American Gastroenterological Association (AGA) Institute Technology Assessment on Image-Enhanced Endoscopy

Preparation technique for indigo carmine IEE. (A) For 0.2% diluted solution, mix 5 mL 0.8% solution with 15 mL sterile water. (B) Diluted solution is sprayed onto the area of interest using a syringe via the accessory channel of the endoscope.

System configuration of 2-band NBI on color chip illumination system. Courtesy of Mr. Kota Nozue at Olympus Corp, Japan.

IEE of a submucosally invasive oropharyngeal squamous cell carcinoma. (A) A slightly reddish area was appreciated during standard endoscopy. The border of the lesion was difficult to distinguish from the surrounding normal mucosa. (B) NBI was used through a switch at the control body of the endoscope. The lesion appeared brownish as compared with the surrounding normal mucosa. A magnified white light (C) and NBI (D) image demonstrated several red and brown dots, respectively, which represent dilated and irregular-shaped and density of intraepithelial papillary capillary loops. The resected specimen revealed well-differentiated squamous cell carcinoma invading the superficial part of the submucosa. Courtesy of Dr M. Muto, National Cancer Center East, Japan.

Dye-based and optical-based IEE of a submucosally invasive esophageal squamous cell carcinoma. (A) A large patch of reddish area was observed during standard endoscopy. (B) Lugol’s solution was sprayed using a specialized catheter throughout the entire thoracic esophagus. After spraying, normal mucosa became brownish/greenish, while the lesion did not change in color. (C) After the effect of Lugol’s solution has disappeared, NBI was used to view the abnormal mucosa. Irregular-shaped and density of intraepithelial papillary capillary loops was observed. Courtesy of Dr. M. Muto, National Cancer Center East, Japan.

IEE of a depressed colorectal neoplasm. (A) A slightly reddish mucosal area was visualized during standard colonoscopy. (B) Diluted indigo carmine (0.2%) was used to further characterize the lesion and delineate its borders. (C) EMR inject-and-cut technique was used. (D) Following EMR, no residual tissue was identified. Images from VA Palo Alto, California.

NBI of a nonpolypoid colorectal adenoma. Nonpolypoid (IIa) colorectal lesion visualized with (A) standard and (B) NBI colonoscopy. The lesion was resected using EMR inject-and-cut technique. (C) Following resection, the borders are closely inspected for residual tissue. (D) Inspection with NBI shows an area of residual tissue (arrow). Argon plasma coagulation was then applied to the residual lesion for complete resection. Images from VA Palo Alto, California.

Ulcerative lesion in a patient with long-standing ulcerative colitis. There was concern that the lesion contained an ulcerated neoplasm. (A) Ulcer in the center in the image. (B) Indigo carmine is applied for further visualization. (C) Magnification and (D) NBI show regenerative capillary features. There were no neoplastic changes in the biopsy specimen. Images from VA Palo Alto, CA.