Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

Main Recommendations

1 ESGE suggests that high definition endoscopy, and dye or virtual chromoendoscopy, as well as add-on devices, can be used in average risk patients to increase the endoscopist’s adenoma detection rate. However, their routine use must be balanced against costs and practical considerations.

Weak recommendation, high quality evidence.

2 ESGE recommends the routine use of high definition systems in individuals with Lynch syndrome.

Strong recommendation, high quality evidence.

3 ESGE recommends the routine use, with targeted biopsies, of dye-based pancolonic chromoendoscopy or virtual chromoendoscopy for neoplasia surveillance in patients with long-standing colitis.

Strong recommendation, moderate quality evidence.

4 ESGE suggests that virtual chromoendoscopy and dye-based chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps and can replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained, as defined in the ESGE curriculum, and audited.

Weak recommendation, high quality evidence.

5 ESGE recommends the use of high definition white-light endoscopy in combination with (virtual) chromoendoscopy to predict the presence and depth of any submucosal invasion in nonpedunculated colorectal polyps prior to any treatment.

Strong recommendation, moderate quality evidence.

6 ESGE recommends the use of virtual or dye-based chromoendoscopy in addition to white-light endoscopy for the detection of residual neoplasia at a piecemeal polypectomy scar site.

Strong recommendation, moderate quality evidence.

7 ESGE suggests the possible incorporation of computer-aided diagnosis (detection and characterization of lesions) to colonoscopy, if acceptable and reproducible accuracy for colorectal neoplasia is demonstrated in high quality multicenter in vivo clinical studies. Possible significant risks with implementation, specifically endoscopist deskilling and over-reliance on artificial intelligence, unrepresentative training datasets, and hacking, need to be considered.

Weak recommendation, low quality evidence.

