• Diagnosis
• Endoscopy
• Gastroesophageal reflux disease
• Treatment

• gastroesophageal reflux disease
• mucosal barrier
• mucosal resistance
• reflux esophagitis

• Color
• Endoscopy, Gastrointestinal
• Esophagitis, Peptic/diagnostic imaging
• Helicobacter Infections
• Helicobacter pylori
• Humans
• Reproducibility of Results

Esophagogastroduodenoscopy (EGD) with iodine stain is a useful and diffused method for diagnosing esophageal cancer. We can perform the procedure easily with endoscopic system which does not comprise image-enhanced endoscopy. Several studies advocated that iodine-unstained streaks are a characteristic finding of gastroesophageal reflux disease (GERD). However, there are only a few reports about the subject. In this study, we investigated the usefulness of iodine chromoendoscopy for GERD consultation.

The study was conducted with 154 GERD cases in which EGD with iodine stain to the esophagus was performed. For the 154 cases, we analyzed the existence of reflux esophagitis finding and iodine-unstained streaks. In 47 GERD cases (proton pump inhibitor (PPI): 45 cases, histamine H2-receptor antagonist (H2-RA): two cases) where medication was started after EGD, we examined predictive factors of the symptom improvement such as sex, age, weight, reflux esophagitis finding, and iodine-unstained streak.

An iodine-unstained streak was observed in 50/154 cases (32.5%). For 50 cases with iodine-unstained streak, there were only 24/50 cases (48.0%) that had both reflux esophagitis findings (≥ Los Angeles classification: grade M) and an iodine-unstained streak. For 47 cases in which medication was started, 34 cases showed improvement in their symptoms, and 13 cases did not show improvement. An iodine-unstained streak was observed more often in “Improved” group rather than in “Not improved” group (P < 0.01). When we supposed an iodine-unstained streak to be the predictive factor of the medication effect for GERD, sensitivity was 61.8% and specificity was 84.6%.

No erosion was often found in the GERD cases without reflux esophagitis, and iodine-unstained streak was observed more often in “Improved” group rather than in “Not improved” group. We think that iodine-unstained streak can be useful for diagnosing of GERD and predictive factor of the medication effect.

• Esophagogastroduodenoscopy
• Gastric secretion inhibitor
• Gastroesophageal reflux disease
• Iodine-unstained streak

With more prevalent gastroesophageal reflux disease comes increased cases of Barrett's esophagus and esophageal adenocarcinoma. Image-enhanced endoscopy using linked-color imaging (LCI) differentiates between mucosal colors. We compared LCI, white light imaging (WLI), and blue LASER imaging (BLI) in diagnosing reflux esophagitis (RE).

Consecutive RE patients (modified Los Angeles [LA] classification system) who underwent esophagogastroduodenoscopy using WLI, LCI, and BLI between April 2017 and March 2019 were selected retrospectively. Ten endoscopists compared WLI with LCI or BLI using 142 images from 142 patients. Visibility changes were scored by endoscopists as follows: 5, improved; 4, somewhat improved; 3, equivalent; 2, somewhat decreased; and 1, decreased. For total scores, 40 points was considered improved visibility, 21–39 points was comparable to white light, and < 20 points equaled decreased visibility. Inter- and intra-rater reliabilities (Intra-class Correlation Coefficient [ICC]) were also evaluated. Images showing color differences (ΔE*) and L* a* b* color values in RE and adjacent esophageal mucosae were assessed using CIELAB, a color space system.

