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  • Review Article
  • Published:

A guide to multimodal endoscopy imaging for gastrointestinal malignancy — an early indicator

Nature Reviews Gastroenterology & Hepatology volume 14, pages 421–434 (2017)Cite this article

Subjects

Key Points

  • High-definition white-light endoscopy (WLE) is valuable for early detection of cancer because it provides detailed information about the lesion

  • WLE, chromoendoscopy and virtual chromoendoscopy permit the detection and characterization of dysplasia in the gastrointestinal tract

  • Narrow-band imaging is most effective in identifying changes in the vascular system

  • Autofluorescence imaging detects subtle changes in tissue after it has been activated by specific wavelengths of light

  • Confocal endomicroscopy is used for the in vivo diagnosis of pre-malignant lesions and early gastric cancer

  • Molecular imaging renders pathological changes visible at the cellular level

Abstract

Multimodality imaging is an essential aspect of endoscopic surveillance for the detection of neoplastic lesions, such as dysplasia or intramucosal cancer, because it improves the efficacy of endoscopic surveillance and therapeutic procedures in the gastrointestinal tract. This approach reveals mucosal abnormalities that cannot be detected by standard endoscopy. Currently, these imaging techniques are divided into those for primary detection and those for targeted imaging and characterization, the latter being used to visualize areas of interest in detail and permit histological evaluation. This Review outlines the use of virtual chromoendoscopy, narrow-band imaging, autofluorescence imaging, optical coherence tomography, confocal endomicroscopy and volumetric laser endomicroscopy as new imaging techniques for diagnostic investigation of the gastrointestinal tract. Insights into use of multimodal endoscopic imaging for early disease detection, in particular for pre-malignant lesions, in the oesophagus, stomach and colon are described.

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Figure 1: Virtual chromoendoscopy in the colon.
Figure 2: Enhanced imaging techniques and autofluorescence endoscopy for Barrett oesophagus.
Figure 3: Optical coherence tomography images of specialized intestinal metaplasia with and without intramucosal carcinoma or high-grade dysplasia.
Figure 4: Type IIc oesophageal Barrett cancer before and after virtual chromoendoscopy with i-scan.
Figure 5: Early gastric cancer before and after virtual chromoendoscopy.
Figure 6: Small flat polyp in the colon identified with high-definition endoscopy.
Figure 7: Ulcerative-colitis associated dysplasia with high-grade intraepithelial neoplasia.
Figure 8: Confocal endomicroscopy after staining with fluorescein in the colon.

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Authors and Affiliations

  1. Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Ludwig-Erhard-Strasse 100, 65199, Wiesbaden, Germany

    Arthur Hoffman, Henrik Manner, Johannes W. Rey & Ralf Kiesslich

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  2. Henrik Manner
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All authors researched data for the article. R.K. and A.H. made substantial discussions to discussions and reviewed/edited the manuscript before submission. A.H. wrote the article.

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Correspondence to Arthur Hoffman.

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Hoffman, A., Manner, H., Rey, J. et al. A guide to multimodal endoscopy imaging for gastrointestinal malignancy — an early indicator. Nat Rev Gastroenterol Hepatol 14, 421–434 (2017). https://doi.org/10.1038/nrgastro.2017.46

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