and dysplasia in Barrett's esophagus (BE). Narrow Band Imaging (NBI) is a novel imaging technique that uses optical filters to enhance the mucosal contrast, revealing the superficial structural and microvascular patterns. The aim of our study was to study the utility of high resolution magnification endoscopy (HRME) with NBI in patients with BE. Methods: Consecutive patients with known BE undergoing surveillance endoscopy were enrolled in the study. Conventional white light endoscopy was followed by HRME with NBI using a high resolution magnification endoscope (Olympus GIF-Q240Z, 115×) and an NBI light source. Structural and microvascular patterns within the Barrett's segment were identified and biopsies taken that were read by pathologists blinded to NBI findings. Results: Thirty patients with BE were evaluated (mean age 63 yrs, 24 males). Mean length of Barrett's segment was 3.6 cm (range 1-10 cm). With NBI, striking contrast was observed between squamous and columnar mucosa. Three distinct mucosal pit patterns (tubular/villous/linear, circular, distorted) and two microvascular patterns (regular lace-like network, and irregular-dilated-tortuous) were seen. A total of 183 biopsies were taken. The yield of SIM on targeted biopsies according to the pit patterns was as follows: tubular/linear/villous structural pattern with regular microvessels 83/87 (95.4%), circular 0/9 (0%), and regular microvascular pattern (RMVP) with no structural pattern 52/53 (98.1%). Sensitivity, specificity, and positive predictive values of the combination of tubular/villous/linear pattern with regular microvessels and/or RMVP with no structural pattern for detecting SIM were 100%, 69%, and 97.5%, respectively. The sensitivity and specificity of the above patterns in patients with long segment BE and short segment BE were 100%, 75%, and 100%, 67% respectively. High grade dysplasia (HGD) was diagnosed in 5 cases. Sensitivity, specificity, and positive predictive values of the irregular microvascular pattern for the detection of HGD were 100%. In all cases with HGD we could visualise a demarcation line between the neoplastic and non-neoplastic tissue. Conclusion: Using HRME with NBI we described the non-dysplastic and dysplastic features in BE. It provides detailed images of capillaries and mucosal pit patterns without the need for chromoscopy. Further studies are required to prove the efficacy of this technique in routine clinical practice for BE surveillance.

High Resolution Magnification Endoscopy Can Identify the Normal Gastric Mucosa, Helicobacter Pylori-Associated Gastritis and Gastric Atrophy

High Resolution Magnification Endoscopy Can Identify the Normal Gastric Mucosa, Helicobacter Pylori-Associated Gastritis and Gastric Atrophy

Accuracy of Laryngeal Examination during Upper Gastrointestinal Endoscopy for Premalignancy Screening: Prospective Study in Patients with and without Reflux Symptoms

Gastroesophageal reflux disease may be associated with laryngeal damage caused by reflux material. The aim of this study was to investigate the accuracy of laryngeal examinations during routine upper gastrointestinal endoscopy as a method of screening for major laryngeal injury in a series of patients with reflux symptoms. A total of 100 consecutive patients with reflux symptoms and 100 control individuals underwent upper gastrointestinal endoscopy with standard or high-resolution magnifying video endoscopes. Any laryngeal abnormalities were initially identified by the gastroenterologist before the scope was inserted into the esophagus. All of the examinations were recorded on video and subsequently reevaluated by an otorhinolaryngologist. All of the patients underwent standard laryngoscopy as a reference procedure. All of the patients completed the study. The sensitivity, specificity, negative predictive value, and positive predictive value of the preliminary laryngeal exploration for detecting laryngeal abnormalities (such as laryngitis and vocal leukoplakia) were 90%, 90%, 92%, and 89%, respectively. High-resolution magnifying endoscopy had a higher sensitivity and specificity than standard endoscopy for detecting laryngeal pathology. Two patients were found to have laryngeal leukoplakia. This study shows that preliminary diagnosis of laryngeal disorders can be accurately carried out by the gastroenterologist when patients are undergoing upper endoscopy for reflux symptoms. This approach could also be helpful for the timely diagnosis of major reflux-related laryngeal disease.