With the emergence of image-enhanced endoscopy (IEE), it is no longer difficult to
visualize the microvasculature in the gastrointestinal (GI) tract [1]
[2]. Magnifying Blue Light Imaging (BLI; Fujifilm, Tokyo, Japan) provides enhanced images
of superficial vessels in the GI tract as hemoglobin absorbs light with a narrow wavelength.
A substantial number of studies using Blue Light Imaging have been conducted, but
none of them have focused on its advantage in visualizing the dynamic microvascular
architecture with the microcirculation of red blood cells.
We attempted to visualize the microcirculation in the GI tract using magnifying Blue
Light Imaging ([Video 1], [Fig. 1]). We used the distal attachment or soft hood to stabilize the distance between the
tip of the scope and mucosal surface, as previously reported by Yao et al. [3]. We used the zoom function, which provided up to approximately 135 times magnification.
In addition to using the cap, we observed the mucosa underwater to obtain clearer
images. In the esophagus, intrapapillary capillary loops were observed at the end
of long branching mucosal vessels [4]. In the duodenum and ileum, a loop-like formation of the capillary network was observed
within the villi. In the colon, a honeycomb-like subepithelial capillary network was
observed [3]. In the rectum, distinctly different from the colon, long branching vessels were
heterogeneously distributed with various densities. Using magnifying Blue Light Imaging,
it was possible to visualize the microcirculation owing to the rapid movement of red
blood cells in the capillaries. The use of a cap and water was significant.
Video 1 Endoscopic dynamic visualization of the microcirculation in the gastrointestinal
mucosa using magnifying Blue Light Imaging.
Fig. 1 Microcirculation was visualized as dynamic movement of blood cells in the capillary
network within the gastrointestinal mucosa. a Ileum. b Duodenum. c Stomach. d Rectum.
Utilizing the technique described here, analysis of the microcirculation is possible,
thereby suggesting a new approach that could be used to investigate the pathology
of diseases such as inflammatory bowel disease, functional GI disorders, and celiac
disease.
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AH
Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high quality video and all
contributions are freely accessible online. Processing charges apply (currently EUR
375), discounts and wavers acc. to HINARI are available.
This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos