Use Of Narrow Band Imaging Research Articles

Prevalence, Clinical Characteristics, and Treatment Response in Patients with Post Cricoid Inlet Patch—A Descriptive Retrospective Study

Abstract Objectives The aim of this study was to determine the incidence of post cricoid inlet patch (PC-IP) and to assess the clinical characteristics, pathological features, and treatment response. Materials and Methods A retrospective cross-sectional study was conducted from April 2016 to April 2021 in the tertiary gastroenterology unit of urban India. All patients with symptoms of globus sensation, chronic cough, heartburn, hoarseness, throat pain, dysphagia, and acid regurgitation after a thorough clinical examination underwent esophagogastroduodenoscopy by experienced endoscopists including biopsy. Sociodemographic data, symptoms and its duration, previous hospital visits, and chronic proton pump inhibitor (PPI) use were noted during the study. Results Three-thousand two-hundred fifty upper gastrointestinal endoscopies were performed during the study period. The prevalence of PC-IP was 2.7%, comprising 36.3% males and rest females. Mean age was 36.2 ± 17years. The most common symptom among these patients was globus sensation (81.8%) followed by acid regurgitation (75%), dyspepsia (64.7%), dysphagia (48.8%), throat pain (29.54%), chronic cough (22.72%), hoarseness (22.72%), and others (6.81%). Mean diameter of PC-IP was 1.5 ± 0.5 cm, more than one patch was found in 23.76% of patients. Histopathological examination showed heterotrophic gastric mucosa in 77.27%, out of which 38.23% had oxyntic type, 44.11% had mucoid type, and the rest had mixed cell type. On median follow-up after 20 months, 68.18% of patient had persistent symptoms, 77.27% were PPI responsive, and 22.73% were PPI refractory. On follow-up, 38.63% of patients had a repeat endoscopic procedure and biopsy (20.45%); none showed any changes in size or dysplasia. Conclusion Prevalence of PC-IP could be higher than the estimated. Careful examination of upper esophagus and use of narrow band imaging will increase the possibility of identifying IP. Those symptomatic patients need treatment with PPI, sometimes for long term. Ablative therapy with radiofrequency or argon plasma coagulation needs further clarification.

S2146 To Remove or Not to Remove? A Case of Appendiceal Inversion and Its Diagnostic Challenges

Introduction: Appendiceal inversion occurs when the appendix is pulled into the lumen of the cecum, and can be an uncommon incidental finding on colonoscopy. When found, they may present as a diagnostic challenge to the endoscopist, as they may be mistaken as a colon polyp or even a neoplasm due to its appearance. Case Description/Methods: A 75-year-old woman with a history of hysterectomy, hypertension, and reported hemorrhoids presented to gastroenterology clinic for evaluation after being found to have a positive Cologuard test. She subsequently underwent colonoscopy, where she was found to have a large polypoid lesion protruding from the appendiceal orifice. Biopsies of the lesion revealed normal mucosa. Given the concerning appearance of the lesion despite normal biopsies, the patient was referred for repeat colonoscopy for endoscopic removal. Repeat endoscopy re-demonstrated a 5 by 10 millimeter non-bleeding, non-ulcerated, finger-like projection from the appendiceal orifice. Normal appearing mucosa of the lesion and its surroundings was observed under narrow band imaging. These findings were suggestive of an appendiceal inversion. The decision was made to not remove the lesion. The patient subsequently underwent CT imaging, where no significant underlying pathology was identified (Figure). Discussion: At present, there are no definitive guidelines on the workup of suspected appendiceal inversions. Appendiceal inversion may occur iatrogenically after open appendectomy or they may be congenital. These are benign causes that would not require further intervention. However, they may be associated with conditions including endometriosis, adenomas, and neoplasms. Anecdotally, there have been reports of peritonitis or significant bleeding with removal of these lesions. A careful approach is thus imperative to prevent unnecessary complications. A thorough surgical history should be taken as history of prior open appendectomy may increase suspicion for appendiceal inversion. Endoscopically, evaluation for surrounding inflammation and use of narrow band imaging to identify abnormal mucosa should be considered. Biopsy of the lesion may also be considered, but should be performed with caution. CT imaging may help exclude any underlying malignancy. Prior case reports have reported identification of mucinous neoplasms on CT following colonoscopy if the lesion cannot be determined to be an appendiceal inversion on endoscopy. In this patient, CT did not reveal any underlying malignancy.Figure 1.: Endoscopic appearance of an appendiceal inversion both under normal white light endoscopy (A) and narrow band imaging (B).

