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  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

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    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

    Deputy Editor

    Deputy Editor
    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
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    All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
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Blue Laser Imaging, Blue Light Imaging, and Linked Color Imaging for the Detection and Characterization of Colorectal Tumors

Naohisa Yoshida1 , Osamu Dohi1, Ken Inoue1, Ritsu Yasuda1, Takaaki Murakami1, Ryohei Hirose1, Ken Inoue1, Yuji Naito1, Yutaka Inada2, Kiyoshi Ogiso3, Yukiko Morinaga4, Mitsuo Kishimoto4, Rafiz Abdul Rani5, Yoshito Itoh1

1Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan, 2Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan, 3Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan, 4Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan, 5Gastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia

Correspondence to:Naohisa Yoshida (https://orcid.org/0000-0001-6167-9705)
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
Tel: +81-75-251-5519, Fax: +81-75-251-0710, E-mail: naohisa@koto.kpu-m.ac.jp

Received: June 15, 2018; Revised: July 23, 2018; Accepted: July 30, 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gut Liver 2019; 13(2): 140-148

Published online March 31, 2019 https://doi.org/10.5009/gnl18276

Copyright © Gut and Liver.

Abstract

A laser endoscopy system was developed in 2012. The system allows blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI) to be performed as modes of narrow-band light observation; these modes have been reported to be useful for tumor detection and characterization. Furthermore, an innovative endoscopy system using four-light emitting diode (LED) multilight technology was released in 2016 to 2017 in some areas in which laser endoscopes have not been approved for use, including the United States and Europe. This system enables blue light imaging (this is also known as BLI) and LCI with an LED light source instead of a laser light source. Several reports have shown that these modes have improved tumor detection. In this paper, we review the efficacy of BLI and LCI with laser and LED endoscopes in tumor detection and characterization.

Keywords: Colorectal neoplasms, Linked color imaging, Blue laser imaging, Blue light imaging


Article

Review

Gut and Liver 2019; 13(2): 140-148

Published online March 31, 2019 https://doi.org/10.5009/gnl18276

Copyright © Gut and Liver.

Blue Laser Imaging, Blue Light Imaging, and Linked Color Imaging for the Detection and Characterization of Colorectal Tumors

Naohisa Yoshida1 , Osamu Dohi1, Ken Inoue1, Ritsu Yasuda1, Takaaki Murakami1, Ryohei Hirose1, Ken Inoue1, Yuji Naito1, Yutaka Inada2, Kiyoshi Ogiso3, Yukiko Morinaga4, Mitsuo Kishimoto4, Rafiz Abdul Rani5, Yoshito Itoh1

1Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan, 2Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan, 3Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan, 4Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan, 5Gastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia

Correspondence to:Naohisa Yoshida (https://orcid.org/0000-0001-6167-9705)
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
Tel: +81-75-251-5519, Fax: +81-75-251-0710, E-mail: naohisa@koto.kpu-m.ac.jp

Received: June 15, 2018; Revised: July 23, 2018; Accepted: July 30, 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A laser endoscopy system was developed in 2012. The system allows blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI) to be performed as modes of narrow-band light observation; these modes have been reported to be useful for tumor detection and characterization. Furthermore, an innovative endoscopy system using four-light emitting diode (LED) multilight technology was released in 2016 to 2017 in some areas in which laser endoscopes have not been approved for use, including the United States and Europe. This system enables blue light imaging (this is also known as BLI) and LCI with an LED light source instead of a laser light source. Several reports have shown that these modes have improved tumor detection. In this paper, we review the efficacy of BLI and LCI with laser and LED endoscopes in tumor detection and characterization.

Keywords: Colorectal neoplasms, Linked color imaging, Blue laser imaging, Blue light imaging

Fig 1.

Figure 1.Characteristics of laser and light emitting diode (LED) endoscopy.

LASER, light amplification by stimulated emission of radiation.

Gut and Liver 2019; 13: 140-148https://doi.org/10.5009/gnl18276

Fig 2.

Figure 2.T1 cancer observed by linked color imaging (LCI) and blue laser imaging (BLI) with a laser endoscope. (A) A nonpolypoid polyp 20 mm in size with depression. (B) LCI presented the lesion as reddish and increased polyp visibility. (C) BLI magnification revealed irregular surface patterns and vessel patterns (JNET type 2B). (D) Narrow band imaging (NBI) magnification revealed irregular surface patterns and vessel patterns, similar to BLI magnification. (E) Mapping of the resected specimen. T1 cancer (submucosal invasion length, 500 μm) with adenoma. Direction for an endoscopic observation (arrow). (F) Histological findings of submucosal invasion (H&E, ×100).O, oral side; A, anal side; JNET, Japan NBI Expert Team.
Gut and Liver 2019; 13: 140-148https://doi.org/10.5009/gnl18276

Fig 3.

Figure 3.JNET classifications.JNET, Japan narrow band imaging (NBI) Expert Team.
Gut and Liver 2019; 13: 140-148https://doi.org/10.5009/gnl18276

Fig 4.

Figure 4.A comparison of laser and light emitting diode (LED) endoscopes in the detection of high-grade rectal dysplasia. (A) White-light imaging (WLI) with a laser endoscope. (B) Linked color imaging (LCI) with a laser endoscope. (C) Blue laser imaging (BLI) with a laser endoscope (JNET classification: type 2B). (D) WLI with an LED endoscope. (E) LCI with an LED endoscope. (F) Blue light imaging (BLI) with an LED endoscope (JNET classification: type 2B).JNET, Japan narrow band imaging (NBI) Expert Team.
Gut and Liver 2019; 13: 140-148https://doi.org/10.5009/gnl18276

Fig 5.

