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Publications on Blue Laser / BLI

Usefulness of close observation with non-magnified blue laser imaging for determining cold polypectomy indications.

Suzuki T1, Kitagawa Y1, Nankinzan R1, Takashiro H2, Hara T3, Yamaguchi T2.

Scand J Gastroenterol. 2018 Jul 24:1-5. doi: 10.1080/00365521.2018.1488181

Purpose: To examine the usefulness of non-magnified close observation with blue laser imaging (BLI) using a colonoscope with close observation capability in determining indications for cold polypectomy.

Methods: We conducted an image evaluation study on 100 consecutive colorectal lesions of 10 mm or less which were observed endoscopically without magnification using BLI mode prior to treatment. Two experts and two non-experts reviewed the images using the Japan NBI expert team (JNET) classification and the diagnostic accuracy was analyzed.

Results: The final pathological diagnoses of the 100 lesions were hyperplastic/sessile serrated polyp (HP/SSP), low grade dysplasia (LGD), high grade dysplasia (HGD) and deep submucosal invasive cancer (dSM), respectively, in 12, 79, 9 and 0 lesions. When JNET classification type 1 corresponds to HP/SSP; 2A to LGD; 2B to HGD; and 3 to dSM; the overall diagnostic accuracy was 84.3%. Accuracy was 90.5% for experts and 78.0% for non-experts. High confidence rate was 67.5% for experts and 48.0% for non-experts. In diagnostic accuracy for HGD, the sensitivity, specificity, PPV and NPV were, respectively, 77.8%, 98.9%, 87.5% and 97.8% for experts; and 66.6%, 92.3%, 46.2% and 96.6% for non-experts.

Conclusions: The diagnostic accuracy of unmagnified close observation with BLI using a colonoscope with close observation capability is similar to that reported for magnifying endoscopy and is useful in predicting the histological diagnosis of colorectal polyps of 10 mm or less although the effectiveness may be limited for non-experts. This modality is a potentially useful tool in deciding indications for cold polypectomy.

1 Department of Endoscopy, Chiba Cancer Center, Chiba, Japan
2 Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan
3 Hara Clinic

Artificial intelligence diagnosis of Helicobacter pylori infection using blue laser imaging-bright and linked color imaging: a single-center prospective study.

Nakashima H1, Kawahira H2, Kawachi H3, Sakaki N1.

Ann Gastroenterol. 2018 Jul-Aug;31(4):462-468. doi: 10.20524/aog.2018.0269. Epub 2018 May 3.

Background: Deep learning is a type of artificial intelligence (AI) that imitates the neural network in the brain. We generated an AI to diagnose Helicobacter pylori (H. pylori) infection using blue laser imaging (BLI)-bright and linked color imaging (LCI). The aim of this pilot study was to establish an AI diagnosing system that predicts H. pylori infection status using endoscopic images to improve the accuracy and productivity of endoscopic examination.

Methods: A total of 222 enrolled subjects (105 H. pylori-positive) underwent esophagogastroduodenoscopy and a serum test for H. pylori IgG antibodies. During esophagogastroduodenoscopy, an endoscopist sequentially took 3 still images of the lesser curvature of the stomach using white light imaging (WLI), BLI-bright, and LCI. EG-L580NW endoscopic equipment (FUJIFILM Co., Japan) was used for the study. The specifications of the AI were as follows: operating system, Linux; neural network, GoogLeNet; framework, Caffe; graphic processor unit, Geforce GTX TITAN X (NVIDIA Co., USA).

Results: The area under the curve (AUC) on receiver operating characteristics analysis was 0.66 for WLI. In contrast, the AUCs of BLI-bright and LCI were 0.96 and 0.95, respectively. The AUCs obtained for BLI-bright and LCI were significantly larger than those for WLI (P<0.01).

Conclusion: The results demonstrate that the developed AI has an excellent ability to diagnose H. pylori infection using BLI-bright and LCI. AI technology with image-enhanced endoscopy is likely to become a useful image diagnostic tool.

1 Foundation for Detection of Early Gastric Carcinoma, Tokyo (Hirotaka Nakashima, Nobuhiro Sakaki)
2 Center for Frontier Medical Engineering, Chiba University, Chiba (Hiroshi Kawahira)
3 Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (Hiroshi Kawachi), Japan

Ability of blue laser imaging with magnifying endoscopy for the diagnosis of gastric intestinal metaplasia.

