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To explore the use of real-time virtual chromoendoscopy (i-scan) in characterizing the mucosal changes present in subjects with suspected laryngopharyngeal reflux (LPR) and to compare the inter-rater and intra-rater agreement of Reflux Finding Scores (RFS) from both laryngologists and general otolaryngologists (ORL) observing exams using both white light endoscopy (WLE) and i-scan. This is a cross-sectional study that included 66 subjects: 46 symptomatic and 20 asymptomatic of suspected LPR based on the reflux symptom index (RSI). Subjects underwent flexible video laryngoscopic evaluation of the larynx utilising both WLE and i-scan during one continuous exam. Subjects also underwent 24-hour oropharyngeal pH-monitoring (Dx-pH). Two laryngologists and two general otolaryngologists evaluated the anonymized videos independently using RFS. Dx-pH results were interpreted using the pH graph, report and RYAN score. Subjects were then designated into one of three groups: no reflux, acid reflux and alkaline reflux. For the symptomatic group, no mucosal irregularities or early mucosal lesions were observed except in one subject who had granulation tissue. The mean RFS using WLE and i-scan were, respectively: 11.8 (SD 6.1) and 11.3 (SD 5.6) in symptomatic and 7.3 (SD 5.7) and 7.3 (SD 5.2) in asymptomatic group. The inter-rater agreement of RFS using WLE and i-scan for both groups were good with intraclass correlation, ICC of 0.84 and 0.88 (laryngologists); and 0.85 and 0.81 (ORL). The intra-rater agreement among all four raters were good to excellent and similar for both WLE and i-scan (ICC of 0.80 to 0.99). 47 of 66 subjects had evidence of LPR on Dx-pH results which more specifically showed 39 subjects had "acid reflux" and 8 had "alkaline reflux". Sixteen subjects demonstrated a positive RYAN score but showed none were significantly correlated with their RFS. This study reports the first utilization of real-time video chromoendoscopy with i-scan technology through high-definition flexible endoscopes to attempt to characterize laryngopharyngeal findings in patients suspected of having LPR. Both general otolaryngologists and laryngologists were equally capable of reliably calculating the RFS using both WLE and i-scan, however no significant improvement in agreement or change in RFS was found when i-scan technology was employed. Level 2 [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) is one of the most common diseases that occurs secondary to failure of the antireflux barrier system, resulting in the frequent and abnormal reflux of gastric contents to the esophagus. GERD is diagnosed in routine clinical practice based on the classic symptoms of heartburn and regurgitation. However, a subset of patients with atypical symptoms can pose challenges in diagnosing GERD. An esophagogastroduodenoscopy (EGD) is the most common initial diagnostic test used in the assessment for GERD, although half of these patients will not have any positive endoscopic findings suggestive of GERD. The advanced endoscopic techniques have improved the diagnostic yield of GERD diagnosis and its complications, such as Barrett's esophagus and early esophageal adenocarcinoma. These newer endoscopic tools can better detect subtle irregularities in the mucosa and vascular structures. The management options for GERD include lifestyle modifications, pharmacological therapy, and endoscopic and surgical interventions. The latest addition to the armamentarium is the minimally invasive endoscopic interventions in carefully selected patients, including the electrical stimulation of the LES, Antireflux mucosectomy, Radiofrequency therapy, Transoral Incisionless Fundoplication, Endoscopic Full-Thickness plication (GERDx™), and suturing devices. With the emergence of these advanced endoscopic techniques, it is crucial to understand their selection criteria, advantages, and disadvantages. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated vocal fold leukoplakia using i-scan combined with laryngovideostroboscopy for risk assessment prediction. Methods: A total of 141 patients with 218 lesions were enrolled in this study. Morphological characteristics of leukoplakia, assessment of the vascular pattern using i-scan, and vocal fold vibratory function were analyzed. Results: The number of patients with no, mild, moderate, severe dysplasia, and invasive carcinoma were 68, 40, 17, 46 and 47, respectively. The sensitivity of morphological characteristic, vascular pattern, vibratory function and predictive model were 77.4%, 72%, 69.9%, and 82.8%, respectively. Receiver operating characteristic curve analysis of morphological characteristic, vascular pattern, vibratory function and predictive model were 0.771, 0.824, 0.769, and 0.923, respectively. The results of logistic regression analysis showed that rough morphological types, perpendicular vascular pattern, severe decrease and absence of mucosal waves increased the risk of malignancy (OR = 5.531, 4.973, and 16.992, respectively; P < 0.001). Conclusions: I-scan combined with laryngovideostroboscopy can improve the differential diagnosis of low-risk and high-risk vocal fold leukoplakia. [ABSTRACT FROM AUTHOR]

