Use of narrowband imaging for the detection of endometriosis.

STUDY OBJECTIVE: To show a new technique using narrowband imaging for the detection of endometriosis. DESIGN: A step-by-step illustration of the difference in visualization of endometriosis using a visible light spectrum laparoscope compared with a narrowband imaging light source. SETTING: Radical excision of endometriosis is considered the best treatment to control the disease extent and symptoms of endometriosis. Therefore, it is imperative that all endometriotic lesions are recognized and identified in order to thoroughly remove them. A narrowband imaging system enhances the visualization of capillary vessels and microstructures containing blood hemoglobin on the mucosal surface. It makes use of 415- and 540-nm filters that are strongly absorbed by blood hemoglobin. In this manner, microvessels, which are not clearly seen by conventional light, are enhanced. With the inherent neovascularization noted in endometriosis, endometriotic lesions may be more recognizable. Clear vesicular lesions of endometriosis are glandular excrescences, which are early signs of recurrent inflammation from endometriosis with accompanying angiogenesis. These are more pronounced under narrowband imaging. INTERVENTIONS: The use of the visible light spectrum contrasted with narrowband imaging that changes the normal color contrasts of the endoscopic image in the different areas of the pelvic cavity. MEASUREMENTS AND MAIN RESULTS: Narrowband imaging is helpful as an additional modality for the identification of endometriosis. In particular, clear vesicular lesions of endometriosis, which are not as evident under the visible light spectrum, are more pronounced under narrowband imaging. Its strength lies in its usefulness in the treatment of patients with endometriosis with symptoms of pain. It is especially useful for those with marked symptoms but, on first glance at laparoscopy, seems to have minimal disease. Narrowband imaging enhances the endometriotic lesions and makes it easier to visualize and identify them, knowing that these subtle lesions may well be the cause of the pain. However, its usefulness is decreased if performed after the initiation of surgery because of the bleeding incurred from dissection, which makes it difficult to distinguish between the red blood cells and endometriotic lesions. CONCLUSION: Narrowband imaging can be used as an adjunct to improve the detection of endometriosis.