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1
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Segundo-Arizmendi N, Arellano-Maciel D, Rivera-Ramírez A, Piña-González AM, López-Leal G, Hernández-Baltazar E. Bacteriophages: A Challenge for Antimicrobial Therapy. Microorganisms 2025; 13:100. [PMID: 39858868 PMCID: PMC11767365 DOI: 10.3390/microorganisms13010100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Revised: 12/22/2024] [Accepted: 01/03/2025] [Indexed: 01/27/2025] Open
Abstract
Phage therapy, which involves the use of bacteriophages (phages) to combat bacterial infections, is emerging as a promising approach to address the escalating threat posed by multidrug-resistant (MDR) bacteria. This brief review examines the historical background and recent advancements in phage research, focusing on their genomics, interactions with host bacteria, and progress in medical and biotechnological applications. Additionally, we expose key aspects of the mechanisms of action, and therapeutic uses of phage considerations in treating MDR bacterial infections are discussed, particularly in the context of infections related to virus-bacteria interactions.
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Affiliation(s)
- Nallelyt Segundo-Arizmendi
- Laboratorio de Microbiología y Parasitología, Facultad de Farmacia de la, Universidad Autónoma del Estado de Morelos, Cuernavaca 62209, Mexico;
| | - Dafne Arellano-Maciel
- Laboratorio de Biología Computacional y Virómica Integrativa, Centro de Investigación en Dinámica Celular, Universidad Autónoma del Estado de Morelos, Cuernavaca 62209, Mexico; (D.A.-M.); (A.M.P.-G.)
| | - Abraham Rivera-Ramírez
- Laboratorio de Estudios Ecogenómicos, Centro de Investigación en Biotecnología, Universidad Autónoma del Estado de Morelos, Cuernavaca 62209, Mexico;
| | - Adán Manuel Piña-González
- Laboratorio de Biología Computacional y Virómica Integrativa, Centro de Investigación en Dinámica Celular, Universidad Autónoma del Estado de Morelos, Cuernavaca 62209, Mexico; (D.A.-M.); (A.M.P.-G.)
| | - Gamaliel López-Leal
- Laboratorio de Biología Computacional y Virómica Integrativa, Centro de Investigación en Dinámica Celular, Universidad Autónoma del Estado de Morelos, Cuernavaca 62209, Mexico; (D.A.-M.); (A.M.P.-G.)
| | - Efren Hernández-Baltazar
- Laboratorio 1 de Tecnología Farmacéutica, Facultad de Farmacia de la, Universidad Autónoma del Estado de Morelos, Cuernavaca 62209, Mexico
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Fasulo E, D’Amico F, Zilli A, Furfaro F, Cicerone C, Parigi TL, Peyrin-Biroulet L, Danese S, Allocca M. Advancing Colorectal Cancer Prevention in Inflammatory Bowel Disease (IBD): Challenges and Innovations in Endoscopic Surveillance. Cancers (Basel) 2024; 17:60. [PMID: 39796690 PMCID: PMC11718813 DOI: 10.3390/cancers17010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 12/27/2024] [Accepted: 12/27/2024] [Indexed: 01/13/2025] Open
Abstract
Patients with inflammatory bowel disease (IBD) face an elevated risk of developing colorectal cancer (CRC). Endoscopic surveillance is a cornerstone in CRC prevention, enabling early detection and intervention. However, despite recent advancements, challenges persist. Chromoendoscopy (CE), considered the gold standard for dysplasia detection, remains underutilized due to logistical constraints, prolonged procedural times, and the need for specialized training. New technologies, such as endomicroscopy, confocal laser endomicroscopy (CLE), and molecular endoscopy (ME), promise unprecedented precision in lesion characterization but are limited to specialized centers. Artificial intelligence (AI) can transform the field; however, barriers to widespread AI adoption include the need for robust datasets, real-time video integration, and seamless incorporation into existing workflows. Beyond technology, patient adherence to surveillance protocols, including bowel preparation and repeat procedures, remains a critical hurdle. This review aims to explore the advancements, ongoing challenges, and future prospects in CRC prevention for IBD patients, focusing on improving outcomes and expanding the implementation of advanced surveillance technologies.
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Affiliation(s)
- Ernesto Fasulo
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.F.); (F.D.); (A.Z.); (F.F.); (C.C.); (T.L.P.); (S.D.)
| | - Ferdinando D’Amico
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.F.); (F.D.); (A.Z.); (F.F.); (C.C.); (T.L.P.); (S.D.)
| | - Alessandra Zilli
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.F.); (F.D.); (A.Z.); (F.F.); (C.C.); (T.L.P.); (S.D.)
| | - Federica Furfaro
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.F.); (F.D.); (A.Z.); (F.F.); (C.C.); (T.L.P.); (S.D.)
| | - Clelia Cicerone
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.F.); (F.D.); (A.Z.); (F.F.); (C.C.); (T.L.P.); (S.D.)
| | - Tommaso Lorenzo Parigi
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.F.); (F.D.); (A.Z.); (F.F.); (C.C.); (T.L.P.); (S.D.)
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France;
- NSERM, NGERE, University of Lorraine, F-54000 Nancy, France
- INFINY Institute, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- Groupe Hospitalier Privé Ambroise Paré-Hartmann, Paris IBD Center, F-92200 Neuilly sur Seine, France
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.F.); (F.D.); (A.Z.); (F.F.); (C.C.); (T.L.P.); (S.D.)
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.F.); (F.D.); (A.Z.); (F.F.); (C.C.); (T.L.P.); (S.D.)
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Yoshida N, Suzuki S, Inoue K, Aniwan S, Chiu HM, Laohavichitra K, Chirapongsathorn S, Yamamura T, Kuo CY, Ang TL, Takezawa T, Rerknimitr R, Ishikawa H. Analysis of the Characteristics of Coexisting Lesions in Colorectal Cancer Patients in an International Study: A Subgroup Analysis of the ATLAS Trial. Digestion 2024; 105:280-290. [PMID: 38631318 DOI: 10.1159/000538955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/16/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION We investigated coexisting lesion types in patients with invasive colorectal cancer (CRC) in a multinational study for comprehending the adenoma-carcinoma and serrated pathway about the development of CRC. METHODS We retrospectively reviewed 3,050 patients enrolled in the international randomized controlled trial (ATLAS study) to evaluate the colorectal polyp detection performance of image-enhanced endoscopy in 11 institutions in four Asian countries/regions. In the current study, as a subgroup analysis of the ATLAS study, 92 CRC patients were extracted and compared to 2,958 patients without CRC to examine the effects of age, sex, and coexisting lesion types (high-grade adenoma [HGA], low-grade adenoma with villous component [LGAV], 10 adenomas, adenoma ≥10 mm, sessile serrated lesions [SSLs], and SSLs with dysplasia [SSLD]). Additional analyses of coexisting lesion types were performed according to sex and location of CRC (right- or left-sided). RESULTS A multivariate analysis showed that HGA (odds ratio [95% confidence interval] 4.29 [2.16-8.18]; p < 0.01), LGAV (3.02 [1.16-7.83], p = 0.02), and age (1.04 [1.01-1.06], p = 0.01) were independently associated with CRC. According to sex, the coexisting lesion types significantly associated with CRC were LGAV (5.58 [1.94-16.0], p < 0.01) and HGA (4.46 [1.95-10.20], p < 0.01) in males and HGA (4.82 [1.47-15.80], p < 0.01) in females. Regarding the location of CRC, SSLD (21.9 [1.31-365.0], p = 0.03) was significant for right-sided CRC, and HGA (5.22 [2.39-11.4], p < 0.01) and LGAV (3.46 [1.13-10.6], p = 0.02) were significant for left-sided CRC. CONCLUSIONS The significant coexisting lesions in CRC differed according to sex and location. These findings may contribute to comprehending the pathogenesis of CRC.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan,
| | - Sho Suzuki
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satimai Aniwan
- Center of Excellence in Endoscopy for Gastrointestinal Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Sakkarin Chirapongsathorn
- Division of Gastroenterology and Hepatology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chen-Ya Kuo
- Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore, Singapore
| | - Takahito Takezawa
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Rungsun Rerknimitr
- Center of Excellence in Endoscopy for Gastrointestinal Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Pal P, Ramchandani M, Patel R, Banerjee R, Kanaganti S, Gupta R, Tandan M, Reddy DN. Role of ultra-high definition endoscopy (endomicroscopy and endocytoscopy) and real-time histologic examination in inflammatory bowel disease: Scoping review. Dig Endosc 2024; 36:274-289. [PMID: 37573562 DOI: 10.1111/den.14659] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/06/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES Confocal laser endomicroscopy (CLE) and endocytoscopy (EC) are ultra-high definition (HD) imaging modalities that enable real-time histological assessment. Although existent for nearly two decades, their role in current clinical decision making in inflammatory bowel disease management is not well defined. METHODS We searched PubMed using keywords ("confocal" OR "CLE" OR "endocytoscopy") AND ("IBD" OR "inflammatory bowel" OR "Crohn*" OR "Crohn's" OR "colitis ulcerosa" OR "ulcerative colitis") between 2005 and March 2023. We identified 52 studies for detailed review. RESULTS Confocal laser endomicroscopy was useful in real-time assessment of histologic inflammation and dysplasia characterization in both ulcerative colitis (UC) and Crohn's disease. Although CLE was associated with higher per-biopsy yield for UC-associated neoplasia (UCAN), the benefit was offset by higher procedure time, frequent equipment failure, and conflicting results on incremental yield over chromoendoscopy. Assessment of barrier dysfunction by CLE did not correlate with disease/endoscopic activity but could predict major adverse outcomes. The implications of residual CLE abnormalities in endoscopic remission remain uncertain. Ex vivo binding of labeled biologics can help in predicting biologic response in UC. EC can discriminate mucosal inflammatory cells by morphology and allows assessment of histologic activity. EC combined with pit pattern was better than pit pattern alone for UCAN. Artificial intelligence-assisted EC in UCAN needs further study. CONCLUSION Ultra-HD imaging in inflammatory bowel disease can be useful in assessment of UCAN, barrier dysfunction, predicting histologic remission, and biologic response. Future controlled studies are warranted to define the role of these novel technologies in clinical decision making.
