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Review
. 2018 Dec;26(1):40-53.
doi: 10.1159/000487470. Epub 2018 Mar 27.

Narrow-Band Imaging: Clinical Application in Gastrointestinal Endoscopy

Sandra Barbeiro  1 , Diogo Libânio  2 , Rui Castro  2 , Mário Dinis-Ribeiro  2 , Pedro Pimentel-Nunes  2
Affiliations
Review

Narrow-Band Imaging: Clinical Application in Gastrointestinal Endoscopy

Sandra Barbeiro et al. GE Port J Gastroenterol. 2018 Dec.

Abstract
in English, Portuguese

Narrow-band imaging is an advanced imaging system that applies optic digital methods to enhance endoscopic images and improves visualization of the mucosal surface architecture and microvascular pattern. Narrow-band imaging use has been suggested to be an important adjunctive tool to white-light endoscopy to improve the detection of lesions in the digestive tract. Importantly, it also allows the distinction between benign and malignant lesions, targeting biopsies, prediction of the risk of invasive cancer, delimitation of resection margins, and identification of residual neoplasia in a scar. Thus, in expert hands it is a useful tool that enables the physician to decide on the best treatment (endoscopic or surgical) and management. Current evidence suggests that it should be used routinely for patients at increased risk for digestive neoplastic lesions and could become the standard of care in the near future, at least in referral centers. However, adequate training programs to promote the implementation of narrow-band imaging in daily clinical practice are needed. In this review, we summarize the current scientific evidence on the clinical usefulness of narrow-band imaging in the diagnosis and characterization of digestive tract lesions/cancers and describe the available classification systems.

O sistema de iluminação narrow-band imaging é um sistema de imagem avançada que utiliza ferramentas digitais óticas para realçar imagens endoscópicas e melhorar a observação da superfície e do padrão microvascular da mucosa. O narrow-band imaging tem demonstrado ser um importante adjuvante à endoscopia com luz branca, melhorando a deteção de lesões no tubo digestivo. Tam-bém, possibilita a distinção entre lesões benignas e mali-gnas, guia as biópsias para zonas suspeitas, prediz o risco de cancro invasivo, delimita as margens de ressecção e identifica lesões residuais em cicatrizes. Portanto, em mãos experientes, é uma ferramenta útil que permite ao médico decidir o melhor tratamento (endoscópico ou cirúrgico) e orientação. A evidência atual sugere que esta técnica deve ser utilizada por rotina em doentes com risco aumentado para lesões neoplásicas do tubo digestivo e poderá tornar-se o método de escolha num futuro próxi-mo, pelo menos nos centros de referência. Contudo, são necessários programas de treino adequados para pro-mover a utilização do narrow-band imaging na prática clinica diária. Nesta revisão, resumimos a evidência científi-ca disponível acerca da utilidade do narrow-band imaging no diagnóstico e caracterização das lesões do tubo di-gestivo e descrevem-se os sistemas de classificação dis-poníveis.

Keywords: Barrett esophagus; Chromoendoscopy; Colonic polyps; Early gastric cancer; Endoscopic classifications; Gastric intestinal metaplasia; Narrow-band imaging; Squamous cell carcinoma.

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Figures

Fig. 1.
Fig. 1.
Narrow-band imaging features in normal mucosa of the esophagus (a), in squamous cell dysplasia (b), and in cancer (d). c White-light features in cancer.
Fig. 2.
Fig. 2.
Narrow-band imaging features in Barrett esophagus (BE). a Nondysplastic BE. b Dysplastic BE.
Fig. 3.
Fig. 3.
Narrow-band imaging simplified classification for gastric lesions. a Pattern Aa (normal antrum, with regular oval/circular mucosa and regular vessels in the center of the gland). b Pattern Ab (normal gastric body, with regular circular mucosa and the gland surrounded by regular vessels). c, d Pattern B corresponds to intestinal metaplasia of the antrum and of the gastric body (regular, ridge, or tubulovillous mucosal patterns with regular vessels; presence of a light-blue crest). e Pattern C is associated with dysplasia/cancer (absent or irregular mucosal patterns with architectural distortion and irregular vascular patterns).
Fig. 4.
Fig. 4.
NBI International Colorectal Endoscopic (NICE) classification.
Fig. 5.
Fig. 5.
a Workgroup Serrated Polyps and Polyposis (WASP) classification. b Serrated polyp.
See this image and copyright information in PMC

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