Narrow band imaging (NBI) endoscopy is an optical image enhancing technology that allows a detailed inspection of vascular and mucosal patterns, providing the ability to predict histology during real-time endoscopy. By combining NBI with magnification endoscopy (NBI-ME), the accurate assessment of lesions in the gastrointestinal tract can be achieved, as well as the early detection of neoplasia by emphasizing neovascularization. Promising results of the method in the diagnosis of premalignant and malignant lesions of gastrointestinal tract have been reported in clinical studies. The usefulness of NBI-ME as an adjunct to endoscopic therapy in clinical practice, the potential to improve diagnostic accuracy, surveillance strategies and cost-saving strategies based on this method are summarized in this review. Various classification systems of mucosal and vascular patterns used to differentiate preneoplastic and neoplastic lesions have been reviewed. We concluded that the clinical applicability of NBI-ME has increased, but standardization of endoscopic criteria and classification systems, validation in randomized multicenter trials and training programs to improve the diagnostic performance are all needed before the widespread acceptance of the method in routine practice. However, published data regarding the usefulness of NBI endoscopy are relevant in order to recommend the method as a reliable tool in diagnostic and therapy, even for less experienced endoscopists.

Background & Aims: Over the past few decades, the incidence of adenocarcinomas of the gastroesophageal junction has rapidly increased. Barrett's esophagus is a risk factor for esophageal adenocarcinoma, but the role of intestinal metaplasia of the gastric cardia as a precursor in cardia-related cancer is controversial. The aims of the present study were to examine the prevalence of intestinal metaplasia in the gastroesophageal junction and to evaluate the clinical, endoscopical and histological features of patients with intestinal metaplasia in the gastric cardia and patients with Barrett's esophagus.Methods: 286 consecutive patients undergoing gastroduodenoscopy were enrolled in a prospective study. Biopsy specimens were performed in the distal esophagus, squamocolumnar junction, gastric cardia, gastric corpus and antrum.Results: We identified 44 patients (15.3%) with intestinal metaplasia in biopsies from gastric cardia and 24 patients (8.3%) with Barrett's esophagus. Cardia intestinal metaplasia was significantly associated with older age (p=0.03), with intestinal metaplasia in the antrum (p=0.017) and H. pylori infection (p<0.0001). Severe chronic cardia inflammation increased the presence of cardia intestinal metaplasia 6.2 fold (OR=6.288; p<0.0001). Patients with Barrett's esophagus were predominantly men. Barrett's esophagus presence significantly correlated with reflux symptoms(p<0.0001), endoscopic esophagitis (p<0.0001) and hiatal hernia >2 cm (p=0.002). No patient had dysplasia in the gastroesophageal region.Conclusions: Presence of intestinal metaplasia at the gastroesophageal region correlated with reflux symptoms and endoscopic signs of reflux disease in patients with Barrett's esophagus and with H.pylori infection and distal intestinal metaplasia in patients with cardia intestinal metaplasia.Abbreviations: BE- Barrett_s esophagus; CIM- cardia intestinal metaplasia; CLE- columnar lined esophagus; GEJ- gastroesophageal junction; GERD - gastroesophageal reflux disease; IM- intestinal metaplasia; LSBE- long segment Barrett's esophagus; SCJ - squamocolumnar junction; SSBE- short segment Barrett's esophagus; USSBE- ultrashort segment Barrett's esophagus.

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Background: The clinical utility of non-invasive markers in the diagnosis and monitoring of ulcerative colitis (UC) has been intensively studied. The aim of our study was to evaluate the value of fecal calprotectin (FC) in differentiating between UC and irritable bowel syndrome (IBS), and in estimating inflammatory activity in UC. Method: A total number of 140 patients were included in the study. All patients underwent ileocolonoscopy with biopsies, quantitative determination of FC, and blood tests (white blood cell count, CRP, ESR). The severity of UC was assessed by using the Ulcerative Colitis Disease Activity Index (UCDAI) and Mayo endoscopic score. Results: In patients with active UC the mean values of FC were 373.8 +/- 146.3 μg/g, significantly higher than those in the inactive UC (mean values 36.04 +/- 13.25 μg/g), and in IBS (42.9 +/- 16.00 μg/g). In univariate regression analysis, elevated FC levels strongly correlated with pancolitis (p=0.0001), UCDAI and Mayo scores (p=0.0001), and elevated CRP levels. In multivariate regression model, FC was positively associated with severe pancolitis, and elevated CRP. The optimal cutoff value of FC for the prediction of severe pancolitis (Mayo score˃ 3) was 540 μg/g. We obtained 71.4% sensitivity (CI95%: 41.95-91.6) and 96.1% specificity (CI95%: 89.2 -99.2) of FC in assessing the severity of inflammation in UC patients. Conclusion: FC is a promising marker that can be used in clinical practice to select patients with organic intestinal disorders, compared with those with functional disorders. It also correlates very well with the extent of lesions and the severity of clinical symptoms in UC, with increased sensitivity and specificity.