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Affiliation(s)
- Partha Pal
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | - Rupa Banerjee
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Rajesh Gupta
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Manu Tandan
- Asian Institute of Gastroenterology, Hyderabad, India
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Sun J, Sheng J, Zhang LJ. Gastrointestinal tract. TRANSPATHOLOGY 2024:281-296. [DOI: 10.1016/b978-0-323-95223-1.00005-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Palenca I, Seguella L, Zilli A, Basili Franzin S, Del Re A, Pepi F, Troiani A, Pesce M, Rurgo S, De Palma FDE, Luglio G, Tropeano FP, Sarnelli G, Esposito G. Intrarectal Administration of Adelmidrol plus Hyaluronic Acid Gel Ameliorates Experimental Colitis in Mice and Inhibits Pro-Inflammatory Response in Ex Vivo Cultured Biopsies Derived from Ulcerative Colitis-Affected Patients. Int J Mol Sci 2023; 25:165. [PMID: 38203336 PMCID: PMC10778920 DOI: 10.3390/ijms25010165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Improving clinical outcomes and delaying disease recrudescence in Ulcerative Colitis (UC) patients is crucial for clinicians. In addition to traditional and new pharmacological therapies that utilize biological drugs, the development of medical devices that can ameliorate UC and facilitate the remission phase should not be overlooked. Drug-based therapy requires time to be personalized and to evaluate the benefit/risk ratio. However, the increasing number of diagnosed UC cases worldwide necessitates the exploration of new strategies to enhance clinical outcomes. By incorporating medical devices alongside pharmacological treatments, clinicians can provide additional support to UC patients, potentially improving their condition and slowing down the recurrence of symptoms. Chemically identified as an azelaic acid derivative and palmitoylethanolamide (PEA) analog, adelmidrol is a potent anti-inflammatory and antioxidant compound. In this study, we aimed to evaluate the effect of an intrarectal administration of 2% adelmidrol (Ade) and 0.1% hyaluronic acid (HA) gel formulation in both the acute and resolution phase of a mouse model of colitis induced via DNBS enema. We also investigated its activity in cultured human colon biopsies isolated from UC patients in the remission phase at follow-up when exposed in vitro to a cytomix challenge. Simultaneously, with its capacity to effectively alleviate chronic painful inflammatory cystitis when administered intravesically to urological patients such as Vessilen, the intrarectal administration of Ade/HA gel has shown remarkable potential in improving the course of colitis. This treatment approach has demonstrated a reduction in the histological damage score and an increase in the expression of ZO-1 and occludin tight junctions in both in vivo studies and human specimens. By acting independently on endogenous PEA levels and without any noticeable systemic absorption, the effectiveness of Ade/HA gel is reliant on a local antioxidant mechanism that functions as a "barrier effect" in the inflamed gut. Building on the findings of this preliminary study, we are confident that the Ade/HA gel medical device holds promise as a valuable adjunct in supporting traditional anti-UC therapies.
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Affiliation(s)
- Irene Palenca
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.P.); (A.Z.); (S.B.F.); (A.D.R.); (G.E.)
| | - Luisa Seguella
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.P.); (A.Z.); (S.B.F.); (A.D.R.); (G.E.)
| | - Aurora Zilli
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.P.); (A.Z.); (S.B.F.); (A.D.R.); (G.E.)
| | - Silvia Basili Franzin
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.P.); (A.Z.); (S.B.F.); (A.D.R.); (G.E.)
| | - Alessandro Del Re
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.P.); (A.Z.); (S.B.F.); (A.D.R.); (G.E.)
| | - Federico Pepi
- Department of Chemistry and Drug Technologies, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; (F.P.); (A.T.)
| | - Anna Troiani
- Department of Chemistry and Drug Technologies, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy; (F.P.); (A.T.)
| | - Marcella Pesce
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (S.R.); (G.S.)
| | - Sara Rurgo
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (S.R.); (G.S.)
| | - Fatima Domenica Elisa De Palma
- Department of Molecular Medicine and Medical Biotechnologies, Centro Ingegneria Genetica-Biotecnologie Avanzate s.c.a rl, 80131 Naples, Italy;
| | - Gaetano Luglio
- Endoscopic Surgery Unit, Department of Medical and Surgical Gastrointestinal Disease, Federico II University of Naples, 80131 Naples, Italy; (G.L.); (F.P.T.)
| | - Francesca Paola Tropeano
- Endoscopic Surgery Unit, Department of Medical and Surgical Gastrointestinal Disease, Federico II University of Naples, 80131 Naples, Italy; (G.L.); (F.P.T.)
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (M.P.); (S.R.); (G.S.)
| | - Giuseppe Esposito
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (I.P.); (A.Z.); (S.B.F.); (A.D.R.); (G.E.)
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Waldner MJ, Neurath MF. Molecular Endoscopy for the Diagnosis and Therapeutic Monitoring of Colorectal Cancer. Front Oncol 2022; 12:835256. [PMID: 35280747 PMCID: PMC8913894 DOI: 10.3389/fonc.2022.835256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
Colorectal cancer (CRC) is one of the leading causes of cancer related death in the western world. Its successful treatment requires early detection and removal of precursor lesions as well as individualized treatment of advanced disease. During recent years, molecular imaging techniques have shown promising results to improve current clinical practice. For instance, molecular endoscopy resulted in higher detection rates of precursors in comparison to conventional endoscopy in preclinical and clinical studies. Molecular confocal endomicroscopy allowed a further classification of suspect lesions as well as the prediction and monitoring of the therapeutic response. In this review, we summarize recent achievements for molecular imaging of CRC in preclinical studies, initial clinical trials and the remaining challenges for future translation into clinical practice.
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Affiliation(s)
- Maximilian J Waldner
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F Neurath
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Huguet JM, Ferrer-Barceló L, Suárez P, Sanchez E, Prieto JD, Garcia V, Sempere J. Colorectal cancer screening and surveillance in patients with inflammatory bowel disease in 2021. World J Gastroenterol 2022; 28:502-516. [PMID: 35316962 PMCID: PMC8905018 DOI: 10.3748/wjg.v28.i5.502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/10/2021] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
The detection of dysplasia in patients with inflammatory bowel disease (IBD) continues to be important given the increased risk of colorectal cancer in this population. Therefore, in 2017, we performed a review and update of the recommendations for the management and follow-up of patients with IBD based on the clinical practice guidelines of various scientific societies. The present manuscript focuses on new aspects of the detection, follow-up, and management of dysplasia according to the latest studies and recommendations. While chromoendoscopy with targeted biopsy continues to be the technique of choice for the screening and detection of dysplasia in IBD, the associated difficulties mean that it is now being compared with other techniques (virtual chromoendoscopy), which yield similar results with less technical difficulties. Furthermore, the emergence of new endoscopy techniques that are still being researched but seem promising (e.g., confocal laser endomicroscopy and full-spectrum endoscopy), together with the development of devices that improve endoscopic visualization (e.g., Endocuff Vision), lead us to believe that these approaches can revolutionize the screening and follow-up of dysplasia in patients with IBD. Nevertheless, further studies are warranted to define the optimal follow-up strategy in this patient population.
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Affiliation(s)
- Jose Maria Huguet
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Luis Ferrer-Barceló
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Patrícia Suárez
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Eva Sanchez
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Jose David Prieto
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Victor Garcia
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Javier Sempere
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
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9
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Pilonis ND, Januszewicz W, di Pietro M. Confocal laser endomicroscopy in gastro-intestinal endoscopy: technical aspects and clinical applications. Transl Gastroenterol Hepatol 2022; 7:7. [PMID: 35243116 PMCID: PMC8826043 DOI: 10.21037/tgh.2020.04.02] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 03/30/2020] [Indexed: 08/24/2023] Open
Abstract
Confocal laser endomicroscopy (CLE) is an advanced endoscopic imaging technology that provides a magnified, cellular level view of gastrointestinal epithelia. In conjunction with topical or intravenous fluorescent dyes, CLE allows for an "optical biopsy" for real-time diagnosis. Two different CLE system have been used in clinical endoscopy, probe-based CLE (pCLE) and endoscope-based CLE (eCLE). Using pCLE, the device can be delivered: (I) into the luminal gastrointestinal tract through the working channel of standard endoscopes; (II) into extraluminal cystic and solid parenchymal lesions through an endoscopic ultrasound (EUS) needle; or (III) into the biliary system through an endoscopic retrograde cholangiopancreatography (ERCP) accessory channel. With eCLE, the probe is directly integrated into the tip of a conventional endoscope, however, these endoscopes are no longer commercially available. CLE has moderate to high diagnostic accuracy for neoplastic and inflammatory conditions through the gastrointestinal tract including: oesophageal, gastric and colonic neoplasia, pancreatic cysts and solid lesions, malignant pancreatobiliary strictures and inflammatory bowel disease. Some studies have demonstrated the diagnostic benefit of CLE imaging when combined with either conventional white light endoscopy or advanced imaging technologies. Therefore, optical biopsies using CLE can resolve diagnostic dilemmas in some cases where conventional imaging fails to achieve conclusive results. CLE could also reduce the requirement for extensive tissue sampling during surveillance procedures. In the future, CLE in combination with molecular probes, could allow for the molecular characterization of diseases and assess response to targeted therapy. However, the narrow field of view, high capital costs and specialized operator training requirements remain the main limitations. Future multi-center, randomized trials with a focus on conventional diagnostic applications, cost-effectiveness and standardized training will be required for definitive evidence. The objective of this review is to evaluate the technical aspects and current applications of CLE in patients with gastrointestinal and pancreatobiliary diseases and discuss future directions for this technique.
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Affiliation(s)
- Nastazja Dagny Pilonis
- MRC Cancer Unit at the University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
- Department of Gastroenterological Oncology, the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Wladyslaw Januszewicz
- Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
- Department of Gastroenterological Oncology, the Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Massimiliano di Pietro
- MRC Cancer Unit at the University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
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Wang W, Tian S, Jiang X, Pang S, Shi H, Fan M, Wang Z, Jiang W, Hu W, Xiao X, Lin R. Molecular Imaging of Ulex Europaeus Agglutinin in Colorectal Cancer Using Confocal Laser Endomicroscopy (With Video). Front Oncol 2022; 11:792420. [PMID: 34988023 PMCID: PMC8722710 DOI: 10.3389/fonc.2021.792420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/23/2021] [Indexed: 01/05/2023] Open
Abstract
Background and Study Aims Previous studies have identified that colorectal cancer has different fucosylation levels compared to the normal colon. Ulex europaeus agglutinin-I (UEA-I), which specifically combines with α1-2 fucose glycan, is usually used to detect fucosylation levels. Therefore, we used confocal laser endomicroscopy (CLE) to investigate fluorescently labeled UEA-Fluorescein isothiocyanate (FITC) for detecting colonic cancer. Patients and Methods We stained frozen mouse colon tissue sections of normal, adenoma, and adenocarcinoma species with UEA-FITC to detect fucosylation levels in different groups. White light endoscopy and endocytoscopy were first used to detect the lesions. The UEA-FITC was then stained in the mice and human colon tissues in vitro. The CLE was used to detect the UEA-FITC levels of the corresponding lesions, and videos were recorded for quantitation analysis. The diagnostic accuracy of UEA-FITC using CLE was evaluated in terms of sensitivity and specificity. Results The UEA expression level in colorectal cancer was lower than that in normal intestinal epithelium. The fluorescence intensity ratio of UEA-FITC in colorectal cancer was significantly lower than that in normal tissue detected by CLE in both mice and humans. The combination of UEA-FITC and CLE presented a good diagnostic accuracy with a sensitivity of 95.6% and a specificity of 97.7% for detecting colorectal cancer. The positive and negative predictive values were 91.6% and 95.6%, respectively. Overall, 95.6% of the sites were correctly classified by CLE. Conclusions We developed a new imaging strategy to improve the diagnostic efficacy of CLE by using UEA-FITC.