Squamous cell metaplasia of the rectum associated with a longstanding ulcerative colitis (clinical cases report)

INTRODUCTION: squamous cell metaplasia in the rectum is found in patients with longstanding inflammation or infectious lesions [1]. Colonoscopy plays a major role in the diagnostic of squamous cell metaplasia, especially with the use of Narrow Band Imaging (NBI) or Blue Light Imagining (BLI), which allows for targeted visualization of intraepithelial capillary loopspeculiar for the squamous epithelium [1,2]. The final conclusion cannot be reached without morphological diagnostics. We would like to show on two clinical cases of patients with a longstanding ulcerative colitis the occurrence of squamous cell metaplasia in the rectum. These areas of metaplasia may be the source of squamous cell cancer.CLINICAL CASES: a clinical cases of squamous cell metaplasia in the rectum in two patients with a longstanding ulcerative colitis (9 and 14 years) are presented. The total ulcerative colitis was verified in both patients by colonoscopy. Against the background of endoscopic remission, flat whitish areas of irregular shape, up to 3 cm in size, in the form of “tongues” of metaplastic epithelium with clear boundaries were found in the low rectum. When examined in a Narrow Band Imaging (NBI) and Blue Light Imagining (BLI), the microvascular pattern in the detected areas was identical in structure to the microvascular pattern of the squamous epithelium. The biopsies confirmed the presence of squamous cell epithelium.CONCLUSION: patients with a longstanding ulcerative colitis may have squamous cell metaplasia of the rectal mucosa, which can be detected by colonoscopy in white light. Using a Narrow Band Imaging (NBI) followed by a targeted biopsy allows the most accurate diagnosis to be established. Patients of this group require repeated colonoscopies using the above methods, since areas of metaplasia can be a source of squamous cell cancer of the rectum.

Squamous cell metaplasia of the rectum associated with a longstanding ulcerative colitis (clinical cases report)

INTRODUCTION: squamous cell metaplasia in the rectum is found in patients with longstanding inflammation or infectious lesions [1]. Colonoscopy plays a major role in the diagnostic of squamous cell metaplasia, especially with the use of Narrow Band Imaging (NBI) or Blue Light Imagining (BLI), which allows for targeted visualization of intraepithelial capillary loopspeculiar for the squamous epithelium [1,2]. The final conclusion cannot be reached without morphological diagnostics. We would like to show on two clinical cases of patients with a longstanding ulcerative colitis the occurrence of squamous cell metaplasia in the rectum. These areas of metaplasia may be the source of squamous cell cancer.CLINICAL CASES: a clinical cases of squamous cell metaplasia in the rectum in two patients with a longstanding ulcerative colitis (9 and 14 years) are presented. The total ulcerative colitis was verified in both patients by colonoscopy. Against the background of endoscopic remission, flat whitish areas of irregular shape, up to 3 cm in size, in the form of “tongues” of metaplastic epithelium with clear boundaries were found in the low rectum. When examined in a Narrow Band Imaging (NBI) and Blue Light Imagining (BLI), the microvascular pattern in the detected areas was identical in structure to the microvascular pattern of the squamous epithelium. The biopsies confirmed the presence of squamous cell epithelium.CONCLUSION: patients with a longstanding ulcerative colitis may have squamous cell metaplasia of the rectal mucosa, which can be detected by colonoscopy in white light. Using a Narrow Band Imaging (NBI) followed by a targeted biopsy allows the most accurate diagnosis to be established. Patients of this group require repeated colonoscopies using the above methods, since areas of metaplasia can be a source of squamous cell cancer of the rectum.

Detecting Aspiration During FEES with Narrow Band Imaging in a Clinical Setting.

