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Ian M Gralnek - One of the best experts on this subject based on the ideXlab platform.
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comparison of adenoma detection and miss rates between a novel balloon colonoscope and standard Colonoscopy a randomized tandem study
Endoscopy, 2015Co-Authors: Zamir Halpern, Ian M Gralnek, Seth A Gross, Beni Shpak, Mark Pochapin, Arthur Hoffman, Meir Mizrahi, Yosef S Rochberger, Menachem MoshkowitzAbstract:Background and study aims: Although Colonoscopy is the “gold standard” for colorectal cancer screening, a significant number of adenomas are still missed during standard Colonoscopy, often because they are hidden behind colonic folds and flexures. The aim of this study was to assess the ability of a novel balloon colonoscope (G-EYE endoscope; Smart Medical Systems, Ra’anana, Israel) to increase adenoma detection and reduce the miss rate compared with standard Colonoscopy. Patients and methods: This was a multicenter, randomized, prospective, controlled study in patients (age ≥ 40 years) undergoing Colonoscopy for screening or diagnostic work-up (including surveillance). Patients underwent same-day, back-to-back tandem Colonoscopy. Patients in Group A underwent standard Colonoscopy followed by balloon Colonoscopy, and patients in Group B underwent balloon Colonoscopy followed by the standard technique. The adenoma detection and miss rates were compared between the two Colonoscopy procedures. Results: A total of 126 patients were enrolled and randomized into Group A (n = 60) or Group B (n = 66). The adenoma miss rate of balloon Colonoscopy was significantly lower than that of standard Colonoscopy (7.5 % vs. 44.7 %; P = 0.0002). The detection of additional adenomas by balloon Colonoscopy was significant (81.0 %; P = 0.0002), in particular, the relative amount of adenomas detected in the ascending colon by balloon Colonoscopy was 41 % versus 14 % for standard Colonoscopy. Conclusions: A novel balloon Colonoscopy technique detected significantly more adenomas than standard Colonoscopy, and missed fewer adenomas. Balloon Colonoscopy has the potential to increase the effectiveness of colorectal cancer screening and surveillance Colonoscopy.
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emerging technological advancements in Colonoscopy third eye retroscope and third eye panoramic tm fuse full spectrum endoscopy Colonoscopy platform extra wide angle view colonoscope and naviaid tm g eye tm balloon colonoscope
Digestive Endoscopy, 2015Co-Authors: Ian M GralnekAbstract:Colonoscopy is the criterion standard for detecting colorectal adenomas and cancers. However, multiple studies have reported a significant percentage of adenomas are missed during standard, forward-viewing Colonoscopy. Missed adenomas can lead to interval colorectal cancers. Aside from inadequate colon preparation, incomplete examinations (e.g. failure to intubate the cecum), short withdrawal times, and patient-related factors, the primary reason for missing colorectal adenomas and early cancers is poor visualization of the proximal aspect of colonic folds, at anatomical flexures, and in the ileocecal valve area. These anatomical sites tend to be hidden from the standard forward-viewing colonoscope (170-degree angle of view) and can often only be seen through manipulation of the colonoscope by the endoscopist. Thus, there is mounting evidence supporting the need to reduce the adenoma ‘miss rate’ of standard forward-viewing Colonoscopy by improving upon current colonoscope technology and its current visualization/optics limitations. Recently, there are a number of emerging technologies that may help revolutionize how Colonoscopy is carried out and that will significantly reduce adenoma miss rates. These include the Third Eye® Retroscope® and Third Eye® PanoramicTM (Avantis Medical Systems, Sunnyvale, CA, USA); Fuse® Full Spectrum Endoscopy® Colonoscopy platform (EndoChoice Inc., Alpharetta, GA, USA); Extra-Wide-Angle-View colonoscope (Olympus, Tokyo, Japan), and the NaviAidTM G-EYETM balloon colonoscope (SMART Medical Systems Ltd, Ra'anana, Israel).