Current standard methods for evaluating benign vocal lesions, including white light laryngoscopy and video laryngostroboscopy, may struggle to identify smaller lesions. While histopathological results obtained from laryngeal microsurgery provide definitive results, their invasiveness can lead to scarring and impaired phonological outcomes. Intralesional steroid injection has recently gained acceptance, but it lacks pathological diagnostic capabilities. Therefore, there is a growing need for a simple examination that can enhance the diagnosis of benign vocal lesions. NBI, from Olympus Corporation, has shown promising outcomes in detecting and characterizing laryngeal lesions. The i-scan technology by PENTAX, while providing the ability to improve visual clarity during endoscopic procedures, has been addressed less in this field. Our study aims to further investigate the application of i-scan imaging in benign vocal lesions, enrolling patients diagnosed with vocal cysts, polyps, and nodules. We conducted i-scan imaging prior to office-based intralesional steroid injection, assessing the possibility of its providing additional diagnostic information for benign vocal lesions without additional burden. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) is one of the most common diseases that occurs secondary to failure of the antireflux barrier system, resulting in the frequent and abnormal reflux of gastric contents to the esophagus. GERD is diagnosed in routine clinical practice based on the classic symptoms of heartburn and regurgitation. However, a subset of patients with atypical symptoms can pose challenges in diagnosing GERD. An esophagogastroduodenoscopy (EGD) is the most common initial diagnostic test used in the assessment for GERD, although half of these patients will not have any positive endoscopic findings suggestive of GERD. The advanced endoscopic techniques have improved the diagnostic yield of GERD diagnosis and its complications, such as Barrett’s esophagus and early esophageal adenocarcinoma. These newer endoscopic tools can better detect subtle irregularities in the mucosa and vascular structures. The management options for GERD include lifestyle modifications, pharmacological therapy, and endoscopic and surgical interventions. The latest addition to the armamentarium is the minimally invasive endoscopic interventions in carefully selected patients, including the electrical stimulation of the LES, Antireflux mucosectomy, Radiofrequency therapy, Transoral Incisionless Fundoplication, Endoscopic Full-Thickness plication (GERDx™), and suturing devices. With the emergence of these advanced endoscopic techniques, it is crucial to understand their selection criteria, advantages, and disadvantages.

Introduction: The incremental yield of I-Scan virtual chromoendoscopy compared to high-definition white light endoscopy (HD-WLE) in detection of colorectal adenomas has not been thoroughly elucidated. Methods: A systematic search from inception to April 2023 was conducted to identify randomized controlled trials (RCTs) comparing I-Scan to HD-WLE for detection of adenomas. A random effects model was used to compute risk difference (RD) with corresponding 95% confidence intervals in adenoma detection rate (ADR). Influence analysis was done to assess robustness of findings. The number needed to diagnose was computed. Heterogeneity was assessed using the I2 statistic and explored further by subgroup analyses defined a priori. Certainty in effect estimates was assessed using the GRADE approach. Results: We identified four studies (I-Scan n = 730, HD-WLE n = 765). I-Scan increased adenoma detection by 9% (risk difference (RD), 0.09; 0.04, 0.14; I2 02%; certainty, low). Influence analysis revealed that the gain in yield remained statistically significant with exclusion of all but one study. The number needed to capture one additional adenomatous polyp with I-Scan use was 11.2. I-Scan 1 use was associated with a statistically significant gain in ADR, whereas no significant difference in ADR was noted with I-Scan use on subgroup analysis. Discussion: In conclusion, I-Scan increases the yield of adenoma detection by 9% compared to HD-WLE, with low certainty in the estimate of this effect. Data on the gain in yield of detecting large polyps, sessile serrated lesions, and on the impact of formally training endoscopists and trainees in I-Scan use and similar technology on adenoma detection rate are needed. [ABSTRACT FROM AUTHOR]

Background: Mucosal healing (MH) is recognized as a therapeutic target in ulcerative colitis (UC) because of evidence that it is associated with favorable clinical outcomes. Current endoscopic assessment of MH by conventional white-light endoscopy is subject to several important clinical issues including the subjective nature of assessment, intra- and interobserver variability, and persistent microscopic inflammation, even in mucosa it was observed as quiescent on conventional endoscopy. Summary: Advances in image-enhancement technologies enable the provision of high-contrast images that emphasize the mucosal structures, blood vessel patterns, and color tones of the intestinal mucosa, and recently, several image-enhanced endoscopy (IEE) techniques have become available for the assessment of MH in UC. Narrow-band imaging and dual-red imaging facilitate visualization of mucosal vascular structures, which is useful for detecting minor inflammation and predicting relapse because of the capturing of information on incomplete vascular regeneration in patients with UC. Linked-color imaging (LCI) is optimized to emphasize the redness of the mucosa and blood vessels, and is superior for depicting subtle color changes arising from mucosal inflammation. LCI could possibly be used to stratify UC patients with MH on conventional endoscopy. Autofluorescence imaging and i-scan can also depict subtle histological changes underlying the healing of mucosa in UC, revealing them as simple color changes. Key Messages: Accumulating evidence suggests that IEE techniques could overcome current unmet needs in the endoscopic assessment of MH in UC and contribute to improving therapy based on treat-to-target strategies. [ABSTRACT FROM AUTHOR]

Background/Aims To date, no reports have compared the diagnostic efficacy of narrow-band imaging (NBI) and i-scan for the histologic prediction of intermediate-to-large colorectal polyps. We aimed to compare the diagnostic accuracy of NBI and i-scan in predicting histology, and their inter-/intra-observer agreement. Methods We performed a prospective, randomized study that included 66 patients (NBI, n=33 vs. i-scan, n=33) with colorectal polyps (size >10 mm but

Background DEFINA (EPK 3000) plus (with i-scan) is a digital chromoendoscopy. It uses surface/tone/contrast enhancement for detection, demarcation, and characterization of lesions. The aim of this study was to compare the usefulness of i-scan and conventional magnification white light endoscopy (M-WLE) for diagnosing Helicobacter pylori (Hp) infection in stomach. Patients and Methods Subjects undergoing evaluation for functional dyspepsia were prospectively enrolled at Ramaiah Medical College and Hospitals, Bangalore from November 2018 to February 2019. In total, 68 participants underwent gastroscopy with standard M-WLE followed by i-scan. Two biopsies from greater curve at 3 cm from the angulus were collected for histology. Successful diagnosis of Hp using imaging modality with M-WLE and i-scan were compared with histology. Results A total of 68 (36 men and 32 women) patients with a mean age of 47 ± 13 years (range 18–75 years) were enrolled in our study. The prevalence of Hp on the biopsies was 41%; 64% of the patients used proton pump inhibitors, 20% were current smokers; 25% of the patients were consuming alcohol. The sensitivity: 96.4%; specificity: 95%; accuracy: 95.5% of i-scan in diagnosis of Hp gastritis is better than the sensitivity: 50%; specificity: 50%; accuracy: 50% with M-WLE. Conclusion In conclusion, the diagnostic ability of i-scan (95%) for predicting Hp status is acceptable as compared with M-WLE (50%) for accurate diagnosis. The results suggest that i-scan improves endoscopic diagnostic accuracy of Hp infection compared with M-WLE.