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Affiliation(s)
- Weijun Wang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Gastroenterology, National Health Commission (NHC) Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Shuxin Tian
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Gastroenterology, National Health Commission (NHC) Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China.,Department of Gastroenterology, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Xin Jiang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suya Pang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huiying Shi
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengke Fan
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zeyu Wang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Jiang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiqian Hu
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xueyan Xiao
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Lin
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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11
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van der Laan JJH, van der Waaij AM, Gabriëls RY, Festen EAM, Dijkstra G, Nagengast WB. Endoscopic imaging in inflammatory bowel disease: current developments and emerging strategies. Expert Rev Gastroenterol Hepatol 2021; 15:115-126. [PMID: 33094654 DOI: 10.1080/17474124.2021.1840352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Developments in enhanced and magnified endoscopy have signified major advances in endoscopic imaging of ileocolonic pathology in inflammatory bowel disease (IBD). Artificial intelligence is increasingly being used to augment the benefits of these advanced techniques. Nevertheless, treatment of IBD patients is frustrated by high rates of non-response to therapy, while delayed detection and failures to detect neoplastic lesions impede successful surveillance. A possible solution is offered by molecular imaging, which adds functional imaging data to mucosal morphology assessment through visualizing biological parameters. Other label-free modalities enable visualization beyond the mucosal surface without the need of tracers. AREAS COVERED A literature search up to May 2020 was conducted in PubMed/MEDLINE in order to find relevant articles that involve the (pre-)clinical application of high-definition white light endoscopy, chromoendoscopy, artificial intelligence, confocal laser endomicroscopy, endocytoscopy, molecular imaging, optical coherence tomography, and Raman spectroscopy in IBD. EXPERT OPINION Enhanced and magnified endoscopy have enabled an improved assessment of the ileocolonic mucosa. Implementing molecular imaging in endoscopy could overcome the remaining clinical challenges by giving practitioners a real-time in vivo view of targeted biomarkers. Label-free modalities could help optimize the endoscopic assessment of mucosal healing and dysplasia detection in IBD patients.
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Affiliation(s)
- Jouke J H van der Laan
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen , Groningen, The Netherlands
| | - Anne M van der Waaij
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen , Groningen, The Netherlands
| | - Ruben Y Gabriëls
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen , Groningen, The Netherlands
| | - Eleonora A M Festen
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen , Groningen, The Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen , Groningen, The Netherlands
| | - Wouter B Nagengast
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen , Groningen, The Netherlands
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12
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Ham NS, Myung SJ. Endoscopic molecular imaging in inflammatory bowel disease. Intest Res 2021; 19:33-44. [PMID: 32299156 PMCID: PMC7873406 DOI: 10.5217/ir.2019.09175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
Molecular imaging is a technique for imaging the processes occurring in a living body at a molecular level in real-time, combining molecular cell biology with advanced imaging technologies using molecular probes and fluorescence. Gastrointestinal endoscopic molecular imaging shows great promise for improving the identification of neoplasms, providing characterization for patient stratification and assessing the response to molecular targeted therapy. In inflammatory bowel disease, endoscopic molecular imaging can be used to assess disease severity and predict therapeutic response and prognosis. Endoscopic molecular imaging is also able to visualize dysplasia in the presence of background inflammation. Several preclinical and clinical trials have evaluated endoscopic molecular imaging; however, this area is just beginning to evolve, and many issues have not been solved yet. In the future, it is expected that endoscopic molecular imaging will be of increasing interest among clinicians as a new technology for the identification and evaluation of colorectal neoplasm and colitis-associated cancer.
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Affiliation(s)
- Nam Seok Ham
- Department of Gastroenterology, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Digestive Diseases Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Seung-Jae Myung, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3917, Fax: +82-2- 476-0824, E-mail:
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13
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Sacco M, De Palma FDE, Guadagno E, Giglio MC, Peltrini R, Marra E, Manfreda A, Amendola A, Cassese G, Dinuzzi VP, Pegoraro F, Tropeano FP, Luglio G, De Palma GD. Serrated lesions of the colon and rectum: Emergent epidemiological data and molecular pathways. Open Med (Wars) 2020; 15:1087-1095. [PMID: 33336065 PMCID: PMC7718641 DOI: 10.1515/med-2020-0226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 07/14/2020] [Accepted: 08/07/2020] [Indexed: 12/26/2022] Open
Abstract
In 2010, serrated polyps (SP) of the colon have been included in the WHO classification of digestive tumors. Since then a large corpus of evidence focusing on these lesions are available in the literature. This review aims to analyze the present data on the epidemiological and molecular aspects of SP. Hyperplastic polyps (HPs) are the most common subtype of SP (70-90%), with a minimal or null risk of malignant transformation, contrarily to sessile serrated lesions (SSLs) and traditional serrated adenomas (TSAs), which represent 10-20% and 1% of adenomas, respectively. The malignant transformation, when occurs, is supported by a specific genetic pathway, known as the serrated-neoplasia pathway. The time needed for malignant transformation is not known, but it may occur rapidly in some lesions. Current evidence suggests that a detection rate of SP ≥15% should be expected in a population undergoing screening colonoscopy. There are no differences between primary colonoscopies and those carried out after positive occult fecal blood tests, as this screening test fails to identify SP, which rarely bleed. Genetic similarities between SP and interval cancers suggest that these cancers could arise from missed SP. Hence, the detection rate of serrated-lesions should be evaluated as a quality indicator of colonoscopy. There is a lack of high-quality longitudinal studies analyzing the long-term risk of developing colorectal cancer (CRC), as well as the cancer risk factors and molecular tissue biomarkers. Further studies are needed to define an evidence-based surveillance program after the removal of SP, which is currently suggested based on experts' opinions.
