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

[Guest guest]

A long link but a worthwhile read for the IBD'ers.

My London GI (I have one in Holland also!) is very excited about the NBI technology, which I've experienced twice so far. It really IS amazing to see those capillaries without a microscope......

As someone with UC for 50 years already I'll take ANY improved surveillance technique........

DutchPat

This is a full free text.

http://www.sciencedirect.com/science?_ob=ArticleURL & _udi=B6WFX-4R17TV0-1 & _user=10 & _coverDate=01%2F31%2F2008 & _rdoc=42 & _fmt=full & _orig=browse & _srch=doc-info(%23toc%236806%232008%23998659998%23677734%23FLA%23display%23Volume) & _cdi=6806 & _sort=d & _docanchor= & _ct=73 & _acct=C000050221 & _version=1 & _urlVersion=0 & _userid=10 & md5=4a8cb3989bede4c92c91d8dbbbaffe11

doi:10.1053/j.gastro.2007.10.062 Copyright © 2008 AGA Institute Published by Elsevier Inc.

AGA Institute

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

Tonya Kaltenbacha, , Yasushi Sanob, Shai Friedlanda and Roy Soetiknoa aVeterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto, CaliforniabNational Cancer Center East, Kashiwa, Japan Available online 30 October 2007.

This document presents the official recommendations of the American Gastroenterological Association (AGA) Institute Technology Assessment on “Image-Enhanced Endoscopy.” It was approved by the Clinical Practice and Economics Committee on August 3, 2007, and by the AGA Institute Governing Board September 27, 2007.

The Technology Assessment on Image-Enhanced Endoscopy developed under the aegis of the AGA Institute and its Clinical Practice and Economics Committee (CPEC) was approved by the AGA Institute Governing Board. The data used to formulate these recommendations are derived from the data available at the time of their creation and may be supplemented and updated as new information is assimilated. These recommendations are intended for adult patients, with the intent of suggesting preferred approaches to specific medical issues or problems. They are based upon the interpretation and assimilation of scientifically valid research, derived from a comprehensive review of published literature. Ideally, the intent is to provide evidence based upon prospective, randomized placebo-controlled trials; however, when this is not possible the use of experts’ consensus may occur. The recommendations are intended to apply to healthcare providers of all specialties. It is important to stress that these recommendations should not be construed as a standard of care. The AGA Institute stresses that the final decision regarding the care of the patient should be made by the physician with a focus on all aspects of the patient’s current medical situation. Executive Summary

Introduction

Gastrointestinal cancers represent the leading cause of cancer-related death worldwide. The diagnosis of precursor and early gastrointestinal cancers is therefore of great interest because their endoscopic and surgical treatment present the best chance for cure. These precancers and early cancers are often subtle and can pose a challenge to gastroenterologists to visualize using standard white light endoscopy. Contrast enhancement of the endoscopy images, through use of dye solutions, has been developed and used in select indications. Newer endoscopes are now equipped with optical and/or electronic technologies to also increase the contrast of structures or cells imaged during endoscopy. The term “image-enhanced endoscopy” (IEE) encompasses various means of enhancing contrast during endoscopy using dye, optical, and/or electronic methods. IEE allows improved visualization of lesions and can be used to gain insight into the pathology of the lesion, which, in turn, provides guidance to select the optimal treatment. Recommendations

Available data support the use of IEE in the detection and treatment of early squamous cell carcinoma of the esophagus, early gastric cancer, and superficial colorectal lesions. The use of Lugol’s solution may improve the endoscopic visualization of high-grade dysplasia and early squamous cell carcinoma of the esophagus and thus may be considered in high-risk patient populations. The use of diluted indigo carmine solution aids the diagnosis and treatment of early gastric cancer. The solution pools at the border of the lesion and thus enhances visualization of these lesions, which are most often nonpolypoid. By pooling into the depression or ulceration of the lesion, the solution aids in the classification of the morphology, which in turn is important in the medical decision making of treatment strategy. Similarly, diluted indigo carmine solution is useful in the evaluation of areas suspected of containing nonpolypoid colorectal neoplasms in defining the border and morphology of lesions. By filling the pits of the glands and imaging using high-resolution or high-magnification colonoscopes, endoscopic diagnosis of neoplastic and nonneoplastic lesions and estimation of depth of invasion can be performed to aid in the decision of treatment strategy. IEE is not routinely used in the management of diseases of the small intestine. Equipment-based IEE is increasingly reported to aid in the detailed visualization of the microvessels and surface structures of neoplastic, metaplastic, and hyperplastic tissues. Technology Assessment

The following guidelines were developed to assist physicians in the appropriate use of various modalities of contrast enhancement of endoscopic images, termed “image-enhanced endoscopy” (IEE). They emanate from a comprehensive review of the medical literature pertaining to IEE, which previously required the use of dyes and was called chromoendoscopy but more recently can also be accomplished using optical and/or electronic technology. The new IEE technology will allow us to visualize the gastrointestinal mucosa in detail. Drawing an analogy to the use of radiology image enhancement methods, such as contrast, the use of IEE will play a similarly important role. Thus, we herein provide a timely and necessary review on the current state of IEE in order to summarize its clinical application today and outline its future potentials.