NBI in Gastroenterology

A New Wave of Diagnostic Possibilities

How NBI Works

Olympus Narrow Band Imaging (NBI) is an optical technology available for a variety of medical disciplines which helps to visualise the minutest vascular and mucosal patterns. NBI uses only wavelengths absorbed by haemoglobin for maximum contrast. A number of studies highlight the clinical value of NBI, especially with regard to the detection of cancer and characterisation of suspicious mucosal areas. Compared to white-light endoscopy, the images of capillaries are less blurred and the probability of missing a lesion is reduced.

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NBI is a powerful and proven optical technology that allows for a reliable optical diagnosis of all major indications in the gastrointestinal tract.1-8

Efficient lesion management strategies that are empowered by NBI include:

  • Targeted biopsies in the upper gastrointestinal tract.2, 5
  • Easier decision-making for suitable endoscopic resection techniques.4, 5
  • Potentially avoiding histological assessment of low-risk lesions
    (e.g. diminutive rectosigmoid polyps under the resect and discard paradigm).6-8

Experience the power of NBI with the EVIS X1, our most advanced endoscopy system.

This conclusion arises from an international, randomised, crossover trial comparing HD-WLE and NBI with 123 patients by Sharma et al. , published in Gut. 2013, 62 (1), pp. 15–21.

The aim of the study was to compare high-definition white-light endoscopy (HD-WLE) applying the Seattle protocol and NBI targeted biopsy for detection of IM and neoplastic tissue in Barrett’s Oesophagus. The authors examined the differences of HD-WLE and NBI biopsies with respect to (1) the proportion of patients with intestinal metaplasia and neoplasia; (2) the proportion of neoplastic area; and (3) the number of overall biopsies performed.

The results: For detection of IM, HD-WLE and NBI each yielded detection rates of 92%. While HD-WLE required a mean of 7.6 biopsies per patient, NBI only required 3.6 biopsies. For detection of dysplasia, the diagnostic yield of HD-WLE and NBI were equivalent. However, NBI required fewer biopsies than HD-WLE in patients with short-segment BO (3.0 vs. 3.9) and patients with long-segment BO (4.1 vs. 10.9).

Thus, NBI may improve the efficiency of Barrett’s Oesophagus endoscopic screening and surveillance and even reduce pathology costs, thanks to fewer biopsies being taken.

  1. 1.Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett's esophagus: a meta-analysis and systematic review. Qumseya et al. Clin Gastroenterol Hepatol. 2013 Dec;11(12):1562-70.e1-2.
  2. 2.Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus: a prospective, international, randomised controlled trial. Sharma et al. Gut. 2013 Jan;62(1):15-21.
  3. 3.Development and validation of a classification system to identify high-grade dysplasia and esophageal adenocarcinoma in Barrett's esophagus using narrow-band imaging. Sharma et al. Gastroenterology. 2016 Mar;150(3):591-8.
  4. 4.Early Detection of Superficial Squamous Cell Carcinoma in the Head and Neck Region and Esophagus by Narrow Band Imaging: A Multicenter Randomized Controlled Trial Muto, Manabu et al. Journal of Clinical Oncology, 28 (9), 2010, p. 1570.
  5. 5.ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett's esophagus. Thosani et al. Gastrointest Endosc. 2016 Apr;83(4):684-98.e7.
  6. 6.Esophageal Cancer: An Updated Surveillance Epidemiology and End Results Database Analysis. Then et al. World J Oncol. 2020 Apr; 11(2): 55–64.
  7. 7.Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging: a multicenter randomized controlled trial Muto et al J Clin Oncol. 28 (9), 2010, 1566–1572.
  8. 8.Magnification endoscopy in esophageal squamous cell carcinoma: a review of the intrapapillary capillary loop classification Inoue et al. Ann Gastroenterol. 2015 Jan-Mar; 28(1): 41–48.
  9. 9.Narrow-Band Imaging for Detection of Neoplasia at Colonoscopy: A Meta-analysis of Data From Individual Patients in Randomized Controlled Trials Atkinson et al. Gastroenterology 2019 Aug;157(2):462-471.
  10. 10.Narrow band imaging to differentiate neoplastic and non-neoplastic colorectal polyps in real time: a meta-analysis of diagnostic operating characteristics. McGill et al. Gut. 2013 Dec;62(12):1704-13.
  11. 11.Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019 Bisschops et al. Endoscopy 2019; 51: 1155–1179
  12. 12.ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. Dayyeh et al. Gastrointest Endosc. 2015 Mar;81(3):502.e1-502.e16.

This result was found by Manabu Muto et al.in a randomised controlled clinical study with 360 patients, comparing the real-time detection rate of superficial SCC and HNSCC with WLE and NBI in a back-to-back fashion. See details in the Journal of Clinical Oncology. 2010, 28 (9), pp. 1566–1572.

Oesophageal cancer is the eighth most common cancer in the world with mostly a poor prognosis. This is mainly due to the fact that white-light endoscopy has a poor detection rate of early-stage cancers. Therefore, oesophageal SCC and head & neck SCC (HNSCC) are often detected at a late stage. The aim of the study was to verify if NBI could improve the detection rates for squamous cell carcinoma of the head and neck region as well as the oesophagus.

The results were promising. While primary NBI detected all (100%) of the superficial cancers in the H&N region, primary WLE detected only 8.0% (Table 1). In the oesophagus, primary NBI detected 97% of the lesions while primary WLE reached only 55%. The detection rate of secondary NBI after primary WLE significantly increased in both the H&N region (8.0% vs. 77%) and oesophagus (55% vs. 95%). In contrast, if NBI was followed by secondary WLE, the detection rate declined. Fifty-seven percent of superficial cancers in the H&N region and 23% in the oesophagus even were detected only by NBI. There was only one lesion that was detected by WLE but was missed by secondary NBI.

In conclusion, NBI has a significantly higher detection rate for SCC than white-light endoscopy and may become the standard examination for the early detection of superficial cancer in the H&N region and the oesophagus.