Efficacy of Image-Enhanced Endoscopy Using a Novel Double-Balloon Enteroscope for Visibility of Small-Bowel Lesions

Introduction: The novel double-balloon enteroscope (DBE), EN-840T, is the first DBE system to incorporate image-enhanced endoscopy (IEE) technologies, such as blue laser imaging (BLI) and linked color imaging (LCI). This study aimed to evaluate the efficacy of IEE in improving the visibility of small-bowel lesions using EN-840T. Methods: We conducted a retrospective analysis of 49 patients with 120 lesions who underwent double-balloon enteroscopy using EN-840T between March and June 2024. Lesion visibility and color differences were compared among BLI, LCI, and white light imaging (WLI). Five physicians assessed lesion visibility by assigning scores. Additionally, color differences between normal mucosa and the patchy reddish lesions <5 mm in diameter, including angioectasia and erythema, were calculated for each IEE and WLI image. The primary and secondary outcomes were the visibility of small-bowel lesions on IEE and the color differences in these lesions, respectively. Result: Lesions were classified as inflammatory (n = 71), tumorous (n = 39), and vascular (n = 10). LCI improved lesion visibility by 75% (53/71) for inflammatory lesions, 72% (28/39) for tumorous lesions, and 80% (8/10) for vascular lesions compared with WLI. Furthermore, the mean color difference (mean ± SD) of reddish lesions was significantly greater in LCI than in WLI for both angioectasia (25.2 ± 1.83 vs. 20.6 ± 2.14 [P < 0.001]) and erythema (25.3 ± 2.25 vs. 19.8 ± 1.82 [P < 0.001]). Conclusions: IEE using EN-840T enhanced the visibility of small-bowel lesions. Specifically, LCI improved lesion visibility and may contribute to detecting small lesions.