Introduction Bronchoscopy with i-scan (image-scan) is a new image-enhanced endoscopic technology used for the detection of small intraepithelial and preinvasive lesions. Aim Comparing the diagnostic yield of high definition (HD)+i-scan bronchoscopy vs white light bronchoscopy (WLB) in the detection of vascular abnormalities and preinvasive lesions for early diagnosis of lung cancer. Patients and methods This cross-sectional study enrolled 40 patients with suspected lung cancer admitted to the Chest Department, Mansoura University, Egypt, 2016–2018. Patients with suspected lung cancer were included while patients unfit for bronchoscopy or with endobronchial mass were excluded. All patients after clinical, laboratory, and radiological assessment were screened by bronchoscopy using: WLB, HD-bronchoscopy, i-scan1, i-scan2, and i-scan3. When suspicious sites were detected, they were graded, counted, and categorized, afterwards cryobiopsies were taken to correlate between bronchoscopic and pathological findings followed by calculation of sensitivity and accuracy. Results Most of the patients were men, with a mean age of 59.25 years. Few abnormal sites detected by WLB (29) lesions were highly significantly lower than i-scan1, i-scan2, and i-scan3 (P

Background Owing to technological advances, a novel technique has become available, called high-definition (HD) bronchoscopy, giving substantially higher resolution images than conventional white light bronchoscopy and producing signal images with resolutions ranging from 850 000 pixels to more than 1 million pixels. HD bronchoscopes are designed for image output onto commercial TVs or computer monitors via i-scan video device. Aim The aim of this study was to determine the relation between different vascular patterns and histopathological type of bronchogenic carcinoma by using HD bronchoscopy and i-scan. Patients and methods The study was performed at Chest Department, Ain Shams University Hospital, from January 2015 till January 2016. The study included 30 patients, comprising 24 males and six females, with age ranging from 45 to 73 years. Bronchogenic carcinoma was diagnosed in all patients: 10 patients had squamous cell type, eight patients had adenocarcinoma, seven patients had small cell type, and five cases had large cell type. All patients were subjected to full history taking, complete clinical examination, and radiographic studies including plain chest radiography and computerized tomography of the chest. Laboratory evaluations included complete blood count, liver functions, renal functions, prothrombin time, partial thromboplastin time, international normalized ratio, and spirometry if needed. All cases were prepared and examined by HD PENTAX 3.2 Medical 70K-series (EB-1970TK) video bronchoscope and i-scan Video Processor EPK-i 5000. Results There was a statistically significant association between vascular pattern and pathology of bronchogenic carcinoma. Tortuous vessels were identified in 80% of patients with squamous cell carcinoma, 60% of large cell type, 42.8% of small cell type, and 12.5% of patients of adenocarcinoma. Dotted vessels were identified in 78.5% of adenocarcinoma cases, 42.8% of small cell type, 20% of large cell type, and 10% of squamous cell type. Abrupt-ending vessels were identified in 10% of squamous cell carcinoma cases, 14.4% of small cell type, and 20% of large cell type. Incidence of tortuous vessels in cases with squamous cell carcinoma was significantly greater (7.429 times) than nontortuous vessels. Incidence of dotted vessels in cases with adenocarcinoma was significantly higher (23.80 times) than nondotted vessels. Conclusion Advanced bronchoscopic technologies may enable obtaining an ‘optical biopsy’ of the bronchial tree, providing high-resolution and three-dimensional virtual images. These technologies may fundamentally improve the diagnostic and therapeutic assessment of bronchial tumors.

Background  DEFINA (EPK 3000) plus (with i-scan) is a digital chromoendoscopy. It uses surface/tone/contrast enhancement for detection, demarcation, and characterization of lesions. The aim of this study was to compare the usefulness of i-scan and conventional magnification white light endoscopy (M-WLE) for diagnosing Helicobacter pylori (Hp) infection in stomach. Patients and Methods  Subjects undergoing evaluation for functional dyspepsia were prospectively enrolled at Ramaiah Medical College and Hospitals, Bangalore from November 2018 to February 2019. In total, 68 participants underwent gastroscopy with standard M-WLE followed by i-scan. Two biopsies from greater curve at 3 cm from the angulus were collected for histology. Successful diagnosis of Hp using imaging modality with M-WLE and i-scan were compared with histology. Results  A total of 68 (36 men and 32 women) patients with a mean age of 47 ± 13 years (range 18–75 years) were enrolled in our study. The prevalence of Hp on the biopsies was 41%; 64% of the patients used proton pump inhibitors, 20% were current smokers; 25% of the patients were consuming alcohol. The sensitivity: 96.4%; specificity: 95%; accuracy: 95.5% of i-scan in diagnosis of Hp gastritis is better than the sensitivity: 50%; specificity: 50%; accuracy: 50% with M-WLE. Conclusion  In conclusion, the diagnostic ability of i-scan (95%) for predicting Hp status is acceptable as compared with M-WLE (50%) for accurate diagnosis. The results suggest that i-scan improves endoscopic diagnostic accuracy of Hp infection compared with M-WLE. [ABSTRACT FROM AUTHOR]