Figure 5.A sessile, serrated polyp 10 mm in size in the cecum viewed with a laser endoscope. (A) White-light imaging. (B) Blue laser imaging (BLI)-bright. (C) Linked color imaging, (D) BLI magnification showing thick and branched vessels and an enlarged crypt opening.
Gut and Liver 2019; 13: 140-148https://doi.org/10.5009/gnl18276

Fig 6.

Figure 6.A polypoid tumor 25 mm in size in the sigmoid colon, high-grade dysplasia, as viewed with a laser endoscope. (A) White-light imaging showing a polypoid tumor with slight depression (possible T1 cancer). (B) Blue laser imaging magnification showing a severely irregular surface pattern. The margin of the surface pattern was unclear. (C) Pit pattern observation with crystal violet staining showing a severely irregular pattern; however, some of the area was not stained well. (D) Linked color imaging with crystal violet staining clearly showed an irregular pit pattern.
Gut and Liver 2019; 13: 140-148https://doi.org/10.5009/gnl18276

Fig 7.

Figure 7.A nonpolypoid tumor 12 mm in size in the rectum, high-grade dysplasia, as viewed with a laser endoscope. (A) White-light imaging showing a nonpolypoid tumor. The margin was not clear (polyp visibility score: 2). (B, C) Blue laser imaging (BLI)-bright and Linked color imaging performed with a laser endoscope showing a clear tumor margin (polyp visibility score: 4). (D) BLI magnification showing irregular surface patterns and vessel patterns (JNET classification: type 2B).JNET, Japan narrow band imaging (NBI) Expert Team.
Gut and Liver 2019; 13: 140-148https://doi.org/10.5009/gnl18276

Fig 8.

Figure 8.A polypoid tumor 4 mm in size in the ascending colon, low-grade adenoma, as viewed with a laser endoscope. (A) White-light imaging (WLI) showing a polyp and a small amount of residual liquid. (B) Blue laser imaging (BLI)-bright showing a polyp and reddish residual liquid; this endoscopic view was darker than that of WLI. (C) Linked color imaging showing a polyp and yellowish residual liquid; this endoscopic view was brighter than that of BLI-bright. (D) BLI magnification showed a regular surface patterns and vessel patterns.
Gut and Liver 2019; 13: 140-148https://doi.org/10.5009/gnl18276

Fig 9.

Figure 9.A nonpolypoid tumor 30 mm in size, high-grade dysplasia, as viewed with a laser endoscope. (A) WLI (polyp visibility score, 3; color difference value, 9.8). (B) BLI-bright (polyp visibility score, 4; color difference value, 18.0). (C) LCI (polyp visibility score, 4; color difference value, 22.0). (D) BLI magnification showing an irregular pattern (JNET classification: type 2B).WLI, white-light imaging; BLI, blue laser imaging; LCI, linked color imaging; JNET, Japan narrow band imaging (NBI) Expert Team.
Gut and Liver 2019; 13: 140-148https://doi.org/10.5009/gnl18276

Table 1 Reports on BLI and Laser Imaging with a Laser Endoscope for Tumor Characteristics

AuthorSystemMagnificationNo. of casesSubjectsOverall accuracy (%)Accuracy for differentiating between neoplastic and non-neoplastic (%)Sensitivity of T1b in invasive BLI magnification patterns (%)Specificity of T1b in invasive BLI magnification patterns (%)
Yoshida et al.4BLIYes104Neoplastic lesions74.0NA37.5100.0
Yoshida et al.5BLIYes314Neoplastic and non-neoplastic lesions84.385.064.399.3
Yoshida et al.5BLINo125Neoplastic and non-neoplastic lesionsNA95.2NANA
Nakano et al.6BLIYes748Neoplastic and non-neoplastic lesions89.398.440.0100.0
Wu et al.11LCINo94Neoplastic and non-neoplastic lesionss91.591.5100.099.0
Suzuki et al.7LCI + crystal violetYes3Tis100.0NANANA

BLI, blue laser imaging; LCI, linked color imaging; NA, not available.


Table 2 Reports on BLI and Laser Imaging with a Laser Endoscope for Tumor Detection

AuthorSystemSettingNo. of casesMethodsEfficacy
Ikematsu et al.9BLI with LASERRCT963ADR from the cecum to hepatic flexurePositive
Shimoda et al.10BLI with LASERRCT127ADR in tandem endoscope for the right sided colonPositive
Min et al.15LCI with LASERRCT141PDR and ADR in tandem endoscope in tandem endoscope for whole the colorectumPositive
Fujimoto et al.16LCI with LASERRCT44SSP detection in tandem endoscope from the cecum to splenic flexurePositive
Paggi et al.17LCI with LEDRCT600ADR in tandem endoscope for the right sided colonPositive
Yoshida et al.18LCI with LASERParallel130Additional 30 seconds observation to the right sided colonPositive

BLI, blue laser imaging; LASER, light amplification by stimulated emission of radiation; RCT, randomized control study; ADR, adenoma detection rate; LCI, linked color imaging; PDR, polyp detection rate; SSP, sessile serrated polyp.


Gut and Liver

Vol.16 No.3
May, 2022

pISSN 1976-2283
eISSN 2005-1212

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