Endoscopy 2016; 48(11): 1029-1045
DOI: 10.1055/s-0042-118087
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) Technology Review

James E. East
1  Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, United Kingdom
,
Jasper L. Vleugels
2  Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
,
Philip Roelandt
3  Gastroenterology Department, University Hospital Leuven, Leuven, Belgium
,
Pradeep Bhandari
4  Solent Centre for Digestive Diseases, Queen Alexandra Hospital, Portsmouth, United Kingdom
,
Raf Bisschops
3  Gastroenterology Department, University Hospital Leuven, Leuven, Belgium
,
Evelien Dekker
2  Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
,
Cesare Hassan
5  Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
,
Gareth Horgan
6  Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
,
Ralf Kiesslich
7  Klinik für Innere Medizin II, Dr Horst Schmidt Kliniken GmbH, Wiesbaden, Germany.
,
Gaius Longcroft-Wheaton
4  Solent Centre for Digestive Diseases, Queen Alexandra Hospital, Portsmouth, United Kingdom
,
Ana Wilson
8  Wolfson Unit for Endoscopy, St. Mark’s Hospital, London, United Kingdom
,
Jean-Marc Dumonceau
9  Gedyt Endoscopy Center, Buenos Aires, Argentina
› Author Affiliations
Further Information

Publication History

Publication Date:
06 October 2016 (online)

Background and aim: This technical review is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the utilization of advanced endoscopic imaging in gastrointestinal (GI) endoscopy.

Methods: This technical review is based on a systematic literature search to evaluate the evidence supporting the use of advanced endoscopic imaging throughout the GI tract. Technologies considered include narrowed-spectrum endoscopy (narrow band imaging [NBI]; flexible spectral imaging color enhancement [FICE]; i-Scan digital contrast [I-SCAN]), autofluorescence imaging (AFI), and confocal laser endomicroscopy (CLE). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendation and the quality of evidence.

Main recommendations:

1. We suggest advanced endoscopic imaging technologies improve mucosal visualization and enhance fine structural and microvascular detail. Expert endoscopic diagnosis may be improved by advanced imaging, but as yet in community-based practice no technology has been shown consistently to be diagnostically superior to current practice with high definition white light. (Low quality evidence.) 2. We recommend the use of validated classification systems to support the use of optical diagnosis with advanced endoscopic imaging in the upper and lower GI tracts (strong recommendation, moderate quality evidence). 3. We suggest that training improves performance in the use of advanced endoscopic imaging techniques and that it is a prerequisite for use in clinical practice. A learning curve exists and training alone does not guarantee sustained high performances in clinical practice. (Weak recommendation, low quality evidence.)

Conclusion: Advanced endoscopic imaging can improve mucosal visualization and endoscopic diagnosis; however it requires training and the use of validated classification systems.