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Publications on Blue Laser / BLI

Benefits of Linked Color Imaging for Recognition of Early Differentiated-Type Gastric Cancer: In Comparison With Indigo Carmine Contrast Method and Blue Laser Imaging

Takeshi Yasuda1,2, Nobuaki Yagi1, Tatsushi Omatsu1, Sadanari Hayashi1, Yuki Nakahata1, Yuriko Yasuda1, Akihiro Obora1, Takao Kojima1, Yuji Naito2, Yoshito Itoh2

Surg Endosc. 2020 Jun 16. doi: 10.1007/s00464-020-07706-1. Online ahead of print.

Background and aim: Linked color imaging (LCI) is a novel endoscopy system, which enhances slight differences in mucosal color. However, whether LCI is more useful than other kinds of image-enhanced endoscopy (IEE) in recognizing early gastric cancer remains unclear. This study aimed to evaluate LCI efficacy compared with the indigo carmine contrast method (IC), and blue laser imaging-bright (BLI-brt) in early differentiated-type gastric cancer recognition.

Methods: We retrospectively analyzed early differentiated-type gastric cancer, which were examined by all four imaging techniques (white light imaging, IC, LCI, BLI-brt) at Asahi University Hospital from June 2014 to November 2018. Both subjective evaluation (using ranking score: RS) and objective evaluation (using color difference score: CDS) were adopted to quantify early differentiated-type gastric cancer recognition.

Results: During this period, 87 lesions were enrolled in this study. Both RS and CDS of LCI were significantly higher (p < 0.01) than those of IC and BLI-brt. Both RS and CDS of BLI-brt had no significant difference compared with those of IC. Subgroup analysis revealed that LCI was especially useful in post-Helicobacter pylori eradication patients and flat or depressed lesions compared with IC and BLI-brt.

Conclusions: LCI appears to be more beneficial for the recognition of early differentiated-type gastric cancer in endoscopic screenings than IC and BLI-brt from the middle to distant view.

1 Department of Gastroenterology, Asahi University Hospital, 3-23 Hashimoto, Gifu 500-8523, Japan
2 Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 465 Kawaramachi–Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan

A detailed comparison between the endoscopic images using blue laser imaging and three-dimensional reconstructed pathological images of colonic lesions

Takeshi Ueda1,2, Kohei Morita3, Fumikazu Koyama1,4, Yuichi Teramura5, Tadashi Nakagawa6, Shinji Nakamura7, Yayoi Matsumoto1, Takashi Inoue1, Takayuki Nakamoto 1,4, Yoshiyuki Sasaki1, Hiroyuki Kuge1, Maiko Takeda3, Chiho Ohbayashi3, Hisao Fujii8, Masayuki Sho1

PLoS One. 2020 Jun 29;15(6):e0235279. doi: 10.1371/journal.pone.0235279. eCollection 2020.

Blue laser/light imaging (BLI) is an image-enhanced endoscopy (IEE) technique that can provide an accurate diagnosis by closely observing the surface structure of various colonic lesions. However, complete correspondence between endoscopic images and pathological images has not been demonstrated. The aim of this study was to accurately compare endoscopic images and the pathological images using a three-dimensionally (3D) reconstructed pathological model. Continuous thin layer sections were prepared from colonic tissue specimens and immunohistochemically stained for CD34 and CAM5.2. Three-dimensional reconstructed images were created by superimposing immunohistochemically stained pathological images. The endoscopic image with magnifying BLI was compared with the top view of the 3D reconstructed image to identify any one-to-one correspondence between the endoscopic images and histopathological images using the gland orifices and microvessels as a guide. Using 3D reconstructed pathological images, we were able to identify the location on the endoscope image in cases of colonic adenocarcinoma, adenoma and normal mucosa. As a result, the horizontal plane of the endoscopic image and the vertical plane of the 2D pathological specimen were able to be compared, and we successfully determined the visible blood vessel depth and performed a detailed evaluation on magnifying BLI. Examples are as follows: (1) The median vasculature depth from the mucosal surface that could be recognized as vasculature on magnifying BLI was 29.4 μm. The median depth of unrecognizable vessels on magnifying BLI was 218.8 μm, which was significantly deeper than recognizable vessels. (2) Some brownish structures were suggested to potentially be not only dense vessels, vessel expansions, corrupted vessels but also bleeding or extravasation of erythrocytes. Overall, we demonstrated a new approach to matching endoscopic images and pathological findings using a 3D-reconstructed pathological model immunohistochemically stained for CD34 and CAM5.2. This approach may increase the overall understanding of endoscopic images and positively contribute to making more accurate endoscopic diagnoses.

