How Can Olympus Technology Help to Reduce Biopsies?

NBI has been vastly studied to assess its capability to detect and diagnose gastrointestinal lesions: The diagnostic accuracy of NBI for colorectal lesions has been shown to be >90%. 7,8,9 Dual Focus raised the ratio of high-confidence decisions. 9 Thus, NBI with Dual Focus may help to reduce the need to biopsy lesions prior to treatment.

NBI proved to be a reliable modality for targeted biopsy in Barrett’s Esophagus – identifying more neoplasia but using significantly less biopsies. 10,11 Although, biopsy cannot be avoided completely, NBI may thus improve quality and cost-effectiveness of Barrett’s Esophagus surveillance.

European and American gastroenterology societies endorsed the use of NBI for optical diagnosis of colorectal polyps (ESGE, ASGE, and NICE) (25,26,48) and targeted biopsy in Barrett's Esophagus surveillance (ASGE). 46 Also for other gastrointestinal indications, NBI targeted biopsy is investigated and seems to be a promising tool to improve clinical outcomes. 12,13

What Issues Exist with Biopsies?

Biopsies are only small interventions bearing a minimum risk for the patient 1 , but this may differ for patients medicated with anticoagulants. 1 Taken together, biopsies are valuable for risk stratification with very low complication ratios. Their biggest drawback is cost for the histological examination.

According to current guidelines, biopsies are randomly taken in Barrett’s Esophagus surveillance, stomach, and CRC high-risk patients (e.g. IBD). 2,3,4 Most of these biopsies do not contain dysplastic tissue, since they are not targeted, leading to high costs with moderate detection capability, warranting a more efficient modality. 5,6

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"NBI is the only virtual chromoendoscopy that uses an internationally validated and acknowledged classification system – the NICE classification – and is ready to be used in daily clinical practice."

Prof. Thierry Ponchon
Edouard Herriot Hospital
Head of Department, Dept. of Digestive Diseases
Lyon, France

