Clin Endosc.  2023 Sep;56(5):553-562. 10.5946/ce.2023.055.

Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials

• Nagai M
• Suzuki S
• Minato Y
• Ishibashi F
• Mochida K
• Ohata K
• Morishita T

• KMID: 2546133
• DOI: http://doi.org/10.5946/ce.2023.055

Abstract

Colonoscopy plays an important role in reducing the incidence and mortality of colorectal cancer by detecting adenomas and other precancerous lesions. Image-enhanced endoscopy (IEE) increases lesion visibility by enhancing the microstructure, blood vessels, and mucosal surface color, resulting in the detection of colorectal lesions. In recent years, various IEE techniques have been used in clinical practice, each with its unique characteristics. Numerous studies have reported the effectiveness of IEE in the detection of colorectal lesions. IEEs can be divided into two broad categories according to the nature of the image: images constructed using narrowband wavelength light, such as narrowband imaging and blue laser imaging/blue light imaging, or color images based on white light, such as linked color imaging, texture and color enhancement imaging, and i-scan. Conversely, artificial intelligence (AI) systems, such as computer-aided diagnosis systems, have recently been developed to assist endoscopists in detecting colorectal lesions during colonoscopy. To better understand the features of each IEE, this review presents the effectiveness of each type of IEE and their combination with AI for colorectal lesion detection by referencing the latest research data.

Keyword

Adenoma detection rate; Colonoscopy; Image-enhanced endoscopy; Polyp detection rate

Figure

• 

  Fig. 1. Imaging of colon cancer under white light endoscopy (WLE), narrow-band imaging (NBI), texture and color enhancement imaging (TXI) mode 1, and TXI mode 2. A type IIa+IIc early cancer is identified using (A) WLE, (B) NBI, (C) TXI mode 1, and (D) TXI mode 2.

• 

  Fig. 2. Imaging of a sessile serrated lesion under white light endoscopy (WLE), blue laser imaging/blue light imaging (BLI), and linked color imaging (LCI). Flat, elevated sessile serrated lesions are shown on (A) WLE, (B) BLI, and (C) LCI.

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  Fig. 3. Imaging of an adenoma under i-scan. A protruding adenoma lesion is shown with i-scan: (A) white-light endoscopy, (B) surface enhancement, (C) contrast enhancement, (D) tone enhancement, (E) optical enhancement mode 1, and (F) optical enhancement mode 2.

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