|
1
|
Li J, Yao H, Lu Y, Zhang S, Zhang Z. Chinese national clinical practice guidelines on prevention, diagnosis and treatment of early colorectal cancer. Chin Med J (Engl) 2024; 137:2017-2039. [PMID: 39104005 PMCID: PMC11374253 DOI: 10.1097/cm9.0000000000003253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND The incidence and mortality of colorectal cancer (CRC) in China are increasing in recent years. The clarified pathogenesis and detectable precancerous lesions of CRC make it possible to prevent, screen, and diagnose CRC at an early stage. With the development of endoscopic and surgical techniques, the choice of treatment for early CRC is also worth further discussion, and accordingly, a standard follow-up program after treatment needs to be established. METHODS This clinical practice guideline (CPG) was developed following the recommended process of the World Health Organization, adopting Grading of Recommendations Assessment, Development and Evaluation (GRADE) in assessing evidence quality, and using the Evidence to Decision framework to formulate clinical recommendations, thereby minimizing bias and increasing transparency of the CPG development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guides to ensure the guideline's completeness and transparency. RESULTS This CPG comprises 46 recommendations concerning prevention, screening, diagnosis, treatment, and surveillance of CRC. In these recommendations, we have indicated protective and risk factors for CRC and made recommendations for chemoprevention. We proposed a suitable screening program for CRC based on the Chinese context. We also provided normative statements for the diagnosis, treatment, and surveillance of CRC based on existing clinical evidence and guidelines. CONCLUSIONS The 46 recommendations in this CPG are formed with consideration for stakeholders' values and preferences, feasibility, and acceptability. Recommendations are generalizable to resource-limited settings with similar CRC epidemiology pattern as China.
Collapse
Affiliation(s)
- Jingnan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
| | - Hongwei Yao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Yun Lu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| |
Collapse
|
|
2
|
Ghosh NK, Kumar A. Ultra-minimally invasive endoscopic techniques and colorectal diseases: Current status and its future. Artif Intell Gastrointest Endosc 2024; 5:91424. [DOI: 10.37126/aige.v5.i2.91424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/12/2024] [Accepted: 05/06/2024] [Indexed: 05/11/2024] Open
Abstract
Colorectal diseases are increasing due to altered lifestyle, genetic, and environmental factors. Colonoscopy plays an important role in diagnosis. Advances in colonoscope (ultrathin scope, magnetic scope, capsule) and technological gadgets (Balloon assisted scope, third eye retroscope, NaviAid G-EYE, dye-based chromoendoscopy, virtual chromoendoscopy, narrow band imaging, i-SCAN, etc.) have made colonoscopy more comfortable and efficient. Now in-vivo microscopy can be performed using confocal laser endomicroscopy, optical coherence tomography, spectroscopy, etc. Besides developments in diagnostic colonoscopy, therapeutic colonoscopy has improved to manage lower gastrointestinal tract bleeding, obstruction, perforations, resection polyps, and early colorectal cancers. The introduction of combined endo-laparoscopic surgery and robotic endoscopic surgery has made these interventions feasible. The role of artificial intelligence in the diagnosis and management of colorectal diseases is also increasing day by day. Hence, this article is to review cutting-edge developments in endoscopic principles for the management of colorectal diseases.
Collapse
Affiliation(s)
- Nalini Kanta Ghosh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| |
Collapse
|
|
3
|
Chen Y, Xu X, Wang M, Wang X, Wang Y, Zhang Y, Zhao L, Fan Z, Liu L. Moxifloxacin as a contrast agent of two-photon microscopic imaging for detecting colorectal diseases. JOURNAL OF BIOPHOTONICS 2023; 16:e202200367. [PMID: 36633193 DOI: 10.1002/jbio.202200367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/26/2022] [Accepted: 01/01/2023] [Indexed: 05/17/2023]
Abstract
Since two-photon microscopy (TPM) can obtain high-resolution images at cellular and subcellular level and moxifloxacin has multiphoton fluorescence characteristic, our study aimed to explore the feasibility and diagnostic value of moxifloxacin-assisted TPM in different human colorectal diseases, including low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN) and cancer tissues. Excitation power for TPM imaging with and without moxifloxacin was (2.74 ± 0.16) mW and (0.28 ± 0.02) mW, respectively (p < 0.05). Whether labeled with moxifloxacin or not, images of normal, LGIN, HGIN and cancer tissues all reached the strongest signal at 30 μm from the mucosa. Normalized fluorescence intensity of TPM images with moxifloxacin was approximately 10 times stronger than that without moxifloxacin. Fluorescence signal was differed significantly in normal, LGIN, HGIN and cancer tissues with or without moxifloxacin (p < 0.05). Besides, moxifloxacin-assisted TPM could present variant tissue features with different colorectal diseases, such as the crypt opening, glandular structure, adjacent glandular space and fluorescence distribution.
Collapse
Affiliation(s)
- Yingtong Chen
- Digestive Endoscopy Department, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Department of General Surgery, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Department of Hematology, Lymphoma Research Center, Peking University Third Hospital, Beijing, China
| | - Xiaoyi Xu
- National Laboratory of Solid State Microstructure of Nanjing University, Nanjing, China
| | - Min Wang
- Digestive Endoscopy Department, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Department of General Surgery, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiang Wang
- Digestive Endoscopy Department, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Department of General Surgery, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yan Wang
- Digestive Endoscopy Department, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Department of General Surgery, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yong Zhang
- National Laboratory of Solid State Microstructure of Nanjing University, Nanjing, China
| | - Lili Zhao
- Digestive Endoscopy Department, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Department of General Surgery, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhining Fan
- Digestive Endoscopy Department, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Department of General Surgery, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Li Liu
- Digestive Endoscopy Department, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Department of General Surgery, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Gusu College of Nanjing Medical University, Suzhou, China
| |
Collapse
|
|
4
|
João M, Areia M, Pinto-Pais T, Gomes LC, Saraiva S, Alves S, Elvas L, Brito D, Saraiva S, Teixeira-Pinto A, Claro I, Dinis-Ribeiro M, Cadime AT. Can white-light endoscopy or narrow-band imaging avoid biopsy of colorectal endoscopic mucosal resection scars? A multicenter randomized single-blind crossover trial. Endoscopy 2023. [PMID: 36690030 DOI: 10.1055/a-2018-1612] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND : Current guidelines suggest that routine biopsy of post-endoscopic mucosal resection (EMR) scars can be abandoned, provided that a standardized imaging protocol with virtual chromoendoscopy is used. However, few studies have examined the accuracy of advanced endoscopic imaging, such as narrow-band imaging (NBI) vs. white-light endoscopy (WLE) for prediction of histological recurrence. We aimed to assess whether NBI accuracy is superior to that of WLE and whether one or both techniques can replace biopsies. METHODS : The study was a multicenter, randomized, pathologist-blind, crossover trial, with consecutive patients undergoing first colonoscopy after EMR of lesions ≥ 20 mm. Computer-generated randomization and opaque envelope concealed allocation. Patients were randomly assigned to scar examination with NBI followed by WLE (NBI + WLE), or WLE followed by NBI (WLE + NBI). Histology was the reference method, with biopsies being performed for all tissues. RESULTS : The study included 203 scars (103 in the NBI + WLE group, 100 in the WLE + NBI group). Recurrence was confirmed histologically in 29.6 % of the scars. The diagnostic accuracy of NBI was not statistically different from that of WLE (95 % [95 %CI 92 %-98 %] vs. 94 % [95 %CI 90 %-97 %]; P = 0.48). The negative predictive values (NPVs) were 96 % (95 %CI 93 %-99 %) for NBI and 93 % (95 %CI 89 %-97 %) for WLE (P = 0.06). CONCLUSIONS : The accuracy of NBI for the diagnosis of recurrence was not superior to that of WLE. Endoscopic assessment of EMR scars with WLE and NBI achieved an NPV that would allow routine biopsy to be avoided in cases of negative optical diagnosis.