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standard forward viewing Colonoscopy versus full spectrum endoscopy an international multicentre randomised tandem Colonoscopy trial
Lancet Oncology, 2014Co-Authors: Ian M Gralnek, Peter D Siersema, Zamir Halpern, Ori Segol, Alaa Melhem, Alain Suissa, Erwin Santo, Alan Sloyer, Jay FensterAbstract:Summary Background Although Colonoscopy is the accepted standard for detection of colorectal adenomas and cancers, many adenomas and some cancers are missed. To avoid interval colorectal cancer, the adenoma miss rate of Colonoscopy needs to be reduced by improvement of Colonoscopy technique and imaging capability. We aimed to compare the adenoma miss rates of full-spectrum endoscopy Colonoscopy with those of standard forward-viewing Colonoscopy. Methods We did an international, multicentre, randomised trial at three sites in Israel, one site in the Netherlands, and two sites in the USA between Feb 1, 2012, and March 31, 2013. Patients aged 18–70 years referred for colorectal cancer screening, polyp surveillance, or diagnostic assessment underwent same-day, back-to-back tandem Colonoscopy with standard forward-viewing colonoscope and the full-spectrum endoscopy colonoscope. The patients were randomly assigned (1:1), via computer-generated randomisation with block size of 20, to which procedure was done first. The endoscopist was masked to group allocation until immediately before the start of Colonoscopy examinations; patients were not masked. The primary endpoint was adenoma miss rates. We did per-protocol analyses. This trial is registered with ClinicalTrials.gov, number NCT01549535. Findings 197 participants were enrolled. 185 participants were included in the per-protocol analyses: 88 (48%) were randomly assigned to receive standard forward-viewing Colonoscopy first, and 97 (52%) to receive full-spectrum endoscopy Colonoscopy first. By per-lesion analysis, the adenoma miss rate was significantly lower in patients in the full-spectrum endoscopy group than in those in the standard forward-viewing procedure group: five (7%) of 67 vs 20 (41%) of 49 adenomas were missed (p Interpretation Full-spectrum endoscopy represents a technology advancement for Colonoscopy and could improve the efficacy of colorectal cancer screening and surveillance. Funding EndoChoice.
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comparison of standard forward viewing mode versus ultrawide viewing mode of a novel Colonoscopy platform a prospective multicenter study in the detection of simulated polyps in an in vitro colon model with video
Gastrointestinal Endoscopy, 2013Co-Authors: Ian M Gralnek, Peter D Siersema, Zamir Halpern, Ori Segol, Alan Sloyer, Jay Fenster, David L Carrlocke, Basil S Lewis, Erwin SantoAbstract:Background Although Colonoscopy is the criterion standard for detecting colorectal adenomas and cancers, a significant percentage of adenomas are missed. Objective To compare forward-viewing with ultrawide-viewing Colonoscopy in the detection of simulated colon polyps in an in vitro colon model. Design Prospective, multicenter. Setting Six endoscopy units (3 in the United States and 3 in Israel). Patients In vitro colon model with simulated colon polyps (n = 21 metallic beads). Interventions Detection of simulated colon polyps on colonoscope withdrawal. Main Outcome Measurements Incremental detection of simulated colon polyps and endoscopist evaluation of the usability, visibility, and maneuverability of ultrawide-viewing Colonoscopy. Results On forward-viewing Colonoscopy, the number of simulated polyps (mean ± standard deviation) detected per endoscopist was 11.1 ± 2.3 polyps, a 52.9% detection rate. Simulated polyp detection rates per colon segment were 3.0 ± 0.93 (60.0%) right colon, 2.4 ± 0.87 (48.0%) transverse colon, and 5.7 ± 1.5 (51.8%) left colon. On ultrawide-viewing Colonoscopy, the simulated polyp detection rate per endoscopist significantly increased to 18.0 ± 1.98 polyps, an overall 85.7% polyp detection rate ( P P P Limitations Nonrandomized design, use of a colon model, and "simulated" colon polyps. Conclusions Ultrawide-view Colonoscopy significantly improved simulated polyp detection in a colon model. Clinical studies in human subjects should be pursued to further evaluate this new endoscopic technology.