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Clinical Studies

  1. 1.Update on Endoscopic Tissue Sampling Devices. Technology Assessment Committe et al. Gastrointest Endosc. 2006 May;63(6):741-5.
  2. 2.The Role of Endoscopy in Barrett‘s Esophagus and Other Premalignant Conditions of the Esophagus. ASGE Standards of Practice Committee, Evans JA et al. Gastrointest Endosc. 2012 Dec;76(6):1087-94. doi: 10.1016/j.gie.2012.08.004.
  3. 3.American Gastroenterological Association Institute Guideline on the Role of Upper Gastrointestinal Biopsy to Evaluate Dyspepsia in the Adult Patient in the Absence of Visible Mucosal Lesions Yang YX, Brill J et al. Gastroenterology. 2015 Oct;149(4):1082-7. doi: 10.1053/j.gastro.2015.07.039. Epub 2015 Aug 14.
  4. 4.The Role of Endoscopy in Inflammatory Bowel Disease American Society for Gastrointestinal Endoscopy Standards of Practice Committee et al. Gastrointest Endosc. 2015 May;81(5):1101-21.e1-13. doi: 10.1016/j. ie.2014.10.030. Epub 2015 Mar 20.
  5. 5.The Seattle Protocol Does Not More Reliably Predict the Detection of Cancer at the Time of Esophagectomy Than a Less Intensive Surveillance Protocol Kariv R, Plesec TP et al. Clin Gastroenterol Hepatol. 2009 Jun;7(6):653-8; quiz 606. doi: 10.1016/j. cgh.2008.11.024. Epub 2008 Dec 13.
  6. 6.Random Biopsies Taken During Colonoscopic Surveillance of Patients with Longstanding Ulcerative Colitis: Low Yield and Absence of Clinical Consequences van den Broek FJ, Stokkers PC et al. Am J Gastroenterol. 2014 May;109(5):715-22. doi: 10.1038/ajg.2011.93. Epub 2011 Mar 22.
  7. 7.Validation of a Simple Classification System for Endoscopic Diagnosis of Small Colorectal Polyps Using Narrow-Band Imaging Hewett DG, Kaltenbach T et al. Gastroenterology. 2012 Sep;143(3):599-607.e1. doi:
    10.1053/j.gastro.2012.05.006. Epub 2012 May 15.
  8. 8.Endoscopic Prediction of Deep Submucosal Invasive Carcinoma: Validation of the Narrow-Band Imaging International Colorectal Endoscopic (NICE) Classification Hayashi N, Tanaka S et al. Gastrointest Endosc. 2013 Oct;78(4):625-32. doi: 10.1016/j.gie.2013.04.185. Epub 2013 Jul 30.
  9. 9.Narrow-Band Imaging with Dual Focus Magnification in Differentiating Colorectal Neoplasia Singh R, Jayanna M et al. Dig Endosc. 2013 May;25 Suppl 2:16-20. doi: 10.1111/den.12075.
  10. 10.Standard Endoscopy with Random Biopsies Versus Narrow Band Imaging Targeted Biopsies in Barrett‘s Oesophagus: A Prospective, International, Randomised Controlled Trial Sharma P, Hawes RH et al. Gut. 2013 Jan;62(1):15-21. doi: 10.1136/gutjnl-2011-300962. Epub 2012 Feb 7.
  11. 11.Advanced Imaging Technologies Increase Detection of Dysplasia and Neoplasia in Patients with Barrett‘s Esophagus: A Meta-Analysis and Systematic Review Qumseya BJ, Wang H et al. Clin Gastroenterol Hepatol. 2013 Dec;11(12):1562-70.e1-2. doi: 10.1016/j. cgh.2013.06.017. Epub 2013 Jul 12.
  12. 12.White-Light or Narrow-Band Imaging Colonoscopy in Surveillance of Ulcerative Colitis: A Prospective Multicenter Study Leifeld L, Rogler G et al. Clin Gastroenterol Hepatol. 2015 Oct;13(10):1776-1781.e1. doi: 10.1016/j. cgh.2015.04.172. Epub 2015 May 5.
  13. 13.Narrow Band Imaging with Magnification Endoscopy for Celiac Disease: Results from a Prospective, Single-Center Study De Luca L, Ricciardiello L et al. Diagn Ther Endosc. 2013;2013:580526. doi: 10.1155/2013/580526. Epub 2013 Aug 6.
  14. 14.Adenoma Detection Rate and Risk of Colorectal Cancer and Death van den Broek E, Richard W et al. N Engl J Med. 2014 Apr 3;370(14):1298-306
  15. 15.Improving Measurement of the Adenoma Detection Rate and Adenoma Per Colonoscopy Quality Metric: The Indiana University Experience Kahi CJ, Vemulapalli KC et al. Gastrointest Endosc. 2014 Mar;79(3):448-54.