The effect of nozzle pressure ratio n on the flow field of an air jet was investigated to obtain the basis of nozzle design. The flow field structure and abrasive acceleration of these nozzles were numerically simulated via Fluent, which was verified by I-Scan and erosion experiment. It was concluded that n is the primary factor that affects nozzle structure design, n = 1.12 can generate a better flow field structure. The dynamic pressure of the jet was measured via I-Scan, and the range of dynamic pressure variation was low when n = 1 and n = 1.12. Improvements in the flow field structure are more advance to the abrasive acceleration. The abrasive was accelerated to the maximum velocity at n = 1.12. Thus, n = 1.12 is the most advantageous to abrasive acceleration and material erosion wear. For example, the erosion depth and volume corresponding to n = 1.12 at 15 MPa increased by 60% and 27% when compared to n = 5. Unlabelled Image • The nozzle pressure ratio is the main factor of flow field structure of an abrasive air jet. • Full-expansion and low underexpansion exhibit a better flow field structure. • The pressure oscillation is disadvantageous to abrasive acceleration. • Nozzle with a nozzle pressure ratio of 1.12 is optimal to material removal rate. [ABSTRACT FROM AUTHOR]

Background. Crohn’s disease and ulcerative colitis are inflammatory bowel diseases (IBD) associated with colorectal cancer risk in long-standing diseases. In order to assess the colonic mucosa and to discover dysplastic or neoplastic lesions, advanced endoscopic techniques are needed. Such techniques are detailed in this review: chromoendoscopy, autofluorescence imaging (AFI), narrow band imaging (NBI), i-SCAN, Fujinon Intelligent Color Enhancement (FICE) and confocal laser endomicroscopy (CLE).

Background/Aims: The aim of this study was to evaluate the efficacy of high definition (HD) i-SCAN for colorectal polyp detection in screening colonoscopy. Methods: We retrospectively analyzed the records of 501 patients who had undergone screening colonoscopy performed by three endoscopists with either HD i-SCAN (n=149) or standard white light (n=352) from January 2, 2014 through June 30, 2014. Patient information and inter-endoscopist variation as well as polyp number, endoscopic findings, and pathologic characteristics were reviewed. Results: The detection rates of colorectal and neoplastic polyps were significantly higher using HD i-SCAN than standard white light colonoscopy (52% vs. 38.1%, p=0.004 for colorectal polyps; and 37.2% vs. 27.9%, p=0.041 for neoplastic polyps). Analysis of endoscopic findings revealed no difference in detected polyp size between HD i-SCAN and standard white light colonoscopy (4.59±2.35 mm vs. 4.82±2.81 mm, p=0.739), but non-protruding polyps were more commonly detected by i-SCAN than by standard white light colonoscopy (24.6% vs. 13.5%, p=0.007). Conclusions: Colonoscopy using HD i-SCAN had a significantly higher detection rate of colorectal polyps, including neoplastic polyps, because of improved sensitivity for detecting non-protruding lesions.

Despite the remarkable progress recently made to enhance the resolution of white-light endoscopy, detection, and diagnosis of premalignant lesions, such as adenomas and subtle early-stage cancers, remains a great challenge. As for example, although chromoendoscopy, such as endoscopy using indigo carmine, is useful for the early diagnosis of subtle lesions, the technique presents various disadvantages ranging from the time required for spray application of the dye and suctioning of excess dye to the increased difficulty in identifying lesions in the presence of severe inflammation and obstruction of visual field due to the pooling of solution in depressed-type lesions. To overcome these diagnostic problems associated with chromoendoscopy, research has focused on the development of endoscopes based on new optical technologies. Several types of image-enhanced endoscopy methods have recently been presented. In particular, image-enhanced endoscopy has emerged as a new paradigm for the diagnosis of gastrointestinal disorders. Image-enhanced endoscopes provide high-contrast images of lesions by means of optical or electronic technologies, including the contrast enhancement of the mucosal surface and of blood vessels. Chromoendoscopy, narrow-band imaging, i-SCAN, and flexible spectral imaging color enhancement are representative examples of image-enhanced endoscopy discussed in this paper.

To improve the detection rate of gastrointestinal tumors, image-enhanced endoscopy has been widely used during screening and surveillance endoscopy in Korea. In addition to narrow band imaging (NBI) with/without magnification, various types of electronic chromoendoscopies have been used, including autofluorescence imaging, I-scan, and flexible spectral imaging color enhancement. These technologies enable the accurate characterization of tumors because they enable visualization of microvascular and microsurface patterns. The present review focuses on understanding the principle and clinical applications of advanced imaging technologies other than NBI.

