InFocus - Issue 3, April 2016 

Scientific Update


PENTAX Medical image enhanced technology: What’s the next step?

Roel Bogie, MD, PhD-student
Silvia Sanduleanu, MD, PhD, Principal Investigator CRC research
Division of Gastroenterology & Hepatology
Maastricht University Medical Center, The Netherlands

With the upcoming Digestive Disease Week (DDW) in San Diego, it is time to give thought to the latest developments. An important event of this year is the launching of the novel i-scan OE or optical enhancement technology. Here we summarize the scientific evidence regarding i-scan optical enhancement that will be presented at the DDW 2016.

The key principle of image-enhanced endoscopy relies on the combination between image enhancement (high-definition imaging) and contrast enhancement (dye-based or digital chromoendoscopy). White light endoscopy alone does not provide sufficient detail on mucosal vascular pattern and epithelial surface structures. Contrast enhancement is additionally required to delineate the borders (especially of the subtle appearing lesions, i.e small and flat adenomas and serrated polyps) and to characterize such lesions in order to predict their histology. In the past, conventional chromoendoscopy using indigo carmine or methylene blue was exclusively used for this purpose. Nowadays, virtual chromoendoscopy is widely available and should be implemented in routine practice (1). Both post-processing techniques (i.e. i-scan which relies on analysis of different color tones separately) and the newly developed pre-processing techniques (i.e. optical enhancement which uses a specific blue light spectrum optimized for hemoglobin absorption) can be used (2, 3). Different settings have been developed: i-scan 1 aims to improve detection of lesions, i-scan 2 improves lesion characterization and i-scan 3 (i-scan OE) emphasizes epithelial surface details and mucosal vascularization, for an in vivo diagnosis, as illustrated in the Figure (1).

Two recent studies compared standard HD white light colonoscopy with i-scan 1 colonoscopy showing that i-scan detects more colorectal polyps than standard HD (3, 4). Furthermore, a meta-analysis to the diagnostic accuracy of polyp detection using i-scan, showed an overall high sensitivity and specificity (both >90%) to distinguish between neoplastic from non-neoplastic colorectal lesions (5). I-scan OE can perform even better, as Prof. Neumann (University of Erlangen-Nuremberg, Erlangen, Germany) and colleagues will present at the DDW this year (# 2436608).

The new i-scan OEtechnique is designed to optimize visualization of the vascular pattern. Increased vascularization is a key feature for neoplastic transformation, but is also present in inflammation. I-scan OE clearly improves the recognition of areas with a high density of blood vessels. Therefore, i-scan OE has many applications to the diagnosis of both upper and lower GI tract diseases. For example, it may help to differentiate small adenomas from small hyperplastic polyps, to predict submucosal invasion in larger polyps and to endoscopically diagnose and characterize inflammation in case of gastroesophageal erosive reflux disease and inflammatory bowel disease. As a next step, it is important to develop and validate standard classification systems for optical enhancement techniques. Better communication to enhance feedback from clinicians is important for implementation of this very promising technology in daily practice. 


A selection of optical enhancement topics on the DDW:

Day and time



Title, presenting author

Sunday 22nd May




9:30 – 9:45 AM

Hall C (SDCC)

Poster session: Colon and Rectum Endoscopy: Colorectal Polyps Development and Validation of a Simple Classification System for In Vivo Diagnosis of Colorectal Polyps Using the Newly Introduced Optical Enhancement (OE) Technology, Prof. Neumann

Monday 23rd May




8:30 – 8:45 AM

Topic Forum

Advances in Endoscopic Diagnosis and Imaging

Minimal Esophageal Lesions Detected By Digital Chromoendoscopy Using Optical Enhancement System™ Associated to High Definition With Optical Magnification in Non Erosive Reflux Disease (NERD), Dr. Robles-Medranda

10:00 – 10:15 AM

Research Forum

Imaging to Diagnose and Stage Inflammation and Neoplasia in Inflammatory Bowel Disease

Final Results of a Randomized Study Comparing High Definition Colonoscopy Alone With High Definition Dye Spraying and Electronic Virtual Chromoendoscopy Using iSCAN for Detection of Colonic Neoplastic Lesions During IBD Surveillance Colonoscopy, Prof. Iacucci

10:15 – 10:30 AM

Research Forum

Imaging to Diagnose and Stage Inflammation and Neoplasia in Inflammatory Bowel Disease

Real Time Histology at Endoscopy - Virtual Electronic Chromoendoscopy and Probe Confocal Laser Endomicroscopy Can Assess Fine Details of Inflammatory Changes in Ulcerative Colitis Patients, Prof. Iacucci

12 AM

Hall C

Poster Session: Imaging for the Colon

Accuracy and Inter-Observer Agreement for Characterization of Colonic Polyps Using the New Optical Enhancement -iSCAN ClosefocusTM Colonoscope, Prof. Iacucci

10:30 – 10:45 AM

Research Forum

Imaging to Diagnose and Stage Inflammation and Neoplasia in Inflammatory Bowel Disease

Beyond White Light: The First Experience With the New Green-Red-Orange Light Optical Enhancement Magnification Colonoscopy to Define Fine Details of Mucosal Inflammation in Ulcerative Colitis Patients, Prof. Iacucci

12 AM

Hall C

Poster session: Esophagus Endoscopy: Barrett's Esophagus, Screening, Surveillance

Magnification Endoscopy with i-scan imaging and acetic acid chromoendoscopy in Barrett’s Esophagus improves neoplasia detection, Dr. Haidry

Tuesday 24th May




9:30 AM

Hall C (SDCC)

Poster session: Esophagus Endoscopy: Gastroesophageal Reflux (GERD)

Feasibility trial of the newly introduced Optical Enhancement (OE) technology in patients with gastroesophageal reflux disease, Prof. Neumann

12 AM

Hall C

Poster Session: Clinical Endoscopic Practice: Quality Measures and Quality Improvement

Detection and Characterization of Colorectal Polyps Using High Definition White Light and i-Scan: Evidence- and Delphi Process-based consensus recommendations, Prof. Bhandari




Neumann H, Fujishiro M, Wilcox CM, Monkemuller K. Present and future perspectives of virtual chromoendoscopy with i-scan and optical enhancement technology. Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society. 2014;26 Suppl 1:43-51.

2 Kodashima S, Fujishiro M, Ono S, Niimi K, Mochizuki S, Asada-Hirayama I, et al. Evaluation of a new image-enhanced endoscopic technology using band-limited light for detection of esophageal squamous cell carcinoma. Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society. 2014;26(2):164-71.

Kim WJ, Park SY, Park I, Lee WJ, Park J, Chon N, et al. Increased Detection of Colorectal Polyps in Screening Colonoscopy Using High Definition i-SCAN Compared with Standard White Light. Clin Endosc. 2016;49(1):69-75.

Bowman EA, Pfau PR, Mitra A, Reichelderfer M, Gopal DV, Hall BS, et al. High Definition Colonoscopy Combined with i-SCAN Imaging Technology Is Superior in the Detection of Adenomas and Advanced Lesions Compared to High Definition Colonoscopy Alone. Diagn Ther Endosc. 2015;2015:167406.

5 Guo CG, Ji R, Li YQ. Accuracy of i-Scan for Optical Diagnosis of Colonic Polyps: A Meta-Analysis. PLoS One. 2015;10(5):e0126237.


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