Chen H1, Liu Y1, Lu Y1, Lin X1, Wu Q1, Sun J1, Li C1.

Lasers Med Sci. 2018 May 18. doi: 10.1007/s10103-018-2536-3. [Epub ahead of print]

We aimed to determine the utility of blue laser imaging (BLI) with magnifying endoscopy (BLI-ME) for the prediction and diagnosis of gastric intestinal metaplasia (GIM). Participants, aged between 40 and 75 years, undergoing gastroscopy from January to April 2017 were included in this study. The ability of BLI-ME and white light endoscopy (WLE) to detect GIM was assessed by comparing the endoscopic findings with the histological findings. The correlation between the grades of light blue crest (LBC) appearance and histology grade of GIM was calculated. We included 100 participants in this study. GIM was diagnosed in 27 participants; 20 participants were detected by both BLI and WLE, four by BLI only, and three exclusively by random biopsies. The values of sensitivity, specificity, positive predictive values, and negative predictive values for detecting GIM were 34.9, 38.9, 25.4, and 57.1%, respectively, for WLE and 88.9, 96.7, 94.1, and 93.3%, respectively, for BLI-ME. The diagnostic accuracy for GIM was 43% for WLE and 94.0% for BLI-ME. A good correlation between the grades of LBC and the grades of GIM on histology was observed (P < 0.01). BLI-ME achieved a good diagnostic efficiency for detection of GIM. LBC seen on BLI-ME is a typical indicator of GIM.

1 Department of Gastrointestinal Endoscopy, Guangdong Provincial Key Laboratory ofColorectal and Pelvic Floor Diseases, the Sixtli Affiliated Hospital, Sun Yat-sen University, No.26 Yuancun Er Heng Rd, Tianhe Dishict, Guangzhou 510655, Guangdong Province, People’s Republic of China

Diagnostic ability of blue laser imaging combined with magnifying endoscopy for early esophageal cancer.

Diao W1, Huang X1, Shen L1, Zeng Z2.

Dig Liver Dis. 2018 Mar 30. pii: S1590-8658(18)30668-6. doi: 10.1016/j.dld.2018.03.027. [Epub ahead of print]

Background: Blue laser imaging (BLI) is a new image-enhanced endoscopy technique that utilizes a laser light source developed for narrow-band light observation.

Aims: To evaluate the value of BLI combined with magnifying endoscopy (M-BLI) for the diagnosis of early esophageal cancers (EECs).

Methods: This single-center prospective study analyzed 149 patients with focal esophageal lesions detected with white light endoscopy (WLE) at Renmin Hospital of Wuhan University between April 2015 and June 2017. In this study, patients were examined sequentially with narrow-band imaging combined with magnifying endoscopy (M-NBI), M-BLI and 1.25% Lugol’s iodine chromoendoscopy. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated using the agreement (kappa) test. The paired chi-square test was used to compare the concordance of M-NBI, M-BLI and Lugol’s iodine chromoendoscopy.

Results: This study analyzed 153 lesions (four patients had two lesions each). The sensitivity, specificity, accuracy, concordance rates and kappa value of M-BLI were 95.2%, 91.9%, 85.7%, 92.8% and 0.891, respectively; those of M-NBI were 95.2%, 92.8%, 87.5%, 93.5% and 0.906; and those of Lugol’s iodine chromoendoscopy were 95.2%, 94.6%, 91.3%, 94.8% and 0.936.

Conclusion: M-BLI has a diagnostic profile similar to that of M-NBI and could improve the accuracy of EEC diagnosis.

1 Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
2 Department of Pathology, Renmin Hospital of Wuhan University. Wuhan, China

Classification of atrophic mucosal patterns on Blue LASER Imaging for endoscopic diagnosis of Helicobacter pylori-related gastritis: A retrospective, observational study.

Nishikawa Y1, Ikeda Y2, Murakami H3, Hori SI4, Hino K4, Sasaki C3, Nishikawa M4.

PLoS One. 2018 Mar 29;13(3):e0193197. doi: 10.1371/journal.pone.0193197. eCollection 2018.

Background: Atrophic gastritis can be classified according to characteristic mucosal patterns observed by Blue LASER Imaging (BLI) in a medium-range to distant view.

Aims: To facilitate the endoscopic diagnosis of Helicobacter pylori (HP)-related gastritis, we investigated whether atrophic mucosal patterns correlated with HP infection based on the image interpretations of three endoscopists blinded to clinical features.

