C OLON AT L AS 309

Figure 14.177 A 3 mm submucosal mass in

Figure 14.176 Melanosis coli, magni- sigmoid – pathology shows low-grade carci-
fied NBI view (corresponds to Figure 14.175) noid (Mount Sinai School of Medicine).
(Hospital Sao Marcos).

Figure 14.179 A 3 mm submucosal mass

Figure 14.178 A 3 mm submucosal in sigmoid – pathology shows low-grade car-
carcinoid in sigmoid – NBI confirms normal cinoid (corresponds to Figures 14.177–14.178)
overyling mucosa (Mount Sinai School of (Mount Sinai School of Medicine).
Medicine).
310 CH APTER 1 4

Figure 14.180 Ischemic ulcer of the cecum, Figure 14.181 Ischemic ulcer of the cecum
white light HRE view. Note the linear ulcer viewed with NBI light (University of Utah
with a white base (University of Utah Health Health Sciences Center).
Sciences Center).

Figure 14.182 The photos depict colonic

mucosa with eosinophilia of the lamina pro-
pria, mild crypt atrophy, and focal mucosal Figure 14.183 Ileocolonic anastomosis low-
hemorrhage, with 20 magnification (cor- magnification NBI view (St. Mark’s Hospital).
responds to Figures 14.180 and 14.181)
(University of Utah Health Sciences Center).
 C OLON AT L AS 311

Figure 14.184 Prior India ink tatoo with Figure 14.185 Prior India ink tatoo mark
polyp partially hidden behind a fold (Mount less visible on NBI non-magnified view. Polyp
Sinai School of Medicine). partially behind fold (Mount Sinai School of
Medicine).

Figure 14.186 Numerous angioectasias of Figure 14.187 NBI low-magnification view

proximal colon with mild oozing, white light of proximal colon angioectasias (NYU School
view (NYU School of Medicine). of Medicine).
312 CH APTER 1 4

Figure 14.188 Non-magnified white light Figure 14.189 Magnified 1.5 NBI
HRE view of a cecal angioectasia (NYU School image of cecal angioectasia (NYU School of
of Medicine). Medicine).

ABBREVIATIONS USED
APC: adenomatous polyposis coli
ASCA: anti-Saccharomyces cerevisiae antibodies
FAP: familial adenomatous polyposis
HGIN: high-grade intraepithelial neoplasia
LGIN: low-grade intraepithelial neoplasia
HRE: high-resolution endoscopy
NBI: narrowband imaging
 313

Index

Note: page numbers in italics represent figures, those in bold represent tables.

absorption 11 mucosal morphology 69–72, 188

in tissue 12 explorative phase 69–70
adenocarcinoma 5 learning phase 70–1
cardia 198 three-step classification
colonic 143–8, 289, 295 system 71–2, 72
esophageal 67, 77, 199, 200, 201, validation phase 71
202, 205 narrowband imaging 68–9
gastric see gastric adenocarcinoma non-dysplastic 183, 184, 185, 186
gastroesophageal junction 199 post-ablation 193, 194, 195, 196
adenoma ridge/villous pattern 184, 185
bile duct 256, 257 short-segment 179, 180, 181
cecal 285, 286, 287, 295, 296 bile 16, 248
colonic see colonic adenoma bile duct adenoma 256, 257
duodenal 252, 253, 254, 255, blood vessels 19
256, 259 superficial 55
gastric 116 tongue 19
squamous cell 8 Bruener’s glands 245, 246
adenomatous polyposis coli 291,
296 Cameron lesions 214
see also colonic polyps Candida esophagitis 178, 179
anal papilla 271 cap technique 24–5
angioectasia carcinoid
cecal 312 colon 310
colonic 311 gastric 238, 239
angiogenesis 128 cardia see gastric cardia
appendiceal orifice 267, 268 cecal adenoma 285, 295
aryepligottic folds, erythema 163 laterally spreading 295, 296
tubulovillous 286, 287
Barrett’s esophagus 5, 67–80, 77, cecal angioectasia 312
179, 186 cecal erosions 300
abnormal vasculature 190, 191, cecal lymphoid follicles 268
193 cecal ulcer 310
with adenocarcinoma 198 celiac disease 87, 304, 305
chromoendoscopy 68 chromoendoscopy
detection of early neoplasia 72–4, Barrett’s esophagus 68
77, 80 indigo carmine 72–4
dysplasia 79 colitis
dysplasia-indefinite 192 Crohn’s disease 303, 304
goblet cells 185, 186 granulomatous 305
gyrus pattern 183, 184 ulcerative see ulcerative colitis
high-grade dysplasia 187, 188, collagenous gastritis 241
189, 191, 192 colon 266, 276
high resolution endoscopy 68 carcinoid 309
histopathology 180, 191 examination 27
intestinal metaplasia 181, feces in 16, 136, 265, 266, 269, 270,
184, 192 271, 272
long-segment 182 hyperplastic mucosa 131, 132
low-grade dysplasia 193 intestinal fluids 136
314 IN D EX

colon (cont’d) duodenal adenoma 252, 253, 254,

Kudo’s IIIs pit pattern 280 255, 256, 259
lymphoid follicles 268 duodenal angioectasia 261
micro-capillary vessels 132, 133 duodenal bulb 245
microvascular lesions 126, Bruener’s glands 245, 246
131, 132 erosions 249
normal mucosa 125, 131, 132, hyperplastic polyp 251
135 inflammation 249
submucosal fat 267 mucosa 245
vascular pattern 266 ulcer 249
colonic adenocarcinoma 143–8, duodenal erosion 250
293 duodenal fold 246
intramucosal 282, 293 duodenal polyps 252
colonic adenoma 131, 282, 288 duodenal villi 29, 247
familial adenomatous villous atrophy 259, 260
polyposis 297, 298 duodenitis 250
flat 283 duodenum
with high-grade dysplasia 280 arterio-vascular
serrated 294 malformation 260
tubular 137, 138, 141, 142, 277, examination 27
278, 283, 291, 292 inflammation 251
tubulovillous 276, 285, 288, magnification endoscopy 87
289, 290, 292 celiac disease 87, 101, 102,
villous 288, 290 103
colonic angioectasia 311 normal mucosa 87, 100
colonic diverticula 269, 270 major papilla 247, 248
colonic lesions 279, 281, 308
adenomatous 125–6, 130, 132 early gastric cancer 3
cancerous 126, 131, 293 en bloc resection 49
management 135 endoscopes 23–4, 29
colonic lipoma 307 endoscopic appearance 21
colonic polyps 272, 275, 276, endoscopic mucosal resection 49
277, 282, 287, 289, 290, endoscopic submucosal
294, 311 dissection 49
adenomatous 283, 284, 285 endoscopy, high-resolution 9–22
hyperplastic 125, 139, 140, 272, eosinophilic esophagitis 206, 207
273, 274 eosinophilic gastritis 244
pedunculated 286 esophageal adenocarcinoma 67,
polypectomy 284 77, 197, 198, 200, 201, 202
post-polypectomy 267, 276, esophageal angiodysplasia 210
277, 290, 296 esophageal carcinoma 205
colonic ulcer 153 nodular superficial 203, 204
Crohn’s disease 305 post-resection 205
color 11, 17 squamous cell 8, 168, 170, 172
contrast 12–13, 18, 19 histology 168
Crohn’s disease 152, 263, 304, invasion-depth diagnosis 52
305 invasive 171
aphthous type 160 irregular vessels 167
colitis 303, 304, 305 margins 170, 171, 173, 174
colonic ulcer 305 neovascularization 167
ileitis 160 pattern classification 52–3
pattern irregularity 51–2
dentate line 264, 265 small lesion detection 53–4
diverticular disease 269, 270 esophageal-gastric
duodenal adenocarcinoma 253 anastomosis 211
 INDE X 315

esophageal leiomyoma 210, feces 16, 136, 265, 266, 269, 270,
211 271, 272
esophageal microabscesses, fundic gland polyps 214, 233,
eosinophilic 207 234, 235, 236
esophageal mucosa
magnification endoscopy 50 gastric adenocarcinoma 227
esophageal squamous intestinal type 230
epithelium 165 poorly differentiated 111, 114
IPCLs 50, 55, 165, 167 well-differentiated 112, 115,
gastroesophageal reflux 118, 120
disease 57, 166 gastric adenoma 116
invasion depth diagnosis gastric angiodysplasia 220, 221
52 gastric antral vascular
magnified 55 ectasia 219, 220
normal pattern 56, 57 gastric antrum
pattern classification carcinoma see gastric
52–3, 56 carcinoma
pattern irregularity 51–2 dyspepsia 216
pinhair pattern 165 erosion 221
small lesions 53–4 healed 217
type IV lesion 59–60, 167 Helicobacter pylori 215, 216
type V-1 lesion 61, 63 normal 215
type VN 65 NSAID lesions 216, 217, 222
types V-1 to V-3 62–64, polyps 237, 238
165, 166 superficial lesion 227
superficial blood vessels 55 gastric body 212
esophageal stricture 206 gastric carcinoid 238, 239
esophageal varices 205, 206 gastric carcinoma 5, 86, 225, 226
esophagectomy, retained difficult diagnosis 117, 119
contents 241 ectopic 169
esophagitis 58, 166 elevated neoplasias 106
candidal 178, 179 endoscopic resection 106–7, 120
eosinophilic 206, 207 intramucosal 229, 230
erosive 177 magnification
gastro-esophageal reflux 177, endoscopy 104–20
178 microvasculature 104–6, 105,
esophagus 109, 110, 111, 118, 231
Barrett’s see Barrett’s NBI 104
esophagus poorly differentiated 231
examination 25–6 superficial 227, 228, 229
gastric inlet patch 208, 209 gastric cardia
glycogen deposits 209 adenocarcinoma 198
normal mucosa 164, 165 carditis 214
palisade vessels 164 dysplasia 225
preparation 25 inflammation 213
squamous papilloma 208 mucosal cancer 198
EVIS EXERA II system 9 mucosal pattern 197, 198
EVIS LUCERA SPECTRUM normal mucosa 30, 197, 212
system 9 gastric crypts 251
gastric dysplasia 224
familial adenomatous gastric fundus
polyposis MALT lymphoma 242
colonic adenoma 297, 298 polyps 214, 233, 234, 235, 236
duodenal lesions 257, 258 varices 218
fundic gland polyps 236 vascular pattern 214
316 IN D EX

gastric inflammation 223 ileocolonic anastomosis 310

gastric inlet patch 208, 209 ileum 248
gastric intestinal metaplasia 224 indigo carmine chromoendos-
gastric mucosa 212 copy 72–3, 106
H. pylori gastritis 91, 108 inflammatory bowel disease 5,
normal 7, 84–5, 108 149–60
gastric polyps 251 Crohn’s disease 152
gastric telangiectasia 226 aphthous type 160
gastric ulcer ileitis 160
benign 222, 223 ulcerative colitis 149–52
malignant 231, 232 active 150
recurrent 232, 233 dysplasia 151–2
scarring 7 endoscopic severity 149–51
gastritis high-grade dysplasia 159
chemical 217 mildly active 154, 155
chronic 85 moderately active 155
collagenous 241 quiescent 150–1, 156, 157,
eosinophilic 244 158, 159
Helicobacter pylori 91, 108, 249 skipped involvement 156
gastrocamera 3 intestinal fluids 136
gastroesophageal junction intra-epithelial papillary
adenocarcinoma 199 capillary loop 50, 55
nodular carcinoma 199, 200 gastroesophageal reflux
gastroesophageal reflux disease 57, 166
disease 166 invasion depth diagnosis 52
esophagitis 177, 178 magnified 55
IPCL pattern 57 normal pattern 56, 57
gastrojejunal anastomosis 240 pattern classification 52–3, 56
gastrojejunal stoma 243 pattern irregularity 51–2
gastropathy, portal hyper- pinhair pattern 165
tension 218, 219 small lesions 53–4
type IV lesion 59–60, 167
HDTV format 10 types V-1 to V-3 62–64, 165,
Helicobacter pylori 84 166
gastric antrum 215, 216 type V-1 lesion 61, 63
gastritis 91, 108, 249 type VN 65
hemorrhoids 270, 271 IPCL see intra-epithelial papillary
hiatal hernia 225 capillary loop
high resolution endoscopy 23–30
Barrett’s esophagus 68 light 11
endoscopes 23–4, 29 light blue crest 85, 92
patient preparation 24 light scattering 11–12
hypoglottis mucous in tissue 12, 17, 18
membrane 20 lipoma, colonic 307
hypopharyngeal squamous cell
carcinoma 174, 175 magnification endoscopy 10
IPCL pattern 176, 177 duodenum 7
margins 175 celiac disease 87, 101, 102,
post-treatment 176 103
normal mucosa 7, 100
ileal ulcers 262, 263 esophageal mucosa 50, 63
ileal villi 248 gastric carcinoma 104–20
ileitis 160 elevated neoplasias 106
ileocecal valve 266 endoscopic resection 106–7
polyps 296, 297 procedure 83–4
 INDE X 317

