title: Flexible imaging color enhancement improves visibility of transnasal endoscopic images in diagnosing esophageal varices: a multicenter prospective blinded study.
abstract: OBJECTIVE
  To clarify the usefulness of transnasal esophagogastroduodenoscope (N-EGD) with all flexible imaging color enhancement (FICE) patterns (0-9) for the diagnosis of esophageal varices (EV).
  
  
  METHODS
  A total of 50 patients with EV were examined during the same period by N-EGD without sedation and by peroral endoscopy (O-EGD) with sedation. The visibility of treatment scars, microvessels, recurrent EV and red color sign (RCS) were measured. Visibility was evaluated by five blinded observers (poor-good: 0-10), and the effect of both endoscopic examinations on the cardiorespiratory function of the patients was measured.
  
  
  RESULTS
  The image scores for O-EGD and N-EGD with ordinary mode and N-EGD with FICE were 7.3 ± 1.2, 6.1 ± 1.0 and 6.9 ± 1.0 for treatment scars; 7.2 ± 1.4, 6.2 ± 1.2 and 7.3 ± 1.0 for microvessels; 7.2 ± 1.2, 6.1 ± 1.0 and 7.1 ± 1.0 for recurrent EV and 7.2 ± 1.3, 6.1 ± 1.3, and 7.2 ± 1.2 for RCS, respectively (intraclass correlation coefficients > 0.6). When FICE patterns 2, 6 and 9 were used, visibility was much improved. Ten minutes after insertion, the double product values in the N-EGD with the FICE group were significantly better (P < 0.05).
  
  
  CONCLUSIONS
  N-EGD with FICE is very useful for the diagnosis of EV and can improve the visibility of N-EGD on each lesion to the same level as that of O-EGD. N-EGD with FICE does not require sedation and may reduce the risk of hepatic encephalopathy.
authors.affiliation: Fourth Department of Internal Medicine, Tokyo, Japan. furuichi@tokyo-med.ac.jp
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Furuichi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawai
authors.forename: Shigeki
authors.initials: S
authors.lastname: Ichimura
authors.forename: Ryo
authors.initials: R
authors.lastname: Metoki
authors.forename: Yuki
authors.initials: Y
authors.lastname: Miyata
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Oshima
authors.forename: Takatomo
authors.initials: T
authors.lastname: Sano
authors.forename: Eigaku
authors.initials: E
authors.lastname: Murashima
authors.forename: Junichi
authors.initials: J
authors.lastname: Taira
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kamamoto
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Imai
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003116:Color; D016292:Procedural Sedation / Q000009:adverse effects; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000473:pathology*; D005260:Female; D006501:Hepatic Encephalopathy / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D007089:Image Enhancement / Q000379:methods* / Q000592:standards; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D009055:Mouth; D009666:Nose; D016037:Single-Blind Method; D055815:Young Adult