Takayuki Matsumoto - One of the best experts on this subject based on the ideXlab platform.
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feasibility of a novel colonoscope with extra wide angle of view a clinical study
Endoscopy, 2014Co-Authors: Toshio Uraoka, Shinji Tanaka, Shiro Oka, Takahisa Matsuda, Yutaka Saito, Tomohiko Moriyama, Reiji Higashi, Takayuki MatsumotoAbstract:Background and study aims: Lesions may be missed during Colonoscopy because of anatomical features such as mucosal folds. This feasibility study assessed the safety and efficacy of a novel colonoscope with extra-wide angle of view, which provides a simultaneous lateral-backward view to complement the forward view. Patients and methods: Consecutive patients undergoing Colonoscopy using the prototype colonoscope were enrolled in this multicenter, single-arm study. The number of adverse events, and the first detection of adenomas during withdrawal by the lateral-backward view and the forward view were evaluated. Results: A total of 47 patients underwent Colonoscopy examination to the cecum. The mean insertion and withdrawal times were 6.4 ± 4.9 minutes and 8.6 ± 4.2 minutes, respectively. Of 47 detected polyps, 28 adenomatous polyps were found (mean size 3.3 ± 3.1 mm). A total of 29 polyps (61.7 %) and 16 adenomatous polyps (57.1 %) were first detected with the lateral-backward view. The lateral-backward view first detected 5/6 adenomatous polyps (83.3 %) in the ascending colon and all (2/2) adenomatous polyps in the sigmoid colon. No adverse events occurred during the study. Conclusions: This exploratory study suggested that a novel colonoscope with extra-wide angle of view is safe and feasible, and has the potential to improve colorectal adenoma detection. Trial register: UMIN000016450
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a novel extra wide angle view colonoscope a simulated pilot study using anatomic colorectal models
Gastrointestinal Endoscopy, 2013Co-Authors: Toshio Uraoka, Shinji Tanaka, Shiro Oka, Takahisa Matsuda, Tomohiko Moriyama, Reiji Higashi, Takayuki Matsumoto, Yutaka SaitoAbstract:Background A major factor that may contribute to a higher adenoma miss rate during Colonoscopy is undetected lesions located behind haustral folds, flexures, or rectal valves. Objective To assess the efficacy of a prototype, novel, extra-wide-angle–view colonoscope that provides a simultaneous lateral-backward view that complements the forward view lens. Design A simulated pilot study of two anatomic colorectal models, each prepared with 8 polyps positioned in obvious locations and 8 polyps placed behind folds. Thirty-two endoscopists with different levels of experience performed examinations on models in a random order by using the extra-wide-angle–view colonoscope and a standard colonoscope. Main Outcome Measurements The detection rates of simulated polyps. Results The mean detection rate for all simulated polyps with the extra-wide-angle–view colonoscope was significantly higher than that with the standard colonoscope (68% vs 51%; P P = .0009). Limitations Not a clinical study. Conclusion The novel, extra-wide-angle–view colonoscope may represent an advancement in colorectal polyp detection. The value of the colonoscope for clinical use awaits further study.
Douglas K Rex - One of the best experts on this subject based on the ideXlab platform.
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faster colonoscope withdrawal time without impaired detection using endorings
PMC, 2018Co-Authors: John C Thygesen, Andrew W. Sullivan, Prasanna L Ponugoti, Jonathan R Garcia, Heather M Broadley, William W Tippins, Douglas K RexAbstract:Background and study aims Mucosal exposure devices on the colonoscope tip have improved detection. We evaluated detection and procedure times in colonoscopies performed with EndoRings. Patients and methods We had 14 endoscopists in a university practice trial EndoRings. We compared detection and procedure times to age- and indication-matched procedures by the same endoscopists. Results There were 137 procedures with EndoRings. The adenoma detection rate was 44 % with EndoRings vs. 39 % without (P = 0.39). Mean adenomas per Colonoscopy (standard deviation) was 1.2 (2.3) with EndoRings vs. 0.9 (1.6) without (P = 0.055). Mean insertion time with EndoRings was 6.2 (3.2) minutes vs. 6.6 (6.7) minutes without (P = 0.81). Mean withdrawal time with EndoRings in all patients with or without polypectomy was 12.2 (5.3) minutes and 16.1 (10.3) minutes without (P = 0.0005). Conclusion EndoRings may allow faster withdrawal during Colonoscopy without any reduction in detection. Prospective trials with mucosal exposure devices targeting procedure times as primary endpoints are warranted.