The mean age of patients was 67.1 years (range: 27–89; 63 males, 79 females). RE LA grades observed included 52 M, 52 A, 24 B, 11 C, and 3 D. Compared with WLI, all RE cases showed improved visibility: 28.2% (40/142), LA grade M: 19.2% (10/52), LA grade A: 34.6% (18/52), LA grade B: 37.5% (9/24), LA grade C: 27.3% (3/11), and LA grade D: 0% (0/3) in LCI, and for all RE cases: 0% in BLI. LCI was not associated with decreased visibility. The LCI inter-rater reliability was “moderate” for LA grade M and “substantial” for erosive RE. The LCI intra-rater reliability was “moderate–substantial” for trainees and experts. Color differences were WLI: 12.3, LCI: 22.7 in LA grade M; and WLI: 18.2, LCI: 31.9 in erosive RE (P < 0.001 for WLI vs. LCI).

LCI versus WLI and BLI led to improved visibility for RE after subjective and objective evaluations. Visibility and the ICC for minimal change esophagitis were lower than for erosive RE for LCI. With LCI, RE images contrasting better with the surrounding esophageal mucosa were more clearly viewed.

• Blue LASER imaging
• Color difference
• Inter-rater reliability
• Linked color imaging
• Reflux esophagitis
• Visibility

• Endoscopy
• narrow band imaging (NBI)
• probe-based confocal laser endomicroscopy (pCLE)

• Gastroesophageal reflux
• endoscopy
• gastrointestinal
• heartburn
• image enhancement

• Clinical guidelines
• Diagnóstico de enfermedad por reflujo gastroesofágico
• Gastroesophageal reflux disease diagnosis
• Gastroesophageal reflux disease treatment
• Guías clínicas
• Recomendaciones
• Recommendations
• Tratamiento en enfermedad por reflujo gastroesofágico

• Adult
• Barrett Esophagus/complications
• Barrett Esophagus/therapy
• Female
• Gastroesophageal Reflux/diagnosis
• Gastroesophageal Reflux/therapy
• Humans
• Male
• Mexico
• Pregnancy

Bronchial vascular remodeling is an underresearched component of airway remodeling in COPD. Image-enhanced bronchoscopy may offer a less invasive method for studying bronchial microvasculature in COPD.

To evaluate endobronchial mucosal vasculature and changes in COPD by image-enhanced i-scan3 bronchoscopy and correlate them pathologically by analyzing bronchial mucosal biopsies.

This case–control study analyzed 29 COPD patients (41.4% Global initiative for chronic Obstructive Lung Disease B [GOLD B] and 58.6% GOLD D) and ten healthy controls admitted at Alexandria Main University Hospital, Egypt. Combined high-definition white light bronchoscopy (HD WLB) with i-scan3 was used to evaluate endobronchial mucosal microvasculature. The vascularity was graded according to the level of mucosal red discoloration (ie, endobronchial erythema) from decreased discoloration to normal, mild, moderate, and severe increased red discoloration (G−1, G0, G+1, G+2, and G+3, respectively) and scored by three bronchoscopists independently. Bronchial mucosal biopsies were taken for microvascular density counting using anti-CD34 antibody as angiogenesis marker.

Different grades of endobronchial erythema were observed across/within COPD patients using combined HD WLB + i-scan3, with significant agreement among scorers (P=0.031; median score of G+1 [G−1–G+2]) being higher in GOLD D (P=0.001). Endobronchial erythema significantly correlated with COPD duration, exacerbation frequency, and body mass index (P<0.05). Angiogenesis was significantly decreased among COPD patients versus controls (10.6 [8–13.3] vs 14 [11–17.1]; P=0.02). Mucosal surface changes (including edema, atrophy, and nodules) were better visualized by the combined HD WLB + i-scan3 rather than HD WLB alone.

Combined HD WLB + i-scan3 seems to be valuable in evaluating mucosal microvasculature and surface changes in COPD, which may represent vasodilatation rather than angiogenesis.

• COPD activity
• angiogenesis
• endobronchial erythema
• vascular remodeling

• Celiac disease
• High definition endoscopy
• I-Scan

The association of minimal change esophagitis (MCE) with GERD is controversial. i-Scan endoscopy (SE) provides high resolution and modulation of images that may improve minimal change lesion (MCL) detection. We aimed to assess the efficacy of SE in detecting MCL in dyspeptic patients with GERD compared with patients without GERD by GerdQ or by endoscopy with 24-h pH monitoring (PHM) and in normal volunteers.