1 Department of Surgery, Nara Medical University, Kashihara, Japan
2 Department of Surgery, Minami-Nara General Medical center, Yoshino, Nara, Japan
3 Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
4 Department of Endoscopy, Nara Medical University Hospital, Kashihara, Japan
5 Clinical Research Endoscopy System Division and Medical System Business Division, FUJIFILM Corporation, Tokyo, Japan,
6 Department of Surgery, Saiseikai Chuwa Hospital, Sakurai, Japan,
7 Department of Surgery, Takanohara Central Hospital, Nara, Japan, 8 Gastrointestinal Endoscopy and IBD center, Yoshida Hospital, Nara, Japan

Linked Color Imaging Followed by Magnifying Blue Laser Imaging Identifies Early Gastric Cancer in Map-Like Redness After Successful Helicobacter Pylori Eradication

Osamu Dohi1, Tsugitaka Ishida1, Naohisa Yoshida1

Dig Endosc. 2020 May 28.

Linked color imaging (LCI; Fujifilm Co., Tokyo, Japan) identifies map‐like redness (MR), which indicates gastric intestinal metaplasia (GIM) histopathologically1 and helps clearly visualize minute differences by mucosal colors.2, 3 Early gastric cancer (EGC) visibility after Helicobacter pylori (HP ) eradication is greater using LCI compared with white light imaging (WLI).4 However, depressed lesions similar to EGCs were sometimes detected in MR using LCI in clinical practice. Magnifying blue laser imaging (M‐BLI) has an excellent diagnostic accuracy for EGC.5 Therefore, we recommend M‐BLI following LCI to accurately identify EGC after HP eradication in MR (Video S1).
Case 1 is a 10‐mm depressed lesion, which was detected on the lesser curvature of the upper body after successful HP eradication (Fig. 1). WLI revealed an indistinct depressed area (Fig. 1A). LCI showed a well‐demarcated orange‐colored lesion with a clear margin surrounding the lavender color area (Fig. 1B). The lesion could be diagnosed as EGC with high confidence because M‐BLI shows irregular microvessels and microstructures with a clear border. The lesion was pathologically diagnosed as a well‐differentiated intramucosal adenocarcinoma surrounding GIM. Case 2 is a 10‐mm depressed lesion, which was detected on the greater curvature of lower body after successful HP eradication. Although the lesion could not be detected using WLI (Fig. 2A), LCI detected a well‐demarcated orange‐colored lesion around the lavender color area (Fig. 2B). The lesion could be diagnosed as EGC with high confidence, because M‐BLI shows irregular microvessels and microstructures with a mostly clear border. The pathological diagnosis was a well‐differentiated intramucosal adenocarcinoma partially covered by surrounding GIM at the edge of the lesion.

1 Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

Blue laser imaging in a patient with Cronkhite-Canada syndrome.

Wang S1, Cao H1, Zhou J1, Feng S2, Jiang K1.

Gastrointest Endosc. 2020 Apr 17. pii: S0016-5107(20)34171-7. doi: 10.1016/j.gie.2020.04.019. [Epub ahead of print]

A 69-year-old woman was seen with diarrhea for 16 years (more than 20 times in recent 6 months). She underwent total colectomy 16 years ago because of multiple colon polyps but without final diagnosis. Physical examination revealed that the distal parts of her nail beds were soft and thick and had fallen off (A), and the hyperpigmented patches could be found on her face, arms, legs, and even her tongue (B). The laboratory results showed a serum albumin level of 23g/L (normal range 35-55 g/L). The blue laser imaging system (BLI) illustrated multiple polyps with dilatation of the mucosal gland and irregular vessels in the esophagus (C), stomach, small intestine (D), and rectum. Histological findings demonstrated hamartoma polyps, hyperplastic mucosal gland, cystic dilatation of mucosal gland, diffuse edema in the intestine, and adenoma in the rectum. Thus, a diagnosis of Cronkhite-Canada syndrome (CCS) was established. To our knowledge, few esophagus lesions in the case of CCS have been reported. Moreover, this case presented the first BLI finding in CCS, and evaluation of potential value of BLI for the early diagnosis of CCS is further required. Our patient’s symptoms were relieved during follow-up by treating with lansoprazole, dexamethasone, and human albumin.

1 Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
2 Department of Geriatrics, General Hospital, Tianjin Medical University, Tianjin, China

Clinical Validation of BASIC Classification for the Resect and Discard Strategy for Diminutive Colorectal Polyps

Rondonotti E1, Hassan C2, Andrealli A1, Paggi S1, Amato A1, Scaramella L1,3, Repici A4, Radaelli F3.

