Clin Endosc.  2011 Dec;44(2):65-75. 10.5946/ce.2011.44.2.65.

Recent Advances in Image-enhanced Endoscopy

• Cho WY
• Jang JY
• Lee DH
• The Endoscopic Technology and Investigation Study Group

• KMID: 1805252
• DOI: http://doi.org/10.5946/ce.2011.44.2.65

Abstract

The desire to better recognized such malignancies, which may be difficult to distinguish from inflammation or trauma, has accelerated the development of endoscopy with new optical technologies. Narrow-band imaging is a novel endoscopic technique that may enhance the accuracy of diagnosis using narrow-bandwidth filters in a red-green-blue sequential illumination system. Autofluorescence imaging is based on the detection of natural tissue fluorescence emitted by endogenous molecules. I-scan technology using a digital filter that modifies normal images through software functions, is the newly developed image-enhanced endoscopic technology from PENTAX. Flexible spectral imaging color enhancement enhances the visualization of mucosal structure and microcirculation by the selection of spectral transmittance with a dedicated wavelength. Confocal laser endomicroscopy images were collected with an argon beam with a scanning depth of 0 (epithelium) to 250 microm (lamina propria) and analyzed using the reflected light.

Keyword

Narrow-band imaging; Autofluorescence imaging; I-scan; Flexible spectral imaging color enhancement; Confocal laser endomicroscopy

MeSH Terms

Argon
Endoscopy
Enzyme Multiplied Immunoassay Technique
Fluorescence
Inflammation
Light
Lighting
Microcirculation
Optical Imaging
Argon

Figure

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  Fig. 1 The intra-epithelial papillary capillary loop (IPCL) image of normal esophageal mucosa in magnifying endoscopy using narrow-band imaging. Branching vessel which are located at the surface of muscularis mucosa are shown as a green vascular network. The IPCL is observed as a brown vessel which is positioned in the most superficial layer and is derived upright from the branching vessel.

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  Fig. 2 Esophageal squamous cell carcinoma. (A) A depressed lesion with irregular nodularity and redness is noted at the mid esophagus. (B) With iodine staining, it is shown as an iodine-void area with a well-defined boundary. The change of intra-epithelial papillary capillary loop type V-3 and VN are observed in (C) the proximal margin and (D) center of the lesion. This lesion was diagnosed as SM2 cancer with lymphatic metastasis.

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  Fig. 3 Magnified endoscopic findings of light blue crests in the gastric antral mucosa. Light blue crest is clearly visualized as blue-white lines on the epithelial edge or surface by magnification with narrow-band imaging.

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  Fig. 4 Low grade dysplasia. (A) A slightly elevated discolored lesion is observed in the antrum. (B) White opaque substances along the surface of the lesion is observed by magnified endoscopy with narrow-band imaging.

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  Fig. 5 Type 0-IIc early gastric cancer of well-differentiated adenocarcinoma. (A) A depressed lesion with central nodule is noted by white light endoscopy. (B) Chromoendoscopy. (C) Magnifying endoscopy with narrow-band imaging demonstrates loss of fine mucosal structure, loss of subepithelial capillary network and presence of an irregular microvascular pattern. (D) At the margin of the carcinoma, demarcation line is noted (arrows).

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  Fig. 6 Type 0-IIb early gastric cancer of signet ring cell carcinoma. (A) A flat pale mucosal lesion is noted on the body. (B) Magnifying endoscopy with narrow-band imaging findings of that pale mucosa show loss of the regular subepithelial capillary network pattern and corkscrew pattern.

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  Fig. 7 Type 0-IIc early gastric cancer of signet ring cell carcinoma. (A) A depressed pale mucosal lesion is noted on the high body. (B, C) Magnifying endoscopy with narrow-band imaging finding shows loss of the microsurface structure, corkscrew, and interrupted microvascular pattern. The vessels in cancerous lesions shows abnormal dilatation, abrupt in caliber and heterogeneity in shape. This lesion was diagnosed as SM1 cancer with lymphatic invasion.

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  Fig. 8 Early esophageal cancer. (A) Conventinal endoscopic image shows flat lesion at left side (arrow). (B) Autofluorescence imaging shows that extent of the tumor become purple color change.

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  Fig. 9 I-scan image of depressed typed early gastric cancer. (A) Small depressed lesion is noted at antrum. (B) I-scan tone enhancement (TE)-g makes it more clear delineation of the tumor.

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  Fig. 10 Confocal laser endomicroscopy imaging of early esophageal cancer. (A) Normal esophageal mucosa shows regular patterns of squamous epithelium with normal intra-epithelial papillary capillary loop (IPCL) (arrow). (B) Tumor shows irregular patterns of squamous epithelium and dilated IPCL (arrow).

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  Fig. 11 Tumor margin delineation with confocal laser endomicroscopy (CLE). (A) Slightly depressed lesion is noted and previous forceps biopsy show signet ring cell adenocarcinoma. (B) It is not easily delineated for the exact tumor margin (red circle). (C) CLE help the delineation of the tumor margin with the determination of in vivo histology (normal mucosal surface; purple arrow in B). (D) Tumor mucosal surface (yellow arrow in B).

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