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Present and future status of flexible spectral imaging color enhancement and blue laser imaging technology.

Osawa H, Yamamoto H.

Dig Endosc. 2014 Jan;26 Suppl 1:105-15.

Abstract: The usefulness of flexible spectral imaging color enhancement (FICE) has been reported for evaluating the esophagus, stomach, and small and large intestine. Higher contrast is shown between cancer and the surrounding mucosa in the esophagus and stomach and may facilitate the detection of gastric cancers missed by white light imaging alone. The surface patterns of gastric mucosa are clearly visualized in non-malignant areas but are irregular
and blurred in malignant areas, leading to clear demarcation. Capsule endoscopy with FICE detects angiodysplasia and erosions of the small intestine. The surface and vascular pattern with FICE is useful for the differential diagnosis of colorectal polyps. However, FICE remains somewhat poor at visualizing mucosal microvasculature on a tumor surface. Narrow-band imaging (NBI) is dark in observing whole gastric mucosa and poor at visualizing mucosal microstructure. Blue laser imaging (BLI) has the potential to resolve these limitations. Narrow-band laser light combined with white light shows irregular microvessels on both differentiated and undifferentiated gastric cancer similar to those using NBI. In addition, irregular surface patterns including minute white zones are clearly seen on the uneven surface of differentiated lesions, resulting in exclusion of undifferentiated lesions. Using both distant and close-up views, a high contrast between green intestinal metaplasia and brown gastric cancer may lead to early detection of gastric cancers and determination of a demarcation line. BLI produces high-contrast images in esophageal cancer with clear vision of intrapapillary capillary loops and also predicts the histopathological diagnosis and depth of invasion in colorectal neoplasms.

Blue Laser Imaging provides excellent endoscopic images of upper gastrointestinal lesions

Osawa H, Yamamoto H et al

VideoJ Encyclopedia GI Endoscopy. 2014;1, 607–10

Background/aim: Image enhanced endoscopy including narrow band imaging, flexible spectral imaging color enhancement and i-scan is usefulf or detailed examination of upper gastro-intestinal lesions.We aimed to clarify the usefulness of blue laser imaging (BLI) method, a new endoscopic system, to image upper gastrointestinal lesions.

Procedure: We observed upper gastrointestinal lesions including early gastric cancer and early esophageal cancer using white light images and subsequently BLI bright images and BLI images.

Results: In gastric cancer, irregular microvessels on the tumor surface are clearly identified for both differentiated and undifferentiated lesions with high magnification, similar to those using narrow band imaging. In addition, irregular surface patterns are seen in differentiated lesions by enhanced white circles, which form white zones on the tumor surface. Finding these circles allow us to rule out undifferentiated lesions. Another advantage is to enhance gastric intestinal metaplasia as green-colored mucosa in both distant and close-up views, leading to higher color contrast with brown gastric cancers. This leads to early detection of gastric cancers and shows a demarcation line between the cancer and areas of metaplasia. In squamous cell carcinoma of the esophagus, BLI produces a higher color contrast between brown lesions within traepithelial papillary capillary loop sand the surrounding area without magnification. The extent of Barrett‘s esophagus is easily shown as a high color contrast with the brown gastric mucosa.

The ability of a novel blue laser imaging system for the diagnosis of invasion depth of colorectal neoplasms.

Yoshida N, Hisabe T et al

J Gastroenterol. 2014 Jan;49(1):73-80.

Background: Fujifilm has developed a novel endoscope system with two kinds of lasers that enables us to allow narrow-band light observation with blue laser imaging (BLI). The aim of this study was to evaluate BLI magnification in comparison with narrow-band imaging (NBI) magnification for the diagnosis of colorectal neoplasms.

Methods: This was a multicenter open study. A total of 104 colorectal neoplasms were examined with BLI and NBI magnifications in Kyoto Prefectural University of Medicine and Fukuoka University Chikushi Hospital. Vascular and surface patterns of tumors under BLI magnification were compared with those under NBI magnification, using a published NBI classification. The main outcome was the correlation between the NBI classification diagnosed by BLI or NBI magnification and the histopathological analyses.

Results: Sixty-two cases of adenoma, 34 cases of intramucosal cancer and shallowly invaded submucosal cancer, and eight cases of deeply invaded submucosal cancer were diagnosed. The diagnostic accuracy of BLI magnification in the NBI classification was 74.0 % (77/104), similar to that of NBI magnification (77.8 %). The consistency rate between BLI and NBI magnification in the NBI classification was 74.0 %. Concerning image evaluation, the interobserver variability of two expert endoscopists (N.Y. and T.H.) in BLI magnification was K = 0.863. On the other hand, the intraobserver variability of the two endoscopists was K = 0.893 (N.Y.) and 0.851 (T.H.).

Conclusion: BLI magnification by laser source could predict histopathological diagnosis and invasion depth of colorectal neoplasms. The diagnostic effectiveness of this method was similar to that of NBI magnification.