Clin Gastroenterol Hepatol. 2020 Jan 7. pii: S1542-3565(20)30001-X. doi: 10.1016/j.cgh.2019.12.028. [Epub ahead of print]

Background and Aims: Blue-light imaging (BLI) is a chromoendoscopy technique that uses direct (not filtered) emission of blue light with short wavelength (410 nm) to increase visibility of microvascular pattern and superficial mucosa. A BLI-based classification system for colorectal polyps (also called BLI Adenomas Serrated International Classification, BASIC) has been created and was validated using still images or short videos. We aimed to validate BASIC in a clinical practice setting, using thresholds recommended by the American Society for Gastrointestinal Endoscopy for the resect and discard strategy as the reference standard.

Methods: We studied 333 patients (mean age, 62.7±8.1 y; 176 men) who underwent screening colonoscopy from January through July 2019. Six endoscopists trained in BASIC participated in the study. All detected diminutive polyps were characterized by real-time BLI and categorized as adenoma or non-adenoma according to BASIC. All polyps were removed and evaluated by histopathology. The BLI-directed surveillance intervals (based on high-confidence characterization of polyps 5 mm or smaller and pathology feature for others) were compared with histology-directed surveillance intervals, according to United States Multi-society Task Force and European Society of Gastrointestinal Endoscopy recommendations. We calculated negative-predictive values of optical real-time analysis of diminutive rectosigmoid adenomas.

Results: When we applied BASIC, 748 polyps smaller than 5 mm were categorized with 89% accuracy (95% CI, 85.9%-90.6%). BLI-directed surveillance was correct for 90% of patients according to the United States Multi-society task force criteria (95% CI, 86%-93%) and for 96% of patients according to European Society of Gastrointestinal Endoscopy criteria (95% CI, 93%-97%). The negative-predictive value for 302 polyps smaller than 5 mm, located in the rectosigmoid colon and evaluated with high confidence, based on histologic features of adenomatous polyps, was 91% (95% CI, 85%-95%).

Conclusions: Our analysis of data from 333 patients undergoing screen colonoscopies supports the validity of BASIC discriminating diminutive colorectal polyps with histologic features of adenomas from non-adenomas. This allows for the implementation of the resect and discard strategy based on BLI in clinical practice. ClinicalTrials.gov no: NCT03746171.

1 Gastroenterology Unit, Valduce Hospital, Como, Italy
2 Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, ltaly
3 Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universita degli Studi di Milano, Milano, Italy
4 Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano, Italy

The efficacy of tumor characterization and tumor detectability of linked color imaging and blue laser imaging with an LED endoscope compared to a LASER endoscope

Naohisa Yoshida 1, Osamu Dohi 1, Ken Inoue 1, Satoshi Sugino 1, Ritsu Yasuda 1, Ryohei Hirose 1, Yuji Naito 1, Yutaka Inada 2, Takaaki Murakami 3, Kiyoshi Ogiso 4, Yukiko Morinaga 5, Mitsuo Kishimoto 5, Yoshito Itoh 1

International Journal of Colorectal Disease 2020 Feb 22[Online ahead of print]

Objectives: An endoscope with a light-emitting diode (LED) light source which has a 2-mm close-distance observation function without magnification, has been marketed, enabling linked color imaging (LCI) and blue laser imaging (BLI) for tumor detection and characterization. We analyzed the efficacy of a LED endoscope compared to a LASER endoscope.

Methods: We retrospectively reviewed 272 lesions observed using the LED endoscopic system (Fujifilm Co., Tokyo, Japan) from May 2018 to September 2019. The Japanese NBI Classification was used for tumor characterization. We analyzed the diagnostic accuracy and confidence level. Sixty-one lesions observed with both the LED and magnified LASER endoscopes were also analyzed to compare the diagnostic accuracy. Regarding the tumor detectability, we calculated color difference values (CDVs) and brightness values (BVs) of white-light imaging, BLI, and LCI modes between the two endoscopes for each tumor.

Results: The mean polyp size was 9.2 ± 11.3 mm. Histology showed 71 sessile serrated lesions, 193 adenoma and high-grade dysplasias, and 8 T1 cancers. The diagnostic accuracy of tumors ≥ 10 and < 10 mm was 72.0% and 92.9% (p < 0.001), respectively and the high confidence rate was 93.8%. The diagnostic accuracy of LED (77.0%) was a little higher than that of LASER without magnification (65.6%, p = 0.16) but was not inferior to that of LASER with magnification (82.0%, p = 0.50). The respective CDVs of LED and LASER endoscopes were 20.6 ± 11.2 and 21.6 ± 11.2 for LCI (p = 0.30), and the respective BVs were 210.0 ± 24.2 and 175.9 ± 21.1 (p < 0.001).

Conclusions: A LED endoscope with close-distance observation improved tumor detection and characterization due to high brightness.

1 Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
2 Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
3 Department of Gastroenterology, JCHO Kyoto Kuramaguchi Medical Center, Kyoto, Japan
4 Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
5 Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan