Evolving endoscopic imaging technology like spectral estimation of the digital RGB signaling allows the characterization of the fine blood vessel network pattern (BVP) on the surface of colorectal lesions in a fast and practical way to perform it, so called FICE technology. The aim of this study is to establish a classification of the(BVP)of colorectal lesions diagnosed during routine colonoscopy, associating FICE with magnifying zoom imaging. From July to November 2006 a total of 111 colorectal lesions were examined with the Fujinon 490ZW5 colonoscope attached to the Fujinon 4400 Processor. All lesions were resected endoscopically and examined by a sole pathologist. The classification of (BVP) was defined in 5 subtypes (I-V) according to the number, morphology and distribution of the fine blood vessels. (BVP) types I and II were characterized by a few short, straight and marginal distributed epithelial blood vessels, while types III to V were of irregularly distributed, elongated and tortuos blood vessels. Results: Among 24 lesions with type I or II (BVP) 23 (95.8%%) were non-neoplastic(inflammatory or hyperplastic polyps). Of the 87 lesions presenting (BVP) types III-V all (98.8%) but one lesion were histologically diagnosed as a neoplastic lesion (adenomatous or early cancer) (p < 0.01). Conclusion: The endoscopic classification of the fine blood vessel pattern on the surface of colorectal lesions significantly correlated with the histopathologic findings. The blood vessel pattern added to other macroscopic features (like pit pattern classification) might greatly enhance the accuracy of the endoscopic diagnosis.