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Affiliation(s)
- Michele Sacco
- Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 – 80131, Naples, Italy
| | - Fatima Domenica Elisa De Palma
- CEINGE Biotecnologie Avanzate s.c.ar.l., Via Comunale Margherita, 80131, Naples, Italy
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, via Sergio Pansini, 5 – 80131, Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples Federico II, Naples, Italy
| | - Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 – 80131, Naples, Italy
| | - Roberto Peltrini
- Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 – 80131, Naples, Italy
| | - Ester Marra
- Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 – 80131, Naples, Italy
| | - Andrea Manfreda
- Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 – 80131, Naples, Italy
| | - Alfonso Amendola
- Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 – 80131, Naples, Italy
| | - Gianluca Cassese
- Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 – 80131, Naples, Italy
| | - Vincenza Paola Dinuzzi
- Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 – 80131, Naples, Italy
| | - Francesca Pegoraro
- Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 – 80131, Naples, Italy
| | - Francesca Paola Tropeano
- Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 – 80131, Naples, Italy
| | - Gaetano Luglio
- Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 – 80131, Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, University of Naples Federico II via Sergio Pansini, 5 – 80131, Naples, Italy
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14
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SAGES TAVAC safety and efficacy analysis confocal laser endomicroscopy. Surg Endosc 2020; 35:2091-2103. [PMID: 32405892 DOI: 10.1007/s00464-020-07607-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Confocal laser endomicroscopy (CLE) is a novel endoscopic adjunct that allows real-time in vivo histological examination of mucosal surfaces. By using intravenous or topical fluorescent agents, CLE highlights certain mucosal elements that facilitate an optical biopsy in real time. CLE technology has been used in different organ systems including the gastrointestinal tract. There has been numerous studies evaluating this technology in gastrointestinal endoscopy, our aim was to evaluate the safety, value, and efficacy of this technology in the gastrointestinal tract. METHODS The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Technology and Value Assessment Committee (TAVAC) performed a PubMed/Medline database search of clinical studies involving CLE in May of 2018. The literature search used combinations of the keywords: confocal laser endomicroscopy, pCLE, Cellvizio, in vivo microscopy, optical histology, advanced endoscopic imaging, and optical diagnosis. Bibliographies of key references were searched for relevant studies not covered by the PubMed search. Case reports and small case series were excluded. The manufacturer's website was also used to identify key references. The United States Food and Drug Administration (U.S. FDA) Manufacturer And User facility and Device Experience (MAUDE) database was searched for reports regarding the device malfunction or injuries. RESULTS The technology offers an excellent safety profile with rare adverse events related to the use of fluorescent agents. It has been shown to increase the detection of dysplastic Barrett's esophagus, gastric intraepithelial neoplasia/early gastric cancer, and dysplasia associated with inflammatory bowel disease when compared to standard screening protocols. It also aids in the differentiation and classification of colorectal polyps, indeterminate biliary strictures, and pancreatic cystic lesions. CONCLUSIONS CLE has an excellent safety profile. CLE can increase the diagnostic accuracy in a number of gastrointestinal pathologies.
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15
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16
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Ahmed S, Galle PR, Neumann H. Molecular endoscopic imaging: the future is bright. Ther Adv Gastrointest Endosc 2019; 12:2631774519867175. [PMID: 31517311 PMCID: PMC6724493 DOI: 10.1177/2631774519867175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/10/2019] [Indexed: 12/24/2022] Open
Abstract
The prediction and final survival rate of gastrointestinal cancers are dependent on the stage of disease. The ideal would be to detect those gastrointestinal lesions at early stage or even premalignant forms which are difficult to detect by conventional endoscopy with white light optical imaging as they show minimum or no changes in morphological characteristics and are thus left untreated. The introduction of molecular imaging has greatly changed the pattern for detecting gastrointestinal lesions from purely macroscopic structural imaging to the molecular level. It allows microscopic examination of the gastrointestinal mucosa with endoscopy after the topical or systemic application of molecular probes. In recent years, major advancements in endoscopic instruments and specific molecular probes have been achieved. This review focuses on the current status of endoscopic imaging and highlights the application of molecular imaging in gastrointestinal and hepatic disease in the context of diagnosis and therapy based on recently published literature in this field. We also discuss the challenges of molecular endoscopic imaging, its future directions and potential that could have a tremendous impact on endoscopic research and clinical practice in future.
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Affiliation(s)
- Shakil Ahmed
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter R Galle
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Helmut Neumann
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
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17
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Peltrini R, Luglio G, Cassese G, Amendola A, Caruso E, Sacco M, Pagano G, Sollazzo V, Tufano A, Giglio MC, Bucci L, Palma GDD. Oncological Outcomes and Quality of Life After Rectal Cancer Surgery. Open Med (Wars) 2019; 14:653-662. [PMID: 31565674 PMCID: PMC6744610 DOI: 10.1515/med-2019-0075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/16/2019] [Indexed: 12/16/2022] Open
Abstract
Surgery for rectal cancer has been completely revolutionized thanks to the adoption of new technologies and up-to-date surgical procedures that have been applied to the traditional milestone represented by Total Mesorectal Excision (TME). The multimodal and multidisciplinary approach, with new technologies increased the patients' life expectancies; nevertheless, they have placed the surgeon in front of newer issues, represented by both oncological outcomes and the patients' need of a less destructive surgery and improved quality of life. In this review we will go through laparoscopic, robotic and transanal TME surgery, to show how the correct choice of the most appropriate technique, together with a deep knowledge of oncological principles and pelvic anatomy, is crucial to pursue an optimal cancer treatment. Novel technologies might also help to decrease the patients' fear of surgery and address important issues such as cosmesis and improved preservation of postoperative functionality.
