• colon cancer surveillance
• crohn’s disease
• dysplasia
• endoscopy
• inflammatory bowel disease
• surveillance
• ulcerative colitis

• Adenoma
• colonoscopy
• colorectal cancer
• endoscopy
• prevention
• screening

• Screening
• colorectal cancer
• endoscopy
• prevention
• quality

In the treat-to-target era, endoscopy has become the backbone of the assessment of remission, defined as mucosal healing, in inflammatory bowel disease (IBD) patients. Current recommendations indicate that endoscopic procedures should be performed with high-definition white-light endoscopy (HD-WLE), as it guarantees the best possible visualization of the mucosa. With respect to endoscopic surveillance, the preventive strategy for dysplasia and colorectal cancer (CRC) in long-standing IBD, is the use of dye-chromoendoscopy (DCE), which enhances the mucosal pattern of the colonic walls. DCE has been established as the gold standard for dysplasia detection and is at present incorporated in all international guidelines. Over the past years, novel technologies, such as high-definition endoscopic imaging, and optical and digital enhancement tools have revolutionized the quality and level of fine details of vascular and mucosal patterns. These endoscopic images have the ambition to reflect histological changes for suspected neoplastic lesions and inflammation or healing and are emerging as potential alternatives to DCE. Indeed, the comparison of DCE with high-definition imaging is an open issue that deserves further investigation. We aimed to examine and summarize the technical aspects and the current evidence on endoscopic technologies with a specific focus on the surveillance in IBD patients.

Endoscopy is the mainstay of inflammatory bowel disease (IBD) evaluation and the pillar of colorectal cancer surveillance. Endoscopic equipment, both hardware and software, are advancing at an incredible pace. Virtual chromoendoscopy is now widely available, allowing the detection of subtle inflammatory changes, thus reducing the gap between endoscopic and histologic assessment. The progress in the field of artificial intelligence (AI) has been remarkable, and numerous applications are now in an advanced stage of development. Computer-aided diagnosis (CAD) systems are likely to reshape most of the evaluations that are now prerogative of human endoscopists. Furthermore, sophisticated tools such as endocytoscopy and probe-based confocal laser endomicroscopy (pCLE) are enhancing our assessment of inflammation and dysplasia. Finally, pCLE combined with molecular labeling could pave the way to a new paradigm of personalized medicine. This review aims to summarize the main changes that occurred in the field of IBD endoscopy and to explore the most promising novelties.

• Crohn’s disease
• artificial intelligence
• capsule endoscopy
• confocal laser endomicroscopy
• endocytoscopy
• endoscopy
• inflammatory bowel disease
• molecular endoscopy
• ulcerative colitis
• virtual chromoendoscopy

It is always challenging to diagnose and characterize early gastric cancer surrounded by non-cancerous mucosa, including the malignant diagnosis and extent and depth of the lesions. Therefore, we developed a light transmission-assisted pathological examination to diagnose and characterize early gastric cancer. Here, we performed a parallel comparison between the light transmission-assisted pathological examination under endoscopy and the histological examination for the diagnosis of early gastric cancer.

First, the endoscopic submucosal dissection (ESD) specimen was first placed on the surface of the light-emitting diode lamp to observe the mucosal surface structure and blood vessels. Second, the sliced and embedded tissue strips were cut into 3-µm sections for hematoxylin and eosin staining. Third, the histopathology of each section was projected onto a macroscopic image. Finally, the macroscopic and microscopic changes in the ESD specimens observed under endoscopy were compared. Seventy cases of early gastric adenocarcinoma were diagnosed and characterized using this new method.

Using the conventional pathological method, the demarcation line of the lesions was seen in 40 of 70 (57.1%) cases. Furthermore, no surface structure or microvascular changes were observed in any of the cases. Based on the light transmission-assisted pathological examination, 58 of 70 (82.9%) cases presented clear edges of neoplastic and non-neoplastic epithelia, with a classifiable surface structure (88.6%) and microvascular type (78.8%).

This pilot method provided a practical bridge between endoscopic and pathological examinations. Compared to the histological examination, the light transmission-assisted pathological examination was an easier and more precise way to match the in vivo endoscopic observation and in vitro pathological examination.

• early gastric cancer
• endoscope
• endoscopic submucosal dissection (ESD)
• light transmission
• pathology

• Adenoma
• Colonoscopia
• Colonoscopy
• Colorectal cancer
• Cáncer colorrectal
• Hyperplastic polyps
• Polipectomía
• Polypectomy
• Pólipos hiperplásicos

• artificial intelligence
• capsule enteroscopy
• confocal laser endomicroscopy
• dye-chromoendoscopy
• endocytoscopy
• inflammatory bowel diseases
• molecular imaging
• virtual chromoendoscopy

• Colonoscopy
• Colorectal Cancer
• Endoscopic Mucosal Resection
• Histology
• Malignant Polyp
• Polypectomy
• Submucosal Invasion

• Advisory Committees
• Colonic Neoplasms
• Colonic Polyps/surgery
• Colonoscopy
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/therapy
• Humans

• Advisory Committees
• Carcinoma/diagnosis
• Carcinoma/pathology
• Carcinoma/surgery
• Colonic Polyps/diagnosis
• Colonic Polyps/pathology
• Colonic Polyps/surgery
• Colonoscopy
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Endoscopic Mucosal Resection
• Humans
• Narrow Band Imaging
• Neoplasm Invasiveness
• Societies, Medical
• Specimen Handling
• United States

Pit pattern classification using magnifying chromoendoscopy is the established method for diagnosing colorectal lesions. The Japan Narrow-band-imaging (NBI) Expert Team (JNET) classification is a novel NBI magnifying endoscopic classification that focuses on the vessel, and surface patterns.

To determine the diagnostic efficacy of each category of the JNET and Pit pattern classifications for colorectal lesions.

A systematic literature search was performed using PubMed, Embase, the Cochrane Library, and Web of Science databases. The pooled sensitivity, specificity, diagnostic odds ratio, and area under the summary receiver operating characteristic curve of each category of the JNET and Pit pattern classifications were calculated.

A total of 19227 colorectal lesions in 31 studies were included. The diagnostic performance of the JNET classification was equivalent to the Pit pattern classification in each corresponding category. The pooled sensitivity, specificity, and area under the curve (AUC) for each category of the JNET classification were as follows: 0.73 (95%CI: 0.55-0.85), 0.99 (95%CI: 0.97-1.00), and 0.97 (95%CI: 0.95-0.98), respectively, for Type 1; 0.88 (95%CI: 0.78-0.94), 0.72 (95%CI: 0.64-0.79), and 0.84 (95%CI: 0.81-0.87), respectively, for Type 2A; 0.56 (95%CI: 0.47-0.64), 0.91 (95%CI: 0.79-0.96), and 0.72 (95%CI: 0.68-0.76), respectively, for Type 2B; 0.51 (95%CI: 0.42-0.61), 1.00 (95%CI: 1.00-1.00), and 0.90 (95%CI: 0.87-0.93), respectively, for Type 3.

This meta-analysis suggests that the diagnostic efficacy of the JNET classification may be equivalent to that of the Pit pattern classification. However, due to its simpler and clearer clinical application, the JNET classification should be promoted for the classification of colorectal lesions, and to guide the treatment strategy.

• Colorectal neoplasms
• Colonoscopy
• Chromoendoscopy
• Japan Narrow-band-imaging Expert Team
• Pit pattern
• Meta-analysis

• Colonic Polyps
• Colonoscopy
• Colorectal Neoplasms/diagnostic imaging
• Humans
• Japan
• Narrow Band Imaging

• Helicobacter pylori
• endoscopy
• intestinal metaplasia

• Chromoendoscopy
• Colon Cancer
• Endoscopy
• Visualization

• Animals
• Biopsy
• Cystitis/diagnosis
• Cystitis/veterinary
• Cystoscopy/methods
• Equidae
• Female
• Mucous Membrane/pathology
• Urinary Bladder/diagnostic imaging
• Urinary Bladder/pathology
• Urothelium/diagnostic imaging
• Urothelium/pathology

• Adenoma/diagnostic imaging
• Biomedical Technology/instrumentation
• Colonic Polyps/diagnostic imaging
• Colonoscopy
• Colorectal Neoplasms/diagnostic imaging
• Humans
• Inventions

• CT colonography
• colonoscopy
• colorectal cancer
• screening

• colonoscopy
• epidemiology
• hyperplastic polyp
• serrated polyp
• sessile serrated adenoma
• sessile serrated polyp
• traditional serrated adenoma

• adenomatous polyp
• colonic endolaparoscopic surgery
• endoscopic mucosal resection
• endoscopic submucosal dissection
• laparoscopic colectomy

AIM: To evaluate the full-spectrum endoscopy (FUSE) colonoscopy system as the first report on the utility thereof in a Korean population.

