High Definition Scopes, Narrow Band Imaging, Chromoendoscopy
Just as technology continues to improve our television images with new high definition sets, endoscopic images are following a similar path. A new generation of endoscopes are being used by most endoscopists that allow high definition imaging with stunning detail. Not only does high definition provide a clearer picture for the doctor to look at, but it literally gives more information due to the increased resolution of the picture. When endoscopists are trying to find small polyps, early cancer and flat lesions, the addition of high definition may further improve identification of these abnormalities.
Along with a high definition picture, new techniques are being developed to enhance certain mucosal or vascular characteristics so that abnormal growths are visualized better. One example is a technology called Narrow Band Imaging (NBI) (Olympus America, Center Valley, PA). NBI uses a special filter to illuminate tissue with light at specific wavelengths, which enhances underlying vasculature and produces the greatest contrast between the vessels and surrounding mucosa. This can help the physician see the margins of an abnormal growth better and assist in determining which areas are the best to biopsy. Fujinon Intelligent Color Enhancement (FICE; Fujinon, Inc. Wayne, NJ) and I-scan (Pentax Medical Montvale, NJ) are similar technologies that use computer processing to enhance mucosal detail
Chromoendoscopy is a special technique used in conjunction with endoscopy to improve visualization of the mucosa or lining of the intestine. Chromoendoscopy can help the endoscopist find abnormalities that are present during the endoscopic examination which may be difficult to identify using only “white light” endoscopy. Chromoendoscopy is performed by spraying specialized nonpermanent stains or dyes on the lining of the intestine during the endoscopic procedure.
Once the area of interest has been sprayed, the dye works either as a direct contrast agent or is absorbed by the cells of the lining of the intestine. In either case, a color change occurs and the endoscopist evaluates the surface appearance to detect a characteristic appearance which is either normal or abnormal. If an abnormal appearance is detected, the endoscopist may then perform tissue sampling of the area (endoscopic biopsy) or remove the area entirely (polypectomy).
Chromoendoscopy is used to evaluate a variety of conditions including cancer of the esophagus, stomach and colon, and a number or premalignant or precancerous conditions. These include Barrett’s esophagus, a change in the lining of the esophagus which may increase the risk of esophageal cancer, and ulcerative colitis, one type of inflammatory bowel disease involving the colon. Chromoendoscopy can also be used to evaluate benign (noncancerous) conditions in the gastrointestinal tract including Helicobacter pylori infections and abnormal, but not precancerous, gastric mucosa found in the esophagus or small intestine.
Reviewed November 2010