Collapse
Affiliation(s)
- Mafalda João
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Miguel Areia
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Teresa Pinto-Pais
- RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto / Porto Comprehensive Cancer Center, Porto, Portugal
| | - Luís Correia Gomes
- Gastroenterology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Sofia Saraiva
- Gastroenterology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Susana Alves
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Luís Elvas
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Daniel Brito
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Sandra Saraiva
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | | | - Isabel Claro
- Gastroenterology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Mário Dinis-Ribeiro
- RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto / Porto Comprehensive Cancer Center, Porto, Portugal.,Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Teresa Cadime
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| |
Collapse
|
|
5
|
Probe-Based Confocal Laser Endomicroscopy versus White-Light Endoscopy with Narrow-Band Imaging for Predicting and Collecting Residual Cancer Tissue in Patients with Gastric Cancer Receiving Chemotherapy. Cancers (Basel) 2022; 14:cancers14174319. [PMID: 36077854 PMCID: PMC9454914 DOI: 10.3390/cancers14174319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Collecting appropriate gastric cancer (GC) tissues is critical for molecular biology research or the development of new target drugs for cases resistant to chemotherapy. Chemotherapy may reduce or alter the distribution of GC tissue on the surface, making the detection of GC tissue during upper endoscopy challenging. Our study showed that probe-based confocal laser endomicroscopy (pCLE) is superior to white-light endoscopy (WLE) with magnifying narrow-band imaging (M-NBI) in terms of accuracy for diagnosing residual cancer in GC patients receiving chemotherapy. pCLE might be considered when it is necessary to confirm the presence of residual cancer and get tissue samples from GC patients receiving chemotherapy. Abstract In cases of progression despite chemotherapy, collecting gastric cancer (GC) tissues might be helpful for molecular biology research or the development of new target drugs for treating cases that are refractory to chemotherapy. Chemotherapy, however, may reduce or alter the distribution of GC tissue on the surface, making the detection of GC tissue during upper endoscopy challenging. Probe-based confocal laser endomicroscopy (pCLE) is a new technology that enables histological diagnosis by magnifying the mucous membrane to a microscopic level. Here, we evaluated whether pCLE could increase the yield of endoscopic biopsy for GC compared to white-light endoscopy (WLE) with magnifying narrow-band imaging (M-NBI) in GC patients receiving chemotherapy with its powerful imaging technique. Patients underwent WLE/M-NBI and pCLE for the detection of residual GC for the purpose of response evaluation or clinical trial registration. After WLE/M-NBI and pCLE, each residual GC lesion was biopsied for histological analysis. A total of 23 patients were enrolled between January 2018 and June 2020. Overall, pCLE showed significantly higher sensitivity and negative predictive value than WLE/M-NBI. The accuracy of pCLE was superior to that of WLE/M-NBI. Moreover, pCLE showed better predictive ability for residual GC than WLE/M-NBI, while WLE/M-NBI and pCLE showed inconsistent results. pCLE diagnosed residual GC more accurately than WLE/M-NBI, which resulted in an increased number of GC tissues collected during the endoscopic biopsy.
Collapse
|
|
6
|
Singh RR, Perisetti A, Pallav K, Chandan S, De Leon MR, Sharma NR. Risk Stratification of Pancreatic Cysts With Confocal Laser Endomicroscopy. GASTRO HEP ADVANCES 2022; 1:160-170. [PMID: 39131123 PMCID: PMC11307855 DOI: 10.1016/j.gastha.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/02/2021] [Indexed: 08/13/2024]
Abstract
In the modern era of high-quality cross-sectional imaging, pancreatic cysts (PCs) are a common finding. The prevalence of incidental PCs detected on cross-sectional abdominal imaging (such as CT scan) is 3%-14% which increases with age, up to 8% in those 70 years or older. Although PCs can be precursors of future pancreatic adenocarcinoma, imaging modalities such as CT scan, MRI, or endoscopic ultrasound with fine-needle aspiration (EUS-FNA) are suboptimal at risk stratifying the malignant potential of individual cysts. An inaccurate diagnosis could potentially overlook premalignant lesions, which can lead to missed lesions, lead to unnecessary surveillance, or cause significant long-term surgical morbidity from unwarranted removal of benign lesions. Although current guidelines recommend an EUS or MRI for surveillance, they lack the sensitivity to risk stratify and guide management decisions. Needle-based confocal laser endomicroscopy (nCLE) with EUS-FNA can be a superior diagnostic modality for PCs with sensitivity and accuracy exceeding 90%. Despite this, a significant challenge to the widespread use of nCLE is the lack of adequate exposure and training among gastroenterologists for the real-time interpretation of images. Better understanding, training, and familiarization with this novel technique and the imaging characteristics can overcome the limitations of nCLE use, improving clinical care of patients with PCs. Here, we aim to review the types of CLE in luminal and nonluminal gastrointestinal disorders with particular attention to the evaluation of PCs. Furthermore, we discuss the adverse events and safety of CLE.
Collapse
Affiliation(s)
- Ritu R. Singh
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, Indiana University School of Medicine, Fort Wayne, Indiana
| | - Abhilash Perisetti
- Department of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indiana
| | - Kumar Pallav
- Department of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indiana
| | - Saurabh Chandan
- Department of Gastroenterology, CHI Health, Creighton University Medical Center, Omaha, Nebraska
| | - Mariajose Rose De Leon
- Department of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indiana
| | - Neil R. Sharma
- Department of Medicine, Indiana University School of Medicine, Fort Wayne, Indiana
- Department of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indiana
| |
Collapse
|
|
7
|
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.
Collapse
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
| |
Collapse
|
|
8
|
Solovev EA, Kovalenko TV, Duvanskiy VA. Modern endoscopic methods for the diagnosis of laterally spreading tumors (LST) of the colon. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2021; 1:74-81. [DOI: 10.31146/1682-8658-ecg-189-5-74-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
The aim: to focus on the possibilities of modern endoscopy in the diagnosis of laterally spreading (creeping) tumors — LST (laterally spreading tumor) of the colon.Materials and methods: description and comparison, based on data available in the literature, of modern endoscopic techniques for the diagnosis and differential diagnosis of LST.Results: the analysis and systematization of the obtained data revealed the advantages of modern endoscopic diagnostic methods not only in detecting LST, but also in predicting their morphological structure.Conclusion: the use of modern endoscopic diagnostic methods allows not only to improve the detection of neoplasms, but also to choose the best options for further treatment based on the information received.
Collapse
Affiliation(s)
- E. A. Solovev
- Multidisciplinary medical center of the Bank of Russia
| | - T. V. Kovalenko
- Multidisciplinary medical center of the Bank of Russia; RUDN University
| | - V. A. Duvanskiy
- Skobelkin state scientifi c center of laser medicine; RUDN University
| |
Collapse
|
|
9
|
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.
Collapse
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:
| |
Collapse
|
|
10
|
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.
Collapse
|
|
11
|
Glover B, Teare J, Patel N. The Status of Advanced Imaging Techniques for Optical Biopsy of Colonic Polyps. Clin Transl Gastroenterol 2020; 11:e00130. [PMID: 32352708 PMCID: PMC7145035 DOI: 10.14309/ctg.0000000000000130] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/03/2020] [Indexed: 12/19/2022] Open
Abstract
The progressive miniaturization of photonic components presents the opportunity to obtain unprecedented microscopic images of colonic polyps in real time during endoscopy. This information has the potential to act as "optical biopsy" to aid clinical decision-making, including the possibility of adopting new paradigms such as a "resect and discard" approach for low-risk lesions. The technologies discussed in this review include confocal laser endomicroscopy, optical coherence tomography, multiphoton microscopy, Raman spectroscopy, and hyperspectral imaging. These are in different stages of development and clinical readiness, but all show the potential to produce reliable in vivo discrimination of different tissue types. A structured literature search of the imaging techniques for colorectal polyps has been conducted. The significant developments in endoscopic imaging were identified for each modality, and the status of current development was discussed. Of the advanced imaging techniques discussed, confocal laser endomicroscopy is in clinical use and, under optimal conditions with an experienced operator, can provide accurate histological assessment of tissue. The remaining techniques show potential for incorporation into endoscopic equipment and practice, although further component development is needed, followed by robust prospective validation of accuracy. Optical coherence tomography illustrates tissue "texture" well and gives good assessment of mucosal thickness and layers. Multiphoton microscopy produces high-resolution images at a subcellular resolution. Raman spectroscopy and hyperspectral imaging are less developed endoscopically but provide a tissue "fingerprint" which can distinguish between tissue types. Molecular imaging may become a powerful adjunct to other techniques, with its ability to precisely label specific molecules within tissue and thereby enhance imaging.