Standard KTP laser (potassium titanyl phosphate) wavelength-specific protective eyewear often impairs visualization of tissue changes during laser treatment. This sometimes necessitates eyewear removal to evaluate tissue effects, which wastes time and poses safety concerns. The objective was to determine if "virtual" or "electronic" chromoendoscopy filters, as found on some endoscopy platforms, could alleviate the restricted visualization inherent to protective eyewear. A KTP laser was applied to porcine laryngeal tissue and recorded via video laryngoscopy with 1 optical (Olympus Narrow Band Imaging) and 8 digital (Pentax Medical I-scan) chromoendoscopy filters. Videos were viewed by 11 otolaryngologists wearing protective eyewear. Using a discrete visual analog scale, they rated each filter on its ability to improve visualization,. No filter impaired visualization; 5 of 9 improved visualization. Based on statistical significance, the number of positive responses, and the lack of negative responses, narrow band imaging and the I-scan tone enhancement filter for leukoplakia performed best. These filters could shorten procedure time and improve safety; therefore, further clinical evaluation is warranted. [ABSTRACT FROM AUTHOR]

Background: Current clinical practice is to remove a colorectal polyp detected during colonoscopy and determine whether it is an adenoma or hyperplastic by histopathology. Identifying adenomas is important because they may eventually become cancerous if untreated, whereas hyperplastic polyps do not usually develop into cancer, and a surveillance interval is set based on the number and size of adenomas found. Virtual chromoendoscopy (VCE) (an electronic endoscopic imaging technique) could be used by the endoscopist under strictly controlled conditions for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps to replace histopathological diagnosis. Objective: To assess the clinical effectiveness and cost-effectiveness of the VCE technologies narrow-band imaging (NBI), flexible spectral imaging colour enhancement (FICE) and i-scan for the characterisation and management of diminutive (≤ 5 mm) colorectal polyps using high-definition (HD) systems without magnification. Design: Systematic review and economic analysis. Participants: People undergoing colonoscopy for screening or surveillance or to investigate symptoms suggestive of colorectal cancer. Interventions: NBI, FICE and i-scan. Main outcome measures: Diagnostic accuracy, recommended surveillance intervals, health-related quality of life (HRQoL), adverse effects, incidence of colorectal cancer, mortality and cost-effectiveness of VCE compared with histopathology. Data sources: Electronic bibliographic databases including MEDLINE, EMBASE, The Cochrane Library and Database of Abstracts of Reviews of Effects were searched for published English-language studies from inception to June 2016. Bibliographies of related papers, systematic reviews and company information were screened and experts were contacted to identify additional evidence. Review methods: Systematic reviews of test accuracy and economic evaluations were undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-analyses were conducted, where possible, to inform the independent economic model. A cost–utility decision-analytic model was developed to estimate the cost-effectiveness of VCE compared with histopathology. The model used a decision tree for patients undergoing endoscopy, combined with estimates of long-term outcomes (e.g. incidence of colorectal cancer and subsequent morbidity and mortality) derived from University of Sheffield School of Health and Related Research’s bowel cancer screening model. The model took a NHS perspective, with costs and benefits discounted at 3.5% over a lifetime horizon. There were limitations in the data on the distribution of adenomas across risk categories and recurrence rates post polypectomy. Results: Thirty test accuracy studies were included: 24 for NBI, five for i-scan and three for FICE (two studies assessed two interventions). Polyp assessments made with high confidence were associated with higher sensitivity and endoscopists experienced in VCE achieved better results than those without experience. Two economic evaluations were included. NBI, i-scan and FICE are cost-saving strategies compared with histopathology and the number of quality-adjusted life-years gained was similar for histopathology and VCE. The correct surveillance interval would be given to 95% of patients with NBI, 94% of patients with FICE and 97% of patients with i-scan. Limitations: Limited evidence was available for i-scan and FICE and there was heterogeneity among the NBI studies. There is a lack of data on longer-term health outcomes of patients undergoing VCE for assessment of diminutive colorectal polyps. Conclusions: VCE technologies, using HD systems without magnification, could potentially be used for the real-time assessment of diminutive colorectal polyps, if endoscopists have adequate experience and training. Future work: Future research priorities include head-to-head randomised controlled trials of all three VCE technologies; more research on the diagnostic accuracy of FICE and i-scan (when used without magnification); further studies evaluating the impact of endoscopist experience and training on outcomes; studies measuring adverse effects, HRQoL and anxiety; and longitudinal data on colorectal cancer incidence, HRQoL and mortality. Study registration: This study is registered as PROSPERO CRD42016037767. Funding: The National Institute for Health Research Health Technology Assessment programme.

The limitations of white light colonoscopy result in missing 6% of advanced neoplasias in 6% and up to 25% of adenomas. This has motivated the development of techniques such as virtual chromoendoscopy including the i-Scan system to detect larger numbers of polyps as a strategy for preventing colon cancer. This review summarizes the current application of this technique for detection and characterization of adenomas. The new system is a possible alternative in our environment to the better known NBI and FICE which are already being used here. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of portal hypertensive gastropathy (PHG) is based on endoscopic criteria. I-scan technology, a new technique of virtual chromoendoscopy, increases the diagnostic accuracy for lesions in the gastrointestinal tract. Aim: To establish the role of i-scan endoscopy in the diagnosis of PHG. Method: In this prospective study, endoscopic examination was conducted first by using white light and after that i-scan 1 and i-scan 2 technology in a group of 50 consecutive cirrhotic patients. The endoscopic diagnostic criteria for PHG followed the Baveno criteria. The interobserver agreement between white light endoscopy and i-scan endoscopy was determined using Cohen's kappa statistics. Results: Forty-five of the 50 patients met the diagnostic criteria for PHG when examined by i-scan endoscopy and 39 patients were diagnosed with PHG by white light endoscopy. The strength of agreement between the two methods for the diagnosis of PHG was moderate (k=0.565; 95%CI 0.271-0.859; p<0.001). I-scan 1 classified the mosaic pattern better than classic endoscopy; i-scan 2 described better the red spots. Conclusion: I-scan examination increased the diagnostic sensitivity of PHG. The diagnostic criteria (mosaic pattern and red spots) were easier to observe endoscopically using i-scan than in white light. [ABSTRACT FROM AUTHOR]

