• Clinical Endoscopy
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• 제51권6호
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• pp.541-546
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• 2018

Recent advances in cholangiopancreatoscopy technology permit image-enhanced endoscopy (IEE) for pancreatobiliary diseases. There are limitations in endoscopy performance and in the study of the clinical role of IEE in bile duct or pancreatic duct diseases. However, currently available IEEs during cholangiopancreatoscopy including traditional dye-aided chromoendoscopy, autofluorescence imaging, narrow-band imaging, and i-Scan have been evaluated and reported previously. Although the clinical role of IEE in pancreatobiliary diseases should be verified in future studies, IEE is a useful promising tool in the evaluation of bile duct or pancreatic duct mucosal lesions.

• Clinical Endoscopy
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• 제56권5호
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• pp.563-577
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• 2023

In inflammatory bowel disease (IBD), chronic inflammation leads to unfavorable clinical outcomes and increases the risk of developing colorectal neoplasm (CRN); thereby highlighting the importance of endoscopically evaluating disease activity as well as detecting and characterizing CRN in patients with IBD. With recent advances in image-enhanced endoscopic (IEE) technologies, especially virtual chromoendoscopy (VCE) platforms, this review discusses state-of-the-art IEE techniques and their applicability in assessing disease activity and surveillance colonoscopy in patients with IBD. Among various IEE, VCE demonstrated the capacity to identify quiescent disease activity. And endoscopic remission defined by the new scoring system using VCE platform better predicted clinical outcomes, which may benefit the tailoring of therapeutic strategies in patients with IBD. High-definition dye-chromoendoscopy (HD-DCE) is numerically superior to high-definition white light endoscopy (HD-WLE) in detecting CRN in IBD; however, discrepancy is observed in the statistical significance. VCE showed comparable performance in detecting dysplasia to HD-WLE or DCE and potential for optical diagnosis to differentiate neoplastic from nonneoplastic lesions during surveillance colonoscopy. Applying these novel advanced IEE technologies would provide opportunities for personalized medicine in IBD and optimal treatment of CRN in patients with IBD.

• Clinical Endoscopy
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• 제56권5호
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• pp.553-562
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• 2023

Colonoscopy plays an important role in reducing the incidence and mortality of colorectal cancer by detecting adenomas and other precancerous lesions. Image-enhanced endoscopy (IEE) increases lesion visibility by enhancing the microstructure, blood vessels, and mucosal surface color, resulting in the detection of colorectal lesions. In recent years, various IEE techniques have been used in clinical practice, each with its unique characteristics. Numerous studies have reported the effectiveness of IEE in the detection of colorectal lesions. IEEs can be divided into two broad categories according to the nature of the image: images constructed using narrow-band wavelength light, such as narrow-band imaging and blue laser imaging/blue light imaging, or color images based on white light, such as linked color imaging, texture and color enhancement imaging, and i-scan. Conversely, artificial intelligence (AI) systems, such as computer-aided diagnosis systems, have recently been developed to assist endoscopists in detecting colorectal lesions during colonoscopy. To gain a better understanding of the features of each IEE, this review presents the effectiveness of each type of IEE and their combination with AI for colorectal lesion detection by referencing the latest research data.

• Clinical Endoscopy
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• 제51권6호
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• pp.534-540
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• 2018

From dye-assisted conventional chromoendoscopy to novel virtual chromoendoscopy, image-enhanced endoscopy (IEE) is continuously evolving to meet clinical needs and improve the quality of colonoscopy. Dye-assisted chromoendoscopy using indigo carmine or crystal violet, although slightly old-fashioned, is still useful to emphasize the pit patterns of the colonic mucosa and predict the histological structures of relevant lesions. Equipment-based virtual chromoendoscopy has the advantage of being relatively easy to use. There are several types of virtual chromoendoscopy that vary depending on the manufacturer and operating principle. IEE plays distinctive roles with respect to histologic characterization of colorectal polyps and prediction of the invasion depth of colorectal cancers. In addition, the newest models of IEE have the potential to increase adenoma and polyp detection rates in screening colonoscopy.

