Evaluation of colon mucosa using screening colonoscopy and flexible spectral imaging color enhancement in patients with long lasting ulcerative colitis.

AIM: To determine which flexible spectral imaging color enhancement (FICE) channel best visualizes colon mucosa in ulcerative colitis (UC) and to compare FICE imaging with standard imaging. METHODS: The study enrolled patients with ulcerative colitis in remission who had inflammatory bowel disease for at least 8 years. All patients underwent screening colonoscopy. The entire colon, especially the suspicious areas in terms of dysplasia, were imaged with standard endoscopy and FICE. Random and target biopsies were obtained. Histopathological diagnosis was made and image patterns were evaluated. Seven endoscopists evaluated normal, colitis, and polyp images obtained with FICE. RESULTS: One hundred and twenty-three colon segments were evaluated and 1831 images were obtained from 18 patients. A total of 1652 images were FICE and 179 were standard images. Separate FICE images were obtained for normal colon mucosa, polypoid lesions, and colitis areas. Normal colon mucosa was best visualized using the second, sixth, and ninth FICE channel; polyps using the third, seventh, and ninth channel; and colitis using the second, third, and ninth channel. When all images were analyzed, the second and ninth channel were significantly better than the other channels. A total of 584 biopsies were obtained, including 492 (84.2%) random biopsies and 92 (15.7%) target biopsies. Random biopsies detected no dysplasia, but target biopsies detected low-grade dysplasia in three diminutive polyps. CONCLUSION: FICE was not significantly better at dysplasia screening than the standard procedure, but it effectively detected diminutive polyps and evaluated surface patterns without using magnification. FICE might contribute to the assessment of inflammation severity in patients with UC in clinical remission. However, more extensive studies are necessary to confirm these findings.

High-resolution magnified endoscopy combined with flexible spectral imagining colour enhancement techniques in the diagnosis of Helicobacter pylori disease.

AIM: To evaluate the efficiency of the flexible spectral imaging colour enhancement (FICE) procedure added to high-resolution magnified endoscopy (HRME) for the evaluation of structural changes in gastric mucosa infected with Helicobacter pylori (H. pylori). MATERIAL AND METHODS: A total of 104 patients were included in the study. First HRME and then HRME + FICE methods were used for the evaluation of the gastric mucosal structure, and examined areas were studied histopathologically. Mucosal appearance was evaluated with the modified Yagi classification. Images were shown to five endoscopists in order to examine inter- and intra-observer variability in image assessment. RESULTS: Sensitivity and specificity of the image pattern noted with HRME in the antrum in the detection of H. pylori were 67.9% and 84.6%, respectively, while these were 93.5% and 92.3%, respectively, with HRME + FICE. Type 5 pattern in the antrum, which we thought to be associated with intestinal metaplasia, was not observed in any patient with HRME. Sensitivity and specificity values of type 5 pattern noted with HRME + FICE technique for intestinal metaplasia were 50% and 98.8%, respectively. CONCLUSIONS: The results show that HRME + FICE as a digital chromoendoscopic method provided an additional diagnostic contribution to HRME for showing the presence of H. pylori and intestinal metaplasia and is a method with higher sensitivity and specificity. The "patchy appearance" (type 5) observed in the antrum not previously described in the evaluations with FICE can be a guiding sign especially for the diagnosis of intestinal metaplasia.