How NBI Works

Olympus Narrow Band Imaging (NBI) is an optical technology available for a variety of medical disciplines which helps to visualize the minutest vascular and mucosal patterns. NBI uses only wavelengths absorbed by hemoglobin for maximum contrast. A number of studies highlight the clinical value of NBI, especially with regard to the detection of cancer and characterization 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.

Practical Advantages of Narrow Band Imaging (NBI)

  • One platform throughout a hospital.
  • Increases quality of care by improving visibility, and facilitating optical diagnosis and the delineation of lesions.
  • No preparation required — technology available at the touch of a button at no extra cost.
  • Comprehensive training is available online and face-to-face with renowned experts.
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Esophagus Screening

Narrow Band Imaging Guides the Detection of Neoplastic Changes in Barrett’s Esophagus*

NBI proved to be a reliable modality for targeted biopsy in Barrett’s esophagus — identifying more neoplasia but requiring significantly fewer biopsies. 1 2 Although biopsy cannot be avoided completely, NBI may improve the quality and cost-effectiveness of Barrett’s esophagus surveillance.

With the BING criteria, a comprehensive binary classification system to identify high-grade dysplasia and adenocarcinoma has been developed by renowned Barrett’s experts. 3

In 2016, the American Society for Gastrointestinal Endoscopy (ASGE) endorsed the use of NBI for targeted biopsy in Barrett’s esophagus surveillance. 4

*Image courtesy of Prof. Dr. Stefan Seewald, Gastrozentrum Hirslanden, Zürich

Barrett’s Surveillance with GIF-EZ1500 and NBI

Using an innovative two-stage optical system, HQ and EZ endoscopes allow you to switch between two focus settings, “normal mode” and “near mode,” which overlap so that there is no focus gap. Near focus in our EDOF endoscopes CF-EZ1500DL/I and GIF-EZ1500 provides up to 90-100×** magnification.

** Tested with Olympus OEV321UH monitor.

Narrow Band Imaging Increases the Detection of Squamous Cell Carcinoma (SCC)

Esophageal and head and neck squamous cell carcinoma are often detected at a late stage due to the usually flat appearance and minimal color change in white light imaging. The delayed detection of SCC contributes to its poor five-year survival rate of less than 25%. 5

NBI has been shown to significantly increase detection rates for SCC, thus contributing to earlier treatment and a potentially better prognosis. 6 The visualization of distinct intrapapillary capillary loops (IPCL) patterns helps experts to predict infiltration depth, hence guiding therapy decisions. 7

SCC with GIF-EZ1500 and NBI

As it reduces the number of unnecessary biopsies and shortens examination time as compared to WLI with lugol staining, “NBI is the ideal method for effectively detecting superficial SCC.”5

Narrow Band Imaging Enables High-Confidence Optical Diagnosis of Colorectal Lesions

NBI has been extensively studied with favorable outcomes for the assessment of colorectal lesions. It not only increases adenoma detection rates if bowel preparation is good. 8 NBI also allows for highly accurate optical predictions of polyp histology with >90% negative predictive value (NPV) and >90% surveillance interval agreement with histopathology. 9
As the most validated and broadly available virtual chromoendoscopy technology, European and American gastroenterology societies (ESGE, ASGE and NICE) have endorsed the use of NBI for the optical diagnosis of colorectal polyps. 10 , 11 , 12

Diagnosis of Colorectal Lesions with CF-EZ1500D and NBI

In combination with our proven NBI technology, the advanced optics of the CF-EZ1500DL/I endoscope are designed to assist accurate, high-confidence optical diagnosis.

NBI Optical Diagnosis Training

Olympus is committed to providing the most advanced technologies for endoscopic diagnosis and treatment, helping you to advance patient care.

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  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.