• 대한두경부종양학회지
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• 제34권2호
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• pp.29-34
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• 2018

Background/Objectives: The aim of this study was to investigate the diagnostic value of i-scan in the differential diagnosis of oral cavity leukoplakia based on visualization of abnormal vascular features. Materials & Methods: Thirty- one patients with oral cavity leukoplakia were enrolled in the study. Images of their oral cavity obtained using conventional white light endoscopy and an i-scan-enhanced endoscopy (Pentax DEFINA EPK-3000 Video Processors, with Pentax VNLJ10) were reviewed. The microvascular features of the lesions and vascular changes were analyzed and the results were compared with the histopathologic diagnosis. Results: Among the 31 oral cavity leukoplakia patients, 8 (25.8%) patients revealed hyperkeratosis, 10 (31.2%) low-grade dysplasia, 5 (16.2%) high-grade dysplasia and 8 (25.8%) invasive squamous cell carcinoma on histopathologic examination. Using i-scan-enhanced endoscopy, we could found abnormal vascular change with neoplastic neoangiogenesis in most high-grade dysplasia or invasive cancer in oral cavity. (high-grade dysplasia: 4/5 [80.0%], and invasive squamous cell carcinoma: 7/8 [87.5%]). Conclusion: i-scan-enhanced endoscopy could be a useful optical technique for the diagnosis of oral cavity leukoplakia. Our results suggest that i-scan may be a promising diagnostic tool in the early detection of suspected oral mucosal lesion.

• 대한기관식도과학회지
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• 제17권1호
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• pp.14-18
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• 2011

The diagnosis and treatment of early gastrointestinal cancers is the gastroenterologists' mission because of national cancer screening program in South Korea. The detection of early cancers is emphasized, because these were previously treated with surgical treatment can be currently cured with endoscopic treatment. Gastroenterologists who achieved at least on some level can make an exact diagnosis regardless of what type of endoscopy, but generally, there are some required conditions for an optimal diagnosis. First, clinically important lesions have to be detected easily. Second, the border and morphology of lesions have to be characterized easily. Third, lesions have to be diagnosed exactly. Precancers and early cancers are often subtle and can pose a challenge to gastroenterologists to visualize using standard white light endoscopy. The use of dye solutions aids the diagnosis of early gastrointestinal cancers, however, it is a quite cumbersome to use dye solutions all the time and the solution often bothers the exact observation by pooling into the depression or ulceration of the lesion. To overcome this weakness, newer endoscopes are now developed so called "image enhanced endoscopy" using optical and/or electronic methods such as narrow band imaging (NBI), autofluorescence imaging (AFI), i-scan, flexible spectral imaging color enhancement (FICE) and confocal endomicroscopy (CLE).

• 대한후두음성언어의학회지
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• 제29권2호
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• pp.98-102
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• 2018

Background and Objectives : Detection of vascular abnormalities in vocal cord (VC) leukoplakia is important for the diagnosis of neoplastic change of the mucosa. The aim of this study was to investigate the value of i-scan in the differential diagnosis of VC leukoplakia based on visualization of abnormal vascular features. Material and Methods : Fifty-two patients with leukoplakia were enrolled in the study. Images of their larynx obtained using conventional white light endoscopy and an i-scan-enhanced endoscopy (Pentax DEFINA EPK-3000 Video Processors, with Pentax VNLJ10) were reviewed. The microvascular features of the lesions and vascular changes were analyzed and the results were compared with the histopathologic diagnosis. Results : Among the 52 leukoplakia patients, 7 (13.5%) patients had squamous hyperplasia, 10 (19.3%) mild dysplasia, 2 (3.8%) moderate dysplasia, 14 (26.9%) severe dysplasia, 4 (7.7%) carcinoma in situ, and 15 (28.8%) invasive squamous cell carcinoma on histopathologic examination. Using i-scan-enhanced endoscopy, abnormal vascular change with neoplastic neoangiogenesis was detected in most cases of malignant VC lesion [severe dysplasia : 9/14 (64.3%), carcinoma in situ: 2/4 (50.0%), and invasive squamous cell carcinoma : 11/15 (73.4%)]. Conclusion : i-scan-enhanced endoscopy is a useful optical technique for the diagnosis of VC leukoplakia. Our results suggest that i-scan may be a promising diagnostic tool in the early detection of laryngeal cancer.