Collapse
Affiliation(s)
- Ben Glover
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Julian Teare
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nisha Patel
- Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
|
12
|
Zhang QW, Zhang JJ, Yang AM, Sheng JQ, Liu YL, Li ZS, Chen HY, Feng N, Jiang QW, Jin P, Zhang LM, Fu HY, Gao YJ, Ge ZZ, Li XB. Feasibility of using narrow band imaging international colorectal endoscopic classification for diagnosing colorectal neoplasia in China: A multicenter pilot observational study. J Dig Dis 2020; 21:88-97. [PMID: 31895484 DOI: 10.1111/1751-2980.12841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/31/2019] [Accepted: 12/30/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to investigate whether Chinese endoscopists without narrow-band imaging (NBI) experiences could achieve high accuracy in the real-time diagnosis of colorectal polyps using NBI International Colorectal Endoscopic (NICE) classification after web-based training. METHODS Altogether 15 endoscopists from five centers with no NBI experiences followed a short, web-based training program on the NICE classification and took web-based test. Their performances were compared with 15 matched experienced endoscopists with no NBI experience who received no NBI training. These 15 trained endoscopists then made real-time diagnoses of colorectal neoplasia. A logistic regression was used to assess potential predictors of diagnostic performance. RESULTS Compared with those who received no training, trained endoscopists achieved comparable overall accuracy (85.3% vs 83.1%, P = 0.408) and accuracy at a high-confidence level (87.0% vs 86.0%, P = 0.670), but had a higher confidence rate (86.1% vs 83.7%, P = 0.004) for the diagnosis of neoplasia. Real-time diagnostic accuracy, sensitivity and specificity were 94.3% (95% confidence interval [CI] 91.5%-96.2%), 96.2% (95% CI 93.4%-97.9%) and 85.3% (95% CI 74.8%-92.1%) at high-confidence level. The high-confidence level was the strongest predictor of real-time diagnostic accuracy (odds ratio 12.66, P < 0.001). CONCLUSIONS Web-based training can improve the confidence level of endoscopists in accurately diagnosing colorectal polyps using the NICE classification. Chinese endoscopists can achieve high accuracy in diagnosing colorectal neoplasia at a high confidence level (ClinicalTrials ID: NCT02033980).
Collapse
Affiliation(s)
- Qing Wei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Jing Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ai Ming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jian Qiu Sheng
- Department of Gastroenterology and Gastrointestinal Endoscopy Center, PLA General Hospital, Beijing, China
| | - Yu Lan Liu
- Department of Gastroenterology, Peking University People's Hospital, Beijing, China
| | - Zhao Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Hai Ying Chen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Feng
- Department of Emergency, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Wei Jiang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Peng Jin
- Department of Gastroenterology and Gastrointestinal Endoscopy Center, PLA General Hospital, Beijing, China
| | - Li Ming Zhang
- Department of Gastroenterology, Peking University People's Hospital, Beijing, China
| | - Hong Yu Fu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Yun Jie Gao
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi Zheng Ge
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao Bo Li
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
|
13
|
Pamudurthy V, Lodhia N, Konda VJA. Advances in endoscopy for colorectal polyp detection and classification. Proc (Bayl Univ Med Cent) 2019; 33:28-35. [PMID: 32063760 DOI: 10.1080/08998280.2019.1686327] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 02/08/2023] Open
Abstract
While colonoscopy is considered the gold standard for colon cancer screening, recent advancements in endoscopes have allowed for improved visualization of the colonic mucosa and improved polyp detection rates. Newer technologies also allow for assessment of structural changes for polyp discrimination and determination of histologic type. Classification of polyps prevents the need for a histopathologic report, which requires the additional time and expertise of a pathologist and adds to the overall cost. This review considered advances in endoscopic technologies reported in PubMed over the past 12 years. Technologies that allow for increased visual field of colonic mucosa and may lead to improved colon polyp detection rates include cap-assisted colonoscopy, RetroView, extra-wide-angle view colonoscope, full-spectrum endoscopy, Third Eye Retroscope, NaviAid G-EYE balloon colonoscope, EndoRings, and Endocuff. Image-enhancing methods allow for pit pattern analysis of colorectal lesions, which enables the physician to classify colorectal polyps according to certain polyp characteristics. Image-enhancing methods include chromoendoscopy, autofluorescence, and virtual chromoendoscopy, including narrow band imaging, i-SCAN, flexible spectral imaging chromoendoscopy, and STORZ professional image enhancement systems. In addition, advancements have been made in in vivo microscopic evaluation of colonic epithelium, including confocal laser endomicroscopy, endocytoscopy, optical coherence tomography, spectroscopy, and autofluorescence spectroscopy. Colon capsule endoscopy also has a role in colon polyp detection and classification. The advancements in polyp detection and classification have great promise for earlier detection and removal of advanced adenomas before they advance to colorectal cancer.
Collapse
Affiliation(s)
| | - Nayna Lodhia
- Department of Medicine, University of Chicago Medical CenterChicagoIllinois
| | - Vani J A Konda
- Section of Gastroenterology, Baylor University Medical CenterDallasTexas
| |
Collapse
|
|
14
|
Taunk P, Atkinson CD, Lichtenstein D, Rodriguez-Diaz E, Singh SK. Computer-assisted assessment of colonic polyp histopathology using probe-based confocal laser endomicroscopy. Int J Colorectal Dis 2019; 34:2043-2051. [PMID: 31696259 DOI: 10.1007/s00384-019-03406-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Probe-based confocal laser endomicroscopy (pCLE) is a promising modality for classifying polyp histology in vivo, but decision making in real-time is hampered by high-magnification targeting and by the learning curve for image interpretation. The aim of this study is to test the feasibility of a system combining the use of a low-magnification, wider field-of-view pCLE probe and a computer-assisted diagnosis (CAD) algorithm that automatically classifies colonic polyps. METHODS This feasibility study utilized images of polyps from 26 patients who underwent colonoscopy with pCLE. The pCLE images were reviewed offline by two expert and five junior endoscopists blinded to index histopathology. A subset of images was used to train classification software based on the consensus of two GI histopathologists. Images were processed to extract image features as inputs to a linear support vector machine classifier. We compared the CAD algorithm's prediction accuracy against the classification accuracy of the endoscopists. RESULTS We utilized 96 neoplastic and 93 non-neoplastic confocal images from 27 neoplastic and 20 non-neoplastic polyps. The CAD algorithm had sensitivity of 95%, specificity of 94%, and accuracy of 94%. The expert endoscopists had sensitivities of 98% and 95%, specificities of 98% and 96%, and accuracies of 98% and 96%, while the junior endoscopists had, on average, a sensitivity of 60%, specificity of 85%, and accuracy of 73%. CONCLUSION The CAD algorithm showed comparable performance to offline review by expert endoscopists and improved performance when compared to junior endoscopists and may be useful for assisting clinical decision making in real time.
Collapse
Affiliation(s)
- Pushpak Taunk
- Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Christopher D Atkinson
- Department of Medicine, Section of Gastroenterology, VA Boston Healthcare System, Boston, MA, USA
| | - David Lichtenstein
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | | | - Satish K Singh
- Department of Medicine, Section of Gastroenterology, VA Boston Healthcare System, Boston, MA, USA. .,Boston University School of Medicine & College of Engineering, Boston University, Boston, MA, USA.
| |
Collapse
|
|
15
|
Nabi Z, Reddy DN. Optical biopsy in gastroenterology: Focus on confocal laser endomicroscopy. Indian J Gastroenterol 2019; 38:281-286. [PMID: 31578678 DOI: 10.1007/s12664-019-00986-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/26/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Zaheer Nabi
- Asian institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad, 500 082, India
| | - D Nageshwar Reddy
- Asian institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad, 500 082, India.
| |
Collapse
|
|
16
|
Optical Technologies for Endoscopic Real-Time Histologic Assessment of Colorectal Polyps: A Meta-Analysis. Am J Gastroenterol 2019; 114:1219-1230. [PMID: 30848728 DOI: 10.14309/ajg.0000000000000156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Accurate, real-time, endoscopic risk stratification of colorectal polyps would improve decision-making and optimize clinical efficiency. Technologies to manipulate endoscopic optical outputs can be used to predict polyp histology in vivo; however, it remains unclear how accuracy has progressed and whether it is sufficient for routine clinical implementation. METHODS A meta-analysis was conducted by searching MEDLINE, Embase, and the Cochrane Library. Studies were included if they prospectively deployed an endoscopic optical technology for real-time in vivo prediction of adenomatous colorectal polyps. Polyposis and inflammatory bowel diseases were excluded. Bayesian bivariate meta-analysis was performed, presenting 95% confidence intervals (CI). RESULTS One hundred two studies using optical technologies on 33,123 colorectal polyps were included. Digital chromoendoscopy differentiated neoplasia (adenoma and adenocarcinoma) from benign polyps with sensitivity of 92.2% (90.6%-93.9% CI) and specificity of 84.0% (81.5%-86.3% CI), with no difference between constituent technologies (narrow-band imaging, Fuji intelligent Chromo Endoscopy, iSCAN) or with only diminutive polyps. Dye chromoendoscopy had sensitivity of 92.7% (90.1%-94.9% CI) and specificity of 86.6% (82.9%-89.9% CI), similarly unchanged for diminutive polyps. Spectral analysis of autofluorescence had sensitivity of 94.4% (84.0%-99.1% CI) and specificity of 50.9% (13.2%-88.8% CI). Endomicroscopy had sensitivity of 93.6% (85.3%-98.3% CI) and specificity of 92.5% (81.8%-98.1% CI). Computer-aided diagnosis had sensitivity of 88.9% (74.2%-96.7% CI) and specificity of 80.4% (52.6%-95.7% CI). Prediction confidence and endoscopist experience alone did not significantly improve any technology. The only subgroup to demonstrate a negative predictive value for adenoma above 90% was digital chromoendoscopy, making high confidence predictions of diminutive recto-sigmoid polyps. Chronologic meta-analyses show a falling negative predictive value over time. A significant publication bias exists. DISCUSSION This novel approach to meta-analysis demonstrates that existing optical technologies are increasingly unlikely to allow safe "resect and discard" strategies and that step-change innovation may be required. A "diagnose and leave" strategy may be supported for diminutive recto-sigmoid polyps diagnosed with high confidence; however, limitations exist in the evidence base for this cohort.
Collapse
|
|
17
|
Shah PA, Shah BB, Rai VK, Khan E, Goenka MK. A study on confocal endomicroscopy in comparison with histopathology for polypoidal lesions of the gastrointestinal tract: A prospective single-centre experience. Indian J Gastroenterol 2019; 38:332-337. [PMID: 31446613 DOI: 10.1007/s12664-019-00973-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Confocal laser endomicroscopy (CLE) has a potential to make optical diagnosis of neoplastic polypoidal lesions and may replace traditional histology in the proposed "diagnose and discard approach". The present study was planned to assess the accuracy of probe-based CLE in predicting histology of polypoidal lesions of gastrointestinal (GI) tract in vivo before their removal. METHODS In this prospective single-centre study, patients with upper and/or lower GI polypoidal lesions were enrolled. After detection of polypoidal lesions with white light endoscopy, probe-based CLE examination was performed. Real-time and offline presumptive CLE diagnosis of polypoidal lesions was made as per Miami classification and was compared with histopathology as the gold standard. RESULTS A total of 50 GI polyps from 50 patients (28 males) were assessed. The mean (±SD) size of polyps was 13.7 (± 8.5) mm. Most polyps were located at the cecum (24.0%) or stomach (24.0%). On histological examination, hyperplastic and adenomatous polyps, adenocarcinoma, and lipoma were seen in 54%, 26%, 18% and 2% patients, respectively. On comparison of real-time CLE examination with histopathology, 40 (83.3%) and 8 patients (16.7%) had concordant and discordant results, respectively. Two polyps were inconclusively diagnosed on CLE. On offline examination, concordance with histopathology was observed in 85.4% (n = 41) of polyps, which was marginally better than online examination, though the difference was not statistically significant (p = 0.45). On comparing the real-time and offline findings of CLE, concordance was found in 91.7% of the cases. Accuracy, sensitivity, specificity, positive and negative predictive values on real-time evaluation were 83.3%, 87.5%, 79.1%, 80.7%, and 86.3%, respectively. CONCLUSION CLE is a useful tool for prediction of histology to assess the polypoidal lesions of the GI tract, and it may avoid polypectomy at least in some patients.
Collapse
Affiliation(s)
- Parvez Ahmed Shah
- Institute of Gastrosciences and Liver, Apollo Gleneagles Hospitals, Kolkata, 700 054, India
| | - Bhavik Bharat Shah
- Institute of Gastrosciences and Liver, Apollo Gleneagles Hospitals, Kolkata, 700 054, India.
| | - Vijay Kumar Rai
- Institute of Gastrosciences and Liver, Apollo Gleneagles Hospitals, Kolkata, 700 054, India
| | - Enam Khan
- Department of Pathology, Apollo Gleneagles Hospitals, Kolkata, 700 054, India
| | - Mahesh Kumar Goenka
- Institute of Gastrosciences and Liver, Apollo Gleneagles Hospitals, Kolkata, 700 054, India
| |
Collapse
|
|
18
|
Capuano A, Andreuzzi E, Pivetta E, Doliana R, Favero A, Canzonieri V, Maiero S, Fornasarig M, Magris R, Cannizzaro R, Mongiat M, Spessotto P. The Probe Based Confocal Laser Endomicroscopy (pCLE) in Locally Advanced Gastric Cancer: A Powerful Technique for Real-Time Analysis of Vasculature. Front Oncol 2019; 9:513. [PMID: 31263680 PMCID: PMC6584847 DOI: 10.3389/fonc.2019.00513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/29/2019] [Indexed: 12/24/2022] Open
Abstract
Probe based confocal laser endomicroscopy (pCLE) is an advanced technique which provides imaging of gastrointestinal mucosa at subcellular resolution and, importantly, a valid tool for the evaluation of microvasculature during endoscopic examination. In order to assess intratumoral vascularization and the efficiency of blood flow in locally advanced gastric cancer, we examined 57 patients through pCLE imaging. The vascular alterations in gastric cancer were mainly characterized by leakage and by the presence of tortuous and large size vessels. Defects in blood flow were detected very rarely. No association between the angiogenic score and the gastric tumor site or histological type was observed. Interestingly, no correlation was also found with the tumor grading indicating that the vascular angiogenic anomalies in gastric cancer represent an early pathological event to be observed and detected. The majority of patients displayed unchanged vascular alterations following neoadjuvant chemotherapy and this positively correlated with stable or progressive disease, suggesting that an unaltered angiogenic score could per se be indicative of poor therapeutic efficacy. Different vascular parameters were evaluated by immunofluorescence using bioptic samples and the vessel density did not correlate with clinical staging, site or histologic type. Interestingly, only CD105, Multimerin-2 and GLUT1 were able to discriminate normal from tumoral gastric mucosa. Taken together, these findings indicate that functional and structural angiogenic parameters characteristic of tumor blood network were fully detectable by pCLE. Moreover, the evaluation of tumor vasculature by real-time assessment may provide useful information to achieve tailored therapeutic interventions for gastric cancer patients.
Collapse
Affiliation(s)
- Alessandra Capuano
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Eva Andreuzzi
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Eliana Pivetta
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Roberto Doliana
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Andrea Favero
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | | | - Stefania Maiero
- Oncological Gastroenterology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Mara Fornasarig
- Oncological Gastroenterology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Raffaella Magris
- Oncological Gastroenterology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Renato Cannizzaro
- Oncological Gastroenterology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Maurizio Mongiat
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Paola Spessotto
- Molecular Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| |
Collapse
|
|
19
|
Assessment of Intratumoral Doxorubicin Penetration after Mild Hyperthermia-Mediated Release from Thermosensitive Liposomes. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:2645928. [PMID: 30956626 PMCID: PMC6431439 DOI: 10.1155/2019/2645928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/14/2019] [Indexed: 01/31/2023]
Abstract
In solid tumors, rapid local intravascular release of anticancer agents, e.g., doxorubicin (DOX), from thermosensitive liposomes (TSLs) can be an option to overcome poor extravasation of drug nanocarriers. The driving force of DOX penetration is the drug concentration gradient between the vascular compartment and the tumor interstitium. In this feasibility study, we used fibered confocal fluorescence microscopy (FCFM) to monitor in real-time DOX penetration in the interstitium of a subcutaneous tumor after its intravascular release from TSLs, Thermodox®. Cell uptake kinetics of the released DOX was quantified, along with an in-depth assessment of released-DOX penetration using an evolution model. A subcutaneous rat R1 rhabdomyosarcoma xenograft was used. The rodent was positioned in a setup including a water bath, and FCFM identification of functional vessels in the tumor tissue was applied based on AngioSense. The tumor-bearing leg was immersed in the 43°C water for preheating, and TSLs were injected intravenously. Real-time monitoring of intratumoral (i.t.) DOX penetration could be performed, and it showed the progressing DOX wave front via its native fluorescence, labeling successively all cell nuclei. Cell uptake rates (1/k) of 3 minutes were found (n=241 cells), and a released-DOX penetration in the range of 2500 µm2·s−1 was found in the tumor extravascular space. This study also showed that not all vessels, identified as functional based on AngioSense, gave rise to local DOX penetration.
Collapse
|
|
20
|
Steiger C, Abramson A, Nadeau P, Chandrakasan AP, Langer R, Traverso G. Ingestible electronics for diagnostics and therapy. NATURE REVIEWS MATERIALS 2018; 4:83-98. [DOI: 10.1038/s41578-018-0070-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
|
|
21
|
Tang Y, Polydorides AD, Anandasabapathy S, Richards-Kortum RR. Quantitative analysis of in vivo high-resolution microendoscopic images for the detection of neoplastic colorectal polyps. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-6. [PMID: 30460794 PMCID: PMC6276307 DOI: 10.1117/1.jbo.23.11.116003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 10/26/2018] [Indexed: 05/04/2023]
Abstract
Colonoscopy is routinely performed for colorectal cancer screening but lacks the capability to accurately characterize precursor lesions and early cancers. High-resolution microendoscopy (HRME) is a low-cost imaging tool to visualize colorectal polyps with subcellular resolution. We present a computer-aided algorithm to evaluate HRME images of colorectal polyps and classify neoplastic from benign lesions. Using histopathology as the gold standard, clinically relevant features based on luminal morphology and texture are quantified to build the classification algorithm. We demonstrate that adenomatous polyps can be identified with a sensitivity and specificity of 100% and 80% using a two-feature linear discriminant model in a pilot test set. The classification algorithm presented here offers an objective framework to detect adenomatous lesions in the colon with high accuracy and can potentially improve real-time assessment of colorectal polyps.
Collapse
Affiliation(s)
- Yubo Tang
- Rice University, Department of Bioengineering, Houston, Texas, United States
- Address all correspondence to: Yubo Tang, E-mail:
| | | | - Sharmila Anandasabapathy
- Baylor College of Medicine, Section of Gastroenterology and Hepatology, Houston, Texas, United States
| | | |
Collapse
|
|
22
|
Suchartlikitwong S, Laoveeravat P, Teerakanok J, Mingbunjerdsuk T, Thavaraputta S, Vutthikraivit W, Thongprayoon C, Nugent K, Cheungpasitporn W. Meta-analysis comparing the effects of statins on the risk of Clostridium difficilediarrhea. Proc (Bayl Univ Med Cent) 2018; 31:447-452. [DOI: 10.1080/08998280.2018.1472994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/29/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - Passisd Laoveeravat
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Jirapat Teerakanok
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | | | - Subhanudh Thavaraputta
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Wasawat Vutthikraivit
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | | | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo ClinicRochesterMinnesota
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical CenterJacksonMississippi
| |
Collapse
|
|
23
|
Picot J, Rose M, Cooper K, Pickett K, Lord J, Harris P, Whyte S, Böhning D, Shepherd J. Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation. Health Technol Assess 2017; 21:1-308. [PMID: 29271339 PMCID: PMC5757183 DOI: 10.3310/hta21790] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Current clinical practice is to remove a colorectal polyp detected during colonoscopy and determine whether it is an adenoma or hyperplastic by histopathology. Identifying adenomas is important because they may eventually become cancerous if untreated, whereas hyperplastic polyps do not usually develop into cancer, and a surveillance interval is set based on the number and size of adenomas found. Virtual chromoendoscopy (VCE) (an electronic endoscopic imaging technique) could be used by the endoscopist under strictly controlled conditions for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps to replace histopathological diagnosis. OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of the VCE technologies narrow-band imaging (NBI), flexible spectral imaging colour enhancement (FICE) and i-scan for the characterisation and management of diminutive (≤ 5 mm) colorectal polyps using high-definition (HD) systems without magnification. DESIGN Systematic review and economic analysis. PARTICIPANTS People undergoing colonoscopy for screening or surveillance or to investigate symptoms suggestive of colorectal cancer. INTERVENTIONS NBI, FICE and i-scan. MAIN OUTCOME MEASURES Diagnostic accuracy, recommended surveillance intervals, health-related quality of life (HRQoL), adverse effects, incidence of colorectal cancer, mortality and cost-effectiveness of VCE compared with histopathology. DATA SOURCES Electronic bibliographic databases including MEDLINE, EMBASE, The Cochrane Library and Database of Abstracts of Reviews of Effects were searched for published English-language studies from inception to June 2016. Bibliographies of related papers, systematic reviews and company information were screened and experts were contacted to identify additional evidence. REVIEW METHODS Systematic reviews of test accuracy and economic evaluations were undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-analyses were conducted, where possible, to inform the independent economic model. A cost-utility decision-analytic model was developed to estimate the cost-effectiveness of VCE compared with histopathology. The model used a decision tree for patients undergoing endoscopy, combined with estimates of long-term outcomes (e.g. incidence of colorectal cancer and subsequent morbidity and mortality) derived from University of Sheffield School of Health and Related Research's bowel cancer screening model. The model took a NHS perspective, with costs and benefits discounted at 3.5% over a lifetime horizon. There were limitations in the data on the distribution of adenomas across risk categories and recurrence rates post polypectomy. RESULTS Thirty test accuracy studies were included: 24 for NBI, five for i-scan and three for FICE (two studies assessed two interventions). Polyp assessments made with high confidence were associated with higher sensitivity and endoscopists experienced in VCE achieved better results than those without experience. Two economic evaluations were included. NBI, i-scan and FICE are cost-saving strategies compared with histopathology and the number of quality-adjusted life-years gained was similar for histopathology and VCE. The correct surveillance interval would be given to 95% of patients with NBI, 94% of patients with FICE and 97% of patients with i-scan. LIMITATIONS Limited evidence was available for i-scan and FICE and there was heterogeneity among the NBI studies. There is a lack of data on longer-term health outcomes of patients undergoing VCE for assessment of diminutive colorectal polyps. CONCLUSIONS VCE technologies, using HD systems without magnification, could potentially be used for the real-time assessment of diminutive colorectal polyps, if endoscopists have adequate experience and training. FUTURE WORK Future research priorities include head-to-head randomised controlled trials of all three VCE technologies; more research on the diagnostic accuracy of FICE and i-scan (when used without magnification); further studies evaluating the impact of endoscopist experience and training on outcomes; studies measuring adverse effects, HRQoL and anxiety; and longitudinal data on colorectal cancer incidence, HRQoL and mortality. STUDY REGISTRATION This study is registered as PROSPERO CRD42016037767. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Joanna Picot
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Micah Rose
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Keith Cooper
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Karen Pickett
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Joanne Lord
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Petra Harris
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Sophie Whyte
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Dankmar Böhning
- Southampton Statistical Sciences Research Institute (S3RI), Mathematical Sciences, University of Southampton, Southampton, UK
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| |
Collapse
|
|
24
|
Belderbos TDG, van Oijen MGH, Moons LMG, Siersema PD. Implementation of real-time probe-based confocal laser endomicroscopy (pCLE) for differentiation of colorectal polyps during routine colonoscopy. Endosc Int Open 2017; 5:E1104-E1110. [PMID: 29104910 PMCID: PMC5668136 DOI: 10.1055/s-0043-117948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/16/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND AIMS Probe-based confocal laser endomicroscopy (pCLE) is used to differentiate between neoplastic and non-neoplastic colorectal polyps during colonoscopy. We aimed to assess the accuracy of two endoscopists starting to use real-time pCLE for differentiation of colorectal polyps and to determine the negative predictive value (NPV) for neoplasia in polyps ≤ 5 mm. METHODS Patients undergoing colonoscopy in a tertiary hospital were included in this prospective trial. After a training session, two colonoscopists assessed 50 polyps between August 2012 and April 2014. They sequentially used narrow-band imaging (NBI) and real-time pCLE to differentiate non-adenomatous, adenomatous, and carcinomatous polyps during colonoscopy. Histologic diagnosis by a gastrointestinal pathologist was the gold standard. Results were compared to post-hoc pCLE by a panel of gastroenterologists and pathologists. RESULTS The accuracy of real-time pCLE was 76 %, compared to 73 % for NBI, and was not significantly different between the first 50 cases (74 %) and the last 50 cases (78 %, P = 0.64). The accuracy in polyps > 5 mm was 87 % versus 59 % in polyps ≤ 5 mm ( P = 0.04) and increased from 45 % (13/29) in poor quality images to 86 % (44/51) in fair quality images and 95 % (19/20) in good quality images ( P < 0.01). The post-hoc pCLE accuracy was 62 %. The NPV for polyps ≤ 5 mm was 58 % for real-time pCLE and 54 % for post-hoc pCLE. CONCLUSION Although a fair accuracy of real-time pCLE for differentiation of colorectal polyps can be achieved within 50 cases, low NPV and difficulty in obtaining high-quality pCLE images hamper implementation in routine clinical practice.
Collapse
Affiliation(s)
- Tim D. G. Belderbos
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands,Corresponding author T.D.G. Belderbos, MD Department of Gastroenterology and HepatologyUniversity Medical Center UtrechtPO Box 855003508 GA UtrechtThe Netherlands+31-88-7555533
| | - Martijn G. H. van Oijen
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Leon M. G. Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter D. Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands,Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
|
25
|
Robles-Medranda C, Vargas M, Ospina J, Puga-Tejada M, Valero M, Soria M, Bravo G, Robles-Jara C, Lukashok HP. Clinical impact of confocal laser endomicroscopy in the management of gastrointestinal lesions with an uncertain diagnosis. World J Gastrointest Endosc 2017; 9:389-395. [PMID: 28874959 PMCID: PMC5565504 DOI: 10.4253/wjge.v9.i8.389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/10/2017] [Accepted: 05/05/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the clinical impact of confocal laser endomicroscopy (CLE) in the diagnosis and management of patients with an uncertain diagnosis.
METHODS A retrospective chart review was performed. Patients who underwent CLE between November 2013 and October 2015 and exhibited a poor correlation between endoscopic and histological findings were included. Baseline characteristics, indications, previous diagnostic studies, findings at the time of CLE, clinical management and histological results were analyzed. Interventions based on CLE findings were also analyzed. We compared the diagnostic accuracy of CLE and target biopsies of surgical specimens.
RESULTS A total of 144 patients were included. Of these, 51% (74/144) were female. The mean age was 51 years old. In all, 41/144 (28.4%) lesions were neoplastic (13 bile duct, 10 gastric, 8 esophageal, 6 colonic, 1 duodenal, 1 rectal, 1 ampulloma and 1 pancreatic). The sensitivity, specificity, positive predictive value, negative predictive value, and observed agreement when CLE was used to detect N-lesions were 85.37%, 87.38%, 72.92%, 93.75% and 86.81%, respectively. Cohen’s Kappa was 69.20%, thus indicating good agreement. Changes in management were observed in 54% of the cases.
CONCLUSION CLE is a new diagnostic tool that has a significant clinical impact on the diagnosis and treatment of patients with uncertain diagnosis.
Collapse
|
|
26
|
Fracczak L, Kobierska A, Koter K, Zak P, Czkwianiac E, Kolejwa M, Nowak A, Socha-Banasiak A, Slezak J. The diagnostic gastroenterology needs in relation to exisiting tools, research and design work on a new tool in endoscopy field. 2017 22ND INTERNATIONAL CONFERENCE ON METHODS AND MODELS IN AUTOMATION AND ROBOTICS (MMAR) 2017:705-710. [DOI: 10.1109/mmar.2017.8046914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
|
|
27
|
Allen JE, Sharma P. Polyp characterization at colonoscopy: Clinical implications. Best Pract Res Clin Gastroenterol 2017; 31:435-440. [PMID: 28842053 DOI: 10.1016/j.bpg.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/05/2017] [Indexed: 01/31/2023]
Abstract
Although advancements in endoscopic imaging of colorectal mucosa have outstripped the pace of research in the field, the potential clinical applications of these novel technologies are promising. Chief among these is the ability to diagnose colorectal polyps in vivo. This feature appears most applicable to diminuitive polyps, which have very little malignant potential yet represent over 70% of resected polyps. In an ideal application, the capability to predict diminutive hyperplastic polyp histology in vivo precludes the need for excision whereas dimunitive adenomas do require excision, but not necessarily histopathologic analysis if the diagnosis is made in vivo with adequate confidence. However, the vast array of new advanced imaging modalities and polyp classification tools have been difficult to reconcile. We aim to highlight the current status of real-time colorectal polyp diagnosis and identify the barriers that remain to its widespread implementation.
Collapse
Affiliation(s)
- James E Allen
- Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, USA
| | - Prateek Sharma
- Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, USA.
| |
Collapse
|
|
28
|
Placek SB, Nelson J. Combined Endoscopic Laparoscopic Surgery Procedures for Colorectal Surgery. Clin Colon Rectal Surg 2017; 30:145-150. [PMID: 28381946 DOI: 10.1055/s-0036-1597321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Colonoscopy is the standard of care for screening and surveillance of colorectal cancers. Removal of adenomatous polyps prevents the transformation of adenomas to potential adenocarcinoma. While most polyps are amenable to simple endoscopic polypectomy, difficult polyps that are large, broad-based, or located in haustral folds or in tortuous colon segments can present a challenge for endoscopists. Traditionally, patients with endoscopically unresectable polyps have been referred for oncologic surgical resection due to the underlying risk of malignancy within the polyp; however, the majority of these polyps are benign on final pathology. Combined endoscopic laparoscopic surgery can help facilitate endoscopic removal of difficult lesions, or allow the surgeon to select the correct laparoscopic approach for polyp excision. Current literature suggests that these procedures are safe and effective and can potentially save patients from the morbidity of laparotomy and segmental colectomy.