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high definition Colonoscopy versus endocuff versus endorings versus full spectrum endoscopy for adenoma detection at Colonoscopy a multicenter randomized trial
Author, 2018Co-Authors: Douglas K Rex, Andrew W. Sullivan, Cesare Hassan, Alessandro Repici, Seth A Gross, Prasanna L Ponugoti, Jonathan R Garcia, Heather M Broadley, Jack C Thygesen, William W TippinsAbstract:Background and Aims Devices used to improve polyp detection during Colonoscopy have seldom been compared with each other. Methods We performed a 3-center prospective randomized trial comparing high-definition (HD) forward-viewing Colonoscopy alone to HD with Endocuff to HD with EndoRings to the full spectrum endoscopy (FUSE) system. Patients were age ≥50 years and had routine indications and intact colons. The study colonoscopists were all proven high-level detectors. The primary endpoint was adenomas per Colonoscopy (APC). Results Among 1188 patients who completed the study, APC with Endocuff (APC mean ± standard deviation: 1.82 ± 2.58), EndoRings (1.55 ± 2.42), and standard HD Colonoscopy (1.53 ± 2.33) were all higher than FUSE (1.30 ± 1.96; P Conclusions For high-level detectors at Colonoscopy, forward-viewing HD instruments dominate the FUSE system, indicating that for these examiners image resolution trumps angle of view. Further, Endocuff is a dominant strategy over EndoRings and no mucosal exposure device on a forward-viewing HD colonoscope. (Clinical trial registration number: NCT02345889.)
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new colonoscope technology impact on image capture and quality and on confidence and accuracy of endoscopy based polyp discrimination
Endoscopy, 2014Co-Authors: Kaely Bade, Margaret E Macphail, Cynthia S Johnson, Charles J Kahi, Douglas K RexAbstract:Background and study aims: A newer colonoscope series has optical magnification and improvement in image freezing function. We aimed to assess the impact on image capture, image quality, and polyp discrimination. Patients and methods: In consecutive patients undergoing outpatient Colonoscopy images of colorectal polyps were taken with Olympus 190 or 180 series instruments. The number of image captures needed to obtain an adequate image, quality of stored images, proportion of polyps with a high confidence estimate of likely histology, and accuracy of interpretations were compared. Results: An acceptable image at the first attempt was obtained in 97.3 % of photos with the 190 device vs. 83.8 % with the 180 instrument (P 98 % of polyps in both the 180 group and the 190 group. A second endoscopist agreed with the original high confidence interpretations for 90 % of polyps imaged with either the 180 or the 190 scope. Conclusion: The new colonoscope had less image blurring, improved subjective quality of stored images, and increased the proportion of high confidence endoscopic estimates of polyp histology, but did not improve accuracy in estimating polyp histology.
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high cecal intubation rates with a new computer assisted colonoscope a feasibility study
The American Journal of Gastroenterology, 2011Co-Authors: Stefan Groth, Douglas K Rex, Thomas Rosch, N HoepffnerAbstract:OBJECTIVES: The acceptability of Colonoscopy as a screening test is limited by several factors including patient discomfort. A new self-propelled colonoscope, the Invendo SC20 (Invendo Medical GmbH), may be helpful in reducing sedation. It consists of a sheathed endoscope contained within an “inverted sleeve,” and having an instrument channel and an electrohydraulic bendable tip; it is steered using a handheld device and propelled by a motorized drive unit. This study assessed the safety and efficacy of this new endoscope in volunteers undergoing colorectal cancer (CRC) screening.
