Endoscopic Detection and Analysis of Mucosal Neoplastic Lesions: Enhanced Imaging and Tumor Morphology

  • Frieder BerrEmail author
  • Toshio Uraoka
  • Thierry Ponchon
  • Naohisa Yahagi


Endoscopic imaging techniques aim for detection of small and even minute neoplasias and analysis of macroscopic type, microsurface, and capillary architecture. Magnifying image-enhanced endoscopy displays surface and capillary architecture of normal and neoplastic mucosa and allows highly accurate endoscopic diagnosis of margins, malignant transformation, and likelihood of deep submucosal invasion of early mucosal neoplasias, which is fundamental for curative endoscopic resection. We provide an introduction to techniques of image-enhanced endoscopy and diagnostic analysis of endoscopic observations.


Early Gastric Cancer Depressed Lesion Early Neoplasia Specialized Intestinal Metaplasia Capillary Pattern 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The contribution of cases or images by Dr. Hans-Peter Allgaier/Freiburg and Dr. Gerhard Kleber/Aalen, Germany; Dr. Tsuneo Oyama, Saku Central Hospital/Nagano, Japan; and Dr. Daniel Neureiter, University Institute of Pathology/Salzburg, Austria, is gratefully acknowledged.


  1. 1.
    The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: Nov 30 to Dec 1, 2002. Gastrointest Endosc. 2003;58:S3–43.Google Scholar
  2. 2.
    George SM, et al. Classification of advanced colorectal carcinomas by tumor edge morphology: evidence for different pathogenesis and significance of polypoid and nonpolypoid tumors. Cancer. 2000;89:1901–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Heresbach D, et al. Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy. 2008;40:284–90.PubMedCrossRefGoogle Scholar
  4. 4.
    Rembacken BJ, et al. Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK. Lancet. 2000;355:1211–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Kaltenbach T, et al. American Gastroenterological Association (AGA) Institute technology assessment on image-enhanced endoscopy. Gastroenterology. 2008;134:327–40.PubMedCrossRefGoogle Scholar
  6. 6.
    Kodashima S, et al. Novel image-enhanced endoscopy with i-scan technology. World J Gastroenterol. 2010;16:1043–9.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Kudo S, et al. Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer. World J Surg. 2000;24:1081–90.PubMedCrossRefGoogle Scholar
  8. 8.
    Muto M, et al. Improving visualization techniques by narrow band imaging and magnification endoscopy. J Gastroenterol Hepatol. 2009;24:1333–46.PubMedCrossRefGoogle Scholar
  9. 9.
    Uedo N, et al. Role of narrow band imaging for diagnosis of early-stage esophagogastric cancer: current consensus of experienced endoscopists in Asia-Pacific region. Dig Endosc. 2011;23 Suppl 1:58–71.PubMedCrossRefGoogle Scholar
  10. 10.
    Uraoka T, et al. Narrow-band imaging for improving colorectal adenoma detection: appropriate system function settings are required. Gut. 2009;58:604–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy. 2005;37:570–78.Google Scholar
  12. 12.
    Ishihara R, et al. Quantitative analysis of the color change after iodine staining for diagnosing esophageal high-grade intraepithelial neoplasia and invasive cancer. Gastrointest Endosc. 2009;69:213–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Kondo H, et al. Sodium thiosulfate solution spray for relief of irritation caused by Lugol’s stain in chromoendoscopy. Gastrointest Endosc. 2001;53:199–202.PubMedCrossRefGoogle Scholar
  14. 14.
    Kawahara Y, et al. Novel chromoendoscopic method using an acetic acid-indigocarmine mixture for diagnostic accuracy in delineating the margin of early gastric cancers. Dig Endosc. 2009;21:14–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Japanese Research Society for Gastric Cancer. Japanese classification of gastric carcinoma. First English ed. Tokyo: Kanehara & Co., Ltd; 1995.Google Scholar
  16. 16.
    Everett SM, et al. Early gastric cancer in Europe. Gut. 1997;41:142–50.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Uraoka T, et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut. 2006;55:1592–7.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Saito Y, et al. Endoscopic submucosal dissection (ESD) for colorectal tumors. Dig Endosc. 2009;21 Suppl 1:S7–12.PubMedCrossRefGoogle Scholar
  19. 19.
    Yoshida T, et al. Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions. Gastrointest Endosc. 2004;59:288–95.PubMedCrossRefGoogle Scholar
  20. 20.
    Yao K, et al. Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer. Gastrointest Endosc. 2002;56:279–84.PubMedCrossRefGoogle Scholar
  21. 21.
    Hoffman A, 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.PubMedCrossRefGoogle Scholar
  22. 22.
    Inoue T, et al. Comparative study of conventional colonoscopy and pan-colonic narrow-band imaging system in the detection of neoplastic colonic polyps: a randomized, controlled trial. J Gastroenterol. 2008;43:45–50.PubMedCrossRefGoogle Scholar
  23. 23.
    Pohl J, et al. Computed image modification for enhancement of small-bowel surface structures at video capsule endoscopy. Endoscopy. 2010;42:490–2.PubMedCrossRefGoogle Scholar
  24. 24.
    Sano Y, et al. Magnifying observation of microvascular architecture of colorectal lesions using a narrow-band imaging system. Dig Endosc. 2006;18:s44–51.CrossRefGoogle Scholar