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Affiliation(s)
- Roberto Peltrini
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Gaetano Luglio
- Department of Public Health. University of Naples “Federico II”, Naples, Italy
| | - Gianluca Cassese
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Alfonso Amendola
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Emanuele Caruso
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Michele Sacco
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Gianluca Pagano
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Viviana Sollazzo
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Antonio Tufano
- Department of Urology, University of Rome “La Sapienza”, 00161Roma RMItaly
| | - Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Luigi Bucci
- Department of Public Health. University of Naples “Federico II”, Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
- Center of Excellence for Technical Innovation in Surgery (CEITC). University of Naples Federico II, 80131Naples, Italy
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18
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Buchner AM. Confocal Laser Endomicroscopy in the Evaluation of Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1302-1312. [PMID: 30877772 DOI: 10.1093/ibd/izz021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Indexed: 12/13/2022]
Abstract
Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, can be effectively monitored with the use of endoscopy. The additional application of small field imaging technology such as confocal laser endomicroscopy CLE during ongoing endoscopic evaluation has led to real-time visualization of mucosal abnormalities and thus in vivo histology. The endomicroscopy (CLE) can improve IBD endoscopic evaluation by identifying seemingly normal-appearing mucosa, assessing the function of the intestinal barrier of the epithelium and vascular permeability, and by characterizing any mucosal lesions, including dysplastic lesions. CLE used during conventional endoscopy could especially facilitate the evaluation of mucosal healing in IBD. In addition, future developments in molecular imaging in IBD may optimize therapeutic approaches by identifying mucosal targets for therapy and determining the reasons for lack of response to specific therapy or subsequent loss of the response.
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Affiliation(s)
- Anna M Buchner
- Division of Gastroenterology at University of Pennsylvania, Philadelphia, Pennsylvania
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19
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Imperatore N, Castiglione F, Testa A, De Palma GD, Caporaso N, Cassese G, Rispo A. Augmented Endoscopy for Surveillance of Colonic Inflammatory Bowel Disease: Systematic Review With Network Meta-analysis. J Crohns Colitis 2019; 13:714-724. [PMID: 30597029 DOI: 10.1093/ecco-jcc/jjy218] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Considering the high risk of dysplasia and cancer in inflammatory bowel disease [IBD], surveillance is advocated. However, international guidelines do not reach a uniform recommendation on the way to perform surveillance. We performed a systematic review with a meta-analysis to assess the best endoscopic surveillance strategy in colonic IBD. METHODS The systematic review was performed in PubMed/MEDLINE, EMBASE, SCOPUS, and Cochrane databases to identify studies comparing white light endoscopy [WLE] and augmented endoscopy [AE] in the detection of dysplasia/neoplasia in colonic IBD. A sub-analysis between dye-spray chromoendoscopy [DCE], narrow-band imaging [NBI], I-SCAN, full-spectrum endoscopy [FUSE], and auto-fluorescence imaging [AFI] was also performed. Furthermore, a meta-regression and a network meta-analysis were also performed. RESULTS A total of 27 studies [6167 IBD patients with 2024 dysplastic lesions] met the inclusion criteria. There was no publication bias. AE showed a higher likelihood of detecting dysplasia than WLE (19.3% vs 8.5%, odds ratio [OR] = 2.036), with an incremental yield [IY] of 10.8%. DCE [OR = 2.605] and AFI [OR = 3.055] had higher likelihood of detecting dysplasia than WLE; otherwise, I-SCAN [OR = 1.096], NBI [OR = 0.650], and FUSE [OR = 1.118] were not superior to WLE. Dysplasia was found in 1256/7267 targeted biopsies [17.3%] and in 363/110 040 random biopsies [0.33%] [OR = 66.559, IY = 16.9%]. Meta-regression found no variable impacting on the efficacy of AE techniques. Network meta-analysis identified a significant superiority of DCE to WLE in detecting dysplasia [OR 2.12], but no other single technique was found to be superior to all others in dysplasia detection. CONCLUSIONS DCE was associated with higher likelihood of discovering dysplastic lesions than WLE. Chromoendoscopy is the best supported endoscopic technique for IBD surveillance.
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Affiliation(s)
- Nicola Imperatore
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
| | - Giovanni Domenico De Palma
- Surgical Endoscopy, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
| | - Nicola Caporaso
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
| | - Gianluca Cassese
- Surgical Endoscopy, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
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20
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Iacucci M, Furfaro F, Matsumoto T, Uraoka T, Smith S, Ghosh S, Kiesslich R. Advanced endoscopic techniques in the assessment of inflammatory bowel disease: new technology, new era. Gut 2019; 68:562-572. [PMID: 30580249 DOI: 10.1136/gutjnl-2017-315235] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/05/2018] [Accepted: 09/21/2018] [Indexed: 12/18/2022]
Abstract
Endoscopic assessment of inflammation and mucosal healing is crucial for appropriate management in IBD. Current definition of endoscopic mucosal healing has been derived using previous generation of standard white light endoscopes. New endoscopy technologies widely available provide much more detailed images of mucosal and vascular patterns. Novel endoscopic techniques with high definition image, optical and digital enhancement have enhanced the quality and fine details of vascular and mucosal pattern so that endoscopic images have started to reflect histological changes for lesions and inflammation/healing. These technologies can now define subtle inflammatory changes and increase detection and characterisation of colonic lesions in patients with IBD. The best endoscopic technique to detect dysplasia in IBD is still debated. Dye chromoendoscopy with targeted biopsies is considered by Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in inflammatory Bowel Disease Patients: International Consensus Recommendations (SCENIC consensus the standard of care and recommended for adoption by gastroenterologists in practice. In future, it is possible that well-trained colonoscopists using high definition equipment with image enhancements may be able to obtain equivalent yield without pan-colonic dye spraying and characterise lesions. Finally, SCENIC introduced endoscopic resectability of some dysplastic colonic lesions-new techniques may now better characterise endoscopic resectability and limit the number of colectomies. In this review, we will provide a state-of-the-art opinion on the direction of technological advances in the assessment of IBD and how new concepts will refine clinical practice.
