Introduction
A double-balloon enteroscope was introduced in 2001, enabling comprehensive endoscopic examination of the entire small bowel and significantly enhancing the diagnostic utility for small bowel lesions. The advent of technologies such as double-balloon enteroscopy (DBE) and capsule endoscopy has represented a major advancement over recent decades. The novel double-balloon enteroscope EN-840T is equipped with image-enhanced endoscopy (IEE) technologies, including blue laser imaging (BLI) and linked color imaging (LCI). In clinical practice, BLI and LCI are frequently used for esophagogastroduodenoscopy and colonoscopy. However, because conventional double-balloon enteroscopes lack IEE functionality, the efficacy of IEE for detecting small bowel lesions, apart from those in the duodenum, has not yet been reported. In this study, we aimed to evaluate the efficacy of a novel double-balloon enteroscope for enhancing the visibility of small bowel lesions.
Aims & Methods
This single-center retrospective study was conducted at Hiroshima University Hospital and included 49 patients (30 men and 19 women; median age, 55 years; range, 15–89 years) who underwent DBE using EN-840T between March and July 2024. The DBE insertion was performed antegrade in 20 patients, retrograde in 20, and via both routes in nine patients. Lesion visibility and color differences were compared among BLI, LCI, and white light imaging (WLI). The primary and secondary outcomes were the visibility of small bowel lesions on IEE and color differences in these lesions, respectively. Lesion visibility was assessed by five endoscopists, who assigned visibility scores. Additionally, color differences in each IEE and WLI image between normal mucosa and the small reddish lesions, defined as patchy reddish lesions <5 mm in diameter, including angioectasia and erythema, were quantified using the CIE Lab* color space system.
Results
Lesions were classified as inflammatory (n=71 [ulcerations, n=29; erythema, n=25; erosions, n=17]), tumorous (n=39), and vascular (n=10). Notably, LCI did not yield any lesions with decreased visibility compared to WLI. The visibility score improved for most lesions with LCI , including vascular lesions (80%), erythema (80%), erosions (76%), tumorous lesions (72%), and ulcerations (69%). In contrast, BLI demonstrated visibility scores equivalent to those of WLI for the majority of lesions, including vascular lesions (80%), erythema (76%), ulcerations (72%), tumorous lesions (72%), and erosions (65%).
Given the high visibility of vascular lesions and erythema in LCI, we further examined the color differences in small reddish lesions (N=33 [angioectasia, n=8; erythema, n=25]). For angioectasia, the color difference in LCI was significantly higher than that in WLI (25.2 ± 1.83 vs. 20.6 ± 2.14, P < 0.001). Similarly, for erythema, the color difference in LCI was significantly higher than that observed in WLI (25.3 ± 2.25 vs. 19.8 ± 1.82, P < 0.001). Overall, the color difference for all reddish lesions was significantly higher with LCI than with WLI (25.3 ± 2.07 vs. 20.1 ± 1.91, P < 0.001). In contrast, no significant difference in color difference was observed between BLI and WLI.
Conclusion
IEE using a novel EN-840T enteroscope enhanced the visibility of small bowel lesions. Specifically, LCI improved lesion visibility and may contribute to the detection of small lesions.
Disclosure
We have no conflicts of interests.
