Image-enhanced endoscopy in practice

Abstract

IEE uses dyes and optical and electronic methods to enhance contrast and discrimination between normal, non-neoplastic and neoplastic mucosa. There are sufficient data supporting its use to potentially aid in the detection, diagnosis and treatment of esophageal, gastric and colorectal pre- or early cancer. As such, endoscopy provides only a preliminary diagnosis that can be used to guide the course of treatment - the final diagnosis will require multiple, cross-sectional, pathological examinations of the lesion. Despite its imperfections, endoscopic diagnosis is sufficiently accurate for current practice. Data support the standard use of Lugol's solution for patients at high risk for squamous cell carcinoma of the esophagus, and the use of indigo carmine solution to diagnose and treat early gastric cancer. Other applications, such as the use of indigo carmine dye in the diagnosis and management of NP-CRN, have been described, particularly in high-risk populations. While the use of NBI to enhance the detection of adenoma during screening colonoscopy has not proven beneficial, there is an expanding body of literature regarding the use of NBI or other equipment based IEEs for the diagnosis and management of nonpolypoid gastrointestinal neoplasms. Its role is likely to expand as the technology develops to look closer, see more and distinguish further. Several barriers to its widespread use include the lack of standardized training techniques, absence of an accepted mechanism for reimbursement, and perceptions of its cost and inefficiency. These barriers are perhaps a reflection of the development of a modality that is being perfected and the inherent limitation of the inability to evaluate based on multiple cross-sections that are available during pathological examination. As discussed above, it should not be viewed as a limitation. We emphasize that our successful detection, diagnosis and treatment of flat neoplasms could not have been accomplished without the use of IEE (2,32,33). ©2009 Pulsus Group Inc. All rights reserved.