Gastroenterology. 2009 Jan;136(1):52-5. Epub 2008 Dec 6.
Optical contrast endoscopy: is it ready for routine use?
Cohen J.
New York University School of Medicine, New York, New York 10021, USA. cohen.jonathan@att.net
Significance:
With the growing focus on improving the quality of the procedures that we do, particularly in the emphasis on preventing missed colon cancers among individuals who get screened, new technology holds much promise to increase the endoscopist's diagnostic capability. While issues such as colon preparation quality and careful and sufficient inspection of all mucosal surfaces by endoscopists are paramount, the advent of high resolution "HDTV" endoscopes coupled with the use special filtered light to highlight abnormal blood vessels has generated much interest. This paper reviews the breadth of specific organs in which Narrow Band Imaging (NBI) has been used to enhance diagnosis, detect subtle abnormalities, or assist in therapeutic procedures. It summarizes the key evidence to date supporting its application and points out those applications for which evidence is still lacking.
Excerpt:
[The excerpt reproduced here from the article:Optical Contrast Endoscopy: Is It Ready for Routine Use? By JONATHAN COHEN of New York University School of Medicine, New York, New York is reprinted from GASTROENTEROLOGY 2009;136:52–64 with permission from Elsevier. Link to Gastroenterology January 2009 for this complete article on the Web.]
The literature supports the routine use of high-resolution optical contrast endoscopy today for surveillance in Barrett’s esophagus and for any EGD performed in patients considered at high risk for squamous cancers of the oropharynx or esophagus. Emerging data and expert opinion support the use of optical contrast high-resolution scopes in therapeutic procedures such as ablation of Barrett’s and endoscopic mucosal resection or ESD in which margin assessment is critical.
In the colon, it remains to be seen whether the high yields of adenoma detection seen using high-resolution endoscopy justifies its use during routine examinations. This question is relevant regardless of whether or not the optical contrast confers additional benefit or just provides a learning effect to improve an operator’s white light detection. Will the _60% adenoma detection rate reported by Rex et al lead to a reduction in the interval cancer incidence of patients under surveillance in long-term follow-up? That will be the true measure of whether enhanced detection especially of small lesions and whether more complete polyp resection will have a meaningful clinical impact.
In the meantime, the undisputed advance is the enhanced optical diagnosis with _90% accuracy using NBI or FICE colonoscopes. By looking at pit and vessel patterns using this new technology, routine colonoscopy could easily be made more efficient and less costly. Considerable time and cost might be saved by adopting the practice of not removing small, clearly hyperplastic polyps in the left colon or by following a remove and discard policy once enough information has been obtained optically to determine the recommended timing of the next interval examination.
PMID: 19063888
