Underestimating the training in magnification and Image Enhanced Endoscopy (IEE)
As mentioned for different indications, high-definition endoscopy, including magnification endoscopy, image enhanced endoscopy (IEE) or chromoendoscopy improve the quality of endoscopy when detecting and characterising suspicious lesions. Therefore, specific training is mandatory. After introducing narrow-band imaging (NBI) in 2005, based on optical filters and a selection of wavelengths corresponding to the peak light absorption of haemoglobin, a second-generation of equipment-based IEE technology has been launched by different endoscopic companies over the last few years. This second-generation IEE includes NBI developments, i-Scan Optical Enhancement and Blue Laser / Light Imaging (BLI), as well as Linked Color Imaging (LCI), to mention the most important ones.18
Whilst the first-generation of IEE did not significantly improve adenoma detection rates in colorectal cancer screening compared with white light endoscopy,19 the new generation of IEE has shown much better performance detecting superficial neoplastic lesions. LCI has been demonstrated to have higher adenoma detection rates in randomized trials.20
For the detection of preneoplastic lesions in the stomach, there is significant evidence for the advantage of conventional dye-based chromoendoscopy with high accuracy.21 Similar results were obtained for first-generation NBI, mainly with magnification. The accuracy of the intestinal metaplasia diagnosis was 84 % and 95 % for dysplasia. However, it must be emphasized that these results were generated in expert centres and strongly depend on training. 22-24
The second-generation IEE has been shown to further increase gastric intestinal metaplasia detection rates with high accuracy and a proposed endoscopic scoring system.25,26 LCI has been emphasized to significantly increase detection rates of intestinal metaplasia in the stomach.26,27
As for the stomach, detection of mucosal lesions in Barrett’s oesophagus and further characterization have been greatly improved by the technical developments of IEE. For BLI imaging, the BLINC classification system has been proposed as an endoscopic classification system with high sensitivity and a promising training tool.28
In addition, using next-generation IEE with BLI and LCI improved the visualization of BO even by non-experienced endoscopists.29
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