This is a cohort study conducted at a tertiary center. All dyspeptic patients were prospectively recruited. All patients completed a validated Thai version of GerdQ and then underwent endoscopy. Forty normal volunteers as a control group were recruited for endoscopy. The distal esophagus was examined by high definition endoscopy and SE sequentially. All had PHM done. GERD was diagnosed by Los Angeles classification A-D and/or by a positive PHM. MCE was diagnosed when MCL or combination of MCL was present.

Of 174 patients, 144 completed the study protocol. After the exclusion of 6 patients, 138 remained for analysis. Overlapping GERD symptoms were found in 44.2 % and 26.8 % had confirmed GERD. Group A was comprised of 61 patients with a positive GerdQ and 77 patients in group B had a negative GerdQ. Twenty-four in group A, 28 in group B and 7 in the control group had MCE that was not significantly different. MCE in GERD was significantly higher (51.45 %) than in non-GERD (32.7 %) (p = 0.047) and in the control group (20.58 %) (p = 0.007). The sensitivity, specificity, positive predictive value, and negative predictive value of SE were 51.35 %, 67.33 %, 36.54 % and 79.06 %, respectively.

In dyspeptic patients, SE detected more MCE in GERD than in non-GERD patients and in the control group.

ClinicalTrials.gov number NCT01742377

To improve the detection rate of gastrointestinal tumors, image-enhanced endoscopy has been widely used during screening and surveillance endoscopy in Korea. In addition to narrow band imaging (NBI) with/without magnification, various types of electronic chromoendoscopies have been used, including autofluorescence imaging, I-scan, and flexible spectral imaging color enhancement. These technologies enable the accurate characterization of tumors because they enable visualization of microvascular and microsurface patterns. The present review focuses on understanding the principle and clinical applications of advanced imaging technologies other than NBI.

• Flexible spectral imaging color enhancement
• I-scan
• Image-enhanced endoscopy
• Optical imaging

• Barrett's esophagus
• Lugol's solution
• endoscopic biopsy
• erosive gastroesophageal reflux disease
• high-definition endoscopy
• nonerosive gastroesophageal reflux disease

AIM: To evaluate the diagnostic value of digital chrome endoscopy (I-Scan) in Barrett's esophagus (BE).

METHODS: From August 2012 to March 2013, a total of 420 patients with reflux esophageal disease were enrolled. The patients were randomized into two groups: one group (n = 220) received I-Scan and the other received ordinary endoscopy. Those suspected to have BE were observed closely and underwent biopsy. The detection rate and diagnostic accuracy were compared between the two endoscopic modes.

RESULTS: Suspected BE was diagnosed in 35 patients (15.91%) by I-Scan and in 24 (12.00%) by ordinary endoscopy. There was no significant difference in the detection rate for BE between the two methods (P > 0.05). The coincidence rate of diagnosis between I-Scan and pathology was 87.10%, and was 70.83% for the ordinary endoscopy, with a significant difference between the two groups (P < 0.05). The image score of paliform blood vessels was significant difference between squamoucolumnar junction (SCJ) and gastroesophageal junction (GEJ) (P < 0.05).

CONCLUSION: I-Scan could play an important role in the observation of paliform blood vessels between SCJ and GEJ in BE. The dignostic rate of I-Scan might be better than that of ordinary endoscopy. I-Scan can improve the detection rate for BE.