Background and aims Celiac disease remains underdiagnosed at endoscopy. We aimed to assess the utility of I-Scan (virtual chromo-endoscopy) to improve sensitivity of endoscopy to detect markers of villous atrophy in this condition. Methods Patients from 2 UK hospitals were studied in 3 groups. Group 1: standard high definition, white light endoscopy (WLE); Group 2: WLE plus I-Scan; Group 3: non-high definition control group. The presence of endoscopic markers was recorded. At least 4 duodenal biopsies were taken from all patients. Serology was performed concurrently and observations were compared with histology. Results 758 patients (62% female, mean age 52) were recruited (Group 1: 230; Group 2: 228; Group 3: 300). 135 (17.8%) new diagnoses of coeliac disease were made (21 Group 1; 24 Group 2; 89 Group 3). The sensitivity for detection of endoscopic markers of villous atrophy was significantly higher in both Group 1 (85.7%, p = 0.0004) and Group 2 (75%, p = 0.005) compared to non-high definition controls (41.6%). There was no significant difference between high definition only and I-Scan groups ( p = 0.47). In non-high definition endoscopy a missed diagnosis was associated with lesser degrees of villous atrophy ( p = 0.019) and low tTG titre ( p = 0.007). Conclusions High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy. [ABSTRACT FROM AUTHOR]

Electronic chromoendoscopy (EC) is an equipment-based technology which could be easily activated by push of a button. There are four EC techniques available for use at present: narrow band imaging (NBI), i-Scan, flexible spectral chromoendoscopy and blue laser imaging. Out of the four techniques, NBI has been extensively evaluated for the detection and characterization of dysplasia in colonic polyps and dysplasia associated with inflammatory bowel disease. In this review, we will focus on the new developments and applications of EC. [ABSTRACT FROM AUTHOR]

Enhanced imaging technologies such as narrow band imaging, flexible spectral imaging color enhancement, i-Scan, confocal laser endomicroscopy, and optical coherence tomography are readily available for use by endoscopists in routine clinical practice. In November 2014, the American Gastroenterological Association’s Center for GI Innovation and Technology conducted a 2-day workshop to discuss endoscopic image enhancement technologies, focusing on their role in 2 specific clinical conditions (colon polyps and Barrett’s esophagus) and on issues relating to training and implementation of these technologies (white papers). Although the majority of the studies that use enhanced imaging technologies have been positive, these techniques ideally need to be validated in larger cohorts and in community centers. As it stands today, detailed endoscopic examination with high-definition white-light endoscopy and random 4-quadrant biopsy remains the standard of care. However, the workshop panelists agreed that in the hands of endoscopists who have met the preservation and incorporation of valuable endoscopic innovation thresholds (diagnostic accuracy) with enhanced imaging techniques (specific technologies), use of the technique in Barrett’s esophagus patients is appropriate. [ABSTRACT FROM AUTHOR]

Innovation of endoscopic technology has recently been introduced to improve real-time visualization of mucosal architecture and subepithelial vascular structures. Since the esophagus is easily accessible using endoscopy and the length of required observation is limited, many different types of new imaging modalities have been reported and showing promising data. Early detection of neoplastic changes in the esophagus is devoted to the treatment in early stage cancer and theoretically leads to better prognosis. This review will focus on the emerging endoscopic technologies for the management of esophageal cancer. [ABSTRACT FROM AUTHOR]

The practice of colonoscopy has changed considerably over the last decade. The growth of image-enhanced endoscopy have altered our concepts of how we perform colonoscopy. This article examines the evidence base behind these techniques and looks at where future research needs to be directed. [ABSTRACT FROM AUTHOR]

Despite being the current gold standard, white-light endoscopy may miss a significant proportion of lesions within the colorectum, thus leading to a misinterpretation of various disease findings. Traditionally, dye-based chromoendoscopy is used to improve both detection and characterization of lesions during luminal gastrointestinal ( GI) endoscopy. Recently introduced dye-less chromoendoscopy ( DLC) techniques have overcome many of the limitations of dye-based chromoendoscopy, thereby potentially improving lesion recognition and characterization. In detail, DLC techniques allow for better detection of esophageal lesions, gastric cancer and colorectal pathologies including colorectalpolyps and inflammatory bowel diseases. Moreover, DLC techniques enable a more precise characterization of lesions throughout the whole luminal GI tract, thereby potentially enabling more accurate endoscopic therapies. In the present review we focus on the newly introduced dye-less chromoendoscopy technique i-scan and give an additional outlook on the recent development of optical enhancement technology. [ABSTRACT FROM AUTHOR]

Objective This study aimed to compare the diagnostic value and image quality of high-definition magnifying white light endoscopy ( M- WLE) and high-definition magnifying endoscopy with i-scan ( M-i-scan) for Helicobacter pylori ( H. pylori) infection. Methods Patients complaining of dyspepsia who underwent esophagogastroduodenoscopy at the Endoscopy Unit of Qilu Hospital ( Jinan, Shandong Province, China) from January to March, 2011 were prospectively recruited. The greater curvature of the stomach was carefully observed using both M- WLE and M-i-scan. The gastric mucosal classification and image quality scores were recorded. The relationship between gastric mucosal classification and final diagnosis of H. pylori infection was determined. Results A total of 84 patients were recruited in this study. The accuracy and specificity of the combination of types 2-3 patterns predicting H. pylori infection were significantly higher for M-i-scan than those for M- WLE (accuracy: 94.0% vs 84.5%, P = 0.046; and specificity: 93.5% vs 80.6%, P = 0.032), while the sensitivity of the two modes was the same. The M-i-scan provided a better image quality for H. pylori infection than M- WLE ( P < 0.001). Conclusion The M-i-scan may be superior to M- WLE for the prediction of H. pylori infection, but its diagnostic sensitivity needs to be improved. [ABSTRACT FROM AUTHOR]