The diagnosis of dysplasia and early neoplasia in Barrett's esophagus by conventional endoscopy is based on a four-quadrant random biopsies protocol that is prone to sampling errors. Novel endoscopic techniques have been developed to enhance the detection of premalignant and malignant lesions by real time assessment of microvasculare architecture and mucosal structure. Chromoendoscopy with magnification has improved the visualization of lesions, but the dye application impairs a clear evaluation of vascular network. Narrow band imaging endoscopy enhances vascular imaging by using narrow bandwidth lights, with penetration to superficial mucosal structures. Different classification systems of mucosal and vascular patterns have been developed to improve the diagnostic accuracy of non-dysplastic and dysplastic BE, as well as of early esophageal cancer. This article is focused on both the clinical benefits and controversies surrounding conventional and advanced endoscopic methods used for screening and surveillance of patients with Barrett's esophagus. Current evidence shows that the adoption of new technology in routine practice requires a high level of performance as well as the standardization of various classification systems.

Background and Aim: Gastric intestinal metaplasia represents a risk factor for intestinal type of gastric cancer. Gastric intestinal metaplasia seems to be associated with Helicobacter pilory infection in relatives of patients with gastric cancer. The aim of this study was to determine the prevalence, clinical, endoscopic and histological features of gastric intestinal metaplasia. Material and Methods: We retrospectively analyzed the esophagogastroduodenoscopies with biopsies performed between January 1, 2014 and October 31, 2014. Collected and analyzed data included age, gender, symptoms, endoscopic and histological findings. Results: Four hundred eighty-two patients were included in the study. One hundred thirty-seven patients had gastric intestinal metaplasia, which presented a prevalence was 28,4%. A similar distribution between gender was observed with a significant increase of gastric intestinal metaplasia with age (p=0,0001). Regarding the indication for endoscopy, the prevalence of gastric intestinal metaplasia was: 17 % among patients with dyspeptic syndrome, 2 % in patients with anemia and 5 % in patients examined for other symptoms. Endoscopic findings showed gastric intestinal metaplasia was significantly associated with atrophic gastritis (p=0.0001), erythematous gastritis (p=0.0079), while there was no association with erosive gastritis (p=0.24) and peptic ulcer (p=0.19). Conclusions: Gastric intestinal metaplasia is frequently recorded in patients undergoing in esophagogastroduodenoscopies with associated biopsies. Endoscopic findings like erythema and atrophy is strongly associated with gastric intestinal metaplasia emphasizing the importance of sampling biopsies.

Narrow band imaging represents a promising endoscopic technique which allows real time characterization of colonic lesions by assessment of mucosal and vascular patterns. Due to the ability to make an optical biopsy, NBI could become a useful tool in clinical decisions regarding therapy and surveillance. The aim of this paper is to review the current knowledge on the optical diagnosis of colonic lesions by using NBI endoscopy. We reviewed research articles, reviews and meta-analyses from the PubMed and MEDLINE containing relevant data in this field. The validity of endoscopic criteria for the differentiation of adenoma and hyperplastic polyps, as well as of invasive cancer, has been evaluated in recent studies. Based on the prediction of polyp histology, new potential cost saving strategies have been proposed. Many reports are focused on the accuracy of optical biopsy by using NBI for predicting colonoscopy surveillance intervals and adenomatous histology in diminutive polyps, according to the Preservation and Incorporation of Valuable Endoscopic Innovations statement. Optical diagnosis is still under evaluation, and cannot yet be endorsed in routine practice. The high level of performance achieved by expert endoscopists needs to be replicated in the community utilizing reliable and standardized endoscopic criteria. IntroductionThe development of advanced endoscopic techniques such as narrow band imaging endoscopy, with or without magnification, represents an important step in the improvement of characterization of colonic lesions by predicting underlying histology. This creates the possibility to adopt new strategies regarding therapy and surveillance in clinical practice. The potential benefits of the real time estimation of a polyp's histology during NBI endoscopy, so called "optical biopsy", are related to potentially decreasing total costs of colonoscopy by eliminating unnecessary biopsies and polypectomies. Recent reports have shown promising results in this field, but controversies remain. Concerns center upon a lack of standardization among different classification systems, variable inter-observer agreement, and lagging clinical acceptance.The aim of this paper is to assess the current knowledge on the optical diagnosis of colonic lesions by using NBI endoscopy. We reviewed research articles, reviews and meta-analyses published in the last eight years in the PubMed and MEDLINE databases for the following search terms: narrow band imaging endoscopy, colonic polyps, and colorectal neoplasia.