  16. 16.Impact of Bowel Preparation with Low-Volume (2-Liter) and Intermediate-Volume (3-Liter) Polyethylene Glycol on Colonoscopy Quality: A Prospective Observational Study Cheng CL, Kuo YL et al. Digestion. 2015;92(3):156-64.
  17. 17.Adenoma Detection Rate Is not Influenced by the Timing of Colonoscopy When Performed in Half-Day Blocks Gurudu SR, Ratuapli SK et al. Am J Gastroenterol. 2011 Aug;106(8):1466-71. doi: 10.1038/ajg.2011.125. Epub 2011 Apr 19.
  18. 18.A Patient-Blinded Randomized, Controlled Trial Comparing Air Insufflation, Water Immersion, and Water Exchange During Minimally Sedated Colonoscopy Hsieh YH, Koo M et al. Am J Gastroenterol. 2014 Sep;109(9):1390-400. doi: 10.1038/ajg.2014.126. Epub 2014 Jun 3.
  19. 19.High Definition Colonoscopy vs. Standard Video Endoscopy for the Detection of Colonic Polyps: A Meta-Analysis Subramanian V, Mannath J et al. Endoscopy. 2011 Jun;43(6):499-505. doi: 10.1055/s-0030-1256207. Epub 2011 Feb 28.
  20. 20.Detection of Colorectal Adenoma by Narrow Band Imaging (HQ190) vs. High-Definition White Light Colonoscopy: A Randomized Controlled Trial Leung WK, Lo OS et al. Am J Gastroenterol. 2014 Jun;109(6):855-63. doi: 10.1038/ajg.2014.83. Epub 2014 Apr 22.
  21. 21.Next-Generation Narrow Band Imaging System for Colonic Polyp Detection: A Prospective Multicenter Randomized Trial Horimatsu T, Sano Y et al. Int J Colorectal Dis. 2015 Jul;30(7):947-54. doi: 10.1007/s00384-015-2230-x. Epub 2015 Apr 30.
  22. 22.Narrow Band Imaging to Differentiate Neoplastic and Non-Neoplastic Colorectal Polyps in Real Time: A Meta-Analysis of Diagnostic Operating Characteristics McGill SK, Evangelou E et al. Gut. 2013 Dec;62(12):1704-13. doi: 10.1136/gutjnl-2012-303965. Epub 2013 Jan 7.
  23. 23.Diagnostic Performance of Narrowed Spectrum Endoscopy, Autofluorescence Imaging, and Confocal Laser Endomicroscopy for Optical Diagnosis of Colonic Polyps: A Meta-Analysis Wanders LK, East JE et al. Lancet Oncol. 2013 Dec;14(13):1337-47. doi: 10.1016/S1470-2045(13)70509-6. Epub 2013 Nov 13.
  24. 24.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 ASGE Technology Committee et al. Gastrointest Endosc. 2015 Mar;81(3):502.e1-502.e16. doi:
    10.1016/j.gie.2014.12.022. Epub 2015 Jan 16.
  25. 25.Real-Time Optical Diagnosis for Diminutive Colorectal Polyps Using Narrow-Band Imaging: The VALID Randomised Clinical Trial Kaltenbach T, Rastogi A et al. Gut. 2015 Oct;64(10):1569-77. doi: 10.1136/gutjnl-2014-307742. Epub 2014 Nov 11.
  26. 26.Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019 Bisshops et al. Endoscopy 2019; 51: 1155–1179
  27. 27.An Analysis of the Learning Curve to Achieve Competency at Colonoscopy Using the JETS Database Ward ST, Mohammed MA et al. Gut. 2014 Nov;63(11):1746-54. doi: 10.1136/gutjnl-2013-305973. Epub 2014 Jan 27.
  28. 28.Patient Pain During Colonoscopy: An Analysis Using Real-Time Magnetic Endoscope Imaging Shah SG, Brooker JC et al. Endoscopy. 2002 Jun;34(6):435-40.
  29. 29.Magnetic Endoscopic Imaging Versus Standard Colonoscopy in a Routine Colonoscopy Setting: A Randomized, Controlled Trial. Holme Ö, Höie O et al. Gastrointest Endosc. 2011 Jun;73(6):1215-22. doi: 10.1016/j.gie.2011.01.054. Epub 2011 Apr 8.
  30. 30.Magnetic Endoscopic Imaging Versus Standard Colonoscopy: Meta-Analysis of Randomized Controlled Trials Chen Y, Duan YT et al. World J Gastroenterol. 2013 Nov 7;19(41):7197-204. doi: 10.3748/wjg.v19.i41.7197.
  31. 31.Magnetic Endoscopic Imaging as an Adjuvant to Elective Colonoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Mark-Christensen A et al. Endoscopy. 2015 Mar;47(3):251-61. doi: 10.1055/s-0034-1390767. Epub 2014 Dec 18.
  32. 32.Does “Responsive Insertion Technology” Improve Practice of Colonoscopy? Results of a Randomized Study Cuesta R, Sola-Vera J et al. Scand J Gastroenterol. 2014 Mar;49(3):355-61. doi:
    10.3109/00365521.2013.871576. Epub 2014 Jan 13.