The use of narrow band imaging (NBI) during flexible endoscopic evaluation of swallowing (FEES) is recognised as an emerging technology to improve the contrast of the test fluid during endoscopic dysphagia evaluation. This study tested the hypothesis that the use of NBI in FEES would improve the detection of laryngeal penetration and aspiration in patients with unilateral vocal fold paralysis/paresis (UVFP), a typically difficult population in which to detect the presence of aspiration with FEES. Twenty-one consecutive outpatients with UVFP were evaluated with FEES using white light (WL) and NBI under 150 test conditions (75 WL & 75 NBI). Three speech pathologists, highly experienced in FEES using WL but novices to using NBI, rated laryngeal penetration and aspiration for green dyed thin fluid (5ml and 90ml) and mildly thick fluid (5ml) milk, and were compared to two raters more experienced in using NBI during FEES. Laryngeal penetration and aspiration were significantly higher for larger volumes (90ml) (p < 0.05). With NBI-naïve raters, there was a trend towards lower intra-rater and inter-rater reliability compared to WL on all bolus trials reaching significance on mildly thick fluid (p < 0.01). There was lower rater confidence when using NBI compared to WL in NBI-naïve raters to detect aspiration (p < 0.01). Sensitivity was lower regardless of NBI experience; 80.77-84.21% with WL compared to 46.15-50.00% with NBI. Findings indicate that the improved contrast of a dyed opaque milk trial under WL may negate the potential benefits of using NBI to increase the contrast of the test fluid and supports the use of an opaque test fluid such as milk. NBI may also not be as useful to clinicians with no experience with the altered light condition, and can result in lower sensitivity in even the experienced user.

Use of Narrow Band Imaging in diagnosis of Unexplained Hemoptysis; A Case Report: Endobronchial Telangiectasia

Nonmassive hemoptysis is a frequently encountered consultation at the pulmonary clinic and a few cases are commonly inconclusive. We present a case of unexplained chronic nonmassive hemoptysis, which was finally diagnosed as endobronchial telangiectasia, a rare cause of hemoptysis. Endobronchial telangiectasia can lead to massive hemoptysis, which occasionally can be missed by a casual examination during Flexible bronchoscopy, and these patients may undergo multiple diagnostic procedures before the diagnosis is established. Using narrow band imaging during flexible bronchoscopy can help the pulmonologist to identify the culprit lesions, which would otherwise be missed.

Future strategies to enhance kidney preservation in upper urinary tract urothelial carcinoma.

Though radical nephroureterectomy remains the gold standard treatment for high grade or invasive disease in upper tract urothelial cancer (UTUC), kidney-sparing surgery has become preferred for low risk disease, in order to minimize morbidity and preserve renal function. Many methods exist for endoscopic management, whether via an antegrade percutaneous or retrograde ureteroscopic approach, including electroresection, laser ablation, and fulguration. There has been an increase in use of adjuvant intracavitary therapy, predominantly using mitomycin and bacillus Calmette-Guerin (BCG), to reduce recurrence after primary endoscopic management for noninvasive tumors, although efficacy remains questionable. Intraluminal BCG has additionally been used for primary treatment of CIS in the upper tract, with around 50% success. Newer investigations include use of narrow band imaging or photodynamic diagnosis with ureteroscopy to improve visualization during diagnosis and treatment. Genomic characterization may improve selection for kidney-sparing surgery as well as identify actionable mutations for systemic therapy. The evolution in adjuvant management has seen strategies to increase the dwell time and the urothelial contact of intraluminal agents. Lastly, chemoablation using a hydrogel for sustained effect of mitomycin is under investigation with promising early results. Continued expansion of the armamentarium available and better identification and characterization of tumors ideal for organ-sparing treatment will further improve kidney preservation in UTUC.

Mo1244 IDENTIFICATION OF VISIBLE LESIONS USING NARROW BAND IMAGING: A VIDEO SURVEY STUDY OF ACADEMIC AND COMMUNITY ENDOSCOPISTS