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advances in colonoscope technique and technology
Reviews in Gastroenterological Disorders, 2008Co-Authors: Kyu Chan Huh, Douglas K RexAbstract:Abstract To date, no alternative platform for Colonoscopy seems prepared to substantially supplant the traditional Colonoscopy platform. The Invendoscope and capsule Colonoscopy are the most promising of the alternative platforms. With regard to colonoscope insertion, water immersion is quite noteworthy but requires additional study in broader populations. The benefits of cap-fitted Colonoscopy for insertion are small. With regard to imaging, wide-angle Colonoscopy may produce an operator-dependent improvement in efficiency, but there is no consistent evidence that it improves adenoma detection. Similarly, cap-fitted Colonoscopy is not convincing as a method to improve adenoma detection. There is no method for seeing flat lesions that is both effective and practical for high-level white light adenoma detectors. Narrow-band imaging may have a learning effect on low-level adenoma detectors, and autofluorescence seems promising and deserves additional study. Several methods for determination of real-time histology are promising and seem to be methods by which the cost-effectiveness of Colonoscopy could be improved through reduction in pathology charges for diminutive polyps.
Toshio Uraoka - One of the best experts on this subject based on the ideXlab platform.
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feasibility of a novel colonoscope with extra wide angle of view a clinical study
Endoscopy, 2014Co-Authors: Toshio Uraoka, Shinji Tanaka, Shiro Oka, Takahisa Matsuda, Yutaka Saito, Tomohiko Moriyama, Reiji Higashi, Takayuki MatsumotoAbstract:Background and study aims: Lesions may be missed during Colonoscopy because of anatomical features such as mucosal folds. This feasibility study assessed the safety and efficacy of a novel colonoscope with extra-wide angle of view, which provides a simultaneous lateral-backward view to complement the forward view. Patients and methods: Consecutive patients undergoing Colonoscopy using the prototype colonoscope were enrolled in this multicenter, single-arm study. The number of adverse events, and the first detection of adenomas during withdrawal by the lateral-backward view and the forward view were evaluated. Results: A total of 47 patients underwent Colonoscopy examination to the cecum. The mean insertion and withdrawal times were 6.4 ± 4.9 minutes and 8.6 ± 4.2 minutes, respectively. Of 47 detected polyps, 28 adenomatous polyps were found (mean size 3.3 ± 3.1 mm). A total of 29 polyps (61.7 %) and 16 adenomatous polyps (57.1 %) were first detected with the lateral-backward view. The lateral-backward view first detected 5/6 adenomatous polyps (83.3 %) in the ascending colon and all (2/2) adenomatous polyps in the sigmoid colon. No adverse events occurred during the study. Conclusions: This exploratory study suggested that a novel colonoscope with extra-wide angle of view is safe and feasible, and has the potential to improve colorectal adenoma detection. Trial register: UMIN000016450
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a novel extra wide angle view colonoscope a simulated pilot study using anatomic colorectal models
Gastrointestinal Endoscopy, 2013Co-Authors: Toshio Uraoka, Shinji Tanaka, Shiro Oka, Takahisa Matsuda, Tomohiko Moriyama, Reiji Higashi, Takayuki Matsumoto, Yutaka SaitoAbstract:Background A major factor that may contribute to a higher adenoma miss rate during Colonoscopy is undetected lesions located behind haustral folds, flexures, or rectal valves. Objective To assess the efficacy of a prototype, novel, extra-wide-angle–view colonoscope that provides a simultaneous lateral-backward view that complements the forward view lens. Design A simulated pilot study of two anatomic colorectal models, each prepared with 8 polyps positioned in obvious locations and 8 polyps placed behind folds. Thirty-two endoscopists with different levels of experience performed examinations on models in a random order by using the extra-wide-angle–view colonoscope and a standard colonoscope. Main Outcome Measurements The detection rates of simulated polyps. Results The mean detection rate for all simulated polyps with the extra-wide-angle–view colonoscope was significantly higher than that with the standard colonoscope (68% vs 51%; P P = .0009). Limitations Not a clinical study. Conclusion The novel, extra-wide-angle–view colonoscope may represent an advancement in colorectal polyp detection. The value of the colonoscope for clinical use awaits further study.