METHODS: We explored the efficacy of the FUSE colonoscopy in a retrospective, single-center feasibility study performed between February 1 and July 20, 2015. A total of 262 subjects (age range: 22-80) underwent the FUSE colonoscopy for colorectal cancer screening, polyp surveillance, or diagnostic evaluation. The cecal intubation success rate, the polyp detection rate (PDR), the adenoma detection rate (ADR), and the diverticulum detection rate (DDR), were calculated. Also, the success rates of therapeutic interventions were evaluated with biopsy confirmation.

RESULTS: All patients completed the study and the success rates of cecal and terminal ileal intubation were 100% with the FUSE colonoscope; we found 313 polyps in 142 patients and 173 adenomas in 95. The overall PDR, ADR and DDR were 54.2%, 36.3%, and 25.2%, respectively, and were higher in males, and increased with age. The endoscopists and nurses involved considered that the full-spectrum colonoscope improved navigation and orientation within the colon. No colonoscopy was aborted because of colonoscope malfunction.

CONCLUSION: The FUSE colonoscopy yielded a higher PDR, ADR, DDR than did traditional colonoscopy, without therapeutic failure or complications, showing feasible, effective, and safe in this first Korean trial.

• Colonoscopy
• Colonoscopes
• Feasibility studies
• Colonic polyps

• Adenoma/pathology
• Adenoma/therapy
• Adult
• Aged
• Aged, 80 and over
• Biopsy
• Colonic Neoplasms/pathology
• Colonic Neoplasms/therapy
• Colonic Polyps/pathology
• Colonic Polyps/therapy
• Colonoscopes
• Colonoscopy/adverse effects
• Colonoscopy/instrumentation
• Diverticulum, Colon/pathology
• Diverticulum, Colon/therapy
• Equipment Design
• Feasibility Studies
• Female
• Humans
• Male
• Middle Aged
• Predictive Value of Tests
• Republic of Korea
• Retrospective Studies
• Young Adult

The influence of the endoscopist on the polyp detection rate (PDR) is underappreciated in clinical practice. Moreover, flat lesions or lesions of the proximal colon are more difficult to detect. Here, we evaluated the differences in the PDR and the characteristics of detected polyps according to the experience of the colonoscopist.

We collected data on 2,549 patients who underwent screening colonoscopy performed by three fellows. The PDR was calculated according to the percentage of patients who had at least one polyp (method A) and according to the percentage of detected lesions (method B). The primary outcome included the change in the PDR, and the secondary outcome included the change in the characteristics of the detected polyps with increasing experience of the colonoscopist.

No proportional correlation was found between the PDR and increasing experience in colonoscopy with method A; however, with method B, the PDR increased after 400 colonoscopies (p=0.0209). With method B, the detection rates of small polyps (<5 mm) (p=0.0015) and polyps in proximal sites (p=0.0050) increased after 300 colonoscopies.

Our study demonstrated that the quality of a colonoscopy, measured by using the PDR, may increase when performed by experienced fellows.

• Colonic polyps
• Colonoscopy
• Experience

The aim of this study was to evaluate the efficacy of high definition (HD) i-SCAN for colorectal polyp detection in screening colonoscopy.

We retrospectively analyzed the records of 501 patients who had undergone screening colonoscopy performed by three endoscopists with either HD i-SCAN (n=149) or standard white light (n=352) from January 2, 2014 through June 30, 2014. Patient information and inter-endoscopist variation as well as polyp number, endoscopic findings, and pathologic characteristics were reviewed.

The detection rates of colorectal and neoplastic polyps were significantly higher using HD i-SCAN than standard white light colonoscopy (52% vs. 38.1%, p=0.004 for colorectal polyps; and 37.2% vs. 27.9%, p=0.041 for neoplastic polyps). Analysis of endoscopic findings revealed no difference in detected polyp size between HD i-SCAN and standard white light colonoscopy (4.59±2.35 mm vs. 4.82±2.81 mm, p=0.739), but non-protruding polyps were more commonly detected by i-SCAN than by standard white light colonoscopy (24.6% vs. 13.5%, p=0.007).

Colonoscopy using HD i-SCAN had a significantly higher detection rate of colorectal polyps, including neoplastic polyps, because of improved sensitivity for detecting non-protruding lesions.

