{'fraction_non_alphanumeric': 0.020965930363159864, 'fraction_numerical': 0.004867090977162112, 'mean_word_length': 5.31678486997636, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Diagnosis of Jejunal Diverticulitis by Oral Single-Balloon Enteroscopy

TO THE EDITOR: We read with interest the article by Horiuchi and Nakayama (1) on a transparent retractable extension (TRE) device for colorectal adenoma detection. The TRE device attached to the tip of a colonoscope can be extended for inspection of blind area of the colorectal mucosa or be retracted for dislodgment of adherent fecal matter and for safe retroflexion of the colonoscope whenever desired during colonoscopy. Although colonoscopy with the TRE device detected more adenomas without prolonged withdrawal time of the colonoscope, we believe that a newly developed imaging technology in addition to the device can detect many more adenomas. Although colonoscopy is considered the gold standard for the detection and removal of colorectal adenomatous polyps to prevent subsequent colorectal cancers (2), some polyps and even cancers may be missed during colonoscopy because they lie outside the visual field behind the folds. In a study with the use of CT colonography simulation (3), the percentage of colorectal surface visualized by conventional colonoscopy is 86.6%. Therefore, improved colonoscopic techniques with careful visualization of the proximal side of the folds have been required. We and others previously showed that the use of a transparent hood attached to the tip of a colonoscope helps to examine the proximal side of the folds by depressing the folds, resulting in more polyp detection (2, 4). Because colonoscopy with the hood tends to adhere fecal matter inside the hood, and the colonoscope cannot be safely retroflexed in the colorectum, Horiuchi and Nakayama (1) improved the hood and devised the TRE device with favorable outcomes. Even inside the visual field, small or flat polyps may be missed as a result of their subtle appearance and limited contrast to the surrounding mucosa. The narrow-band imaging (NBI) system, a recently developed imaging technology, can clearly enhance the visualization of the fine microvascular architecture in the surface mucosa with special narrow-band filters (5). Because of its improved mucosal contrast, NBI colonoscopy detects more polyps without prolonged withdrawal time of the colonoscope (6). The NBI magnification also allows indirect assessment of the pit pattern in colorectal polyps through the microvascular features, similar to that provided by chromoendoscopy, and is valuable for the prediction of histological diagnosis (5). Although Horiuchi and Nakayama (1) could address more polyp detection in colonoscopy with a TRE device, we believe that NBI colonoscopy with a TRE device is a more effective candidate.