Collapse
Affiliation(s)
- Sarah B Placek
- Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jeffrey Nelson
- Department of Colorectal Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| |
Collapse
|
|
29
|
Confocal Laser Endomicroscopy in Gastrointestinal and Pancreatobiliary Diseases: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4638683. [PMID: 26989684 PMCID: PMC4773527 DOI: 10.1155/2016/4638683] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 12/31/2015] [Indexed: 12/15/2022]
Abstract
Confocal laser endomicroscopy (CLE) is an endoscopic-assisted technique developed to obtain histopathological diagnoses of gastrointestinal and pancreatobiliary diseases in real time. The objective of this systematic review is to analyze the current literature on CLE and to evaluate the applicability and diagnostic yield of CLE in patients with gastrointestinal and pancreatobiliary diseases. A literature search was performed on MEDLINE, EMBASE, Scopus, and Cochrane Oral Health Group Specialized Register, using pertinent keywords without time limitations. Both prospective and retrospective clinical studies that evaluated the sensitivity, specificity, or accuracy of CLE were eligible for inclusion. Of 662 articles identified, 102 studies were included in the systematic review. The studies were conducted between 2004 and 2015 in 16 different countries. CLE demonstrated high sensitivity and specificity in the detection of dysplasia in Barrett's esophagus, gastric neoplasms and polyps, colorectal cancers in inflammatory bowel disease, malignant pancreatobiliary strictures, and pancreatic cysts. Although CLE has several promising applications, its use has been limited by its low availability, high cost, and need of specific operator training. Further clinical trials with a particular focus on cost-effectiveness and medicoeconomic analyses, as well as standardized institutional training, are advocated to implement CLE in routine clinical practice.
Collapse
|
|
30
|
Hosoe N, Ogata H. Application and Efficacy of Super-Magnifying Endoscopy for the Lower Intestinal Tract. Clin Endosc 2016; 49:37-40. [PMID: 26855922 PMCID: PMC4743732 DOI: 10.5946/ce.2016.49.1.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/01/2015] [Accepted: 11/02/2015] [Indexed: 12/26/2022] Open
Abstract
Endoscopy plays a significant role in the diagnosis, management, and surveillance of colorectal cancer (CRC) and inflammatory bowel diseases (IBDs). Moreover, magnifying endoscopy and image-enhanced endoscopy has a crucial role in the clinical setting. Recently, a super-magnifying endoscope has been developed, and two devices, confocal laser endomicroscopy (CLE) and an endocytoscopy system (ECS), which allow in vivo microscopic inspection of the microstructural mucosal features of the gastrointestinal tract, are currently available. Studies on the use of ECS in CRC were reported by a Japanese group. Additionally, a few studies on the use of ECS in IBD have been reported. CLE has been shown to be reliable in assessing the activity of the disease in IBDs in both ulcerative colitis and Crohn’s disease. Various published studies evaluated the use of CLE during colonoscopy to distinguish colorectal polyp pathology and neoplasia. However, these studies are heterogeneous, and further evidence is necessary to confirm the efficacy of CLE.
Collapse
Affiliation(s)
- Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
|
31
|
Robles-Medranda C. Confocal endomicroscopy: Is it time to move on? World J Gastrointest Endosc 2016; 8:1-3. [PMID: 26788257 PMCID: PMC4707318 DOI: 10.4253/wjge.v8.i1.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/05/2015] [Accepted: 11/13/2015] [Indexed: 02/05/2023] Open
Abstract
Confocal laser endomicroscopy permits in-vivo microscopy evaluation during endoscopy procedures. It can be used in all the parts of the gastrointestinal tract and includes: Esophagus, stomach, small bowel, colon, biliary tract through and endoscopic retrograde cholangiopancreatography and pancreas through needles during endoscopic ultrasound procedures. Many researches demonstrated a high correlation of results between confocal laser endomicroscopy and histopathology in the diagnosis of gastrointestinal lesions; with accuracy in about 86% to 96%. Moreover, in spite that histopathology remains the gold-standard technique for final diagnosis of any diseases; a considerable number of misdiagnosis rate could be present due to many factors such as interpretation mistakes, biopsy site inaccuracy, or number of biopsies. Theoretically; with the diagnostic accuracy rates of confocal laser endomicroscopy could help in a daily practice to improve diagnosis and treatment management of the patients. However, it is still not routinely used in the clinical practice due to many factors such as cost of the procedure, lack of codification and reimbursement in some countries, absence of standard of care indications, availability, physician image-interpretation training, medico-legal problems, and the role of the pathologist. These limitations are relative, and solutions could be found based on new researches focused to solve these barriers.
Collapse
|
|
32
|
Ma HB, Cai LJ, Fan YH. Progress of research and clinical application of probe-based confocal laser endomicroscopy. Shijie Huaren Xiaohua Zazhi 2016; 24:89-96. [DOI: 10.11569/wcjd.v24.i1.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Probe based confocal laser endomicroscopy (pCLE) is a new endoscopic diagnostic method which integrates micro-imaging technology into endoscopy and can identify the morphological structure of particular tissue surface, so that the ongoing procedure of endoscopy can make the histopathological diagnosis. pCLE has the "optical biopsy" function, avoids shortcomings in physical biopsies such as being time-consuming, cumbersome, and prone to sampling error, and thus improves the diagnostic accuracy and efficiency. The field of research of pCLE as a new endoscopic imaging technology has been expanded from the digestive cavity structure to the respiratory system and urinary system. This article reviews the progress of research and clinical application of pCLE.
Collapse
|
|
33
|
Atkinson CD, Singh SK. Luminal Confocal Laser Endomicroscopy. ENDOSCOPIC IMAGING TECHNIQUES AND TOOLS 2016:83-114. [DOI: 10.1007/978-3-319-30053-5_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
|
|
34
|
Lieberman D, Brill J, Canto M, DeMarco D, Fennerty B, Gupta N, Laine L, Lightdale C, Montgomery E, Odze R, Rex D, Sharma P, Kochman M, Tokar J. Management of Diminutive Colon Polyps Based on Endoluminal Imaging. Clin Gastroenterol Hepatol 2015; 13:1860-6; quiz e168-9. [PMID: 26192139 DOI: 10.1016/j.cgh.2015.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/12/2015] [Accepted: 07/14/2015] [Indexed: 02/07/2023]
Abstract
Diminutive colon polyps, defined as 5 mm or less, are encountered increasingly at colonoscopy. The risk of serious pathology in such polyps is low. There is a risk and cost of resecting all such polyps and sending tissue for pathologic evaluation. Enhancement of endoluminal imaging may enable discrimination of neoplastic vs non-neoplastic polyps. If this discrimination can be performed accurately with high confidence, it may be possible to either resect and discard diminutive adenomas, or inspect and do-not-resect diminutive hyperplastic polyps. In 2011, an expert group recommended thresholds of 90% negative predictive value for adenomas, and 90% accuracy in predicting appropriate surveillance intervals. Since 2011, criteria for polyp discrimination have been published and validated by experts and nonexperts. In vivo studies have been performed to compare endoscopic impression and pathologic diagnosis. An expert panel was convened in late 2014 to review the literature to determine if the proposed thresholds for discrimination can be attained and to recommend the next steps for introducing changes in clinical practice. We conclude that threshold levels can be achieved with several endoscopic image enhancements. The next steps to implementation of practice change include acquiring data on training and competence, determining best practices for auditing performance, understanding patient education needs, and the potential cost benefit of such changes.