Aim. The aim of the article is to systematically review the current evidence on the diagnostic use of narrow band imaging (NBI), flexible spectral imaging color enhancement (FICE) and endoscopic image enhancement technology i-scan endoscopies for gastric precancerous and cancerous lesions. Materials and methods. Original manuscripts were searched in PubMed until October 2012. Pertinent data were collected and pooled diagnostic accuracy measures were estimated when possible. Results. In total, 38 studies were evaluated. Thirty-one studies were included for NBI and 7 studies for FICE assessment in this systematic review. No article was found meeting inclusion criteria for i-scan endoscopy. The most defined and evaluated outcomes were cancer-related ( n = 26). Quality Assessment of Diagnostic Accuracy Studies score varied from 9 to 12 (out of 14). Only few studies assessed the interobserver reliability. On a patient level analysis, NBI's pooled sensitivity, specificity and diagnostic odds ratio were 0.67 (95% CI: 0.61-0.73), 0.81 (95% CI: 0.76-0.85) and 22.71 (95% CI: 12.53-41.1), respectively for diagnosing normal mucosa; 0.86 (95% CI: 0.82-0.90), 0.77 (95% CI: 0.73-0.80) and 17.01 (95% CI: 1.4-207.2) for intestinal metaplasia and 0.90 (95% CI: 0.84-0.94), 0.83 (95% CI: 0.80-0.86) and 47.61 (95% CI: 4.61-491.34) for dysplasia. Owing to the insufficient data and different definitions, we could not aggregate the results for FICE. Conclusion. Gastric pattern descriptions have been proposed for NBI and FICE studies by gathering all descriptions in one single description. The classification systems varied between studies, a single description of gastric mucosal features with HR - scopes or at least per technology - will have to be agreed on. [ABSTRACT FROM AUTHOR]

Purpose: Aim of the study was the evaluation of high-definition white light (HDWL) i-Scan endoscopy for diagnostic prediction of histology, inter- and intraobserver agreement for colorectal polyps. Methods: In this prospective single-center cohort study, a skilled endoscopist, with HDWL i-Scan, predicted on real-time the histology of 150 polyps from 78 patients undergoing colonoscopy. Subsequently, four endoscopists, not involved in the collection of cases, predicted the polyps' histology (neoplastic vs nonneoplastic) and repeated the assessment after 6 months. Results: Real-time assessment of the lesions predicted a correct histology in 138/150 cases with a sensitivity, specificity, and accuracy of 95, 82, and 92 %, respectively. Sensitivity, specificity, and accuracy of post-acquisition evaluation were 87.7, 61.7, and 82.2 %, respectively. The κ values of inter- and intraobserver agreement of prediction of histology were 0.462 (0.373-0.537) and 0.657 (0.523-0.917). Among the subset of polyps ( n = 82) with good/excellent quality image, sensitivity and accuracy of HDWL i-Scan improved (97 %, p = 0.003 and 94 %, p = 0.002, respectively) as well as κ value of interobserver agreement (0.699). Conclusions: HDWL i-Scan technology helps for characterization of polyps of the colon with good accuracy even if it cannot replace, at the moment, the histopathological examination. Reproducibility among operators is supported by a moderate substantial interobserver and intraobserver agreement. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Advances in colonoscopy, such as the Pentax i-Scan electronic technique, have the potential to improve the early detection of colorectal cancer. The aim of this multicentre study was to assess the interobserver agreement in the visualization of the surface and margins of colorectal polyps and in distinguishing neoplastic from non-neoplastic polyps. Patients and methods: Eight expert endoscopists examined 400 mixed previously recorded images of polyps taken with different Pentax i-Scan settings in order to give an evaluation of the surface of the polyp and regular colonic mucosa, the pit-pattern and the nature of the lesion. Results: A total of 400 mixed images of polyps with a diameter >5mm and <10mm were stored for analysis. Overall, there was a K f agreement of 0.370 (p <0.001) and 0.306 (p <0.001) regarding pit-pattern and margins, respectively. The K f agreement for the difference between neoplastic and non-neoplastic lesions was of 0.446 (p <0.001). Conclusions: We observed good interobserver agreement in the evaluation of neoplastic and non-neoplastic lesions and poor agreement in the evaluation of pit-pattern and margins. Adequate training is required in order to interpret images acquired with the i-Scan technique. [Copyright &y& Elsevier]

New imaging technologies have been applied in endoscopy to improve the detection and differentiation of subtle mucosal changes using a digital contrast method. Among them, i-SCAN technology is the most recently developed image-enhancing technology. We investigated whether i-SCAN could improve the detection rate of reflux esophagitis. Interobserver agreement between endoscopists was compared with conventional white light (WL) endoscopic examination. We performed a prospective randomized controlled trial. A consecutive series of 514 subjects that underwent an esophagogastroduodenoscopy for health inspection were enrolled and randomized into the i-SCAN group (n = 246) and WL group (n = 268). An esophagogastroduodenoscopy with video recording was used for detecting reflux esophagitis, and reflux esophagitis were categorized by the modified Los Angeles (LA) classification. The total number of reflux esophagitis identified by WL and i-SCAN was 58 (21.7%) and 74 (30.1%), respectively. The diagnostic yield of reflux esophagitis was significantly higher (P = 0.034) in the i-SCAN group (30.1%) as compared to the WL group (21.6%). Using the modified LA classification, the detection rate of minimal changes was significantly higher (P = 0.017) in the i-SCAN group (11.8%) as compared to the WL group (5.6%), but the detection rates of LA-A and LA-B were not significantly different between the two groups (P = 0.897 and P = 0.311, respectively). After comparison of the interobserver agreement using randomly selected video clips, the i-SCAN group showed better agreement than the WL group (Kappa value, 0.793 vs. 0.473). Compared to WL endoscopy, applying i-SCAN in daily practice can improve the diagnostic yield of reflux esophagitis by detecting more minimal changes in the squamo-columnar junction of the esophagus and can improve the interobserver agreement of the modified Los Angeles classification. [ABSTRACT FROM AUTHOR]