• Chromoendoscopy
• Colonic polyps
• Colonoscopy
• i-SCAN

Adenoma detection rate (ADR) is a key component of colonoscopy quality assessment, with a direct link between itself and future mortality from colorectal cancer. There are a number of potential factors, both modifiable and non-modifiable that can impact upon ADR. As methods, understanding and technologies advance, so should our ability to improve ADRs, and thus, reduce colorectal cancer mortality. This article will review new technologies and techniques that improve ADR, both in terms of the endoscopes themselves and adjuncts to current systems. In particular it focuses on effective techniques and behaviours, developments in image enhancement, advancement in endoscope design and developments in accessories that may improve ADR. It also highlights the key role that continued medical education plays in improving the quality of colonoscopy and thus ADR. The review aims to present a balanced summary of the evidence currently available and does not propose to serve as a guideline.

• Colorectal cancer
• Adenoma detection
• New technology
• Techniques
• Colonoscopy

• adenoma classification
• colorectal polyps
• microendoscopy

• Advanced imaging
• Chromocolonoscopy
• Chromoendoscopy
• Inflammatory bowel disease
• Screening colonoscopy
• Society guidelines

• Adenomatous Polyps/pathology
• Adult
• Aged
• Aged, 80 and over
• Colonoscopy/methods
• Colorectal Neoplasms/pathology
• Diagnosis, Differential
• Female
• Humans
• Intestinal Polyps/pathology
• Male
• Middle Aged
• Narrow Band Imaging/methods
• Prospective Studies
• Sensitivity and Specificity

• advanced imaging
• colonic polyps
• colonoscopy
• colorectal cancer
• detection
• quality

• CT colonography
• colon cancer
• nonpolypoid adenoma

AIM: To analyze the current available evidence of Kudo’s pit pattern classification for diagnosing colorectal neoplasms.

METHODS: A search was performed on Pubmed/Embase to identify studies reporting the outcomes of the pit pattern classification in colorectal polyps. Retrieved records were evaluated and selected by two independent investigators. The number of patients, polyps and diagnostic performance of Kudo’s pit pattern classification were retrieved from suitable studies. Pooled sensitivities and specificities were calculated using fixed or random effect models according to their heterogeneity. Publication bias was evaluated using funnel plot, Egger’s test, and Begg’s test. Sensitivity analysis was performed by omitting one study at a time and selecting a subgroup consisting of 11 magnifying chromoendoscopy studies.

RESULTS: 20 eligible studies were included in which a total of 5111 colorectal lesions in 3418 patients were identified for the differentiation of neoplastic and non-neoplastic polyps. Pit pattern classification in all the studies of mucosal patterns with magnification resulted in a pooled sensitivity of 89.0% (95%CI: 85.2-91.9) and pooled specificity of 85.7% (95%CI: 81.3-89.2) and the area under the SROC curve was 0.9354. There was significant publication bias (P = 0.038 and 0.006 for sensitivity and specificity using Egger’s test, P = 0.035 and 0.139 for sensitivity and specificity using Begg’s test, respectively). No single study significantly affected the pooled result, and the magnifying chromoendoscopy subgroup yielded a sensitivity of 92.7% (95%CI: 89.2-95.2) and specificity of 87.3% (95%CI: 81.6-91.4).

CONCLUSION: Kudo’s pit pattern classification is an accurate diagnostic method for the differentiation of neoplastic colorectal lesions. Publication bias is significant in the current available literature.

• Meta-analysis
• Sensitivity
• Specificity
• Colonic neoplasia
• Endoscope
• Magnifying endoscopy

• Area Under Curve
• Chi-Square Distribution
• Colonic Polyps/classification
• Colonic Polyps/pathology
• Colonoscopy
• Colorectal Neoplasms/classification
• Colorectal Neoplasms/pathology
• Diagnosis, Differential
• Early Detection of Cancer
• Humans
• Image Enhancement
• Predictive Value of Tests
• ROC Curve

• Adenoma detection rate
• Colonoscopy
• Colorectal cancer
• Narrow-band imaging
• Screening

• Adenoma/diagnosis
• Adenoma/epidemiology
• Aged
• Colonoscopy/methods
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/epidemiology
• Female
• Follow-Up Studies
• Humans
• Image Processing, Computer-Assisted
• Incidence
• Italy/epidemiology
• Male
• Mass Screening/methods
• Narrow Band Imaging/methods
• Occult Blood
• Prospective Studies