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Affiliation(s)
- Marietta Iacucci
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.,Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.,Department of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | | | - Takayuki Matsumoto
- Department of Gastroenterology, Iwate Medical University, Morioka, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gumna University Graduate School of Medicine, Maebashi, Japan
| | - Samuel Smith
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.,Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Subrata Ghosh
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.,Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Ralf Kiesslich
- Department of Medicine, HSK Hospital, Wiesbaden, Germany
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21
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Cassese G, Amendola A, Maione F, Giglio MC, Pagano G, Milone M, Aprea G, Luglio G, De Palma GD. Serrated Lesions of the Colon-Rectum: A Focus on New Diagnostic Tools and Current Management. Gastroenterol Res Pract 2019; 2019:9179718. [PMID: 30774654 PMCID: PMC6350577 DOI: 10.1155/2019/9179718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023] Open
Abstract
Prompt diagnosis and correct management of the so called "serrated lesions" (SLs) of the colon-rectum are generally considered of crucial importance in the past years, mainly due to their histological heterogeneity and peculiar clinical and molecular patterns; sometimes, they are missed at conventional endoscopy and are possibly implicated in the genesis of interval cancers. The aim of this review is to focus on the diagnostic challenges of serrated lesions, underlying the role of both conventional endoscopy and novel technologies. We will show how an accurate and precise diagnosis should immediately prompt the most appropriate therapy other than defining a proper follow-up program. It will be emphasized how novel endoscopic techniques may provide better visualization of mucosal microsurface structures other than enhancing the microvascular architecture, in order to better define and characterize specific patterns of mucosal lesions of the gastrointestinal tract. Standard therapy of SLs of the colon-rectum is still very debated, also due to the relatively lack of studies focusing on treatment issues. The high risk of incomplete resection, together with the high rate of postcolonoscopy interval cancers, suggests the need of an extra care when facing this kind of lesions. Given this background, we will outline useful technical tips and tricks in the resection of SLs, taking aspects such as the size and location of the lesions, as well as novel available techniques and technologies, other than future perspectives, including confocal laser endomicroscopy into consideration. Follow-up of SLs is another hot topic, also considering that their clinical impact has been misunderstood for a long time. The incidence of the so called interval colorectal cancer underlines how some weaknesses exist in current screening and follow-up programs. Considering the lack of wide consensus for the management of some SLs, we will try to summarize and clarify the best strategies for their optimal management.
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Affiliation(s)
- Gianluca Cassese
- University of Naples “Federico II”, Department of Clinical Medicine and Surgery, Italy
| | - Alfonso Amendola
- University of Naples “Federico II”, Department of Clinical Medicine and Surgery, Italy
| | - Francesco Maione
- University of Naples “Federico II”, Department of Clinical Medicine and Surgery, Italy
| | - Mariano Cesare Giglio
- University of Naples “Federico II”, Department of Clinical Medicine and Surgery, Italy
| | - Gianluca Pagano
- University of Naples “Federico II”, Department of Clinical Medicine and Surgery, Italy
| | - Marco Milone
- University of Naples “Federico II”, Department of Clinical Medicine and Surgery, Italy
| | - Giovanni Aprea
- University of Naples “Federico II”, Department of Clinical Medicine and Surgery, Italy
| | - Gaetano Luglio
- University of Naples “Federico II”, Department of Clinical Medicine and Surgery, Italy
| | - Giovanni Domenico De Palma
- University of Naples “Federico II”, Department of Clinical Medicine and Surgery, Italy
- Center of Excellence for Technological Innovation in Surgery, University of Naples “Federico II”, Italy
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Ahmed S, Strand S, Weinmann-Menke J, Urbansky L, Galle PR, Neumann H. Molecular endoscopic imaging in cancer. Dig Endosc 2018; 30:719-729. [PMID: 29846982 DOI: 10.1111/den.13199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/21/2018] [Indexed: 12/14/2022]
Abstract
Cancer is one of the major causes of death in both the USA and Europe. Molecular imaging is a novel field that is revolutionizing cancer management. It is based on the molecular signature of cells in order to study the human body both in normal and diseased conditions. The emergence of molecular imaging has been driven by the difficulties associated with cancer detection, particularly early-stage premalignant lesions which are often unnoticed as a result of minimal or no structural changes. Endoscopic surveillance is the standard method for early-stage cancer detection. In addition to recent major advancements in endoscopic instruments, significant progress has been achieved in the exploration of highly specific molecular probes and the combination of both will permit significant improvement of patient care. In this review, we provide an outline of the current status of endoscopic imaging and focus on recent applications of molecular imaging in gastrointestinal, hepatic and other cancers in the context of detection, targeted therapy and personalized medicine. As new imaging agents have the potential to broadly expand our cancer diagnostic capability, we will also present an overview of the main types of optical molecular probes with their pros and cons. We conclude by discussing the challenges and future prospects of the field.
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Affiliation(s)
- Shakil Ahmed
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Mainz, Germany
| | - Susanne Strand
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Mainz, Germany
| | - Julia Weinmann-Menke
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Mainz, Germany
| | - Lana Urbansky
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Mainz, Germany
| | - Peter R Galle
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Mainz, Germany
| | - Helmut Neumann
- Department of Interdisciplinary Endoscopy, I. Medical Clinic and Polyclinic, University Hospital Mainz, Mainz, Germany
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