The routine use of Narrow Band Imaging (NBI) has been supported by recent guidelines for improved dysplasia detection during endoscopic surveillance for Barrett’s Esophagus (BE). However, the ability for gastroenterologists to identify neoplastic visible lesions (VL) utilizing NBI remains unclear. We sought to assess the rate at which endoscopists correctly identify VL harboring neoplasia using high-definition white light endoscopy (HD-WLE) and NBI. Academic and community endoscopists who routinely perform surveillance endoscopy for BE were recruited for this video survey study. A total of 25 video clips were randomly selected from our multicenter repository with varying degrees of neoplasia. All clips were standardized to include a 30 second pullback with HD-WLE and NBI, retroflexed view, and distances marked every 1 cm. Endoscopists were asked to identify anatomic landmarks, VL using HD-WLE and NBI, and to identify the correct treatment modality for each VL. Demographics for each endoscopist were collected. A total of 5 blinded experts in BE evaluated each clip to establish a gold standard (17 VL by HD-WLE and 20 VL by NBI). Responses were analyzed using a 90% threshold, established a priori, as a benchmark to assess performance based on published quality metrics data or expert opinion. Assuming a 10% increase in VL detection using NBI based on published data, a total of 40 endoscopists and 20 videos were needed to reach 80% power. Multivariate logistic regression was performed per lesion to assess for predictors of VL identification. Of the 50 invited endoscopists, 44 (88%) completed the survey (Table 1). Interrater reliability for each measure ranged from a κ of 0.73-0.82. A total of 100% (44/44) physicians correctly identified the top of the gastric folds and top of intestinal metaplasia within 2 cm. Compared to the gold standard, participants correctly identified 72% (539/748) VL using HD-WLE and 69% (610/880) using NBI, with only 18% (8/44) and 5% (2/44) reaching the 90% threshold for HD-WLE and NBI, respectively. Community endoscopists had a higher rate of VL detection by NBI (OR 2.07, CI: 1.2-3.5, p<0.008), but they had significantly greater volume of surveillance endoscopies per month (p=0.046, Table 1). VL detection using NBI improved significantly with physicians performing >5 surveillance endoscopies/month (AUC: 0.72; 95% CI: 0.56-0.85; p=0.006, Figure 1). As a whole, participants identified the correct treatment modality for 84% of all VL. The current video based survey study suggests identification of VL by NBI significantly increased with volume of surveillance endoscopies and is independent of practice type, though the expected increase in VL detection with NBI was not observed. Given recent ASGE guidelines, further educational efforts focused on use of NBI for VL detection are needed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Use of narrowband imaging for the diagnosis and screening of laryngeal cancer: A systematic review and meta-analysis.

We evaluated the diagnostic accuracy of narrowband imaging (NBI) in terms of detecting laryngeal cancer compared to that of white light endoscopy (WLE). Two reviewers individually searched the six databases for studies published between the first record date and December 31, 2019. We recorded the numbers of true positives, true negatives, false positives, and false negatives. Quality Assessment of Diagnostic Accuracy Studies ver. 2 software was used to assess the studies. The extent of the inter-rater agreement was also measured. The diagnostic odds ratio (OR) associated with NBI was 87.463 (95% confidence interval [CI]: 46.968, 160.873). The area under the summary receiver operating characteristic curve was 0.954. NBI was more diagnostically accurate than WLE, which was associated with a diagnostic OR of 13.750. NBI affords high diagnostic accuracy, thus supporting a role for NBI in the diagnostic work-up of laryngeal cancer.

The Comparison of Diagnostic Significance of Narrow Band Imaging in Contrast of White Light Endoscopy in the Assessment of Nasopharyngeal Cancer

Background: Narrow band imaging (NBI) is reported to improve the diagnostic importance of nasopharyngeal cancer. The purpose of this review was to evaluate the diagnostic significance of NBI in the literature and compare it to the conventional white light endoscopy. The use of narrow band imaging (NBI) and further technological achievements concerning the resolution and magnification of endoscopic images have in the past 15 years. With the use of NBI, superficial mucosal lesions, which may be missed by standard WLI endoscopy, can be identified easily by their neoangiogenic pattern. Objective: To assess diagnostic value of the narrow band imaging and white light endoscopy in nasopharyngeal carcinoma and compare diagnostic values (sensitivity, specificity, positive predictive value and negative predictive value) with white light endoscopy. Search Methods: From 2010 to 2020, data was searched from electronic databases such as PubMed, web of science. We used narrow band imaging as a key word accordance with diagnostic modalities such as sensitivity, specificity, PPV and NPV and data were collected. Results: We have found mainly 6 studies have discussed about diagnostic value of endoscopy in nasopharyngeal carcinoma in the total of 2746 suspected patients. Among them, 5 studies have compared diagnostic values such as sensitivity, specificity, positive predictive value and negative predictive value between NBI and WLE. Among 5 studies, 4 studies have found higher sensitivity in NBI, 2 studies found higher 1 equal to WLE specificity in NBI. 3 studies have compared PPV and NPV between NBI and WLE. Among them, all the studies found higher PPV and NPV in NBI than WLE. Conclusion: Recently developed narrow band imaging has a great significance in the diagnosis of nasopharyngeal carcinoma. Although NBI has also encountered some problem such as contact bleeding and darker image. So, further evaluation should be done.

CO2 Transoral Laser Microsurgery in Benign, Premalignant and Malignant (Tis, T1, T2) Lesion of the Glottis. A Literature Review

Carbon Dioxide transoral laser microsurgery represents a reliable option for the treatment of early glottic carcinoma (Tis–T2), with good functional and oncological outcomes, nowadays representing one of the main options in larynx preservation protocols. The development and improvement of laser devices means surgeons are able to use more precise instruments compared with classic cold dissection in laser-assisted phonosurgery. Secondary effects on voice, swallowing, or quality of life as well as complications have been well documented. Also, with the introduction of a new proposal for staging systems following the principle of the three-dimensional map of isoprognostic zones, the use of narrow-band imaging in clinical evaluation and intraoperative, and the implementation of diffusion-weighted magnetic resonance during preoperative evaluation, the development of new tools to improve surgical quality and preliminary reports regarding the use of carbon dioxide laser in transoral robotic surgery suggests an exciting future for this technique.

Su1744 DIAGNOSTIC ACCURACY AND LEARNING CURVE IN THE CHARACTERIZATION OF COLORECTAL POLYPS FOR FIRST YEAR GASTROINTESTINAL ENDOSCOPY TRAINEES

Identification and removal of colorectal adenomas during colonoscopy has been associated with risk reduction in colorectal cancer. Multiple studies have shown the utility of endoscopic characterization of polyps in predicting a histopathologic diagnosis. The use of narrow band imaging and visual classifications such as NBI International Colorectal Endoscopic (NICE) and Japan NBI Expert Team classification (JNET) have been associated with a high diagnostic accuracy in the distinction between neoplastic and non-neoplastic lesions with a short learning curve.

Analysis of predictive factors for R0 resection and immediate bleeding of cold snare polypectomy in colonoscopy

BackgroundFactors associated with efficacy and safety of cold snare polypectomy (CSP) are not well established. The aim is to elucidate the predictors of R0 resection and immediate bleeding of CSP.MethodsWe retrospectively reviewed a database of patients who underwent CSP for subcentimetric polyps at the University of Tokyo Hospital in Japan. Using the data regarding the characteristics of patients and polyps, such as location, size, and macroscopic appearance; use of narrow band imaging with magnification (NBI-M); and endoscopists’ experience, we revealed the predictive factors associated with R0 resection and immediate post-CSP bleeding by univariate and multivariate analyses.ResultsIn total, 399 polyps, in 200 patients without antithrombotics, were removed. Failure of tissue retrieval was noted in 4% of resected lesions. There was no intramucosal carcinoma observed. The overall rate of R0 resection was 46%. Multivariate analysis elucidated that the observation of the polyp with NBI-M was an independent predictor associated with R0 resection (odds ratio [OR] 1.90; p = 0.024). Although immediate post-CSP bleeding occurred in 19 polyps (4.8%), no delayed bleeding or perforation was observed. Multivariate analysis revealed protruded lesion as an independent risk factor for immediate bleeding (OR 3.54; p = 0.018).ConclusionsA higher rate of R0 resection with CSP can be achieved by performing colonoscopy with NBI-M, than with white-light imaging. Macroscopic protruding appearance of a polyp is a risk factor for immediate bleeding.

Flexible transnasal endoscopy with white light or narrow band imaging for the diagnosis of laryngeal malignancy: diagnostic value, observer variability and influence of previous laryngeal surgery

PurposeFlexible transnasal endoscopy is a common examination technique for the evaluation of laryngeal lesions, while the use of narrow band imaging (NBI) has been reported to enhance the diagnostic value of white light endoscopy (WLE). The purpose of this study is to assess observer variability and diagnostic value of both modalities and investigate the possible influence of previous laryngeal surgery on the detection rates of laryngeal malignancy.MethodsThe study was based on the retrospective evaluation of 170 WLE and NBI images of laryngeal lesions by three observers in a random order. The histopathological diagnoses serve as the gold standard.ResultsIn identifying laryngeal malignancy, the sensitivity of NBI proved to be higher than that of WLE (93.3% vs. 77.0%). NBI was also superior to WLE in terms of accuracy (96.3% vs. 92%) and diagnostic odds ratio (501.83 vs. 120.65). Both modalities had a specificity of 97.3%. The inter-observer agreement was substantial (kappa = 0.661) for WLE and almost perfect (kappa = 0.849) for NBI. Both WLE and NBI showed a high level of intra-observer agreement. The sensitivity was significantly lower in images with history of previous laryngeal surgery compared to those without.ConclusionsFlexible transnasal endoscopy has been proved to be a valuable tool in the diagnosis of laryngeal malignancy. The use of NBI can increase the sensitivity and observer reliability in that context and can also provide a diagnostic gain in cases with previous laryngeal surgery