• References

• 1 Kamiński M, Hassan C, Bisschops R. et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2014; 46: 435-457
• 2 Stock C, Brenner H. Utilization of lower gastrointestinal endoscopy and fecal occult blood test in 11 European countries: evidence from the Survey of Health, Aging and Retirement in Europe (SHARE). Endoscopy 2010; 42: 546-556
• 3 Chen C, Stock C, Jansen L. et al. Trends in colonoscopy and fecal occult blood test use after the introduction of dual screening offers in Germany: Results from a large population-based study, 2003-2016. Prev Med (Baltim) 2019; 123: 333-340
• 4 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
• 5 Kaminski M, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
• 6 Clark BT, Rustagi T, Laine L. What level of bowel prep quality requires early repeat colonoscopy: systematic review and meta-analysis of the impact of preparation quality on adenoma detection rate. Am J Gastroenterol 2014; 109: 1714-1723 ; quiz 1724
• 7 East J, Vleugels J, Roelandt P. et al. Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) Technology Review. Endoscopy 2016; 48: 1029-1045
• 8 Richardson WS, Wilson MC, Nishikawa J. et al. The well-built clinical question: a key to evidence-based decisions. ACP J Club 1995; 123: A12-13 ; http://www.ncbi.nlm.nih.gov/pubmed/7582737. Accessed 17 Jun 2019
• 9 Atkins D, Best D, Briss PA. et al. Grading quality of evidence and strength of recommendations. BMJ 2004; 328: 1490
• 10 Dumonceau J-M, Hassan C, Riphaus A. et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline Development Policy. Endoscopy 2012; 44: 626-629
• 11 Corley DA, Levin TR, Doubeni CA. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 2539-2541
• 12 Subramanian V, Mannath J, Hawkey CJ. et al. High definition colonoscopy vs. standard video endoscopy for the detection of colonic polyps: A meta-analysis. Endoscopy 2011; 43: 499-505
• 13 Deenadayalu VP, Chadalawada V, Rex DK. 170° Wide-angle colonoscope: Effect on efficiency and miss rates. Am J Gastroenterol 2004; 99: 2138-2142
• 14 Fatima H, Rex DK, Rothstein R. et al. Cecal insertion and withdrawal times with wide-angle versus standard colonoscopes: a randomized controlled trial. Clin Gastroenterol Hepatol 2008; 6: 109-114
• 15 Rex DK, Chadalawada V, Helper DJ. Wide angle colonoscopy with a prototype instrument: Impact on miss rates and efficiency as determined by back-to-back colonoscopies. Am J Gastroenterol 2003; 98: 2000-2005
• 16 Rastogi A, Early DS, Gupta N. et al. Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology. Gastrointest Endosc 2011; 74: 593-602
• 17 Roelandt P, Demedts I, Willekens H. et al. Impact of endoscopy system, high definition, and virtual chromoendoscopy in daily routine colonoscopy: a randomized trial. Endoscopy 2019; 51: 237-243
• 18 Pioche M, Denis A, Allescher HD. et al. Impact of 2 generational improvements in colonoscopes on adenoma miss rates: results of a prospective randomized multicenter tandem study. Gastrointest Endosc 2018; 88: 107-116
• 19 Zimmermann-Fraedrich K, Groth S, Sehner S. et al. Effects of two instrument-generation changes on adenoma detection rate during screening colonoscopy: results from a prospective randomized comparative study. Endoscopy 2018; 50: 878-885
• 20 Dinesen L, Chua TJ, Kaffes AJ. Meta-analysis of narrow-band imaging versus conventional colonoscopy for adenoma detection. Gastrointest Endosc 2012; 75: 604-611
• 21 Jin XF, Chai TH, Shi JW. et al. Meta-analysis for evaluating the accuracy of endoscopy with narrow band imaging in detecting colorectal adenomas. J Gastroenterol Hepatol 2012; 27: 882-887
• 22 Nagorni A, Bjelakovic G, Petrovic B. Narrow band imaging versus conventional white light colonoscopy for the detection of colorectal polyps. Cochrane Database Syst Rev 2012; 1: CD008361
• 23 Omata F, Ohde S, Deshpande GA. et al. Image-enhanced, chromo, and cap-assisted colonoscopy for improving adenoma/neoplasia detection rate: A systematic review and meta-analysis. Scand J Gastroenterol 2014; 49: 222-237
• 24 Pasha SF, Leighton JA, Das A. et al. Comparison of the yield and miss rate of narrow band imaging and white light endoscopy in patients undergoing screening or surveillance colonoscopy: A meta-analysis. Am J Gastroenterol 2012; 107: 363-370
• 25 Atkinson NSS, Ket S, Bassett P. et al. Narrow-band imaging for detection of neoplasia at colonoscopy: a meta-analysis of data from individual patients in randomized controlled trials. Gastroenterology 2019; 157: 462-471 Epub 2019 Apr 15
• 26 Kidambi TD, Terdiman JP, El-Nachef N. et al. Effect of i-scan electronic chromoendoscopy on detection of adenomas during colonoscopy. Clin Gastroenterol Hepatol 2019; 17: 701-708.e1
• 27 Min M, Deng P, Zhang W. et al. Comparison of linked color imaging and white-light colonoscopy for detection of colorectal polyps: a multicenter, randomized, crossover trial. Gastrointest Endosc 2017; 86: 724-730
• 28 Paggi S, Mogavero G, Amato A. et al. Linked color imaging reduces the miss rate of neoplastic lesions in the right colon: a randomized tandem colonoscopy study. Endoscopy 2018; 50: 396-402
• 29 Ikematsu H, Sakamoto T, Togashi K. et al. Detectability of colorectal neoplastic lesions using a novel endoscopic system with blue laser imaging: a multicenter randomized controlled trial. Gastrointest Endosc 2017; 86: 386-394
• 30 Zhao Z-Y, Guan Y-G, Li B-R. et al. Detection and miss rates of autofluorescence imaging of adenomatous and polypoid lesions during colonoscopy: a systematic review and meta-analysis. Endosc Int Open 2015; 3: E226-E235
• 31 Takeuchi Y, Sawaya M, Oka S. et al. Efficacy of autofluorescence imaging for flat neoplasm detection: a multicenter randomized controlled trial (A-FLAT trial). Gastrointest Endosc 2019; 89: 460-469
• 32 Facciorusso A, Del Prete V, Buccino RV. et al. Comparative efficacy of colonoscope distal attachment devices in increasing rates of adenoma detection: a network meta-analysis. Clin Gastroenterol Hepatol 2018; 16: 1209-1219.e9
• 33 Clelia M, Frazzoni L, Fuccio L. et al. Mucosal flattening assisted colonoscopy (FAC) for improving adenoma detection rate: a systematic review with pairwise and network meta-analysis. United Eur Gastroenterol J 2018; 6: A195
• 34 Brown SR, Baraza W, Din S. et al. Chromoscopy versus conventional endoscopy for the detection of polyps in the colon and rectum. Cochrane Database Syst Rev 2016; 4: CD006439
• 35 Lesne A, Rouquette O, Touzet S. et al. Adenoma detection with blue-water infusion colonoscopy: a randomized trial. Endoscopy 2017; 49: 765-775
• 36 Repici A, Wallace MB, East JE. et al. Efficacy of per-oral methylene blue formulation for screening colonoscopy. Gastroenterology 2019; 156: 2198-2207.e1
• 37 Hurlstone DP, Karajeh M, Cross SS. et al. The role of high-magnification-chromoscopic colonoscopy in hereditary nonpolyposis colorectal cancer screening: a prospective “back-to-back” endoscopic study. Am J Gastroenterol 2005; 100: 2167-2173
• 38 Lecomte T, Cellier C, Meatchi T. et al. Chromoendoscopic colonoscopy for detecting preneoplastic lesions in hereditary nonpolyposis colorectal cancer syndrome. Clin Gastroenterol Hepatol 2005; 3: 897-902
