New Image-Enhanced Endoscopy NBI/BLI Atlas

Preface
The history of endoscopy over the past three decades has been marked by steady and rapid progress in endoscopic treatment, as arisen from the development of the video endoscope in 1983, leading to rapid advances in the subsequent years. The 1980s were characterized by improvements in endoscopic treatment of early gastrointestinal cancers using EMR, while in the 1990s, previous concepts of diagnosis and treatment of gastric diseases were overturned when the association between H. pylori and diseases of the gastrointestinal tract was verified. In the 2000s, the rapid dissemination of ESD has led to further advances in endoscopic treatment, while the introduction of the HDTV endoscope to the market in 2002, together with more recent innovations such as image-enhanced endoscopy (IEE) and magnifying endoscopy, has provided the basis for new diagnostic study. Now, thanks to the introduction of high-resolution endoscopes and magnifying endoscopes with NBI (Narrow Band Imaging), which provide clear and accurate observation of the microstructures and microvascular architectures on the mucosal surfaces, the grade of tissue atypism can be estimated with endoscopy. Soon we will enter a new era of endoscopic diagnosis, an era of what we can call “endoscopic pathology” in pretherapeutic examinations.

These minute diagnostics have triggered a quantum leap in traditional endoscopic diagnosis. Supported by the achievements of prospective multicenter studies, these developments have had a profound impact on gastrointestinal endoscopists and cancer researchers around the world. As a result, it has been propagated worldwide and made a significant contribution to actual cancer treatments, as well as to clinical studies.

Since the summer of 2012, two systems have been released which are designed to obtain images with even higher definition easily than before. They are the EVIS LUCERA ELITE system with built-in NBI from Olympus Medical Systems Corporation and the LASEREO laser endoscopy system from Fujifilm Corporation featuring another new method called BLI (Blue Laser Imaging).This book was written in order to give you an idea of what the endoscopic images obtained with the new systems look like, explain how to incorporate IEE in endoscopic diagnosis and provide tips on observation using the new IEE techniques. Drawing on a comprehensive collection of case images as ATLAS sourced from hospitals that have already introduced these new systems, this book will guide you step by step through the diagnostic process, enabling you to observe minute changes in the endoscopic images and compare those observations with the explanations given by the authors. We are confident that this book will serve as a leading reference with high quality for a wide range of people, from young physicians aiming at becoming endoscopy specialists to doctors who are already acting as specialists or trainers, providing them with the knowledge they need to understand the new image-enhanced endoscopy and the guidance they need to take advantage of.

We hope that the material included in this book will give our readers the confidence to take on the challenge of pioneering the use of second-generation NBI, which has surmounted the problems associated with conventional NBI and/or BLI in routine procedures, and to perform evaluations and studies in order to establish more sophisticated diagnostics and advance new functional studies.

Finally, we would like to express our gratitude to the many doctors who contributed to this book even though they were very busy. We would also like to express gratitude to Ms. Setsuko Kurozoe at Nihon Medical Center for her work in the editing of this book.

CONTENTS
Principles of NBI and BLI  
NBI (Narrow Band Imaging)
 
BLI (Blue Laser Imaging)
   
Oropharynx & Hypopharynx
General Theory: How to Observe These Regions with NBI or BLI Tips on in NBI Observation
 
Tips on BLI Observation
Case Atlas  
  • Case 1 NBI Inflammatory pharyngeal lesion
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  • Case 1 NBI Inflammatory pharyngeal lesion
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  • Case 2 BLI Hypopharyngeal papilloma
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  • Case 3 NBI Pharyngeal melanosis
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  • Case 4 BLI Pharyngeal melanosis
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  • Case 5 NBI Oropharyngeal superficial carcinoma (0-IIa)
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  • Case 6 BLI Oropharyngeal superficial carcinoma (0-IIb)
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  • Case 7 NBI Hypopharyngeal superficial carcinoma (0-IIb)
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  • Case 8 BLI Hypopharyngeal superficial carcinoma (0-IIa + IIb)
 