  25. 25.
    Toyoda H, et al. Detection of intestinal metaplasia in distal esophagus and esophagogastric junction by enhanced-magnification endoscopy. Gastrointest Endosc. 2004;59:15–21.PubMedCrossRefGoogle Scholar
  26. 26.
    Tanaka S, et al. Aim to unify the narrow band imaging (NBI) magnifying classification for colorectal tumors: current status in Japan from a summary of the consensus symposium in the 79th Annual Meeting of the Japan Gastroenterological Endoscopy Society. Dig Endosc. 2011;23 Suppl 1:131–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Yao K, et al. Magnifying endoscopy for diagnosing and delineating early gastric cancer. Endoscopy. 2009;41:462–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Kudo S. Early colorectal cancer. Detection of depressed types of colorectal carcinoma. Tokyo: Igaku-Shoin Ltd; 1996.Google Scholar
  29. 29.
    Uraoka T, et al. Sano’s capillary pattern classification for narrow-band imaging of early colorectal lesions. Dig Endosc. 2011;23 Suppl 1:112–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Hewett DG, et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology. 2012;143:599–607.PubMedCrossRefGoogle Scholar
  31. 31.
    Nakayoshi T, et al. Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video). Endoscopy. 2004;36:1080–4.PubMedCrossRefGoogle Scholar
  32. 32.
    Okada K, et al. Diagnosis of undifferentiated type early gastric cancers by magnification endoscopy with narrow-band imaging. J Gastroenterol Hepatol. 2011;26:1262–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Ezoe Y, et al. Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology. 2011;141:2017–25.e2013.CrossRefGoogle Scholar
  34. 34.
    Ezoe Y, et al. Magnifying narrow-band imaging versus magnifying white-light imaging for the differential diagnosis of gastric small depressive lesions: a prospective study. Gastrointest Endosc. 2010;71:477–84.PubMedCrossRefGoogle Scholar
  35. 35.
    Abe S, et al. Depth-predicting score for differentiated early gastric cancer. Gastric Cancer. 2011;14:35–40.PubMedCrossRefGoogle Scholar
  36. 36.
    Tanaka K, et al. Features of early gastric cancer and gastric adenoma by enhanced-magnification endoscopy. J Gastroenterol. 2006;41:332–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Yokoyama A, et al. Novel narrow-band imaging magnifying endoscopic classification for early gastric cancer. Dig Liver Dis. 2010;42:704–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Gatenby PA, et al. Relevance of the detection of intestinal metaplasia in non-dysplastic columnar-lined oesophagus. Scand J Gastroenterol. 2008;43:524–30.PubMedCrossRefGoogle Scholar
  39. 39.
    Kelty CJ, et al. Barrett’s oesophagus: intestinal metaplasia is not essential for cancer risk. Scand J Gastroenterol. 2007;42:1271–4.PubMedCrossRefGoogle Scholar
  40. 40.
    Riddell RH, et al. Definition of Barrett’s esophagus: time for a rethink – is intestinal metaplasia dead? Am J Gastroenterol. 2009;104:2588–94.PubMedCrossRefGoogle Scholar
  41. 41.
    Goda K, et al. Usefulness of magnifying endoscopy with narrow band imaging for the detection of specialized intestinal metaplasia in columnar-lined esophagus and Barrett’s adenocarcinoma. Gastrointest Endosc. 2007;65:36–46.PubMedCrossRefGoogle Scholar
  42. 42.
    Kara MA, et al. Detection and classification of the mucosal and vascular patterns (mucosal morphology) in Barrett’s esophagus by using narrow band imaging. Gastrointest Endosc. 2006;64:155–66.PubMedCrossRefGoogle Scholar
  43. 43.
    Sharma P, et al. The utility of a novel narrow band imaging endoscopy system in patients with Barrett’s esophagus. Gastrointest Endosc. 2006;64:167–75.PubMedCrossRefGoogle Scholar
  44. 44.
    Singh R, et al. Narrow-band imaging with magnification in Barrett’s esophagus: validation of a simplified grading system of mucosal morphology patterns against histology. Endoscopy. 2008;40:457–63.PubMedCrossRefGoogle Scholar
  45. 45.
    Pech O, et al. Prospective evaluation of the macroscopic types and location of early Barrett’s neoplasia in 380 lesions. Endoscopy. 2007;39:588–93.PubMedCrossRefGoogle Scholar
  46. 46.
    Theisen J, et al. Preferred location for the development of esophageal adenocarcinoma within a segment of intestinal metaplasia. Surg Endosc. 2006;20:235–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Endo T, et al. Classification of Barrett’s epithelium by magnifying endoscopy. Gastrointest Endosc. 2002;55:641–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Ishihara R, et al. Significance of each narrow-band imaging finding in diagnosing squamous mucosal high-grade neoplasia of the esophagus. J Gastroenterol Hepatol. 2010;25:1410–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Frieder Berr
    • 1
    Email author
  • Toshio Uraoka
    • 2
  • Thierry Ponchon
    • 4
  • Naohisa Yahagi
    • 3
  1. 1.Department of Internal Medicine IParacelsus Medical University / Salzburger LandesklinikenSalzburgAustria
  2. 2.Department of GastroenterologyTokyo Medical CenterMeguro-kuJapan
  3. 3.Division of Research and Development for Minor Invasive TreatmentCancer Center, Keio University School of MedicineShinjuku-kuJapan
  4. 4.Department of Digestive DiseasesHôpital Eduard HerriotLyonFrance

Personalised recommendations