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IS ADAPTIVE INDEX OF HEMOGLOBIN COLOR ENHANCEMENT EFFECTIVE IN DETECTING SMALL DEPRESSED TYPE COLORECTAL CANCERS?

In Japan, early gastric cancers have been detected with high sensitivity and specificity. However, small, flat and depressed type colorectal cancers (non-polypoid cancer) still constitute a considerable challenge for all endoscopists. Such depressed lesions have more malignant potential at an early stage than other polypoid lesions. Adaptive index of hemoglobin color (IHb) enhancement is a technique that was developed to improve the detection of these lesions. Small depressed type lesions are often detected as faint erythematous mucosal changes. Adaptive IHb color enhancement is used adding a filing system after detecting the lesion with conventional view. Level 5 IHb enhancement visualizes the faint erythematous mucosal changes that would be otherwise overlooked with conventional view without enhancement. Therefore, this technique seems to have the advantage of detecting small depressed type colorectal lesions. However, if attention is centered only on the reddish mucosal changes when we use this technique, the number of false positive lesions would increase with the result of an overdiagnosis. Consequently, this technique still needs to be improved in order to differentiate non-polypoid lesions from neoplastic ones. Japanese endoscopists have been detecting early gastric cancers as small erosions or faintly reddish erythematous changes. 1 Similarly, small flat and depressed type cancers (non-polypoid cancer) in colon and rectum often appear as faint erythematous changes. 2,3 It is difficult to detect such non-polypoid lesions, especially the depressed type cancer, a lesion that has more malignant potential at early stage than other polypoid lesions. Therefore, advances should be made in the detection methods of non-polypoid cancers so that they can be diagnosed more easily by general endoscopists. Adaptive IHb color enhancement is a technique that was developed to improve the detection of non-polypoid cancer. The point at issue is introduced based on the experience of using this instrument to detect the non-polypoid lesions. ADVANTAGES OF ADAPTIVE INDEX OF HEMOGLOBIN COLOR ENHANCEMENT