Esophagus
General Theory: How to Observe These Regions with NBI or BLI
 
Tips on NBI Observation
 
Tips on BLI Observation
Case Atlas
     
  • Case 9 NBI Glycogenic acanthosis (GA)
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  • Case 10 BLI Esophageal papilloma
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  • Case 11 NBI NERD
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  • Case 12 BLI NERD
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  • Case 13 NBI GERD
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  • Case 14 BLI GERD
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  • Case 15 NBI Type 0-I esophageal superficial carcinoma
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  • Case 16 BLI Type 0-Is esophageal superficial carcinoma
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  • Case 17 BLI Type 0-IIa esophageal superficial carcinoma
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  • Case 18 BLI Type 0-IIb esophageal superficial carcinoma
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  • Case 19 NBI/BLI Type 0-IIc esophageal superficial carcinoma
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  • Case 20 NB/BLI Type 0-IIc esophageal superficial carcinoma
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  • Case 21 BLI Type 0-IIc esophageal superficial carcinoma
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  • Case 22 NBI Barrett's esophagus
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  • Case 23 BLI Barrett's esophagus
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  • Case 24 NBI Barrett's esophageal adenocarcinoma
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  • Case 25 BLI Barrett's esophageal adenocarcinoma
  •  
 
   
Stomach & Duodenum
General Theory: How to Observe These Regions with NBI or BLI
Tips on NBI Observation
Tips on BLI Observation
Case Atlas
     
  • Stomach
  •  
  • Case 26 NBI Chronic gastritis
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  • Case 27 BLI Chronic gastritis
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  • Case 28 NBI Gastric adenoma
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  • Case 29 BLI Gastric adenoma
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  • Case 30 NBI Differential diagnosis of adenoma and gastric carcinoma
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  • Case 31 BLI Differential diagnosis of erosion and early gastric carcinoma
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  • Case 32 NBI Diagnosis of extent of early gastric carcinoma
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  • Case 33 BLI Diagnosis of extent of early gastric carcinoma
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  • Case 34 BLI Diagnosis of extent of early gastric carcinoma
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  • Case 35 NBI Type 0-IIc differentiated early gastric carcinoma
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  • Case 36 NBI Diagnosis of histological type of early gastric carcinoma
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  • Case 37 BLI Diagnosis of histological type of early gastric carcinoma
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  • Case 38 BLI Diagnosis of histological type of early gastric carcinoma
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  • Case 39 NBI Transnasal endoscopic observation of early gastric carcinoma
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  • Case 40 NBI Early carcinoma in gastric remnant
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  • Case 41 NBI MALT lymphoma
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  • Case 42 BLI MALT lymphoma
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  • Duodenum
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  • Case 43 NBI Duodenal adenoma
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  • Case 44 BLI Duodenal adenoma
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  • Case 45 NBI Duodenal carcinoma
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  • Case 46 BLI Duodenal carcinoma
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  • Case 47 BLI Duodenal carcinoma
  •  
 
   
Pathologically comparative approach to magnified images
Colon
General Theory: How to Observe These Regions with NBI or BLI
Basics of NBI Observation
Tips on NBI Observation
Case Atlas
     
  • Case 48 NBI Hyperplastic polyp
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  • Case 49 NBI SSA/P (sessile serrated adenoma/polyp)
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  • Case 50 BLI SSA/P (sessile serrated adenoma/polyp)
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  • Case 51 BLI SSA/P (sessile serrated adenoma/polyp)
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  • Case 52 NBI Elevated serrated adenoma
  •  
  • Case 53 NBI Elevated tubular gland duct adenoma
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  • Case 54 NBI Superficial tubular gland duct adenoma
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  • Case 55 NBI Tubulovillous adenoma
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  • Case 56 BLI Villous adenoma
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  • Case 57 NBI Elevated M carcinoma
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  • Case 58 NBI Superficial elevated M carcinoma
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  • Case 59 NBI Superficial depressed M carcinoma
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  • Case 60 NBI Elevated SM carcinoma
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  • Case 61 NBI Superficial depressed SM carcinoma
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  • Case 62 BLI Composite (IIa + IIc) SM carcinoma
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  • Case 63 BLI Composite (IIa + IIc) SM carcinoma
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  • Case 64 NBI Composite (IIa + IIc) SM carcinoma
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  • Case 65 NBI Composite (Is + IIc) SM carcinoma
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  • Case 66 NBI LST-G, homogeneous type
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  • Case 67 BLI LST-G, nodular mixed type
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  • Case 68 NBI LST-NG, pseudo-depressed type
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  • Case 69 BLI LST-NG, pseudo-depressed type
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  • Case 70 NBI/BLI LST-NG, pseudo-depressed type
  •  
  • Case 71 NBI LST-NG, pseudo-depressed type
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  • Case 72 BLI LST-NG, pseudo-depressed type
  •  
  • Case 73 BLI Ulcerative colitis
  •  
  • Case 74 NBI Tumors associated with inflammatory colon diseases (carcinoma/dysplasia)
  •  
Featured Articles
Magnifications of the Near Focus electronic zooming observation of the LUCERA ELITE system
Importance of structure enhancement in NBI magnifying observation