Comprehensive Atlas of High-Resolution Endoscopy and Narrowband Imaging (eBook)

Edited by Jonathan Cohen, MD, FASGE, FACG, Clinical Professor of Medicine, NYU Langone School of Medicine, New York, NY, USA

Comprehensive Atlas of High-Resolution Endoscopy and Narrowband Imaging 3
Contents 7
Preface 8
Acknowledgments 10
Contributors 11
About the Companion Website 14
List of videos illustrating key procedures 15
PART 1 The Basics of NBI 17
1 Narrowband imaging: historical background and basis for its development 19
References 20
2 An introduction to high-resolution endoscopy and narrowband imaging 23
Introduction 23
Light and bio-optics 24
Light and wavelength 24
Color, absorption, and reflection 24
Light scattering 24
Absorption and scattering in tissue 24
Resolution and contrast 24
Basic principles and system design 25
Basic principles 25
System design 25
Blood vessels and bleeding 26
Fine mucosal pattern 26
Squamo-columnar junction 26
Residue and bile 26
Second-generation NBI on EVIS EXERA III 26
3 Getting started with narrowband imaging 32
Introduction 32
NBI endoscopes 32
Preparing the patient 32
Cap-assisted endoscopy 33
Preparing the esophagus 33
Examining the esophagus 33
Examining the stomach, duodenum, and colon 34
Surface patterns observed by NBI 34
Normal patterns 34
Abnormal patterns 34
Learning to use NBI 34
References 35
PART 2 Application of High-Resolution Endoscopy and NBI in Diagnosis and Therapy 39
SECTION 1 Pharynx and Esophagus 41
4 Detection of superficial cancer in oropharyngeal and hypopharyngeal mucosal sites and the value of NBI in qualitative diagnosis 43
Why is diagnostic examination of the pharynx necessary? 43
Cancer in the area of the pharynx and its risk factors 43
Superficial cancer in oropharyngeal and hypopharyngeal mucosal sites 43
Diagnosis of superficial cancer in oropharyngeal and hypopharyngeal mucosal sites by NBI 44
Change in color-defining areas at NBI observation (brownish area) 44
Change in IPCL shape 44
References 45
5 Magnifying endoscopic diagnosis of tissue atypia and cancer invasion depth in the area of pharyngoesophageal squamous epithelium by NBI enhanced magnification image: IPCL pattern classification 55
Background 55
Magnifying endoscopy of normal esophageal mucosa 56
Magnifying endoscopy and the IPCL classification 56
Assessing depth of invasion of superficial carcinoma 56
Differences in IPCL patterns between mucosal and submucosal cancer 57
The pink–silver sign 57
Minute lesions 57
Conclusions 58
References 58
6 Applications of NBI HRE and preliminary data: Barrett’s esophagus and adenocarcinoma 76
Barrett’s esophagus and esophageal adenocarcinoma 76
High-resolution endoscopy, chromoendoscopy, and narrowband imaging 76
Characterization of mucosal morphology in Barrett’s esophagus 77
Intestinal metaplasia 77
Early neoplasia 77
Detection of intestinal metaplasia and early neoplasia 78
Intestinal metaplasia 78
Early neoplasia 78
Delineation of neoplastic lesions and follow-up after radiofrequency ablation 79
Conclusion and future perspectives 79
References 80
SECTION 2 Stomach and Duodenum 89
7 Clinical application of magnification endoscopy with NBI in the stomach and the duodenum 91
Introduction 91
Basic principles for the analysis of magnified endoscopic findings 91
Magnification endoscopy procedure 91
The stomach 91
Normal gastric mucosa (Figures 7.2 and 7.3) 91
Chronic gastritis 92
Early gastric cancer 92
The duodenum 93
Normal duodenal mucosa 93
Celiac disease 93
Conclusion 93
Acknowledgment 93
References 93
8 Magnifying endoscopy with NBI in the diagnosis of superficial gastric neoplasia and its application for endoscopic submucosal dissection 110
Impact of NBI on magnifying endoscopic diagnosis for gastric neoplasia 110
Gastric cancer-specific findings of microvasculature and fine mucosal structure 110
Findings on magnifying endoscopy vary according to macroscopic appearance of gastric cancer 111
Changes in microvasculature in superficial depressed gastric cancer 111
Changes in elevated neoplasias of the stomach 111
Application of magnifying endoscopy with NBI for endoscopic resection 111
References 111
SECTION 3 Colon 123
9 Optical chromoendoscopy using NBI during screening colonoscopy: its usefulness and application 125
Introduction 125
Improvement in visibility 125
Improvement in observation of the surface structure (pit pattern) and the microcapillaries (capillary pattern) 125
Normal colonic mucosa (CP type I) 126
Hyperplastic polyp (CP type I) 126
Adenomatous lesion (CP type II) 127
Cancerous lesion (CP type III) 127
Histology of microvascular proliferation 127
A bench study: comparison between endoscopic resolution and MC vessels 127
Role and benefit of lesion detection and assessment of margins 127
Future prospects 128
References 129
10 Keys to effective performance of resect and discard NBI 147
Introduction 147
NICE classification 147
High and low confidence 148
Other considerations 149
References 150
11 The significance of NBI observation for inflammatory bowel diseases 162
Introduction 162
Ulcerative colitis 162
Determination of endoscopic severity 162
Diagnosis of dysplasia 163
Crohn’s disease 163
Conclusion 164
References 164
SECTION 4 New Horizons for High-Resolution Endoscopy and Narrowband Imaging 177
12 NBI and high-resolution endoscopy in the bile duct and pancreas 179
Introduction 179
Role of video cholangiopancreatoscopy 179
Video cholangioscopy 179
Video pancreatoscopy 179
System of video cholangiopancreatoscopy and NBI 179
Diagnostic ability of video cholangiopancreatoscopy 180
Typical video cholangiopancreatoscopy findings 180
Differential diagnosis 180
Conclusions 181
Acknowledgment 181
References 181
13 Applications in therapeutic endoscopy: impact on timing and completeness of mucosal ablation and resections 190
Introduction 190
Advances in imaging and resection techniques 190
Barrett’s esophagus 191
Colorectal neoplasia 191
References 193
PART 3 Atlas of Images and Histopathologic Correlates 199
14 Pharynx and esophagus atlas 201
ABBREVIATIONS 272
15 Stomach atlas 273
ABBREVIATIONS 332
16 Small intestine atlas 333
ABBREVIATIONS 371
17 Colon atlas 373
ABBREVIATIONS 567
Index 569
EULA 577