• 39 Rahmi G, Lecomte T, Malka D. et al. Impact of chromoscopy on adenoma detection in patients with Lynch syndrome: a prospective, multicenter, blinded, tandem colonoscopy study. Am J Gastroenterol 2015; 110: 288-298
• 40 Stoffel EM, Turgeon DK, Stockwell DH. et al. Missed adenomas during colonoscopic surveillance in individuals with Lynch syndrome (hereditary nonpolyposis colorectal cancer). Cancer Prev Res (Phila) 2008; 1: 470-475
• 41 Hüneburg R, Lammert F, Rabe C. et al. Chromocolonoscopy detects more adenomas than white light colonoscopy or narrow band imaging colonoscopy in hereditary nonpolyposis colorectal cancer screening. Endoscopy 2009; 41: 316-322
• 42 Haanstra JF, Dekker E, Cats A. et al. Effect of chromoendoscopy in the proximal colon on colorectal neoplasia detection in Lynch syndrome: a multicenter randomized controlled trial. Gastrointest Endosc 2019; 90: 624-632 Epub 2019 Apr 24
• 43 Rivero Sanchez L, Arnau Colell C, Balaguer F. et al. High-definition white-light colonoscopy versus chromoendoscopy for surveillance of Lynch syndrome. a multicenter, randomized and controlled study (Endolynch study). United Eur Gastroenterol J 2018; 6: A117 OP295
• 44 East JE, Suzuki N, Stavrinidis M. et al. Narrow band imaging for colonoscopic surveillance in hereditary non-polyposis colorectal cancer. Gut 2008; 57: 65-70
• 45 Bisschops R, Tejpar S, Willekens H. et al. Virtual chromoendoscopy (I-SCAN) detects more polyps in patients with Lynch syndrome: a randomized controlled crossover trial. Endoscopy 2017; 49: 342-350
• 46 Cellier C, Perrod G, Colas C. et al. Back-to-back comparison of colonoscopy with virtual chromoendoscopy using a third-generation narrow-band imaging system to chromoendoscopy with indigo carmine in patients with Lynch syndrome. Am J Gastroenterol 2019; 114: 1665-1670
• 47 Ramsoekh D, Haringsma J, Poley JW. et al. A back-to-back comparison of white light video endoscopy with autofluorescence endoscopy for adenoma detection in high-risk subjects. Gut 2010; 59: 785-793
• 48 van Leerdam ME, Roos VH, van Hooft JE. et al. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2019; 51: 877-895
• 49 Moreira L, Pellisé M, Carballal S. et al. High prevalence of serrated polyposis syndrome in FIT-based colorectal cancer screening programmes. Gut 2013; 62: 476-477
• 50 Biswas S, Ellis AJ, Guy R. et al. High prevalence of hyperplastic polyposis syndrome (serrated polyposis) in the NHS bowel cancer screening programme. Gut 2013; 62: 475 Epub 2012 Jul 31
• 51 Hazewinkel Y, López-Cerón M, East JE. et al. Endoscopic features of sessile serrated adenomas: validation by international experts using high-resolution white-light endoscopy and narrow-band imaging. Gastrointest Endosc 2013; 77: 916-924 Epub 2013 Feb 21
• 52 Kahi CJ, Li X, Eckert GJ. et al. High colonoscopic prevalence of proximal colon serrated polyps in average-risk men and women. Gastrointest Endosc 2012; 75: 515-520
• 53 Abdeljawad K, Vemulapalli KC, Kahi CJ. et al. Sessile serrated polyp prevalence determined by a colonoscopist with a high lesion detection rate and an experienced pathologist. Gastrointest Endosc 2015; 81: 517-524
• 54 Vemulapalli KC, Rex DK. Failure to recognize serrated polyposis syndrome in a cohort with large sessile colorectal polyps. Gastrointest Endosc 2012; 75: 1206-1210
• 55 Rivero-Sanchez L, Lopez-Ceron M, Carballal S. et al. Reassessment colonoscopy to diagnose serrated polyposis syndrome in a colorectal cancer screening population. Endoscopy 2016; 49: 44-53
• 56 López-Vicente J, Rodríguez-Alcalde D, Hernández L. et al. Panchromoendoscopy increases detection of polyps in patients with serrated polyposis syndrome. Clin Gastroenterol Hepatol 2019; 17: 2016-2023.e6 Epub 2018 Oct 24
• 57 Boparai KS, van den Broek FJ, van Eeden S. et al. Increased polyp detection using narrow band imaging compared with high resolution endoscopy in patients with hyperplastic polyposis syndrome. Endoscopy 2011; 43: 676-682 Epub 2011 Aug 2
• 58 Hazewinkel Y, Tytgat KMAJ, van Leerdam ME. et al. Narrow-band imaging for the detection of polyps in patients with serrated polyposis syndrome: a multicenter, randomized, back-to-back trial. Gastrointest Endosc 2015; 81: 531-538
• 59 Rivero-Sánchez L, López Vicente J, Hernandez Villalba L. et al. Endocuff-assisted colonoscopy for surveillance of serrated polyposis syndrome: a multicenter randomized controlled trial. Endoscopy 2019; 51: 637-645
• 60 Cairns SR, Scholefield JH, Steele RJ. et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666-689
• 61 Van Assche G, Dignass A, Bokemeyer B. et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 3: Special situations. J Crohn’s Colitis 2013; 7: 1-33
• 62 Kiesslich R, Fritsch J, Holtmann M. et al. Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology 2003; 124: 880-888
• 63 Kiesslich R, Goetz M, Lammersdorf K. et al. Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology 2007; 132: 874-882
• 64 Subramanian V, Mannath J, Ragunath K. et al. Meta-analysis: the diagnostic yield of chromoendoscopy for detecting dysplasia in patients with colonic inflammatory bowel disease. Aliment Pharmacol Ther 2011; 33: 304-312
• 65 Hlavaty T, Huorka M, Koller T. et al. Colorectal cancer screening in patients with ulcerative and crohnʼs colitis with use of colonoscopy, chromoendoscopy and confocal endomicroscopy. Eur J Gastroenterol Hepatol 2011; 23: 680-689
• 66 Günther U, Kusch D, Heller F. et al. Surveillance colonoscopy in patients with inflammatory bowel disease: comparison of random biopsy vs. targeted biopsy protocols. Int J Colorectal Dis 2011; 26: 667-672
• 67 Deepak P, Hanson GJ, Fletcher JG. et al. Incremental diagnostic yield of chromoendoscopy and outcomes in inflammatory bowel disease patients with a history of colorectal dysplasia on white-light endoscopy. Gastrointest Endosc 2016; 83: 1005-1012
• 68 Marion JF, Waye JD, Israel Y. et al. Chromoendoscopy is more effective than standard colonoscopy in detecting dysplasia during long-term surveillance of patients with colitis. Clin Gastroenterol Hepatol 2016; 14: 713-719
• 69 Mooiweer E, van der Meulen-de Jong AE, Ponsioen CY. et al. Chromoendoscopy for surveillance in inflammatory bowel disease does not increase neoplasia detection compared with conventional colonoscopy with random biopsies: results from a large retrospective study. Am J Gastroenterol 2015; 110: 1014-1021
• 70 Carballal S, Maisterra S, López-Serrano A. et al. Real-life chromoendoscopy for neoplasia detection and characterisation in long-standing IBD. Gut 2018; 67: 70-78
• 71 Feuerstein JD, Rakowsky S, Sattler L. et al. Meta-analysis of dye-based chromoendoscopy compared with standard- and high-definition white-light endoscopy in patients with inflammatory bowel disease at increased risk of colon cancer. Gastrointest Endosc 2019; 90: 186-195.e1 Epub 2019 Apr 19
• 72 Iannone A, Ruospo M, Wong G. et al. Chromoendoscopy for surveillance in ulcerative colitis and crohn’s disease: a systematic review of randomized trials. Clin Gastroenterol Hepatol 2017; 15: 1684-1697.e11