Methods: This study included 441 patients diagnosed as having atrophic gastritis by upper gastrointestinal endoscopy at Nishikawa Gastrointestinal Clinic between April 1, 2015 and March 31, 2016. The presence/absence of HP infection was not taken into consideration. Endoscopy was performed using a Fujifilm EG-L580NW scope. Atrophic mucosal patterns observed by BLI were classified into Spotty, Cracked and Mottled. Image interpretation results were that 89, 122 and 228 patients had the Spotty, Cracked and Mottled patterns, respectively, and 2 patients an undetermined pattern. Further analyses were performed on 439 patients, excluding the 2 with undetermined patterns.

Results: The numbers of patients testing negative/positive for HP infection in the Spotty, Cracked and Mottled pattern groups were 12/77, 105/17, and 138/90, respectively. The specificity, positive predictive value and positive likelihood ratio for endoscopic diagnosis with positive HP infection based on the Spotty pattern were 95.3%, 86.5% and 8.9, respectively. In all patients with the Spotty pattern before HP eradication, the Cracked pattern was observed on subsequent post-eradication endoscopy.

Conclusions: The Spotty pattern may represent the presence of HP infection, the Cracked pattern, a post-inflammatory change as seen after HP eradication, and the Mottled pattern, intestinal metaplasia.

1 Nishikawa Gastrointestinal Clinic, Matsuyama, Ehime, Japan
2 Endoscopy Center, Ehime University Hospital, Toon, Ehime, Japan
3 Department of Internal Medicine, Saiseikai Matsuyama Hospital Matsuyama, Ehime, Japan
4 Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan

Linked color imaging enhances endoscopic detection of sessile serrated adenoma/polyps

Fujimoto D1, Muguruma N1, Okamoto K1, Fujino Y1, Kagemoto K1, Okada Y1, Takaoka Y1, Mitsui Y1, Kitamura S1, Kimura T1, Miyamoto H1, Bando Y2, Sonoda T3, Takayama T1.

Endoscopy International Open 2018 Mar;6(3):E322-E334. doi: 10.1055/s-0043-124469. Epub 2018 Mar 7.

Background and study aims: Although new image-enhanced endoscopy (IEE) technologies such as blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI) have been developed, their utility for the detection of sessile serrated adenoma/polyps (SSA/Ps) is still unclear. This study aimed to evaluate the utility of BLI, BLI-bright, and LCI for SSA/P detection in still image examinations and in a prospective randomized controlled trial (RCT).

Patients and methods: A group of 6 expert and non-expert endoscopists read 200 endoscopic still images containing SSA/P lesions using white light image (WLI), BLI, BLI-bright, and LCI. Color differences were calculated using the color space method. A prospective RCT of tandem colonoscopy with WLI and LCI was performed. Patients with SSA/P and those with a history of SSA/P that had been endoscopically removed were enrolled and randomly allocated to WLI-LCI or LCI-WLI groups. Additional endoscopic detection rates for SSA/P were compared between the 2 groups.

Results: LCI showed the highest SSA/P detection rate among the 4 modes for both expert and non-expert endoscopists. The detection rate with LCI for the 6 expert endoscopists (mean 98.3 ± standard deviation 2.0 %) was significantly higher than that with WLI (86.7 ± 6.0 %, P < 0.01). Likewise, the detection rate with LCI for the 6 non-expert endoscopists (92.3 ± 2.9 %) was significantly higher than that with WLI (72.7 ± 11.5 %, P < 0.01). The color difference of SSA/P with LCI was the highest among the 4 modes, and was significantly higher than with WLI (median 15.9, (interquartile range 13.7 – 20.6) vs. 10.2, (7.6 – 14.2); P < 0.0001). In the RCT, a total of 44 patients (WLI-LCI 22 vs. LCI-WLI 22) underwent colonoscopy. The additional detection rate for SSA/P in the second inspection in the WLI-LCI group (21.6 %, 8/37) was significantly higher than in the LCI-WLI group (3.2 %, 1/31; P = 0.02). The small, flat, non-mucus and isochromatic SSA/Ps in the transverse colon were detected more frequently in the second inspection with LCI.

Conclusions: LCI was the most sensitive mode for SSA/P detection among WLI, BLI, BLI-bright, and LCI in the still image examinations. Our RCT strongly suggests that LCI is superior to conventional WLI for SSA/P detection during colonoscopy. UMIN000017599.

1 Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
2 Division of Pathology, Tokushima University Hospital, Tokushima, Japan.
3 Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan.