Mucosal imaging in colon polyps: New advances and what the future may hold

Table 2 Summary of strengths and weakness of advanced imaging technologies in adenoma detection

Modality		Strengths	Weaknesses
HD-WLI		Widely available	Marginal incremental benefit over SD-WLI
		Increased detection of flat, right-sided adenomas and SSAs
Chromoendoscopy		Increased detection of small and flat adenomas	No significant increase in detection of advanced adenomas
		Increased dysplasia detection in IBD (compared to SD-WLI)	Increased procedural time
		May increase polyp detection in high-risk syndromes (serrated polyposis syndrome, HNPCC)
Virtual chromoendoscopy	NBI	May improve flat lesion detection	Loss of brightness and familiarity of colour patterns
		Effective in those with experience using NBI	No evidence of increased total adenoma detection
			Less effective when used by proceduralists inexperienced in NBI
	i-SCAN	May reduce miss-rates in high-risk populations	Not widely available
			No difference in adenoma detection in larger studies
			Insufficient evidence to recommend use
	FICE	Retains familiar colour patterns	Not widely available
			No difference in ADR
	LCI	Retains familiar colour patterns	Not widely available
		Effective when used by non-LCI experienced proceduralists	Variable evidence regarding overall adenoma detection
		Improve adenoma detection, particularly right sided and flat lesions
	BLI	Improved adenoma detection and miss rate in smaller studies	Not widely available
			No difference in ADR in largest study to date
	TXI	Retains familiar colour patterns	Not widely available
			New technology therefore insufficient evidence
AFI		Improved detection of flat/right sided polyps	Not widely available
			Increased procedure time
			No difference in overall ADR
AI		Improves ADR	Expensive currently
		Improves consistency between proceduralists	Not widely available
		Quality assurance	Some increase in procedure time
FME		In theory may improve detection of flat/poorly visible polyps	Insufficient evidence
			Requires injection/ingestion of tracer

HD-WLI: High-definition white light imaging; SD-WLI: Standard definition white light imaging; HNPCC: Hereditary non-polyposis colon cancer; NBI: Narrow-band imaging; IBD: Inflammatory bowel disease; BLI: Blue light imaging; TXI: Texture and colour enhancement imaging; FME: Fluorescence molecular endomicroscopy; AI: Artificial intelligence; AFI: Autofluorescence imaging; SSA/Ps: Sessile serrated adenomas/polyps; ADR: Adenoma detection rate.