• 73 Bessissow T, Dulai PS, Restellini S. et al. Comparison of endoscopic dysplasia detection techniques in patients with ulcerative colitis: a systematic review and network meta-analysis. Inflamm Bowel Dis 2018; 24: 2518-2526
• 74 Iacucci M, Kaplan GG, Panaccione R. et al. A randomized trial comparing high definition colonoscopy alone with high definition dye spraying and electronic virtual chromoendoscopy for detection of colonic neoplastic lesions during IBD surveillance colonoscopy. Am J Gastroenterol 2018; 113: 225-234
• 75 Elsadani NN, East JE, Walters JRF. New 2010 British Society of Gastroenterology colitis surveillance guidelines: costs and surveillance intervals. Gut 2011; 60: 282-283
• 76 Konijeti GG, Shrime MG, Ananthakrishnan AN. et al. Cost-effectiveness analysis of chromoendoscopy for colorectal cancer surveillance in patients with ulcerative colitis. Gastrointest Endosc 2014; 79: 455-465
• 77 Ignjatovic A, East JE, Subramanian V. et al. Narrow band imaging for detection of dysplasia in colitis: a randomized controlled trial. Am J Gastroenterol 2012; 107: 885-890
• 78 Dekker E, van den Broek FJ, Reitsma JB. et al. Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis. Endoscopy 2007; 39: 216-221
• 79 van den Broek FJC, Fockens P, van Eeden S. et al. Endoscopic tri-modal imaging for surveillance in ulcerative colitis: randomised comparison of high-resolution endoscopy and autofluorescence imaging for neoplasia detection; and evaluation of narrow-band imaging for classification of lesions. Gut 2008; 57: 1083-1089
• 80 Pellisé M, López-Cerón M, Rodríguez de Miguel C. et al. Narrow-band imaging as an alternative to chromoendoscopy for the detection of dysplasia in long-standing inflammatory bowel disease: a prospective, randomized, crossover study. Gastrointest Endosc 2011; 74: 840-848
• 81 Bisschops R, Bessissow T, Joseph JA. et al. Chromoendoscopy versus narrow band imaging in UC: a prospective randomised controlled trial. Gut 2018; 67: 1087-1094
• 82 Har-Noy O, Katz L, Avni T. et al. Chromoendoscopy, narrow-band imaging or white light endoscopy for neoplasia detection in inflammatory bowel diseases. Dig Dis Sci 2017; 62: 2982-2990
• 83 Matsumoto T, Nakamura S, Moriyama T. et al. Autofluorescence imaging colonoscopy for the detection of dysplastic lesions in ulcerative colitis: a pilot study. Colorectal Dis 2010; 12: e291-297
• 84 Vleugels JLA, Rutter MD, Ragunath K. et al. Chromoendoscopy versus autofluorescence imaging for neoplasia detection in patients with longstanding ulcerative colitis (FIND-UC): an international, multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol 2018; 3: 305-316
• 85 Matsumoto T, Nakamura S, Jo Y. et al. Chromoscopy might improve diagnostic accuracy in cancer surveillance for ulcerative colitis. Am J Gastroenterol 2003; 98: 1827-1833
• 86 Rutter MD, Saunders BP, Schofield G. et al. Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis. Gut 2004; 53: 256-260
• 87 Marion JF, Waye JD, Present DH. et al. Chromoendoscopy-targeted biopsies are superior to standard colonoscopic surveillance for detecting dysplasia in inflammatory bowel disease patients: a prospective endoscopic trial. Am J Gastroenterol 2008; 103: 2342-2349
• 88 van den Broek FJC, Stokkers PCF, Reitsma JB. et al. Random biopsies taken during colonoscopic surveillance of patients with longstanding ulcerative colitis: low yield and absence of clinical consequences. Am J Gastroenterol 2014; 109: 715-722
• 89 Watanabe T, Ajioka Y, Mitsuyama K. et al. Comparison of targeted vs random biopsies for surveillance of ulcerative colitis-associated colorectal cancer. Gastroenterology 2016; 151: 1122-1130
• 90 Gasia MF, Ghosh S, Panaccione R. et al. Targeted biopsies identify larger proportions of patients with colonic neoplasia undergoing high-definition colonoscopy, dye chromoendoscopy, or electronic virtual chromoendoscopy. Clin Gastroenterol Hepatol 2016; 14: 704-712.e4
• 91 Moussata D, Allez M, Cazals-Hatem D. et al. Are random biopsies still useful for the detection of neoplasia in patients with IBD undergoing surveillance colonoscopy with chromoendoscopy?. Gut 2018; 67: 616-624
• 92 Kawasaki K, Nakamura S, Esaki M. et al. Clinical usefulness of magnifying colonoscopy for the diagnosis of ulcerative colitis-associated neoplasia. Dig Endosc 2019; 31 (Suppl. 01) 36-42
• 93 Sugimoto S, Naganuma M, Iwao Y. et al. Endoscopic morphologic features of ulcerative colitis-associated dysplasia classified according to the SCENIC consensus statement. Gastrointest Endosc 2017; 85: 639-646.e2
• 94 East JE, Suzuki N, von Herbay A. et al. Narrow band imaging with magnification for dysplasia detection and pit pattern assessment in ulcerative colitis surveillance: a case with multiple dysplasia associated lesions or masses. Gut 2006; 55: 1432-1435
• 95 Matsumoto T, Kudo T, Jo Y. et al. Magnifying colonoscopy with narrow band imaging system for the diagnosis of dysplasia in ulcerative colitis: a pilot study. Gastrointest Endosc 2007; 66: 957-965
• 96 van den Broek FJC, Fockens P, van Eeden S. et al. Narrow-band imaging versus high-definition endoscopy for the diagnosis of neoplasia in ulcerative colitis. Endoscopy 2011; 43: 108-115
• 97 Bisschops R, Bessissow T, Dekker E. et al. Pit pattern analysis with high-definition chromoendoscopy and narrow-band imaging for optical diagnosis of dysplasia in patients with ulcerative colitis. Gastrointest Endosc 2017; 86: 1100-1106.e1
• 98 Vleugels JLA, Rutter MD, Ragunath K. et al. Diagnostic accuracy of endoscopic trimodal imaging and chromoendoscopy for lesion characterization in ulcerative colitis. J Crohn’s Colitis 2018; 12: 1438-1447
• 99 Cassinotti A, Buffoli F, Fociani P. et al. Virtual chromoendoscopy with FICE for the classification of polypoid and nonpolypoid raised lesions in ulcerative colitis. J Clin Gastroenterol 2019; 53: 269-276
• 100 Aladrén BS, González-Lama Y, García-Alvarado M. et al. Even non-experts identify non-dysplastic lesions in inflammatory bowel disease via chromoendoscopy: results of a screening program in real-life. Endosc Int Open 2019; 7: E743-E750
• 101 Iacucci M, McQuaid K, Gui XS. et al. A multimodal (FACILE) classification for optical diagnosis of inflammatory bowel disease associated neoplasia. Endoscopy 2019; 51: 133-141
• 102 Regula J, Rupinski M, Kraszewska E. et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 2006; 355: 1863-1872
• 103 Vleugels JLA, Hassan C, Senore C. et al. Diminutive polyps with advanced histologic features do not increase risk for metachronous advanced colon neoplasia. Gastroenterology 2019; 156: 623-634.e3 Epub 2018 Nov 2
• 104 Pickhardt PJ, Kim DH. Colorectal cancer screening with CT colonography: Key concepts regarding polyp prevalence, size, histology, morphology, and natural history. Am J Roentgenol 2009; 193: 40-46
• 105 Tsai FC, Strum WB. Prevalence of advanced adenomas in small and diminutive colon polyps using direct measurement of size. Dig Dis Sci 2011; 56: 2384-2388 Epub 2011 Feb 12
• 106 Kolligs FT, Crispin A, Graser A. et al. Risk factors for advanced neoplasia within subcentimetric polyps: Implications for diagnostic imaging. Gut 2013; 62: 863-870 Epub 2012 Apr 23
• 107 Lieberman D, Moravec M, Holub J. et al. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology 2008; 135: 1100-1105 Epub 2008 Jul 3
• 108 Butterly LF, Chase MP, Pohl H. et al. Prevalence of clinically important histology in small adenomas. Clin Gastroenterol Hepatol 2006; 4: 343-348
• 109 Church JM. Clinical significance of small colorectal polyps. Dis Colon Rectum 2004; 47: 481-485
• 110 Weston AP, Campbell DR. Diminutive colonic polyps: histopathology, spatial distribution, concomitant significant lesions, and treatment complications. Am J Gastroenterol 1995; 90: 24-28
• 111 Pickhardt PJ, Choi JR, Hwang I. et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 2003; 349: 2191-2200
• 112 Nusko G, Mansmann U, Altendorf-Hofmann A. et al. Risk of invasive carcinoma in colorectal adenomas assessed by size and site. Int J Colorectal Dis 1997; 12: 267-271
• 113 Aldridge AJ, Simson JNL. Histological assessment of colorectal adenomas by size. Are polyps less than 10 mm in size clinically important?. Eur J Surg 2001; 167: 777-781
• 114 Ignjatovic A, East JE, Suzuki N. et al. Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study. Lancet Oncol 2009; 10: 1171-1178 Epub 2009 Nov 10
• 115 Gschwantler M, Kriwanek S, Langner E. et al. High-grade dysplasia and invasive carcinoma in colorectal adenomas: A multivariate analysis of the impact of adenoma and patient characteristics. Eur J Gastroenterol Hepatol 2002; 14: 183-188
• 116 Kudo SE, Takemura O, Ohtsuka K. Flat and depressed types of early colorectal cancers: from East to West. Gastrointest Endosc Clin N Am 2008; 581-593
• 117 Gupta N, Bansal A, Rao D. et al. Prevalence of advanced histological features in diminutive and small colon polyps. Gastrointest Endosc 2012; 1022-1030
• 118 Sakamoto T, Matsuda T, Nakajima T. et al. Clinicopathological features of colorectal polyps: Evaluation of the “predict, resect and discard” strategies. Colorectal Dis 2013; 15: e295-e300
• 119 Chiu HM, Chang LC, Shun CT. et al. Current management of diminutive colorectal polyps in Taiwan. Dig Endosc 2014; 26 (Suppl. 02) 64-67
• 120 Oka S, Tanaka S, Nakadoi K. et al. Endoscopic features and management of diminutive colorectal submucosal invasive carcinoma. Dig Endosc 2014; 26 (Suppl. 02) 78-83
• 121 Suna N, Koksal AS, Yildiz H. et al. Prevalence of advanced histologic features in diminutive colon polyps. Acta Gastroenterol Belg 2015; 78: 287-291
• 122 Ponugoti PL, Cummings OW, Rex DK. Risk of cancer in small and diminutive colorectal polyps. Dig Liver Dis 2017; 49: 34-37 Epub 2016 Jun 28
• 123 Iwai T, Imai K, Hotta K. et al. Endoscopic prediction of advanced histology in diminutive and small colorectal polyps. J Gastroenterol Hepatol 2019; 34: 397-403 Epub 2018 Aug 16
• 124 Turner KO, Genta RM, Sonnenberg A. Lesions of all types exist in colon polyps of all sizes. Am J Gastroenterol 2018; 113: 303-306 Epub 2017 Dec 12
• 125 Vleugels JLA, Dijkgraaf MGW, Hazewinkel Y. et al. Effects of training and feedback on accuracy of predicting rectosigmoid neoplastic lesions and selection of surveillance intervals by endoscopists performing optical diagnosis of diminutive polyps. Gastroenterology 2018; 154: 1682-1693.e1 Epub 2018 Feb 6
• 126 von Renteln D, Kaltenbach T, Rastogi A. et al. Simplifying resect and discard strategies for real-time assessment of diminutive colorectal polyps. Clin Gastroenterol Hepatol 2018; 16: 706-714 Epub 2017 Nov 23
• 127 Jeong YH, Kim KO, Park CS. et al. Risk factors of advanced adenoma in small and diminutive colorectal polyp. J Korean Med Sci 2016; 31: 1426-1430
• 128 Shapiro R, Ben-Horin S, Bar-Meir S. et al. The risk of advanced histology in small-sized colonic polyps: Are non-invasive colonic imaging modalities good enough?. Int J Colorectal Dis 2012; 27: 1071-1075 Epub 2012 Feb 2
• 129 Chaput U, Alberto SF, Terris B. et al. Risk factors for advanced adenomas amongst small and diminutive colorectal polyps: A prospective monocenter study. Dig Liver Dis 2011; 43: 609-612
• 130 Denis B, Bottlaender J, Weiss AM. et al. Some diminutive colorectal polyps can be removed and discarded without pathological examination. Endoscopy 2011; 43: 81-86 Epub 2010 Nov 24
• 131 Graser A, Stieber P, Nagel D. et al. Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut 2009; 58: 241-248 Epub 2008 Oct 13
• 132 Bretagne JF, Manfredi S, Piette C. et al. Yield of high-grade dysplasia based on polyp size detected at colonoscopy: A series of 2295 examinations following a positive fecal occult blood test in a population-based study. Dis Colon Rectum 2010; 53: 339-345
• 133 Yoo TW, Park DI, Kim YH. et al. Clinical significance of small colorectal adenoma less than 10mm: the KASID study. Hepatogastroenterology 2007; 54: 418-421
• 134 Rex DK, Overhiser AJ, Chen SC. et al. Estimation of impact of American College of Radiology recommendations on CT colonography reporting for resection of high-risk adenoma findings. Am J Gastroenterol 2009; 104: 149-153
• 135 Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 37: 570-578
• 136 Rex DK, Kahi C, O’Brien M. et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2011; 73: 419-422
• 137 ASGE Technology Committee. Abu Dayyeh BK, Thosani N. et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2015; 81: 502.e1-502.e16 Epub 2015 Jan 16
• 138 East JE, Suzuki N, Stavrinidis M. et al. Narrow band imaging with magnification for the characterization of small and diminutive colonic polyps: Pit pattern and vascular pattern intensity. Endoscopy 2008; 40: 811-817 Epub 2008 Sep 30
• 139 Rogart JN, Jain D, Siddiqui UD. et al. Narrow-band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience. Gastrointest Endosc 2008; 68: 1136-1145 Epub 2008 Aug 8
• 140 Coe SG, Thomas C, Crook J. et al. Colorectal surveillance interval assignment based on in vivo prediction of polyp histology: Impact of endoscopic quality improvement program. Gastrointest Endosc 2012; 76: 118-125.e1
• 141 Shahid MW, Buchner AM, Heckman MG. et al. Diagnostic accuracy of probe-based confocal laser endomicroscopy and narrow band imaging for small colorectal polyps: A feasibility study. Am J Gastroenterol 2012; 107: 231-239 Epub 2011 Nov 8
• 142 Hewett DG, Huffman ME, Rex DK. Leaving distal colorectal hyperplastic polyps in place can be achieved with high accuracy by using narrow-band imaging: An observational study. Gastrointest Endosc 2012; 76: 374-380 Epub 2012 Jun 12
• 143 Paggi S, Rondonotti E, Amato A. et al. Resect and discard strategy in clinical practice: A prospective cohort study. Endoscopy 2012; 44: 899-904 Epub 2012 Aug 2
• 144 Sakamoto T, Matsuda T, Aoki T. et al. Time saving with narrow-band imaging for distinguishing between neoplastic and non-neoplastic small colorectal lesions. J Gastroenterol Hepatol 2012; 27: 351-355
• 145 Hewett DG, Kaltenbach T, Sano Y. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterol Endosc 2012; 54: 3642
• 146 Repici A, Hassan C, Radaelli F. et al. Accuracy of narrow-band imaging in predicting colonoscopy surveillance intervals and histology of distal diminutive polyps: Results from a multicenter, prospective trial. Gastrointest Endosc 2013; 78: 106-114 Epub 2013 Apr 11
• 147 Singh R, Jayanna M, Navadgi S. et al. Narrow-band imaging with dual focus magnification in differentiating colorectal neoplasia. Dig Endosc 2013; 25 (Suppl. 02) 16-20
• 148 Ladabaum U, Fioritto A, Mitani A. et al. Real-time optical biopsy of colon polyps with narrow band imaging in community practice does not yet meet key thresholds for clinical decisions. Gastroenterology 2013; 144: 81-91 Epub 2012 Oct 3
• 149 Wallace MB, Crook JE, Coe S. et al. Accuracy of in vivo colorectal polyp discrimination by using dual-focus high-definition narrow-band imaging colonoscopy. Gastrointest Endosc 2014; 80: 1072-1087 Epub 2014 Jun 25
• 150 van den Broek FJC, Fockens P, Van Eeden S. et al. Clinical evaluation of endoscopic trimodal imaging for the detection and differentiation of colonic polyps. Clin Gastroenterol Hepatol 2009; 7: 288-295 Epub 2008 Oct 30
• 151 Sano Y, Ikematsu H, Fu KI. et al. Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc 2009; 69: 278-283 Epub 2008 Oct 25
• 152 Rex DK. Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology 2009; 136: 1174-1181 Epub 2008 Dec 10
• 153 Ignjatovic A, East JE, Guenther T. et al. What is the most reliable imaging modality for small colonic polyp characterization? Study of white-light, autofluorescence, and narrow-band imaging. Endoscopy 2011; 43: 94-99 Epub 2011 Jan 26
• 154 Henry ZH, Yeaton P, Shami VM. et al. Meshed capillary vessels found on narrow-band imaging without optical magnification effectively identifies colorectal neoplasia: a North American validation of the Japanese experience. Gastrointest Endosc 2010; 72: 118-1126 Epub 2010 Apr 9
• 155 Lee CK, Lee SH, Hwangbo Y. Narrow-band imaging versus I-Scan for the real-time histological prediction of diminutive colonic polyps: A prospective comparative study by using the simple unified endoscopic classification. Gastrointest Endosc 2011; 74: 603-609 Epub 2011 Jul 18
• 156 Kuiper T, Marsman WA, Jansen JM. et al. Accuracy for optical diagnosis of small colorectal polyps in nonacademic settings. Clin Gastroenterol Hepatol 2012; 10: 1016-1020 ; quiz e79. Epub 2012 May 18
• 157 Gupta N, Bansal A, Rao D. et al. Accuracy of in vivo optical diagnosis of colon polyp histology by narrow-band imaging in predicting colonoscopy surveillance intervals. Gastrointest Endosc 2012; 75: 494-502 Epub 2011 Oct 26
• 158 Chan JL, Lin L, Feiler M. et al. Comparative effectiveness of i-SCANTM and high-definition white light characterizing small colonic polyps. World J Gastroenterol 2012; 18: 5905-5911
• 159 Schachschal G, Mayr M, Treszl A. et al. Endoscopic versus histological characterisation of polyps during screening colonoscopy. Gut 2014; 63: 458-465 Epub 2013 Jun 28
• 160 Hoffman A, Sar F, Goetz M. et al. High definition colonoscopy combined with i-Scan is superior in the detection of colorectal neoplasias compared with standard video colonoscopy: A prospective randomized controlled trial. Endoscopy 2010; 42: 827-833 Epub 2010 Aug 27
• 161 Pigò F, Bertani H, Manno M. et al. i-Scan high-definition white light endoscopy and colorectal polyps: Prediction of histology, interobserver and intraobserver agreement. Int J Colorectal Dis 2013; 28: 399-406 Epub 2012 Sep 27
• 162 Hong SN, Choe WH, Lee JH. et al. Prospective, randomized, back-to-back trial evaluating the usefulness of i-SCAN in screening colonoscopy. Gastrointest Endosc 2012; 75: 1011-1021.e2 Epub 2012 Feb 28
• 163 Hoffman A, Kagel C, Goetz M. et al. Recognition and characterization of small colonic neoplasia with high-definition colonoscopy using i-Scan is as precise as chromoendoscopy. Dig Liver Dis 2010; 42: 45-50 Epub 2009 May 26
• 164 Togashi K, Osawa H, Koinuma K. et al. A comparison of conventional endoscopy, chromoendoscopy, and the optimal-band imaging system for the differentiation of neoplastic and non-neoplastic colonic polyps. Gastrointest Endosc 2009; 69: 734-741
• 165 Buchner AM, Shahid MW, Heckman MG. et al. Comparison of probe-based confocal laser endomicroscopy with virtual chromoendoscopy for classification of colon polyps. Gastroenterology 2010; 138: 834-842 Epub 2009 Nov 10
• 166 Pohl J, Lotterer E, Balzer C. et al. Computed virtual chromoendoscopy versus standard colonoscopy with targeted indigocarmine chromoscopy: A randomised multicentre trial. Gut 2009; 58: 73-78 Epub 2008 Oct 6
• 167 Dos Santos CEO, Lima JCP, Lopes CV. et al. Computerized virtual chromoendoscopy versus indigo carmine chromoendoscopy combined with magnification for diagnosis of small colorectal lesions: A randomized and prospective study. Eur J Gastroenterol Hepatol 2010; 11: 1364-1371
• 168 Kim YS, Kim D, Chung SJ. et al. Differentiating small polyp histologies using real-time screening colonoscopy with Fuji Intelligent Color Enhancement. Clin Gastroenterol Hepatol 2011; 9: 744-749.e1 Epub 2011 Jun 6
• 169 dos Santos CEO, Malaman D, Lopes CV. et al. Digital chromoendoscopy for diagnosis of diminutive colorectal lesions. Diagn Ther Endosc 2012; 2012: 279521 Epub 2012 Oct 3
• 170 Longcroft-Wheaton GR, Higgins B, Bhandari P. Flexible spectral imaging color enhancement and indigo carmine in neoplasia diagnosis during colonoscopy: A large prospective UK series. Eur J Gastroenterol Hepatol 2011; 23: 903-911
• 171 Longcroft-Wheaton G, Brown J, Cowlishaw D. et al. High-definition vs standard-definition colonoscopy in the characterization of small colonic polyps: Results from a randomized trial. Endoscopy 2012; 44: 905-910 Epub 2012 Aug 14
• 172 Paggi S, Rondonotti E, Amato A. et al. Narrow-band imaging in the prediction of surveillance intervals after polypectomy in community practice. Endoscopy 2015; 47: 808-814 Epub 2015 Jun 12
• 173 Patel SG, Schoenfeld P, Kim HM. et al. Real-time characterization of diminutive colorectal polyp histology using narrow-band imaging: implications for the resect and discard strategy. Gastroenterology 2016; 150: 406-418 Epub 2015 Oct 30.
• 174 Bae JH, Lee C, Kang HY. et al. Improved real-time optical diagnosis of colorectal polyps following a comprehensive training program. Clin Gastroenterol Hepatol 2019; pii: S1542-3565(19)30182-X. DOI: 10.1016/j.cgh.2019.02.019. [Epub ahead of print]
• 175 Klare P, Haller B, Wormbt S. et al. Narrow-band imaging vs. high definition white light for optical diagnosis of small colorectal polyps: A randomized multicenter trial. Endoscopy 2016; 48: 909-915 Epub 2016 Jul 22
• 176 Vu HT, Sayuk GS, Hollander TG. et al. Resect and discard approach to colon polyps: real-world applicability among academic and community gastroenterologists. Dig Dis Sci 2015; 60: 502-508 Epub 2014 Oct 7
• 177 Chandran S, Parker F, Lontos S. et al. Can we ease the financial burden of colonoscopy? Using real-time endoscopic assessment of polyp histology to predict surveillance intervals. Intern Med J 2015; 45: 1293-1299
• 178 Kaltenbach T, Rastogi A, Rouse RV. et al. Real-time optical diagnosis for diminutive colorectal polyps using narrow-band imaging: The VALID randomised clinical trial. Gut 2015; 64: 1569-1577 Epub 2014 Nov 11
• 179 Rees CJ, Rajasekhar PT, Wilson A. et al. Narrow band imaging optical diagnosis of small colorectal polyps in routine clinical practice: the Detect Inspect Characterise Resect and Discard 2 (DISCARD 2) study. Gut 2017; 66: 887-895
• 180 IJspeert JEG, Bastiaansen BAJ, Van Leerdam ME. et al. Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut 2016; 65: 963-670 Epub 2015 Mar 9
• 181 dos Santos C, Perez H, Mönkemüller K. et al. Observer agreement for diagnosis of colorectal lesions with analysis of the vascular pattern by image-enhanced endoscopy. Endosc Int Open 2015; 3: E240-245 Epub 2015 Apr 14
• 182 Bisschops R, Hassan C, Bhandari P. et al. BASIC (BLI Adenoma Serrated International Classification) classification for colorectal polyp characterization with blue light imaging. Endoscopy 2018; 50: 211-220 Epub 2017 Oct 24
• 183 Repici A, Ciscato C, Correale L. et al. Narrow-band Imaging International Colorectal Endoscopic Classification to predict polyp histology: REDEFINE study (with videos). Gastrointest Endosc 2016; 84: 479-486.e3 Epub 2016 Feb 27
• 184 Rastogi A, Rao DS, Gupta N. et al. Impact of a computer-based teaching module on characterization of diminutive colon polyps by using narrow-band imaging by non-experts in academic and community practice: A video-based study. Gastrointest Endosc 2014; 79: 390-398 Epub 2013 Sep 8
• 185 Sinh P, Gupta N, Rao DS. et al. Community gastroenterologists can learn diminutive colon polyp histology characterization with narrow band imaging by a computer-based teaching module. Dig Endosc 2015; 27: 374-380 Epub 2014 Dec 8
• 186 Dos Santos CEO, Malaman D, Yoshida N. et al. Blue laser imaging: a new image-enhanced endoscopy for the diagnosis of colorectal lesions. Eur J Gastroenterol Hepatol 2018; 30: 1514-1520
• 187 Smith SCL, Saltzman J, Shivaji UN. et al. Birmingham Colonic Polyp Characterisation Group. A randomized controlled study of the prediction of diminutive/small colorectal polyp histology using didactic vs. computer based self-learning module in gastroenterology trainees. Dig Endosc 2019; 31: 535-543 Epub 2019 Apr 8.
• 188 Iacucci M, Trovato C, Daperno M. et al. SIMPLE Classification Investigator Team. Development and validation of the SIMPLE endoscopic classification of diminutive and small colorectal polyps. Endoscopy 2018; 50: 779-789 Epub 2018 Mar 23
• 189 Kessler WR, Imperiale TF, Klein RW. et al. A quantitative assessment of the risks and cost savings of forgoing histologic examination of diminutive polyps. Endoscopy 2011; 43: 683-691 Epub 2011 May 27
• 190 Vleugels J, Greuter M, Hazewinkel Y. et al. Implementation of an optical diagnosis strategy saves costs and does not impair clinical outcomes of a fecal immunochemical test-based colorectal cancer screening program. Endosc Int Open 2017; 5: E1197-E1207 Epub 2017 Nov 22
• 191 Picot J, Rose M, Cooper K. et al. Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: A systematic review and economic evaluation. Health Technol Assess 2017; 21: 1-308
• 192 Solon C, Klausnitzer R, Blissett D. et al. Economic value of narrow band imaging versus white light endoscopy for the characterization of diminutive polyps in the colon: systematic literature review and cost-consequence model. J Med Econ 2016; 19: 1040-1048
• 193 Hassan C, Pickhardt PJ, Rex DK. A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening. Clin Gastroenterol Hepatol 2010; 8: 865-869. 869.e1-3 Epub 2010 Jun
• 194 Puig I, López-Cerón M, Arnau A. et al. Accuracy of the Narrow-band imaging International Colorectal Endoscopic Classification system in identification of deep invasion in colorectal polyps. Gastroenterology 2019; 156: 75-87
• 195 Bogie R, Veldman M, Snijders L. et al. Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis. Endoscopy 2018; 50: 263-282
• 196 Burgess NG, Hourigan LF, Zanati SA. et al. Risk stratification for covert invasive cancer among patients referred for colonic endoscopic mucosal resection: a large multicenter cohort. Gastroenterology 2017; 153: 732-742.e1
• 197 Bugajski M, Kaminski MF, Orlowska J. et al. Suspicious macroscopic features of small malignant colorectal polyps. Scand J Gastroenterol 2015; 50: 1261-1267
• 198 Backes Y, Moss A, Reitsma JB. et al. Narrow band imaging, magnifying chromoendoscopy, and gross morphological features for the optical diagnosis of t1 colorectal cancer and deep submucosal invasion: a systematic review and meta-analysis. Am J Gastroenterol 2017; 112: 54-64
• 199 Matsuda T, Fujii T, Saito Y. et al. Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 2008; 103: 2700-2706
• 200 Backes Y, Schwartz MP, Ter Borg F. et al. Multicentre prospective evaluation of real-time optical diagnosis of T1 colorectal cancer in large non-pedunculated colorectal polyps using narrow band imaging (the OPTICAL study). Gut 2019; 68: 271-279
• 201 Sumimoto K, Tanaka S, Shigita K. et al. Clinical impact and characteristics of the narrow-band imaging magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Gastrointest Endosc 2017; 85: 816-821
• 202 Komeda Y, Kashida H, Sakurai T. et al. Magnifying narrow band imaging (NBI) for the diagnosis of localized colorectal lesions using the Japan NBI Expert Team (JNET) Classification. Oncology 2017; 93 (Suppl. 01) 49-54
• 203 Minoda Y, Ogino H, Chinen T. et al. Objective validity of the Japan Narrow-band imaging Expert Team classification system for the differential diagnosis of colorectal polyps. Dig Endosc 2019; 31: 544-551 Epub 2019 May 7
• 204 Iwatate M, Sano Y, Tanaka S. et al. Validation study for development of the Japan NBI Expert Team classification of colorectal lesions. Dig Endosc 2018; 30: 642-551
• 205 Sumimoto K, Tanaka S, Shigita K. et al. Diagnostic performance of Japan NBI Expert Team classification for differentiation among noninvasive, superficially invasive, and deeply invasive colorectal neoplasia. Gastrointest Endosc 2017; 86: 700-709
• 206 Sakamoto T, Nakajima T, Matsuda T. et al. Comparison of the diagnostic performance between magnifying chromoendoscopy and magnifying narrow-band imaging for superficial colorectal neoplasms: an online survey. Gastrointest Endosc 2018; 87: 1318-1323
• 207 Kobayashi S, Yamada M, Takamaru H. et al. Diagnostic yield of the Japan NBI Expert Team (JNET) classification for endoscopic diagnosis of superficial colorectal neoplasms in a large-scale clinical practice database. United Eur Gastroenterol J 2019; 7: 914-923 Epub 2019 Apr 26
• 208 Kawaguti FS, Franco MC, Martins BC. et al. Role of magnification chromoendoscopy in the management of colorectal neoplastic lesions suspicious for submucosal invasion. Dis Colon Rectum 2019; 62: 422-428
• 209 Puig I, Mármol C, Bustamante M. Endoscopic imaging techniques for detecting early colorectal cancer. Curr Opin Gastroenterol 2019; 35: 432-439
• 210 Moss A, Williams SJ, Hourigan LF. et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64: 57-65
• 211 Belderbos TDG, Leenders M, Moons LMG. et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014; 46: 388-402
• 212 Atkin WS, Valori R, Kuipers EJ. et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition – Colonoscopic surveillance following adenoma removal. Endoscopy 2012; 44 (Suppl. 03) SE151-163
• 213 Lieberman DA, Rex DK, Winawer SJ. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
