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Aim: Regarding the assessment of colonic lesions, important differences between Japan and the Western world have emerged during the last decade. The aim of this study was to compare the clinical outcomes of the same equipment when used in Japan or in France. Method: Chromoscopy has not been extensively accepted in the West, in contrast to the wide acceptance in Japan which is probably due to the national screening programme for early gastric cancer. With the development of narrow-band imaging (NBI) we might expect a more generalized approach to the clinical use of various classifications. Narrow band imaging might be an important step towards virtual chromoscopy. A total of 48 patients were examined with back-to-back colonoscopy, using a non-sequential (EXERA II, Olympus Medical Systems Corp., Tokyo, Japan) endoscope, and a sequential endoscope (LUCERA, Olympus Medical Systems Corp.). Results: Education differences also play a role in the evaluation of the clinical outcome of the endoscopy. In Japan, detailed classification of the morphology of the detected lesion is done as a preliminary characterization step before the treatment decision. In the West a treatment decision immediately leads to the therapeutic outcome (non-neoplastic or neoplastic; removed or not). This study showed clearly that, with the same equipment, we obtained identical results for image quality of image in Japan and France. Non-Japanese endoscopists could achieve the same results as Japanese colleagues if knowledge of the minute classification is more widely accepted. Conclusion: While the differences in the evaluation of the clinical outcome are mostly cultural, the analysis of endoscopic imaging indicates that the LUCERA and EXERA series provide the same clinical benefit. [ABSTRACT FROM AUTHOR]