Early detection of premalignant lesions of the gastrointestinal tract serves as one of the major indications for endoscopy. Whether an esophag-ogastroduodenoscopy (EGD) is performed for Barrett esophagus or a colonoscopy is performed for colorectal cancer screening, the goals remain the same: identify a premalignant lesion, treat the lesion, and lower the overall risk of developing a malignancy. Although the notion of early detection and survival benefits with the use of standard endoscopy is well supported, there appears to be ample room for technological advancement.Narrow-band imaging (NBI) is a relatively new high-resolution endoscopic technology that helps identify potentially neoplastic changes of the gastrointestinal epi-thelium. Its use is rooted in the concept that the depth of light penetration depends upon its wavelength. As opposed to conventional white-light endoscopy (WLE), NBI utilizes 2 distinct wavelengths of light, 415 nm (blue) and 540 nm (green), with bandwidths of 20–30 nm each, limiting penetrance of the light to the mucosal surface., The blue light highlights the super-ficial capillary networks, whereas the green light focuses on the subepithelial vessels. NBI shows great promise when evaluating patients for Barrett esophagus.

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RLN5705, RLN5707, RLN5707A, battery for your Motorola Minitor V Pager Battery. NiMH & NiCd batteries are not interchangeable. Narrow-band imaging is an imaging technique for endoscopic diagnostic medical tests, where light of specific blue and green wavelengths is used to enhance the detail of certain aspects of the surface of the mucosa.A special filter is electronically activated by a switch in the endoscope leading to the use of ambient light of wavelengths of 415 nm (blue) and 540 nm (green).

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Narrow Band Imaging Pdf

A recent large prospective study reported a sensitivity of 100% for identifying long-segment Barrett esophagus when NBI and directed biopsies were utilized compared to a sensitivity of only 80% when random biopsies were obtained via conventional means. The sensitivity for short-segment Barrett esophagus was 80% with NBI and directed biopsies compared to 30% with random biopsies, again favoring the NBI-directed approach.NBI can also be used to differentiate colonic adenomas from benign lesions. In a study comparing NBI, chromo-endoscopy, and WLE, NBI achieved better visualization of the colonic mucosal vascular network than conventional endoscopy. There was no significant difference between NBI and chromoendoscopy for differentiating neoplastic from nonneoplastic lesions; both techniques had a sensitivity of 100% and a specificity of 75%, though both fared better than WLE, which had a sensitivity of 83% and a specificity of 44% ( P. Case Report #1A 52-year-old man was referred to us for surveillance of Barrett esophagus. The patient had a history of long-segment Barrett esophagus, which was confirmed by a recent EGD.

Random 4-quadrant biopsies every 2 cm during standard endoscopy revealed specialized intestinal metaplasia indefinite for dysplasia. Repeat endoscopy revealed a subtle area of umbilication identified in a segment of Barrett esophagus that was noted only with NBI. Targeted biopsies of this area were again indefinite for dysplasia, a finding that was confirmed by 2 expert gastrointestinal pathologists.

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Given the possibility of high-grade dysplasia and intramucosal carcinoma within the nodule, flow cytometry was performed. Biopsies revealed aneuploidy, which is a potential marker for the development of adenocarcinoma. Endoscopic mucosal resection was performed , and the histology revealed high-grade dysplasia. Clean margins were noted, and repeat biopsies of the area have been unremarkable to date.

NBI detected this high-risk lesion early and gave the patient the opportunity to undergo less invasive but definitive therapy. Case Report #2A 74-year-old man was diagnosed with colon cancer of the left colon and a synchronous 2-cm tubulovillous adenoma of the rectum with high-grade dysplasia. He underwent surgical resection 3 years ago. One year later, he experienced recurrence of a tubulovillous adenoma at the colorectal anastomosis and was treated with argon plasma coagulation. Surveillance was performed with conventional endoscopy to confirm ablation of the dysplastic tissue.

Biopsies from the anastomosis revealed only granulation tissue and hyperplastic changes. Repeat surveillance with NBI allowed for localization of a focal region suspicious for recurrence of adenoma , which was confirmed by directed biopsy. The adenomatous changes identified by NBI were unappreciated with white light. The novel technology of NBI afforded the opportunity to target the area of concern and ultimately ablate the neoplastic tissue. DiscussionThese 2 cases demonstrate the utility and practicality of NBI, which was once considered to be a research-based technology. NBI gives endoscopists the ability to identify lesions that may not be appreciated with conventional WLE.

The sensitivity and specificity of NBI for these lesions are equivalent to those of chromoendoscopy and allow for significant ease of use comparatively.A quandary arises when deciphering the significance of the various mucosal vascular patterns noted at the time of endoscopy. Several classification systems have been proposed with relatively good sensitivity and specificity; however, they lack uniformity and are fairly complex, making the technique less desirable. Hirata and associates recently proposed a less complex approach to evaluating the microvessels of colonic lesions. They examined the clinical usefulness of NBI with magnification in the assessment of microvascular architecture of colonic lesions. The microvascular changes appreciated with this technique appeared to correlate with histologic grade, enabling the endoscopist to predict the diagnosis and ultimately select the most appropriate therapeutic intervention. Their data support the use of NBI for evaluating micro-vascular changes in colonic tissue; however, NBI appears to be useful in other areas of the gastrointestinal tract as well. We have used their methods in the evaluation of colonic lesions and have deemed them to be user-friendly and accurate.Over the last 50 years, we have witnessed an evolution in endoscopy from early rigid limited-viewing endoscopes to the current wide-angle video-magnifying endoscopes.

The future will likely bring further advancement to endoscopic detection of premalignant tissue within the gastrointestinal tract. Currently, NBI with magnification appears to be part of a new revolution in endoscopic detection. This technology, in conjunction with a more straightforward and concise classification system, appears to be promising, as it allows for detailed inspection of suspicious mucosal abnormalities. NBI will also likely improve early detection of these lesions, as demonstrated in our 2 cases.