• 214 Khashab M, Eid E, Rusche M. et al. Incidence and predictors of “late” recurrences after endoscopic piecemeal resection of large sessile adenomas. Gastrointest Endosc 2009; 70: 344-349
• 215 Desomer L, Tutticci N, Tate DJ. et al. A standardized imaging protocol is accurate in detecting recurrence after EMR. Gastrointest Endosc 2017; 85: 518-526
• 216 Kandel P, Brand EC, Pelt J. et al. Endoscopic scar assessment after colorectal endoscopic mucosal resection scars: when is biopsy necessary (EMR Scar Assessment Project for Endoscope (ESCAPE) trial). Gut 2019; 68: 1633-1641 Epub 2019 Jan 11
• 217 Riu Pons F, Andreu M, Gimeno Beltran J. et al. Narrow band imaging and white light endoscopy in the characterization of a polypectomy scar: A single-blind observational study. World J Gastroenterol 2018; 24: 5179-5188
• 218 Knabe M, Pohl J, Gerges C. et al. Standardized long-term follow-up after endoscopic resection of large, nonpedunculated colorectal lesions: a prospective two-center study. Am J Gastroenterol 2014; 109: 183-189
• 219 Topol EJ. High-performance medicine: the convergence of human and artificial intelligence. Nat Med 2019; 25: 44-56
• 220 East JE, Rees CJ. Making optical biopsy a clinical reality in colonoscopy. Lancet Gastroenterol Hepatol 2018; 3: 10-12
• 221 High-Level Expert Group on Artificial Intelligence. Ethics guidelines for trustworthy AI. Available at: https://ec.europa.eu/digital-single-market/en/news/ethics-guidelines-trustworthy-ai Accessed: Jul 1 2019
• 222 Mahmud N, Cohen J, Tsourides K. et al. Computer vision and augmented reality in gastrointestinal endoscopy. Gastroenterol Rep 2015; 3: 179-184
• 223 Lee CK, Park l DI, Lee S-H. et al. Participation by experienced endoscopy nurses increases the detection rate of colon polyps during a screening colonoscopy: a multicenter, prospective, randomized study. Gastrointest Endosc 2011; 74: 1094-1102
• 224 Buchner AM, Shahid MW, Heckman MG. et al. Trainee participation is associated with increased small adenoma detection. Gastrointest Endosc 2011; 73: 1223-1231
• 225 Aslanian HR, Shieh FK, Chan FW. et al. Nurse observation during colonoscopy increases polyp detection: a randomized prospective study. Am J Gastroenterol 2013; 108: 166-172
• 226 Mori Y, Kudo S, Berzin T. et al. Computer-aided diagnosis for colonoscopy. Endoscopy 2017; 49: 813-819
• 227 Urban G, Tripathi P, Alkayali T. et al. Deep learning localizes and identifies polyps in real time with 96% accuracy in screening colonoscopy. Gastroenterology 2018; 155: 1069-1078.e8 Epub 2018 Jun 18
• 228 Wang Y, Tavanapong W, Wong J. et al. Polyp-Alert: Near real-time feedback during colonoscopy. Comput Methods Programs Biomed 2015; 120: 164-179
• 229 Mori Y, Kudo S-E, Mohmed HEN. et al. Artificial intelligence and upper gastrointestinal endoscopy: Current status and future perspective. Dig Endosc 2018; 31: 378-388 Epub 2019 Feb 14
• 230 Kudo S, Mori Y, Misawa M. et al. Artificial intelligence and colonoscopy: Current status and future perspectives. Dig Endosc 2019; 31: 363-371 Epub 2019 Feb 27
• 231 Wang P, Berzin TM, Glissen Brown JR. et al. Real-time automatic detection system increases colonoscopic polyp and adenoma detection rates: a prospective randomised controlled study. Gut 2019; 68: 1813-1819 Epub 2019 Feb 27
• 232 Figueiredo P, Figueiredo I, Pinto L. et al. Polyp detection with computer-aided diagnosis in white light colonoscopy: comparison of three different methods. Endosc Int Open 2019; 07: E209-215
• 233 Byrne MF, Chapados N, Soudan F. et al. Real-time differentiation of adenomatous and hyperplastic diminutive colorectal polyps during analysis of unaltered videos of standard colonoscopy using a deep learning model. Gut 2019; 68: 94-100
• 234 Chen PJ, Lin MC, Lai MJ. et al. Accurate classification of diminutive colorectal polyps using computer-aided analysis. Gastroenterology 2018; 154: 568-575 Epub 2017 Oct 16
• 235 Mori Y, Kudo S, Misawa M. et al. Real-time use of artificial intelligence in identification of diminutive polyps during colonoscopy. Ann Intern Med 2018; 169: 357-366
• 236 Misawa M, Kudo S-E, Mori Y. et al. Accuracy of computer-aided diagnosis based on narrow-band imaging endocytoscopy for diagnosing colorectal lesions: comparison with experts. Int J Comput Assist Radiol Surg 2017; 12: 757-766
• 237 Ichimasa K, Kudo S, Mori Y. et al. Artificial intelligence may help in predicting the need for additional surgery after endoscopic resection of T1 colorectal cancer. Endoscopy 2018; 50: 230-240
• 238 Ito N, Kawahira H, Nakashima H. et al. Endoscopic diagnostic support system for ct1b colorectal cancer using deep learning. Oncology 2019; 96: 44-50
• 239 Lui TKL, Wong KKY, Mak LLY. et al. Endoscopic prediction of deeply submucosal invasive carcinoma with use of artificial intelligence. Endosc Int Open 2019; 7: E514-E520
• 240 Ozawa T, Ishihara S, Fujishiro M. et al. Novel computer-assisted diagnosis system for endoscopic disease activity in patients with ulcerative colitis. Gastrointest Endosc 2019; 89: 416-421.e1
• 241 Kominami Y, Yoshida S, Tanaka S. et al. Computer-aided diagnosis of colorectal polyp histology by using a real-time image recognition system and narrow-band imaging magnifying colonoscopy. Gastrointest Endosc 2016; 83: 643-649
• 242 Rath T, Tontini G, Vieth M. et al. In vivo real-time assessment of colorectal polyp histology using an optical biopsy forceps system based on laser-induced fluorescence spectroscopy. Endoscopy 2016; 48: 557-562
• 243 Kuiper T, Alderlieste Y, Tytgat K. et al. Automatic optical diagnosis of small colorectal lesions by laser-induced autofluorescence. Endoscopy 2014; 47: 56-62
• 244 Klare P, Sander C, Prinzen M. et al. Automated polyp detection in the colorectum: a prospective study (with videos). Gastrointest Endosc 2019; 89: 576-582.e1
• 245 Aihara H, Saito S, Inomata H. et al. Computer-aided diagnosis of neoplastic colorectal lesions using ‘real-time’ numerical color analysis during autofluorescence endoscopy. Eur J Gastroenterol Hepatol 2013; 25: 488-494
• 246 Cabitza F, Rasoini R, Gensini GF. Unintended consequences of machine learning in medicine. JAMA 2017; 318: 517-518
• 247 Povyakalo AA, Alberdi E, Strigini L. et al. How to discriminate between computer-aided and computer-hindered decisions: a case study in mammography. Med Decis Making 2013; 33: 98-107
• 248 Tsai TL, Fridsma DB, Gatti G. Computer decision support as a source of interpretation error: the case of electrocardiograms. J Am Med Inform Assoc 2003; 10: 478-83
• 249 Ross C, Swetlitz I. IBM’s Watson supercomputer recommended ‘unsafe and incorrect’ cancer treatments, internal documents show. Stat News. 2018 https://www.statnews.com/wp-content/uploads/2018/09/IBMs-Watson-recommended-unsafe-and-incorrect-cancer-treatments-STAT.pdf
• 250 Mori Y, Kudo S. Detecting colorectal polyps via machine learning. Nat Biomed Eng 2018; 2: 713-714
• 251 Vinsard DG, Mori Y, Misawa M. et al. Quality assurance of computer-aided detection and diagnosis in colonoscopy. Gastrointest Endosc 2019; 90: 55-63 Epub 2019 Mar 26
• 252 Rajkomar A, Dean J, Kohane I. Machine learning in medicine. N Engl J Med 2019; 380: 1347-1358