  33. 33.Conscious Sedation and Analgesia in Colonoscopy [...] Khajavi M, Emami A et al. Anesth Pain Med. 2013 Summer;3(1):208-13. doi: 10.5812/aapm.9653. Epub 2013 Jul 1.
  34. 34.Safety Analysis of Endoscopist-Directed [...] Sieg A; bng-Study-Group et al. Sieg A; bng-Study-Group et al.
  35. 35.Position Change During Colonoscope Withdrawal Increases Polyp and Adenoma Detection in the Right but not in the Left Side of the Colon: Results of a Randomized Controlled Trial Ball AJ, Johal SS et al. Gastrointest Endosc. 2015 Sep;82(3):488-94. doi: 10.1016/j.gie.2015.01.035. Epub 2015 Apr 22.
  36. 36.Variable Stiffness Colonoscope Versus Regular Adult Colonoscope: Meta-Analysis of Randomized Controlled Trials Othman MO, Bradley AG et al. Endoscopy. 2009 Jan;41(1):17-24. doi: 10.1055/s-0028-1103488. Epub 2009 Jan 21.
  37. 37.[...] Sedation for Colonoscopy with a New Ultrathin or a Standard Endoscope: A Prospective Randomized Controlled Study Töx U, Schumacher B et al. Endoscopy. 2013 Jun;45(6):439-44. doi: 10.1055/s-0032-1326270. Epub 2013 Mar 6.
  38. 38.Long-Term Colorectal-Cancer Incidence and Mortality after Lower Endoscopy Nishihara R, Wu K et al. N Engl J Med. 2013 Sep 19;369(12):1095-105. doi: 10.1056/NEJMoa1301969
  39. 39.The Comparative Cost-Effectiveness of Colorectal Cancer Screening Using Faecal Immunochemical Test Versus Colonoscopy Wong MC, Ching JY et al. Sci Rep. 2015 Sep 4;5:13568. doi: 10.1038/srep13568.
  40. 40.Trends in Adenoma Detection Rates During the First 10 Years of the German Screening Colonoscopy Program Brenner H, Altenhofen L et al. Gastroenterology. 2015 Aug;149(2):356-66.e1. doi:
    10.1053/j.gastro.2015.04.012. Epub 2015 Apr 22.
  41. 41.Global Epidemiology of Barrett‘s Esophagus https://www.ncbi.nlm.nih.gov/pubmed/21309677 Expert Rev Gastroenterol Hepatol. 2011 Feb;5(1):123-30. doi: 10.1586/egh.10.82.
  42. 42.Cost Considerations in Implementing a Screening and Surveillance Strategy for Barrett‘s Oesophagus Inadomi JM. Best Pract Res Clin Gastroenterol. 2015 Feb;29(1):51-63. doi: 10.1016/j. bpg.2014.12.002. Epub 2014 Dec 18.
  43. 43.Preliminary Feasibility Study Using a Novel Narrow-Band Imaging System with Dual Focus Magnification Capability in Barrett‘s Esophagus: Is the Time Ripe to Abandon Random Biopsies? Singh R, Shahzad MA et al. Dig Endosc. 2013 May;25 Suppl 2:151-6. doi: 10.1111/den.12106.
  44. 44.Carbon Dioxide Insufflation Versus Conventional Air Insufflation for Colonoscopy: A Systematic Review and Meta-Analysis of Published Randomized Controlled Trials Sajid MS, Caswell J et al. Sajid MS, Caswell J et al.
  45. 45.Reduced Pain During Screening Colonoscopy with an Ultrathin Colonoscope: A Randomized Controlled Trial Garborg KK, Løberg M et al. Endoscopy. 2012 Aug;44(8):740-6. doi: 10.1055/s-0032-1309755. Epub 2012 May 23.
  46. 46.ASGE guideline on screening and surveillance of Barrett's esophagus Qumseya et al. Gastrointest Endosc. 2019 Sep;90(3):335-359.e2.
  47. 47.Longer Withdrawal Time Is Associated With a Reduced Incidence of Interval Cancer After Screening Colonoscopy. Shaukat A, Rector TS et al. Gastroenterology 2015 Jul 9 (ahead of print)
  48. 48.Virtual chromoendoscopy to assess colorectal polyps during colonoscopy Newland A, Kroese M, Akehurst R, Bagshaw J et al. NICE National Institute for Health and Care Excellence, United Kingdom
  49. 49.Narrow-Band Imaging for Detection of Neoplasia at Colonoscopy: A Meta-analysis of Data From Individual Patients in Randomized Controlled Trials Atkinson et al. Gastroenterology 2019 Aug;157(2):462-471.
  50. 50.Impact of 2 generational improvements in colonoscopes on adenoma miss rates: results of a prospective randomized multicenter tandem study Pioche et al. Gastrointest Endosc. 2018 Jul;88(1):107-116.

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