Narrow Band Imaging: A Novel Technique for Immediate Evaluation of Efficacy in Laparoscopic Radiofrequency Ablation of Exophytic Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the second leading cause of cancer mortality worldwide. Evolution of laparoscopic techniques helps to a great extent in facilitating and replacing the conventional surgical maneuvers. This article describes the novel use of narrow band imaging (NBI) in laparoscopic radiofrequency ablation (LRFA) of exophytic HCC to ensure its adequate ablation. In total, 11 patients with proven HCC were recruited to perform LRFA; NBI were applied during and after completion of ablation session, with NBI, the exophytic HCC appears dark green or blue in color and after start of LRFA; the tumor capsule turned into red color denoting hemoglobin coagulation and vascular damage; in 5 cases and after completion of ablation; the tumor capsule was still dark green or blue denting viability which necessitates needle repositioning and ablation continuation. NBI helps to a great extent in confirmation of successful ablation of exophytic HCC.

P54 - Use of Narrow Band Imaging (NBI) in follow-up of high-grade non-muscle invasive bladder cancer (NMIBC) after Bacillus Calmette Guerìn (BCG) treatment

P54 - Use of Narrow Band Imaging (NBI) in follow-up of high-grade non-muscle invasive bladder cancer (NMIBC) after Bacillus Calmette Guerìn (BCG) treatment

The role of intraoperative narrow-band imaging in transoral laser microsurgery for early and moderately advanced glottic cancer

IntroductionTrans-oral laser microsurgery is an established technique for the treatment of early and moderately advanced laryngeal cancer. ObjectiveThe authors intend to test the usefulness of narrow-band imaging in the intraoperative assessment of the larynx mucosa in terms of specifying surgical margins. MethodsForty-four consecutive T1–T2 glottic cancers treated with trans-oral laser microsurgery Type I–VI cordectomy were presented. Suspected areas (90 samples/44 patients) were biopsied under the guidance of narrow-band imaging and white light and sent for frozen section. ResultsOur study revealed that 75 of 90 (83.3%) white light and narrow-band imaging-guided samples were histopathologically positive: 30 (40%) were confirmed as carcinoma in situ or invasive carcinoma and 45 (60%) as moderate to severe dysplasia. In 6 patients mucosa was suspected only in narrow-band imaging, with no suspicion under white light. Thus, in these 6 patients 18/90 (20%) samples were taken. In 5/6 patients 16/18 (88.8%) samples were positive in frozen section: in 6/18 (33.3%) carcinoma (2 patients), 10/18 (66.6%) severe dysplasia was confirmed (3 patients). In 1 patient 2/18 (11.1%) samples were negative in frozen section. Presented analysis showed, that sensitivity, specificity and accuracy of white light was 79.5%, 20% and 71.1% respectively, while narrow-band imaging was 100%, 0.0% and 85.7%, respectively. ConclusionThe intraoperative use of narrow-band imaging proved to be valuable in the visualization of suspect areas of the mucosa. Narrow-band imaging confirms the suspicions undertaken in white light and importantly, it showed microlesions beyond the scope of white light.