• Barrett's esophagus
• Diagnosis
• Pathology
• Digital chrome endoscopy

• Barrett's oesophagus
• Dysplasia
• Electronic optical filters
• Endoscopy
• Observer variability

• Acetic Acid
• Adult
• Aged
• Aged, 80 and over
• Barrett Esophagus/pathology
• Biopsy/methods
• Cohort Studies
• Esophageal Neoplasms/pathology
• Esophagoscopy/instrumentation
• Esophagoscopy/methods
• Female
• Humans
• Indicators and Reagents
• Male
• Microscopy
• Middle Aged
• Precancerous Conditions/pathology
• Prospective Studies

• chromoendoscopy
• i-scan
• inflammatory bowel disease (IBD)
• optical enhancement technology
• polyp

• Coloring Agents
• Diagnosis, Differential
• Endoscopy, Gastrointestinal/methods
• Gastrointestinal Diseases/diagnosis
• Humans
• Image Enhancement/methods
• Precancerous Conditions/diagnosis

• BE
• Barrett’s esophagus
• CLE
• NBI
• SCE
• columnar-lined lower esophagus or columnar-lined epithelium
• narrow-band imaging
• specialized columnar epithelium

Celiac disease (CD) is an autoimmune disease of the small bowel induced by ingestion of wheat, rye and barley. Current guidelines indicate histological analysis on at least four duodenal biopsies as the only way to diagnose CD. These indications are based on the conception of the inability of standard endoscopy to make diagnosis of CD and/or to drive biopsy sampling. Over the last years, technology development of endoscopic devices has greatly ameliorated the accuracy of macroscopic evaluation of duodenal villous pattern, increasing the diagnostic power of endoscopy of CD. The aim of this paper is to review the new endoscopic tools and procedures proved to be useful in the diagnosis of CD, such as chromoendoscopy, Fujinon Intelligent Chromo Endoscopy, Narrow Band Imaging, Optical Coherence Tomography, Water-Immersion Technique, confocal laser endomicroscopy, high-resolution magnification endoscopy, capsule endoscopy and I-Scan technology.

• Celiac disease
• Malabsorption syndrome
• Duodenum
• Diagnostic techniques and procedures
• Endoscopy
• Chromoendoscopy
• Fujinon intelligent chromo endoscopy
• Narrow band imaging
• Optical coherence tomography
• Water-immersion technique
• Confocal laser endomicroscopy
• High-resolution magnification endoscopy
• Capsule endoscopy
• I-scan technology

• Biopsy
• Capsule Endoscopy
• Celiac Disease/diagnosis
• Celiac Disease/immunology
• Celiac Disease/pathology
• Chromogenic Compounds
• Duodenoscopy/methods
• Duodenum/immunology
• Duodenum/pathology
• Humans
• Microscopy, Confocal
• Narrow Band Imaging
• Predictive Value of Tests
• Prognosis
• Tomography, Optical Coherence

• Confocal microscopy
• Laryngeal diagnosis
• Laryngeal pathology
• Narrow band imaging
• Optical computed tomography
• Optical frequency domain imaging
• Spectrally encoded confocal microscopy
• iScan

• Asymptomatic
• Esophagitis
• Esophagus
• Experimental
• Gender
• Healthy
• Pain
• Sensation
• Sensitization

• Endoscopic techniques
• Endoscopy
• Gastroesophageal reflux disease
• Histology
• Minimal change esophagitis

• Barrett Esophagus/diagnosis
• Colitis, Ulcerative/diagnosis
• Coloring Agents
• Crohn Disease/diagnosis
• Early Detection of Cancer/methods
• Endoscopy, Gastrointestinal/methods
• Esophageal Neoplasms/diagnosis
• Female
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/pathology
• Gastrointestinal Neoplasms/diagnosis
• Humans
• Inflammatory Bowel Diseases/diagnosis
• Male
• Precancerous Conditions/diagnosis
• Predictive Value of Tests
• Sensitivity and Specificity
• Staining and Labeling
• Upper Gastrointestinal Tract/pathology

