Image-Enhanced Endoscopy

  • Jun-Hyung Cho


Various image-enhanced endoscopic systems are available in clinical practice. For effective detection and histological prediction of lesions, endoscopists should understand the advantages and limitations of each imaging technology. Narrowband imaging (NBI) illuminates the tissue surface by using optical filters that narrow the respective red-green-blue bands. I-scan and flexible spectral imaging color enhancement (FICE) have proprietary image processing algorithm applied on white light images based on spectral emission methods. Herein, this chapter focuses on understanding the detailed principle and clinical applications of advanced imaging technologies such as NBI, i-scan, and FICE. With recent advancement in endoscopic imaging technology, optical biopsy has been enabled as real-time histologic prediction of tumor. The improvement of endoscopic resolution can facilitate the accurate and detailed endoscopic findings. Moreover, new imaging technologies may make the endoscopists walk a big step in the field of diagnostic and therapeutic gastrointestinal endoscopy. In the future, further studies are needed for evaluation of cost-effectiveness and diagnostic accuracy.


  1. 1.
    Gono K, Obi T, Yamaguchi M, et al. Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Opt. 2004;9:568–77.CrossRefGoogle Scholar
  2. 2.
    Yao K, Takaki Y, Matsui T, et al. Clinical application of magnification endoscopy and narrow-band imaging in the upper gastrointestinal tract: new imaging techniques for detecting and characterizing gastrointestinal neoplasia. Gastrointest Endosc Clin N Am. 2008;18:415–33.CrossRefGoogle Scholar
  3. 3.
    Kato M, Goda K, Shimizu Y, et al. Image assessment of Barrett’s esophagus using the simplified narrow band imaging classification. J Gastroenterol. 2017;52:466–75.CrossRefGoogle Scholar
  4. 4.
    Morita FH, Bernardo WM, Ide E, et al. Narrow band imaging versus lugol chromoendoscopy to diagnose squamous cell carcinoma of the esophagus: a systematic review and meta-analysis. BMC Cancer. 2017;17:54.CrossRefGoogle Scholar
  5. 5.
    Ezoe Y, Muto M, Uedo N, et al. Magnifying narrow-band imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology. 2011;141:2017–25.CrossRefGoogle Scholar
  6. 6.
    Nagahama T, Yao K, Maki S, et al. Usefulness of magnifying endoscopy with narrow-band imaging for determining the horizontal extent of early gastric cancer when there is an unclear margin by chromoendoscopy (with video). Gastrointest Endosc. 2011;74:1259–67.CrossRefGoogle Scholar
  7. 7.
    Pasha SF, Leighton JA, Das A, et al. Comparison of the yield and miss rate of narrow band imaging and white light endoscopy in patients undergoing screening or surveillance colonoscopy: a meta-analysis. Am J Gastroenterol. 2012;107:363–70.CrossRefGoogle Scholar
  8. 8.
    Nagorni A, Bjelakovic G, Petrovic B. Narrow band imaging versus conventional white light colonoscopy for the detection of colorectal polyps. Cochrane Database Syst Rev. 2012;(1):CD008361.Google Scholar
  9. 9.
    Rees CJ, Rajasekhar PT, Wilson A, et al. Narrow band imaging optical diagnosis of small colorectal polyps in routine clinical practice: the Detect Inspect Characterise Resect and Discard 2 (DISCARD 2) study. Gut. 2017;66:887–95.CrossRefGoogle Scholar
  10. 10.
    Kodashima S, Fujishiro M. Novel image-enhanced endoscopy with i-scan technology. World J Gastroenterol. 2010;16:1043–9.CrossRefGoogle Scholar
  11. 11.
    Kang HS, Hong SN, Kim YS, et al. The efficacy of i-SCAN for detecting reflux esophagitis: a prospective randomized controlled trial. Dis Esophagus. 2013;26:204–11.CrossRefGoogle Scholar
  12. 12.
    Hoffman A, Kagel C, Goetz M, et al. Recognition and characterization of small colonic neoplasia with high-definition colonoscopy using i-Scan is as precise as chromoendoscopy. Dig Liver Dis. 2010;42:45–50.CrossRefGoogle Scholar
  13. 13.
    Hoffman A, Sar F, Goetz M, et al. High definition colonoscopy combined with i-Scan is superior in the detection of colorectal neoplasias compared with standard video colonoscopy: a prospective randomized controlled trial. Endoscopy. 2010;42:827–33.CrossRefGoogle Scholar
  14. 14.
    Hong SN, Choe WH, Lee JH, et al. Prospective, randomized, back-to-back trial evaluating the usefulness of i-SCAN in screening colonoscopy. Gastrointest Endosc. 2012;75:1011–21.CrossRefGoogle Scholar
  15. 15.
    Neumann HN, Vieth M, Fry LC, et al. Learning curve of virtual chromoendoscopy for the prediction of hyperplastic and adenomatous colorectal lesions: a prospective 2-center study. Gastrointest Endosc. 2013;78:115–20.CrossRefGoogle Scholar
  16. 16.
    Neumann H, Vieth M, Günther C, et al. Virtual chromoendoscopy for prediction of severity and disease extent in patients with inflammatory bowel disease: a randomized controlled study. Inflamm Bowel Dis. 2013;19:1935–42.CrossRefGoogle Scholar
  17. 17.
    Li CQ, Li Y, Zuo XL, et al. Magnified and enhanced computed virtual chromoendoscopy in gastric neoplasia: a feasibility study. World J Gastroenterol. 2013;19:4221–7.CrossRefGoogle Scholar
  18. 18.
    Osawa H, Yamamoto H, Yamada N, et al. Diagnosis of endoscopic Barrett’s esophagus by transnasal flexible spectral imaging color enhancement. J Gastroenterol. 2009;44:1125–32.CrossRefGoogle Scholar
  19. 19.
    Jung SW, Lim KS, Lim JU, et al. Flexible spectral imaging color enhancement (FICE) is useful to discriminate among non-neoplastic lesion. Dig Dis Sci. 2011;56:2879–86.CrossRefGoogle Scholar
  20. 20.
    Kim YS, Kim D, Chung SJ, et al. Differentiating small polyp histologies using real-time screening colonoscopy with Fuji Intelligent Color. Clin Gastroenterol Hepatol. 2011;9:744–9.CrossRefGoogle Scholar
  21. 21.
    Pohl J, Nguyen-Tat M, Pech O, May A, Rabenstein T, Ell C. Computed virtual chromoendoscopy for classification of small colorectal lesions: a prospective comparative study. Am J Gastroenterol. 2008;103:562–9.CrossRefGoogle Scholar
  22. 22.
    Mouri R, et al. Evaluation and validation of computed virtual chromoendoscopy in early gastric cancer. Gastrointest Endosc. 2009;69(6):1057.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Jun-Hyung Cho
    • 1
  1. 1.Digestive Disease CenterSoonchunhyang University HospitalSeoulSouth Korea

Personalised recommendations