Recent advances in endoscopic imaging techniques have revolutionized the diagnostic approach of patients with inflammatory bowel disease (IBD). New, emerging endoscopic imaging techniques visualized a plethora of new mucosal details even at the cellular and subcellular level. This review offers an overview about new endoscopic techniques, including chromoendoscopy, magnification endoscopy, spectroscopy, confocal laser endomicroscopy and endocytoscopy in the face of IBD. [ABSTRACT FROM AUTHOR]

The influx of new endoscopic technologies produces continuous evolution in diagnostic modalities, especially in colorectal cancer screening. New technologies seek not only to improve the detection of flat and difficult-to-visualize lesions, but also to more precisely differentiate between neoplastic and non-neoplastic lesions. The oldest technology, chromoendoscopy, has been shown to improve neoplasia detection in high-risk subjects, but it is not widely accepted due to its cumbersome nature. Newer technologies such as narrow-band imaging provide digital chromoendoscopy, yielding improved lesion detection and characterization with less inconvenience. Other technologies such as confocal endomicroscopy allow endoscopists to make in vivo histologic diagnoses of suspicious areas. Collectively, these emerging technologies may change the way that colonoscopy is performed. [ABSTRACT FROM AUTHOR]

Pressure garment therapy is standard of care for prevention and treatment of hypertrophic scarring after burn injury. Nevertheless there is little objective data that confirms effectiveness. The purpose of this study was to determine the effectiveness of pressure garment therapy with objective data obtained with a randomized within-wound comparison. We enrolled consecutive patients with forearm injuries over a 12-year period. The subjects wore custom garments with normal and low compression randomized to either the proximal or distal zones. Hardness, color and thickness of wounds were objectively measured using appropriate devices; clinical appearance was measured by a panel masked to the identity of the pressure treated area. Wounds treated with normal compression were significantly softer, thinner, and had improved clinical appearance. There was no interaction of any effect with patient ethnicity. However, these findings were clinically evident only with moderate to severe scarring. We conclude that pressure garment therapy is effective, but that the clinical benefit is restricted to those patients with moderate or severe scarring. [Copyright &y& Elsevier]

State of the Art: New technologies in the form of high-magnification or "zoom" endoscopy complemented by chromoscopic agents or Narrow Band Imaging permit early detection of neoplastic lesions, particularly flat and depressed types. Detailed characteristics of the mucosal surface can be obtained, enabling an in vivo "optical biopsy" to make an instant diagnosis at endoscopy, previously possible only by using histological or cytological analysis. Advances in fiber optics, light sources, detectors, and molecular biology have led to the development of several novel methods for tissue evaluation in situ. Perspectives: Promising imaging techniques include fluorescence endoscopy, optical coherence tomography, confocal microendoscopy, molecular imaging, and light scattering and Raman spectroscopy. Conclusions: These techniques probably are able to replace conventional biopsy in the near future, but the endoscopists should become increasingly more familiar with histopathologic findings. [ABSTRACT FROM AUTHOR]

Abstract: Background: The EPKi system (Pentax, Japan) enables resolution above HDTV. Aim of the study was to test the efficacy of HD+ alone and with the new post-processing digital filter i-Scan or chromoendoscopy (Methylene blue 0.1%) in screening for colorectal cancer. We focused on lesions less than 5mm as a surrogate marker for the optical possibilities of the EPKi system. Methods: The last 30cm of the colon in a screening population were inspected with HD+ alone, in combination with i-Scan (2:1 randomisation) and subsequently with chromoendoscopy. All lesions were characterized and targeted biopsies were performed. Results: i-Scan augmented in 69 patients the identification of lesions from 176 to 335 (p <0.001) and chromoendoscopy to 646 (p <0.001). The additional lesions were mainly flat (type IIb, 74%), which were only recognized using i-Scan or chromoendoscopy. The amount of neoplasias was not significantly different (HD+: 5, i-Scan: 11, Chromoendoscopy: 11), but all could correctly be predicted using i-Scan or chromoendoscopy. Conclusions: HD+ colonoscopy with and without i-Scan unmask a plethora of small lesions but chromoendoscopy can even advance the number. However, i-Scan was able to predict neoplasia as precisely as chromoendoscopy and might shortly replace chromoendoscopy as a more time efficient tool. [Copyright &y& Elsevier]

Abstract: The accuracy of the center of pressure (CoP) measurement during human quiet standing using an ultra-thin film pressure measurement system (Tekscan, I-Scan) was examined. To this end, CoP sway was measured simultaneously by I-Scan and a force platform (FP) to quantify differences in CoP obtained by the two methods. The sway amplitudes of I-Scan were slightly smaller than those of FP. The differences were systematic, allowing us to identify a filter that could bring every CoP trajectory of I-Scan close to that of FP. We concluded that, with the use of the filter, I-Scan could be used for accurate measurement of CoP sway during quiet standing. [Copyright &y& Elsevier]