Background. i-scan is a software-driven technology that allows modifications of sharpness, hue, and contrast to enhance mucosal imaging. It uses postimage acquisition software with real-time mapping technology embedded in the endoscopic processor. Aims. To review applications of i-scan technology in clinical endoscopic practice. Methods. This is a case series of 20 consecutive patients who underwent endoscopic procedures where i-scan image enhancement algorithms were applied. The main outcome measures were to compare mucosal lesions with high-definition white light endoscopy (HD-WLE) and i-scan image enhancement for the application of diagnostic sampling and therapy. Results. 13 cases involving the upper GI tract and 7 cases of the lower GI tract are included. For upper GI tract pathology i-scan assisted in diagnosis or therapy of Barrett's esophagus with dysplasia, esophageal adenocarcinoma, HSV esophagitis, gastric MALT lymphoma, gastric antral intestinal metaplasia with dysplasia, duodenal follicular lymphoma, and a flat duodenal adenoma. For lower GI tract pathology i-scan assisted in diagnosis or therapy of right-sided serrated adenomas, flat tubular adenoma, rectal adenocarcinoma, anal squamous cell cancer, solitary rectal ulcer, and radiation proctitis. Conclusions. i-scan imaging provides detailed topography of mucosal surfaces and delineates lesion edges, which can directly impact endoscopic management.

AIM: To investigate if high-definition (HD) colonoscope with i-Scan gave a higher detection rate of mucosal lesions vs standard white-light instruments.

METHODS: Data were collected from the computerized database of the endoscopy unit of our tertiary referral center. We retrospectively analyzed 1101 consecutive colonoscopies that were performed over 1 year with standard white-light (n = 849) or HD+ with i-Scan (n = 252) instruments by four endoscopists, in an outpatient setting. Colonoscopy records included patients’ main details and family history for colorectal cancer, indication for colonoscopy (screening, diagnostic or surveillance), type of instrument used (standard white-light or HD+ plus i-Scan), name of endoscopist and bowel preparation. Records for each procedure included whether the cecum was reached or not and the reason for failure, complications during or immediately after the procedure, and number, size, location and characteristics of the lesions. Polyps or protruding lesions were defined as sessile or pedunculated, and nonprotruding lesions were defined according to Paris classification. For each lesion, histological diagnosis was recorded.

RESULTS: Eight hundred and forty-nine colonoscopies were carried with the standard white-light video colonoscope and 252 with the HD+ plus i-Scan video colonoscope. The four endoscopists did 264, 300, 276 and 261 procedures, respectively; 21.6%, 24.0%, 21.7% and 24.1% of them with the HD+ plus i-Scan technique. There were no significant differences between the four endoscopists in either the number of procedures done or the proportions of each imaging technique used. Both techniques detected one or more mucosal lesions in 522/1101 procedures (47.4%). The overall number of lesions recognized was 1266; 645 in the right colon and 621 in the left. A significantly higher number of colonoscopies recognized lesions in the HD+ plus i-Scan mode (171/252 = 67.9%) than with the standard white-light technique (408/849 = 48.1%) (P < 0.0001). HD+ with i-Scan colonoscopies identified more lesions than standard white-light imaging (459/252 and 807/849, P < 0.0001), in the right or left colon (mean ± SD, 1.62 ± 1.36 vs 1.33 ± 0.73, P < 0.003 and 1.55 ± 0.98 vs 1.17 ± 0.93, P = 0.033), more lesions < 10 mm (P < 0.0001) or nonprotruding (P < 0.022), and flat polyps (P = 0.04). The cumulative mean number of lesions per procedure detected by the four endoscopists was significantly higher with HD+ with i-Scan than with standard white-light imaging (1.82 ± 2.89 vs 0.95 ± 1.35, P < 0.0001).

CONCLUSION: HD imaging with i-Scan during the withdrawal phase of colonoscopy significantly increased the detection of colonic mucosal lesions, particularly small and nonprotruding polyps.

