Ultraslim endoscopy with flexible spectral imaging color enhancement for upper gastrointestinal neoplasms

Figure 1 A slightly depressed lesion with hyperemia was found on the surface of the posterior wall of the lower body of the stomach. The hyperemia of the lesion is highlighted and the boundary is more clearly visualized with flexible spectral imaging color enhancement (FICE). The visibility with FICE was graded 4. Endoscopic submucosal dissection (ESD) was performed for local complete resection of the moderately differentiated adenocarcinoma limited to within the mucosa. A: Conventional image with ultraslim endoscopy; B: Image with FICE: The hyperemia of the lesion is highlighted and the boundary is more clearly visualized with FICE (FICE 4); C: Conventional image with conventional esophagogastroduodenoscopy; D: Dissected section after ESD.

Figure 2 A discolored change was found in the anterior wall and surrounding areas of the gastric antrum. Color contrast between the lesion and surrounding mucosa with atrophic changes is highlighted and the boundary is more clearly visualized with flexible spectral imaging color enhancement (FICE). The visibility with FICE was graded 4. Endoscopic submucosal dissection (ESD) was performed for local complete resection of the well-differentiated adenocarcinoma limited to within the mucosa. A: Conventional image with ultraslim endoscopy; B: Image with FICE: Color contrast between the lesion and surrounding mucosa is highlighted and the boundary is more clearly visualized (FICE 4); C: Conventional image with conventional esophagogastroduodenoscopy; D: Dissected section after ESD.

Figure 3 A rough, slightly elevated squamous lesion with hyperemia in a semicircle is found 25 cm distal from the superior incisor line. The hyperemia of the lesion is highlighted and the boundary is more clearly visualized with flexible spectral imaging color enwhancement (FICE). The visibility was graded 4. Endoscopic submucosal dissection (ESD) was performed for local complete resection of the squamous cell carcinoma including the muscularis mucosae. A: Conventional image with ultraslim endoscopy: A rough, elevated squamous lesion with hyperemia in a semicircle is found; B: Image with FICE: The hyperemia of the lesion is highlighted and the boundary is more clearly visualized with FICE (FICE 4); C: Conventional image with conventional esophagogastroduodenoscopy; D: Dissected section sprayed with Iodin after ESD.