Clin Endosc.  2015 Nov;48(6):491-497. 10.5946/ce.2015.48.6.491.

Polyp Detection, Characterization, and Management Using Narrow-Band Imaging with/without Magnification

• Utsumi T
• Iwatate M
• Sano W
• Sunakawa H
• Hattori S
• Hasuike N
• Sano Y

• KMID: 2380405
• DOI: http://doi.org/10.5946/ce.2015.48.6.491

Abstract

Narrow-band imaging (NBI) is a new imaging technology that was developed in 2006 and has since spread worldwide. Because of its convenience, NBI has been replacing the role of chromoendoscopy. Here we review the efficacy of NBI with/without magnification for detection, characterization, and management of colorectal polyps, and future perspectives for the technology, including education. Recent studies have shown that the next-generation NBI system can detect significantly more colonic polyps than white light imaging, suggesting that NBI may become the modality of choice from the beginning of screening. The capillary pattern revealed by NBI, and the NBI International Colorectal Endoscopic classification are helpful for prediction of histology and for estimating the depth of invasion of colorectal cancer. However, NBI with magnifying colonoscopy is not superior to magnifying chromoendoscopy for estimation of invasion depth. Currently, therefore, chromoendoscopy should also be performed additionally if deep submucosal invasive cancer is suspected. If endoscopists become able to accurately estimate colorectal polyp pathology using NBI, this will allow adenomatous polyps to be resected and discarded; thus, reducing both the risk of polypectomy and costs. In order to achieve this goal, a suitable system for education and training in in vivo diagnostics will be necessary.

Keyword

Narrow band imaging; Colonoscopy; Magnifying endoscopy; Polyps; Diagnosis

MeSH Terms

Adenomatous Polyps
Capillaries
Classification
Colonic Polyps
Colonoscopy
Colorectal Neoplasms
Diagnosis
Education
Mass Screening
Narrow Band Imaging
Pathology
Polyps*

Figure

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  Fig. 1. Comparison of the field of view between the Olympus 260 and 290 series colonoscopes. The newly developed 290 series colonoscopes have a 170º field of view, 30º wider than the previous 260 series colonoscopes. This can help physicians to detect mucosal changes more rapidly, with less need for angulation.

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  Fig. 2. Comparison of colonoscopic views using narrow-band imaging (NBI) between the Olympus 260 and 290 series endoscopy systems. (A) Colonoscopic view using NBI in the Olympus 260 series endoscopy system (EVIS LUCERA SPECTRUM). (B) Colonoscopic view using NBI in the Olympus 290 series endoscopy system (EVIS LUCERA ELITE). Colonoscopic views using NBI in the newly developed 290 series endoscopy system are brighter and have a higher resolution than those in the 260 series.

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  Fig. 3. Colonoscopic views using high-definition white light (HD-WL) and high-definition narrow-band imaging (HD-NBI) in the Olympus 290 series endoscopy system. (A) Colonoscopic view using HD-WL. (B) Colonoscopic view using HD-NBI. Colorectal neoplastic lesions are recognized as pale-reddish or reddish areas using WL, and as brownish areas using NBI, which is caused by mucosal microvascular dilatation and neoplastic angiogenesis. White arrows indicate neoplastic lesions.

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  Fig. 4. Capillary pattern classification.

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  Fig. 5. Three-step strategy of narrow-band imaging (NBI). Adapted from Iwatate et al. [23] ELITE, Olympus 290 series endoscopy system EVIS LUCERA ELITE; NICE, NBI International Colorectal Endoscopic.

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