Narrow-band imaging with magnifying endoscopy for the evaluation of gastrointestinal lesions

Figure 1 Narrow band imaging with magnification endoscopy images of the esophagus. A: Normal esophageal mucosa: branching vessel network and intra-epithelial papillary capillary loop (IPCL) surrounding an island of Barrett’s esophagus (BE); B: IPCL type V1: dilatation of intra-epithelial papillary capillary loop, irregular caliber, and form variation; C: Round pits with regular microvasculature corresponding with columnar mucosa; D: Non-dysplastic BE: flat-type mucosa with regular long branching vessels; E: Non-dysplastic BE: regular villous/ridge mucosal pattern; F: Dysplastic BE: distorsion of mucosal pattern and irregular vascular pattern.

Figure 2 Narrow band imaging with magnification endoscopy images of normal gastric mucosa. A: Round pits surrounded by the subepithelial capillary network (SECN) and collecting venules (CVs) in normal corporeal mucosa; B: Coil-shaped appearance of SECN, without the visualization of the CVs in normal antral mucosa.

Figure 3 Narrow band imaging with magnification endoscopy images of gastric lesions. A: Helicobacter pylori gastritis: enlargement of pits, variable vascular density (alternation of lighter and darker areas); B: Extensive areas of intestinal metaplasia (tubulovillous mucosal pattern) and remnant normal gastric body mucosa (small regular and circular pits); C: Areas of intestinal metaplasia: blue whitish slightly raised areas (the light blue crest sign) with regular, tubulovillous mucosal pattern; D: Dysplasia: area with architectural loss of mucosal pattern and irregular vascular pattern.

Figure 4 Superficial gastric cancer: Disappearance of microsurface pattern, irregular microvascular pattern with a demarcation line.

Figure 5 Gastric adenoma: White opaque substance with regular distribution obscures the subepithelial microvascular pattern.

Figure 6 Gastric cancer with submucosal invasion: Blurry mucosal pattern and irregular mesh vascular pattern.

Figure 7 Assessment of colonic lesions by narrow band imaging with magnification endoscopy according to different classification systems. A: Hyperplastic polyp: absent mesh brown capillary network (Type I MBCN) (Sano classification); a lighter color of the polyp than the background, isolated vessels coursing across the lesion (NICE criteria); B: Adenomatous polyp: regular mesh brown capillary network (Type II MBCN) and Kudo’s Type IV mucosal pattern; the brown color relative to background, thick brown vessels surrounding white structures (NICE criteria); C: Cancerous colonic lesion: irregular mucosal and vascular patterns (Type III MBCN); D: Deep submucosal invasive colorectal cancer: amorphous surface pattern and disrupted vessels (NICE criteria).