Developments in dysphagia diagnostics : Presentation of an interdisciplinary concept

Demographic developments and medical progress will cause the already high prevalence of swallowing disorders to increase further in the future. With the same number of specialists and economic resources, it is necessary to improve the efficiency of dysphagia diagnostics and continue to offer patients atreatment concept tailored to their needs. Manifold and often co-existing causes of dysphagia require interdisciplinary cooperation in this area. Endoscopic swallowing diagnostics play aprominent role in dysphagia diagnostics and should always contain thorough endoscopy of the upper aerodigestive tract-the domain of the ENT specialist and phoniatrician. The concept of adysphagia day clinic under phoniatric leadership presented here allows for complete and efficient evaluation of swallowing disorders, and offers the patient acomprehensive treatment concept. Technical innovations such as the use of narrow band imaging (NBI) to significantly enhance visualization of the bolus in an endoscopic swallowing examination, as well as special methods like the "dipping maneuver" to allow aclose-up examination of the subglottis and trachea were able to improve endoscopic dysphagia diagnosis even further. The examination procedure and the selection of test consistencies and placebo tablets should be tailored individually to the patient, and not follow strict procedures. The task of the ENT specialist or phoniatrician should be to assess and advise each patient individually, depending on underlying illnesses, prognosis, living conditions, and their own wishes. An interdisciplinary team of physicians and therapists permits individual counseling and therapy planning.

Use of narrow band imaging and 4K technology in otology and neuro-otology: preliminary experience and feasibility study.

The advent of the endoscope has facilitated otological surgery in recent years. Advances in optical technology have led to the development of high definition visualisation, such as 4K magnification. Narrow band imaging (NBI) has been shown to improve visualisation of tissue based on varying degrees of vascularity. This is a feasibility study, the first of its kind, aiming to investigate the appearances of middle ear anatomy and pathology (tympanic membrane, tympanosclerosis, cholesteatoma, granulation, endolymphatic sac hydrops, otosclerosis) under the NBI filter, using a high definition 4K endoscope. Qualitative analysis of image detail and operating time in minutes were recorded. The study demonstrates that these two technologies can be implemented with ease into practice, and show a clear differentiation between pathology and normal anatomy. NBI and 4K magnification prove to be useful adjuncts to the surgeon during endoscopic ear surgery.

Impact of advanced endoscopic imaging on Barrett’s esophagus in daily clinical practice

Several advanced imaging techniques have been proposed to improve the visualization of dysplastic regions within Barrett's epithelium, with some evidence for the use of narrow-band imaging (NBI) and acetic acid chromoendoscopy (AAC). We retrospectively analyzed consecutive cases of Barrett's esophagus, diagnosed using white-light endoscopy and confirmed histologically by the presence of intestinal metaplasia, between April 2007 and April2010 in a large community hospital. A change in practice was then instituted, whereby a Barrett's team consisting of specialist endoscopists was formed in an attempt to standardize and improve the quality of surveillance. Barrett's epithelium was inspected with both white-light imaging and NBI in all patients. Where the length of Barrett's epithelium was 3 cm or more, AAC was also used. One and a half percent acetic acid was sprayed onto the Barrett's segment and loss of aceto-whitening observed after a 2-minute period. Any abnormal areas noted during advanced imaging underwent target biopsy sampling. We subsequently compared the dysplasia detection rate in Barrett's epithelium identified between April 2011 and April 2014 after these changes. Observed differences between the cohorts were analyzed with the Fisher exact test and the Student t test. From 2007 to 2010 Barrett's esophagus was identified during 560 gastroscopies in 392 individual patients. The mean maximal Barrett's esophagus recorded length was 4.4 cm (range, 1-10), with an average of 4.7 esophageal biopsy specimens taken per endoscopy. In comparison, from 2011 to 2014 Barrett's esophagus was identified during 856 endoscopies in 630 patients. From 2011 to 2014 the Barrett's team performed 85%of all procedures using the aforementioned techniques. The mean maximal Barrett's esophagus lengthwas 3.8 cm (range, 1-16), with an increased average of 5.8 biopsy specimens per endoscopy taken (P<.01). Both cohorts were comparable in age and gender distribution. Our data demonstrated no significant difference in the relative frequencies of occurrence of dysplasia detected between both cohorts of patients. From 2007 to 2010 dysplasia was detected in 11.0% (n= 43) of patients. This consisted of low-grade dysplasia in 7.7% of patients and high-grade dysplasia or cancer 3.3%. From 2011 to 2014 this compared with dysplasia in 11.3% (n= 71) of patients, with low-grade dysplasia in 9.4% and high-grade dysplasia or cancer in 1.9%. Our data show that the use of NBI and AAC in the imaging of Barrett's esophagus did not result in an increased detection rate of dysplasia in routine clinical practice. These findings concur with the recommendations of existing Barrett's esophagus surveillance guidelines, which advocate the continued use of quadratic biopsy sampling within general surveillance programs.