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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EOver the past several decades, blue light technology used in endoscopy (eg, colonoscopy) has evolved. The most recent advances include second-generation, high-definition narrow-band imaging and blue laser imaging. However, these technologies do not necessarily improve adenoma detection rates or miss rates, according to recent studies.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecolonoscopy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eendoscopy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eblue light\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eblue light imaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Enarrow-band imaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eadenoma\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehigh-definition\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ewhite light\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Egastroenterology procedures\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Egastroenterology clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eimaging modalities\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EChromoendoscopy\/narrow-band imaging for the detection of adenomas during colonoscopy has evolved over the last several decades. Michael B. Wallace, MD, MPH, Mayo Clinic, Jacksonville, Florida, USA, discussed the 3 phases of blue light technology.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn the first phase, blue dyes (chromoendoscopy) were used to increase contrast by settling into the depressions of the gastrointestinal epithelium. In addition, the blue dye improved the ability to detect dysplasia. This technology is still used today for routine polyp detection and for conditions such as ulcerative colitis.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe second phase, which began in the mid-1990s, included the use of narrow-band imaging (NBI), in which filters are applied to a white light source in order to restrict the light to blue and green wavelengths during the illumination of the intestinal epithelium. This technology highlights vascular changes because hemoglobin absorbs blue light, thereby creating dark contrast to the surrounding tissue. In addition, due to the differing capacities of wavelengths of light to penetrate tissue, different layers of the epithelium can be visualized.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ESeveral classification schemes arose during the second phase. Sano\u2019s classification used NBI to assess the organization of capillary vessels within a polyp for a differential diagnosis [Sano Y et al. \u003Cem\u003EGastrointest Endosc\u003C\/em\u003E. 2009]. Although this method is accurate when used by experienced clinicians, interobserver variation led to the development of the NBI International Classification for Endoscopy, which incorporated the color, vasculature, and pit patterns to distinguish hyperplastic polyps from adenomas [Hewitt DG et al. \u003Cem\u003EGastroenterology\u003C\/em\u003E. 2012].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EDuring this time, endoscopes also evolved with new technologies and enhanced-light imaging. Indeed, the new endoscopic technology substantially improved detection of adenomas when used in combinations such as high-definition (HD) plus NBI vs standard-definition white light [Gross SA et al. \u003Cem\u003EEndoscopy\u003C\/em\u003E. 2011].\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EA comprehensive systematic review and meta-analysis by the American Society for Gastrointestinal Endoscopy demonstrated that the negative predictive value (NPV) of a hyperplastic polyp was \u0026gt;\u200590% for experts who were highly confident that an adenoma was absent [Abu Dayyeh BK et al. \u003Cem\u003EGastrointest Endosc\u003C\/em\u003E. 2015].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe third and current phase includes second-generation NBI and blue laser light imaging. The second-generation NBI uses dual focus and brighter imaging to improve vascular contrast. In blue laser light imaging, the laser emits blue light with 3 modes: blue light, brighter blue light, and white light. The standard blue light is used for illuminating the superficial epithelium, the bright blue light is used for distant viewing of the superficial surface, and the white light is used for compatibility with the conventional NBI system. However, blue laser imaging is not yet available for use in the United States.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe accuracy of dual-focus HD NBI colonoscopy is similar to that of standard colonoscopy [Wallace MB et al. \u003Cem\u003EGastrointest Endoscopy\u003C\/em\u003E. 2014]. However, a study that compared NBI with HD white light colonoscopy found that the adenoma detection rate was higher with NBI vs HD white light (48.3% vs 34.4%; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.01), but the mean number of polyps per patient (1.49% vs 1.13%; \u003Cem\u003EP\u2005\u003C\/em\u003E=\u2005.07) and the miss rates were similar among both modalities at about 21.5% [Leung WK et al. \u003Cem\u003EAm J Gastroenterol\u003C\/em\u003E. 2014].\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EIn conclusion, Dr Wallace stated that both 180 (1st-generation) and 190 (2nd-generation) NBI perform similarly in terms of adenoma detection rate and polyp surveillance. Although blue light imaging is promising, more research is needed.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/14\/20.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlhre\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}