• Colonoscopy
• High-definition+ with i-Scan colonoscopy
• White-light colonoscopy
• Colonic polyps
• Nonprotruding lesions
• Adenoma detection rate
• Withdrawal time
• Surface enhancement
• Contrast enhancement
• Tone enhancement

• Adult
• Aged
• Aged, 80 and over
• Colonic Polyps/pathology
• Colonoscopy
• Confidence Intervals
• Female
• Humans
• Image Enhancement
• Male
• Middle Aged
• Observer Variation
• Reproducibility of Results
• Sensitivity and Specificity

• Confocal laser endoscopy
• Endocytoscopy
• Fujinon intelligent color enhancement
• HDTV
• I-scan
• Magnifying endoscopy
• Narrow band imaging
• Zoom endoscopy

The aim of the study was to evaluate the efficacy of i-scans for the diagnosis of gastroesophageal reflux disease, especially where only minimal change is involved.

The esophageal mucosa was inspected using an i-scan following conventional white light endoscopy. The examination with iscan was performed under tone enhancement (TE) esophagus (e) mode. Patients with subtle distal esophageal mucosal changes without definite mucosal breaks, such as blurring of Z-line (B), mucosal coarseness (C), hyperemic or purplish discoloration (D), erythema (E), ectopic gastric mucosal islet (I) and mixed type were classified as minimal change.

A total of 156 patients were included. Using i-scan endoscopy, the number of minimal change was found to further increase from 94 (conventional endoscopy; 19B, 9C, 29D, 13E, 5I, 19 mixed type) to 109 (i-scan; 15B, 8C, 29D, 16E, 5I, 36 mixed type). And 14 patients who had single type by conventional endoscopy were converted to mixed type after i-scan. Therefore, 29 of 156 patients were upgraded after i-scan, they were account for 19% (p<0.0001; 95% confidence interval, 0.13 to 0.25).

The use of i-scan endoscopy significantly improves the identification of minimal change and helps to identify more precisely the type of minimal change.

• Gastroesophageal reflux
• I-scan
• Minimal change

• Barrett Esophagus/pathology
• Esophagoscopy
• Humans
• Image Enhancement/methods
• Light
• Microscopy, Confocal
• Precancerous Conditions/pathology
• Staining and Labeling

• R01 CA097048 NCI NIH HHS
• R01 CA111603 NCI NIH HHS
• R21 CA122426 NCI NIH HHS
• U54 CA163004 NCI NIH HHS

• barrett’s esophagus
• endoscopy
• autofluorescence imaging
• narrowband imaging
• early diagnosis of cancer

• Barrett Esophagus/complications
• Barrett Esophagus/diagnosis
• Barrett Esophagus/pathology
• Endoscopes
• Endoscopy/methods
• Esophageal Neoplasms/etiology
• Esophageal Neoplasms/pathology
• Humans
• Precancerous Conditions/diagnosis
• Precancerous Conditions/pathology
• Prognosis

Endoscopy is a widely used diagnostic tool to detect reflux esophagitis. Although its specificity was reported to be excellent at 90%-95%, its sensitivity was only 50%. Therefore, it is quite difficult to detect these lesions under the standard white light endoscopy especially in patients with minimal change esophageal reflux disease (MERD). In recent years, endoscopic technologies have evolved tremendously; these include high resolution and magnification digital chromoendoscopy. These technologies are useful practically for detecting various subtle lesions along the gastrointestinal tract starting from esophagus to colon. Currently, these technologies can be classified in 2 systems; pre-processed system (NBI, Olympus) and post processed system (FICE and i-SCAN, Fujinon and Pentax respectively). Over a few years, there have been many emerging publications on the benefit of these systems on MERD detection. The overall sensitivities to diagnose MERD were reported as much better than controls. However, large, multi-center and randomized controlled studies comparing these new imaging modalities with the conventional white light chromoendoscopy are warranted to validate its accuracy. Standard, simple and precise endoscopic reading criteria for the identification of MERD are also required.

• Digital
• Chromoendoscopy
• Minimal change
• Erosive reflux esophagitis
• Diagnosis
• Pre-processed
• Post processed