Endoscopic features of lymphoid follicles using blue laser imaging (BLI) endoscopy in the colorectum and its association with chronic bowel symptoms

Abstract

Background/AimIn the colorectum, lymphoid follicles hyperplasia (LH) is sometimes observed as small, round, yellowish-white nodules. The novel image-enhanced endoscopy system named blue laser imaging (BLI) provides enhanced the contrast of surface vessels using lasers for light illumination. We investigated the endoscopic features of LH observed by using BLI endoscopy and its association with chronic bowel symptoms.Patients/Methods300 participants undergoing colonoscopy for various indications were enrolled. Entire colorectum was observed by using BLI-bright mode with non-magnification view. LH was defined as well demarcated white nodules. Elevated LH with erythema was distinguished as LH severe.ResultsLHs were observed more clearly by using BLI-bright mode compared to conventional white light colonoscopy and were also histologically confirmed as intense infiltration of lymphocytes or plasmacytes. LH was observed in 134 subjects (44.6%) and 67 (22.3%) were LH severe. LH was associated younger age (Odds ratio (OR) = 1.05, 95%Confidence Interval (95%CI) = 1.03–1.07, P<0.0001) and chronic bowel symptoms including constipation, hard stools, diarrhea and loose stools (all LH: OR = 4.03, 95%CI = 2.36–6.89, P<0.0001, LH severe: OR = 5.31, 95%CI = 2.64–10.71, P<0.0001). LH severe was closely associated with both constipation associated symptoms (OR = 3.94, 95%CI = 1.79–8.66, P = 0.0007) and diarrhea associated symptoms (OR = 5.22, 95%CI = 2.09–13.05, P = 0.0004). In particular, LH severe in the ascending colon was strongly associated with bowel symptoms (P<0.0001).ConclusionLH, visualized by using BLI endoscopy was associated with bowel symptom, raising the possibility of pathogenic role of this endoscopic finding in the functional lower gastrointestinal disorders.

Endoscopic features of lymphoid follicles in the colonic mucosa using the image enhanced endoscopy and its association with colorectal adenoma

“…Moreover, the BLI has bright mode, which achieves a brighter image than usual BLI mode to maintain the enhanced contrast of surface vessels from a far field of view. It has been reported that LHs in the colonic mucosa, predominantly observed in the appendix (cecum) and the ascending colon, can be visualized more clearly by using BLI-bright mode compared to conventional white light colonoscopy [ 7 ] ( Fig 1 ). We therefore used the BLI-bright mode to evaluate the presence of LH in all cases.…”

“…According to the previous report [ 7 ], the presence of LH was defined as well demarcated white nodules. Elevated LH with erythematous change was distinguished as LH severe ( Fig 2 ).…”

“…LHs in the small and large intestine was associated with food hypersensitivity and bowel symptoms [ 6 ]. LH is histologically characterized as intense infiltration of lymphocytes or plasmacytes [ 7 ]. LHs may therefore reflect individual inflammatory immune responses in the colonic mucosa.…”

“…LHs may therefore reflect individual inflammatory immune responses in the colonic mucosa. We have previously reported that LHs are observed more clearly by using blue laser imaging (BLI) endoscopy, a new generation image-enhanced endoscopy (IEE) system and correlated well with chronic bowel symptoms in healthy subjects [ 7 ]. Since colorectal tumorigenesis involves complex inflammatory immune responses that are still not completely understood, we investigated the potential association between occurrence of colorectal lesions including CRC, adenoma and hyperplastic polyp and presence of LHs visualized by the BLI endoscopy.…”

Rotational 3D mechanogenomic Turing patterns of human colon Caco-2 cells during differentiation

“…which are currently used clinically [10, 66, 79–81]. Recent clinical studies demonstrated that Helicobacter pylori infection and eradication can induce endoscopic morphological changes and epigenetic changes in samples collected, these trends may also exist in colon [75, 82, 83]. Patient colon crypts can be isolated from the biopsies for actomyosin meshwork/4D nucelome analysis and organoids culture (Fig.…”