Yutaka Saito - One of the best experts on this subject based on the ideXlab platform.
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feasibility of a novel colonoscope with extra wide angle of view a clinical study
Endoscopy, 2014Co-Authors: Toshio Uraoka, Shinji Tanaka, Shiro Oka, Takahisa Matsuda, Yutaka Saito, Tomohiko Moriyama, Reiji Higashi, Takayuki MatsumotoAbstract:Background and study aims: Lesions may be missed during Colonoscopy because of anatomical features such as mucosal folds. This feasibility study assessed the safety and efficacy of a novel colonoscope with extra-wide angle of view, which provides a simultaneous lateral-backward view to complement the forward view. Patients and methods: Consecutive patients undergoing Colonoscopy using the prototype colonoscope were enrolled in this multicenter, single-arm study. The number of adverse events, and the first detection of adenomas during withdrawal by the lateral-backward view and the forward view were evaluated. Results: A total of 47 patients underwent Colonoscopy examination to the cecum. The mean insertion and withdrawal times were 6.4 ± 4.9 minutes and 8.6 ± 4.2 minutes, respectively. Of 47 detected polyps, 28 adenomatous polyps were found (mean size 3.3 ± 3.1 mm). A total of 29 polyps (61.7 %) and 16 adenomatous polyps (57.1 %) were first detected with the lateral-backward view. The lateral-backward view first detected 5/6 adenomatous polyps (83.3 %) in the ascending colon and all (2/2) adenomatous polyps in the sigmoid colon. No adverse events occurred during the study. Conclusions: This exploratory study suggested that a novel colonoscope with extra-wide angle of view is safe and feasible, and has the potential to improve colorectal adenoma detection. Trial register: UMIN000016450
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a novel extra wide angle view colonoscope a simulated pilot study using anatomic colorectal models
Gastrointestinal Endoscopy, 2013Co-Authors: Toshio Uraoka, Shinji Tanaka, Shiro Oka, Takahisa Matsuda, Tomohiko Moriyama, Reiji Higashi, Takayuki Matsumoto, Yutaka SaitoAbstract:Background A major factor that may contribute to a higher adenoma miss rate during Colonoscopy is undetected lesions located behind haustral folds, flexures, or rectal valves. Objective To assess the efficacy of a prototype, novel, extra-wide-angle–view colonoscope that provides a simultaneous lateral-backward view that complements the forward view lens. Design A simulated pilot study of two anatomic colorectal models, each prepared with 8 polyps positioned in obvious locations and 8 polyps placed behind folds. Thirty-two endoscopists with different levels of experience performed examinations on models in a random order by using the extra-wide-angle–view colonoscope and a standard colonoscope. Main Outcome Measurements The detection rates of simulated polyps. Results The mean detection rate for all simulated polyps with the extra-wide-angle–view colonoscope was significantly higher than that with the standard colonoscope (68% vs 51%; P P = .0009). Limitations Not a clinical study. Conclusion The novel, extra-wide-angle–view colonoscope may represent an advancement in colorectal polyp detection. The value of the colonoscope for clinical use awaits further study.
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complete closure of a large defect after emr of a lateral spreading colorectal tumor when using a two channel colonoscope
Gastrointestinal Endoscopy, 2004Co-Authors: Takahisa Matsuda, Yutaka Saito, Takahiro Fujii, Fabian Emura, Takahiro Kozu, Hiroaki Ikematsu, Daizo SaitoAbstract:CASE REPORTA 64-year-old man with a positive fecal occult blood testunderwent Colonoscopy, at which a protruded Is + IIa(LST-granular type) lesion, 40 3 40 mm in size, withunevensurfacetexturewasdetectedinthelowerrectum.Itwas slightly elevated and had a reddish surface. Chro-moendoscopy with a high-magnification colonoscope(CF240ZI; Olympus Optical Co., Ltd., Tokyo, Japan) andindigo carmine (0.2%) dye demonstrated the surfacecharacter and margin of the lesion (Fig. 1). Staining withcrystal violet (0.05%) revealed a Kudo type IV pit pattern