stomach 84–6 piriform sinus, carcinoma 39–40,

chronic gastritis 85 43, 45
determination of resection polyps
margins 97–8 colonic see colonic polyps
diagnosis 96, 97 duodenal 252
early gastric carcinoma 86, duodenal bulb 251
92–4 fundic gland 214, 233, 234,
H. pylori gastritis 91 235, 236
normal gastric mucosa gastric 251
84–5, 89 gastric antrum 237, 238
occult cancer 99 ileocecal valve 296, 297
MALT lymphoma 242, 243 rectal 273, 275
melanosis coli 308, 309 portal hypertension
mucosal cancer, screening 51 gastropathy 218, 219
mucosal fine capillary pattern 16 pyloric erosion 221

narrowband imaging 9–22, radiation proctitis 307

23–30 rectal polyps 273, 275
abnormal patterns 28, 30 rectal varix 306
application of 22 rectum 264, 265
Barrett’s esophagus 68–9 dentate line 264, 265
basic principles 13 gyriform area 303
cap technique 24–5 reflection 11
endoscopes 23–4, 29 Rendu-Osler-Weber
fine mucosal pattern 15, 16 syndrome 210
history 3–8 gastric angiodysplasia 220, 221
normal patterns 27, 30 resolution 12–13, 18
patient preparation 24
stomach 83–103 Schatski ring 208
system design 14–15, 20 screening colonoscopy 123–48
NBI see narrowband imaging improved visibility 123–4
Nissen-type fundoplication 239 margin assessment 127
non-steroidal anti-inflammatory meshed capillary vessels 127,
drugs see NSAIDs 134
NSAIDs microvascular
antral lesions 216, 217, 222 proliferation 126
ileal ulcers 262, 263 surface structure and
micro-capillaries 124–6
oropharyngeal carcinoma 41, 47 adenomatous lesion 125–6
oropharyngeal papilloma 48 cancerous lesion 126
hyperplastic polyp 125
patient preparation 24 normal colonic mucosa 125
peptic duodenitis 250 shiny silver sign 53, 62
pharyngeal cancer 35–48, 66 spectral reflectance analysis 6
diagnosis 35, 37–8 spectral sensitivity functions 6
endoscopic mucosal squamo-columnar
resection 49–66 junction 15–16
endoscopic submucosal squamous cell adenoma 8
dissection 49–66 stomach
risk factors 36 Cameron lesions 214
superficial 36–7 examination 27
pink color sign 53, 62, 172 magnification endoscopy 84–6
pink-silver sign 53, 54 chronic gastritis 85–6
piriform recess, superficial determination of resection
carcinoma 44 margins 97–8
318 IN D EX

stomach (cont’d) high-grade dysplasia 159, 301

diagnosis 96, 97 high-grade intraepithelial
early gastric cancer 86, 92–4 neoplasia 303
H. pylori gastritis 91 inflammatory polyp 298
normal gastric mucosa 84–5, low-grade intraepithelial
89, 90 neoplasia 303
occult cancer 99 mildly active 154, 166
narrowband imaging 83–103 moderately active 155
see also gastric polypoid lesions 301, 302
subepithelial capillary pseudopolyps 299
network 84 quiescent 150–1, 156, 157,
system design 14–15, 20 158, 159
skipped involvement 156
tongue
blood vessels 19 vallecula epiglottica,
mucosa 14, 16 carcinoma 42, 46
varices
ulcer esophageal 205, 206
cecal 310 fundic 218
colonic 153, 305 rectal 306
duodenal bulb 249 video endoscopy systems 9
gastric villi
benign 222, 223 duodenal 29, 247
malignant 23, 231 ileal 248
recurrent 232, 233 villous atrophy 259, 260
scarring 7 visual perception 21
ileal 262, 263 vocal cords 163
ulcerative colitis 149–52, 153, 299 cyst 163
active 150, 302 nodules 163
cecal lesions 300
dysplasia 151–2 wavelength 11, 17
endoscopic severity 149–51 Whipple’s disease 261, 262