• EGF receptor
• anti-EGFR nanoprobe
• cancer biomarker
• gold nanoparticle
• in vivo imaging
• molecular imaging
• multiplexed detection
• ratiometric imaging
• surface-enhanced Raman scattering
• wide-field Raman

There have been major developments in endoscopic imaging techniques in recent years. Endoscopes with high definition and magnification can provide high quality images that allow for the histological estimation of lesions in vivo and in situ when combined with ancillary enhancement techniques such as chromoendoscopy (CE) and virtual CE (narrow band imaging fujinon intelligent chromoendoscopy, or i-Scan). Despite the enormous potential for these advanced techniques, their value and feasibility in the clinic are still doubted, particularly in cases of colonic polyps that are slated for removal, where in vivo characterization may be deemed unnecessary. However, there are several advantages offered by such advanced endoscopic imaging. CE with or without magnification demonstrates highly accurate histology and invasion depth prediction, and virtual CE is a feasible and less cumbersome alternative to CE in terms of histological estimation, though not sufficiently accurate for depth invasion prediction. Furthermore, the supplementary information provided by advanced imaging systems can assist the endoscopist in the selection of a strategic approach, such as in deciding whether a colonic lesion should be resected, left in situ, or requires more intensive surgical treatment. Lastly, advanced high-resolution imaging techniques may be more cost effective, such that histopathology of low-risk lesions following resection can be eliminated. The results of these evaluations and comparisons with traditional CE are presented and discussed. Taken together, the benefits provided by these advanced capabilities justify their development, and advocates their use for the treatment and management of colonic polyps.

• Colon polyps
• Chromoendoscopy
• Narrow band imaging
• Fujinon intelligent chromoendoscopy
• i-Scan
• Colonoscopy
• Optical biopsy

• Adenoma/diagnosis
• Adenoma/pathology
• Adenoma/surgery
• Colonic Polyps/diagnosis
• Colonic Polyps/pathology
• Colonic Polyps/surgery
• Colonoscopy/methods
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Diagnosis, Differential
• Humans
• Predictive Value of Tests
• Prognosis

• Barrett’s esophagus
• endoscopic imaging
• inflammatory bowel disease
• optical biopsy
• optical coherence tomography

• R44 EY022864 NEI NIH HHS
• R01 CA075289 NCI NIH HHS
• R01 NS057476 NINDS NIH HHS
• R44 CA101067 NCI NIH HHS
• R01 EY011289 NEI NIH HHS
• R01 CA178636 NCI NIH HHS

Hood cap-assisted chromocolonoscopy using indigocarmine is expected to improve the detection rate of colorectal polyps, especially adenomatous polyps. Therefore, aim of the present study was to evaluate the usefulness of hood cap-assisted chromocolonoscopy in routine colonoscopic examinations.

From January, 2013 through March, 2013, a total of 86 patients were enrolled (M:F=33:53, mean age=60 years). For each patient, hood cap-assisted colonoscopic examination was performed, followed by hood cap-assisted chromocolonoscopy using 0.2% indigocarmine from the cecum to the hepatic flexure. Total numbers and characteristics of polyps were compared before and after indigo carmine dye spraying.

Prior to dye spraying, 48 polyps were found in 37 patients, and after dye spraying, 53 additional polyps were found in 34 patients. Of these undetected polyps, 45 (85%) were small sized polyps (≤0.5 cm). Histologically, 19 (36%) were adenomatous polyps, and of these, 15 (28%) were tubular adenomas and 4 (8%) were serrated adenomas. As for the polyp detection rate, there was no difference between the expert and the non-expert groups.

Hood cap-assisted chromocolonoscopic examination using indigocarmine was helpful in detecting cecum and ascending colon polyps, especially small sized polyps (<0.5 cm) and neoplastic polyps.

• Adenoma
• Colonoscopy
• Hood cap
• Indigocarmine
• Polyps

• chromoendoscopy
• i-scan
• inflammatory bowel disease (IBD)
• optical enhancement technology
• polyp

• Coloring Agents
• Diagnosis, Differential
• Endoscopy, Gastrointestinal/methods
• Gastrointestinal Diseases/diagnosis
• Humans
• Image Enhancement/methods
• Precancerous Conditions/diagnosis

• colorectal polyps
• adenoma classification
• microendoscopy
• neoplasia
• diagnostic accuracy

• Aberrant crypt foci
• Adenoma detection rate
• Chromocolonoscopy
• Flat adenomas
• Inflammatory bowel disease
• Kudo classification