Mucosal imaging in colon polyps: New advances and what the future may hold

Table 5 Summary and conclusions for each form of advanced mucosal imaging discussed

Modality		Detection	Characterisation	Comment
HD-WLI		Advantages: Marginal benefit in overall adenoma detection; and improved detection of right-sided, flat polyps, and SSAs1	Advantage: Marginal benefit for small adenomas; disadvantage: Insufficient evidence for large polyps	Advantage: Widely available
Chromo-endoscopy		Advantage: Increases polyp detection; disadvantage: Increases withdrawal time	Advantages: Highly effective for small polyps (although inefficient); and useful in prediction of invasion depth for large polyps1	Disadvantage: Increases procedural time
Virtual chromo-endoscopy	NBI	Disadvantage: No significant difference in ADR	Advantages: Accurate for distinguishing neoplastic from non-neoplastic small and diminutive polyps; and accurate for prediction of invasion depth1	Disadvantage: Loss of brightness; neutral: Greater efficacy when used by expert proceduralists
	i-SCAN	Neutral: Variable results, increased detection of flat and right-sided polyps	Advantage: Effective for diminutive and small polyps
	FICE	Disadvantage: No significant difference in ADR	Disadvantage: Inferior to NBI	Advantage: Familiar colour spectrum
	LCI	Advantages: Improves adenoma detection; and effective for non-expert proceduralists1	Disadvantage: Insufficient evidence	Advantage: Familiar colour spectrum
	BLI	Disadvantage: No significant difference in ADR	Advantage: Similar to NBI in terms of colour spectrum and accuracy1	Advantage: Similar colour spectrum to NBI
	TXI	Advantage: Increases polyp visibility in image-based studies	Disadvantage: Insufficient evidence	Disadvantage: Insufficient evidence; advantage: Familiar colour spectrum
AFI		Disadvantage: Insufficient evidence; advantage: Improves detection of flat, right-sided polyps and reduces miss rates	Disadvantage: Inferior to NBI	Disadvantage: Not widely available
AI		Advantage: Increases adenoma detection; no significant difference in withdrawal time1	Advantages: Highly accurate; superior to non-expert endoscopists for histology prediction; not superior to experts using NBI1	Disadvantage: Not yet widely available
FME		Disadvantages: Expensive; insufficient evidence		Disadvantage: Not widely available
Endo-cystoscopy			Neutral: Accurate but requires expertise for interpretation; advantages: Uptake may increase with incorporation of AI	Disadvantages: Requires additional equipment; and not widely available
Multiphoton microscopy			Disadvantage: Insufficient evidence	Disadvantage: Requires additional equipment

¹The most promising technologies.

HD-WLI: High-definition white light imaging; NBI: Narrow-band imaging; BLI: Blue light imaging; TXI: Texture and colour enhancement imaging; FME: Fluorescence molecular endomicroscopy; AFI: Autofluorescence imaging; ADR: Adenoma detection rate; AI: Artificial intelligence; LCI: Linked colour imaging; SSA: Sessile serrated adenomas.