Clin Endosc.  2018 Nov;51(6):534-540. 10.5946/ce.2018.187.

Image-Enhanced Endoscopy in Lower Gastrointestinal Diseases: Present and Future

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. gidoc4u@gmail.com
  • 2Catholic Photomedicine Research Institute, Seoul, Korea.

Abstract

From dye-assisted conventional chromoendoscopy to novel virtual chromoendoscopy, image-enhanced endoscopy (IEE) is continuously evolving to meet clinical needs and improve the quality of colonoscopy. Dye-assisted chromoendoscopy using indigo carmine or crystal violet, although slightly old-fashioned, is still useful to emphasize the pit patterns of the colonic mucosa and predict the histological structures of relevant lesions. Equipment-based virtual chromoendoscopy has the advantage of being relatively easy to use. There are several types of virtual chromoendoscopy that vary depending on the manufacturer and operating principle. IEE plays distinctive roles with respect to histologic characterization of colorectal polyps and prediction of the invasion depth of colorectal cancers. In addition, the newest models of IEE have the potential to increase adenoma and polyp detection rates in screening colonoscopy.

Keyword

Image enhancement; Colonoscopy; Narrow-band imaging; Colorectal polyp

MeSH Terms

Adenoma
Colon
Colonoscopy
Colorectal Neoplasms
Endoscopy*
Gastrointestinal Diseases*
Gentian Violet
Image Enhancement
Indigo Carmine
Mass Screening
Mucous Membrane
Polyps
Gentian Violet
Indigo Carmine

Figure

  • Fig. 1. Schematic presentation of Kudo’s pit-pattern classification.

  • Fig. 2. Prediction of the histological structure of the detected lesion by magnifying chromoendoscopy using crystal violet. (A) The pits of the polyp appear to be pressed flat, and they are regularly arranged. This pit-pattern is similar to Kudo’s type II pattern, which suggests a hyperplastic polyp. (B) The pit-pattern of the lesion shows a mixed pattern of Kudo’s types IIIL and IIIs. This lesion was confirmed as being an intraepithelial adenocarcinoma.

  • Fig. 3. Prediction of the invasion depth of the detected lesion by magnifying narrow-band imaging. (A) The lesion shows a capillary pattern characterized by a blind ending, lack of uniformity, and curtailed irregularly, which is similar to the Sano IIIA pattern. This lesion was confirmed as being an intraepithelial adenocarcinoma. (B) The slightly depressed center of the lesion shows loose vessel areas and an amorphous surface pattern. This lesion was confirmed as being a deep submucosal invasive adenocarcinoma.

  • Fig. 4. Three-step strategy of narrow-band imaging (NBI) colonoscopy. CP, capillary pattern.


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