International Session（Symposium）9(JGES・JSGE・JSGS・JSGCS)
Sat. November 7th   9:00 - 11:30   Room 11: Portopia Hotel South Wing Topaz
IS-S9-2_E
 Cost Effectiveness of Advanced Mucosal Imaging
Shiaw-Hooi Ho
Department of Medicine, University of Malaya
Mucosal imaging has progressed by leaps and bounds over the last 4 decades since the introduction of video endoscopy in 1983. The current most popular advanced mucosal imaging technologies utilize a combination of magnifying endoscopy (conventional or dual-focus type), dye-based image enhanced endoscopy (D-IEE) and equipment-based IEE (E-IEE). Other scope-based advanced mucosal imaging technologies include endocytoscopy and confocal laser endomicroscopy.
D-IEE has been shown to improve detection of upper gastrointestinal (GI) lesions such as the use of Lugol’s iodine for the detection of squamous cell neoplasia in the esophagus and the use of indigo-carmine for the detection of flat colorectal lesions. Indigo-carmine is also often used to characterize and delineate the border of gastric lesions prior to ESD procedures. When used in conjunction with magnifying endoscopy, crystal violet dye staining is capable of advanced characterization of detected colorectal lesion into different pit pattern type. This, in turn, help in determine the best treatment options. Due to the low cost involved, the dye-based IEE and magnifying endoscopy combination is postulated to have the highest benefit-to-cost ratio.
E-IEE technology is based on the concept of illumination with limited spectrum light source to achieve clear visualization of mucosal surface and superficial vasculature. Such mucosal imaging technologies are the most practical owing to its ease of use and relatively high diagnostic accuracy. Non magnified E-IEE (such as NBI & BLI) can be used as a detection tool in the GI examination. Narrow Band Imaging from Olympus or Blue Light Imaging from Fujifilm is often used as a primary tool to screen for squamous cell neoplasia in the esophagus. Other newer E-IEE modalities such as Linked Color Imaging from Fujifilm and Texture and Color Enhancement Imaging from Olympus may provide detection benefit to the upper and lower GI examination. The true potential of E-IEE comes when used in combination with magnifying endoscopy which allow optical diagnosis to be made throughout the GI tract. E-IEE and magnifying endoscopy combination is postulated to have high benefit-to-cost ratio second only to D-IEE.
Endocytoscopy and confocal laser endomicroscopy allow accurate optical diagnosis of detected lesion. Incorporation of artificial intelligence into endocytoscopy allow AI-assisted diagnosis. Apart from diagnosis, endomicroscopy is also used for border delineation in difficult lesions. High initial setup cost and limited indication of use have restricted their use to only a certain advanced tertiary centres and academic centres. Hence, these advanced imaging technologies are postulated to have the lowest benefit-to-cost ratio.
Index Term 1: Cost effectiveness
Index Term 2: Advanced mucosal imaging
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