• Clinical Endoscopy
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• 제56권3호
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• pp.315-324
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• 2023

Background/Aims: Image-enhanced endoscopy can detect superficial oro-hypopharyngeal squamous cell carcinoma; however, reliable endoscopy of the pharyngeal region is challenging. Endoscopy under general anesthesia during transoral surgery occasionally reveals multiple synchronous lesions that remained undetected on preoperative endoscopy. Therefore, we aimed to determine the lesion detection capability of endoscopy under general anesthesia for superficial oro-hypopharyngeal squamous cell carcinoma. Methods: This retrospective study included 63 patients who underwent transoral surgery for superficial oropharyngeal squamous cell carcinoma between April 2005 and December 2020. The primary endpoint was to compare the lesion detection capabilities of preoperative endoscopy and endoscopy under general anesthesia. Other endpoints included the comparison of clinicopathological findings between lesions detected using preoperative endoscopy and those newly detected using endoscopy under general anesthesia. Results: Fifty-eight patients (85 lesions) were analyzed. The mean number of lesions per patient detected was 1.17 for preoperative endoscopy and 1.47 for endoscopy under general anesthesia. Endoscopy under general anesthesia helped detect more lesions than preoperative endoscopy did (p<0.001). The lesions that were newly detected on endoscopy under general anesthesia were small and characterized by few changes in color and surface ruggedness. Conclusions: Endoscopy under general anesthesia for superficial squamous cell carcinoma is helpful for detecting multiple synchronous lesions.

• Journal of Digestive Cancer Reports
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• 제7권2호
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• pp.31-39
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• 2019

The early detection of early gastric cancer (EGC) is important. However, the sensitivity of conventional white light imaging (WLI) in detecting EGC had been reported to range only from 77% to 84%. Although the resolution of endoscopes has been remarkably developed, precancerous lesions such as adenomas and microscopic early cancers are difficult to diagnose with general endoscopy. Linked Color Imaging (LCI) magnifies the differences in color for easy detection. Therefore, it produces a bright image from a distance and is performed for screening endoscopy. The 410 nm wavelength of BLI (Blue Light Imaging) helps to detect cancer by showing microstructure and microvessels in the mucosal superficial layer. This review will focus on the utility of Image enhanced endoscopy (IEE) techniques in diagnosis of gastrointestinal cancer.

• Clinical Endoscopy
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• 제56권6호
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• pp.681-692
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• 2023

In general, gastroesophageal reflux disease (GERD) is diagnosed clinically based on typical symptoms and/or response to proton pump inhibitor treatment. Upper gastrointestinal endoscopy is reserved for patients presenting with alarm symptoms, such as dysphagia, odynophagia, significant weight loss, gastrointestinal bleeding, or anorexia; those who meet the criteria for Barrett's esophagus screening; those who report a lack or partial response to proton pump inhibitor treatment; and those with prior endoscopic or surgical anti-reflux interventions. Newer endoscopic techniques are primarily used to increase diagnostic yield and provide an alternative to medical or surgical treatment for GERD. The available endoscopic modalities for the diagnosis of GERD include conventional endoscopy with white-light imaging, high-resolution and high-magnification endoscopy, chromoendoscopy, image-enhanced endoscopy (narrow-band imaging, I- SCAN, flexible spectral imaging color enhancement, blue laser imaging, and linked color imaging), and confocal laser endomicroscopy. Endoscopic techniques for treating GERD include esophageal radiofrequency energy delivery/Stretta procedure, transoral incisionless fundoplication, and endoscopic full-thickness plication. Other novel techniques include anti-reflux mucosectomy, peroral endoscopic cardiac constriction, endoscopic submucosal dissection, and endoscopic band ligation. Currently, many of the new endoscopic techniques are not widely available, and their use is limited to centers of excellence.