Collapse
Affiliation(s)
- David Lieberman
- Department of Medicine, Division of Gastroenterology, Oregon Health and Science University, Portland, OR.
| | - Joel Brill
- Predictive Health, LLC, Paradise Valley, AZ
| | - Marcia Canto
- Department of Medicine, Division of Gastroenterology, Johns Hopkins University, Baltimore, MD
| | - Daniel DeMarco
- Department of Medicine, Division of Gastroenterology, Baylor University Medical Center, Dallas, TX
| | - Brian Fennerty
- Department of Medicine, Division of Gastroenterology, Oregon Health and Science University, Portland, OR
| | - Neil Gupta
- Department of Medicine, Division of Gastroenterology, Loyola University Health System, Chicago, IL
| | - Loren Laine
- Department of Medicine, Division of Gastroenterology, Yale University of Medicine, New Haven, CT
| | - Charles Lightdale
- Department of Medicine, Division of Gastroenterology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | - Elizabeth Montgomery
- Department of Medicine, Division of Gastroenterology, Johns Hopkins Medical Laboratories, Baltimore, MD
| | - Robert Odze
- Department of Medicine, Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA
| | - Douglas Rex
- Department of Medicine, Division of Gastroenterology, Indiana University Medical Center, Indianapolis, IN
| | - Prateek Sharma
- Department of Medicine, Division of Gastroenterology, University of Kansas School of Medicine, Kansas City, KS
| | - Michael Kochman
- Department of Medicine, Division of Gastroenterology, University of Pennsylvania Health System, Philadelphia, PA
| | | |
Collapse
|
|
35
|
Intestinal Permeability in Inflammatory Bowel Disease: Pathogenesis, Clinical Evaluation, and Therapy of Leaky Gut. Mediators Inflamm 2015; 2015:628157. [PMID: 26582965 PMCID: PMC4637104 DOI: 10.1155/2015/628157] [Citation(s) in RCA: 473] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/21/2015] [Indexed: 12/13/2022] Open
Abstract
The pathogenesis of inflammatory bowel disease (IBD) is multifactorial with data suggesting the role of a disturbed interaction between the gut and the intestinal microbiota. A defective mucosal barrier may result in increased intestinal permeability which promotes the exposition to luminal content and triggers an immunological response that promotes intestinal inflammation. IBD patients display several defects in the many specialized components of mucosal barrier, from the mucus layer composition to the adhesion molecules that regulate paracellular permeability. These alterations may represent a primary dysfunction in Crohn's disease, but they may also perpetuate chronic mucosal inflammation in ulcerative colitis. In clinical practice, several studies have documented that changes in intestinal permeability can predict IBD course. Functional tests, such as the sugar absorption tests or the novel imaging technique using confocal laser endomicroscopy, allow an in vivo assessment of gut barrier integrity. Antitumor necrosis factor-α (TNF-α) therapy reduces mucosal inflammation and restores intestinal permeability in IBD patients. Butyrate, zinc, and some probiotics also ameliorate mucosal barrier dysfunction but their use is still limited and further studies are needed before considering permeability manipulation as a therapeutic target in IBD.
Collapse
|
|
36
|
Pittayanon R, Rerknimitr R, Imraporn B, Wisedopas N, Kullavanijaya P. Diagnostic values of dual focus narrow band imaging and probe-based confocal laser endomicroscopy in FAP-related duodenal adenoma. Endosc Int Open 2015; 3:E450-5. [PMID: 26528500 PMCID: PMC4612245 DOI: 10.1055/s-0034-1392235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/16/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Familial adenomatous polyposis (FAP) is associated with an increased risk of development of periampullary and nonampullary adenoma. Either routine biopsy or endoscopic removal of the lesion is generally required to identify the presence of adenoma. Because the risk of tissue sampling from the ampulla is high and nonampullary polyps are sometimes numerous, resection of all the lesions is time-consuming. This study aimed to evaluate the diagnostic values of duodenal adenoma by dual focus NBI (dNBI) and probe-based confocal endomicroscopy (pCLE) in FAP patients. PATIENTS AND METHODS The authors conducted a diagnostic study in a single tertiary-care referral center. Surveillance esophagogastroduodenoscopy with dNBI and pCLE was performed on 26 patients with FAP for real-time adenoma diagnosis by two different endoscopists; one used dNBI and the other pCLE. Histology from the matched lesion was used as the gold standard. RESULTS A total of 55 matched biopsies (25 ampullas, 30 nonampullas) were performed. The sensitivity, specificity, post predictive value (PPV), negative predictive value (NPV), and accuracy of dNBI vs. pCLE from all duodenal lesions were 96.9 % vs. 93.8 %, 78.3 % vs. 81 %, 86.1 % vs. 88.2 %, 94.7 vs. 89.5 %, and 92.4 % vs. 88.6 %, respectively. CONCLUSIONS For surveillance of periampullary and nonampullary adenoma in patients with FAP, the real-time readings provided a high degree of diagnostic value when histology was used as the gold standard. ( CLINICAL TRIAL REGISTRATION NUMBER NCT02162173).
Collapse
Affiliation(s)
- Rapat Pittayanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red Cross Society, Bangkok, 10330, Thailand.,Corresponding author Rapat Pittayanon, M.D Division of GastroenterologyDepartment of Internal MedicineFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand66-2-252-7839
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red Cross Society, Bangkok, 10330, Thailand.
| | - Boonlert Imraporn
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red Cross Society, Bangkok, 10330, Thailand.
| | - Naruemon Wisedopas
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Pinit Kullavanijaya
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red Cross Society, Bangkok, 10330, Thailand.
| |
Collapse
|
|
37
|
Sato C, Abe S, Saito Y, So Tsuruki E, Takamaru H, Makazu M, Sato Y, Sasaki H, Tanaka H, Ikezawa N, Yamada M, Sakamoto T, Nakajima T, Matsuda T, Kushima R, Kamiya M, Maeda S, Urano Y. A pilot study of fluorescent imaging of colorectal tumors using a γ-glutamyl-transpeptidase-activatable fluorescent probe. Digestion 2015; 91:70-6. [PMID: 25632921 DOI: 10.1159/000369367] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED Backgrounds/Aim: Colorectal laterally spreading tumors (LSTs) are sometimes difficult to visualize even with image-enhanced endoscopy. γ-Glutamyl-transpeptidase (GGT) is a cell surface-associated enzyme that is overexpressed in various types of human cancers. Furthermore, GGT expression is higher in colorectal cancer cells than in normal colorectal mucosa. γ-Glutamyl hydroxymethyl rhodamine green (gGlu-HMRG), an activatable fluorescent probe, is nonfluorescent under a neutral pH and normal cellular environment; however, it turns highly fluorescent upon reaction with GGT. We evaluated ex vivo fluorescent imaging of colorectal LSTs using this GGT-activatable fluorescent probe. METHODS Between March 2013 and March 2014, 30 endoscopically resected colorectal LSTs were prospectively included in this study. Each was analyzed by first taking a baseline image before spraying, then spraying with gGlu-HMRG onto the freshly resected specimen, and finally taking fluorescent images 15 min after spraying with a dedicated imaging machine. RESULTS Of the LSTs, 67% rapidly showed positive fluorescent activity. These activities were shown in adenoma (54%) and carcinoma in adenoma (76%), and in LST-granular type (80%) and LST-nongranular type (40%). CONCLUSION Topically spraying gGlu-HMRG enabled rapid and selective fluorescent imaging of colorectal tumors owing to the upregulated GGT activity in cancer cells.
Collapse
Affiliation(s)
- Chiko Sato
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
38
|
Buchner AM, Wallace MB. In-vivo microscopy in the diagnosis of intestinal neoplasia and inflammatory conditions. Histopathology 2015; 66:137-46. [PMID: 25639481 DOI: 10.1111/his.12597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Confocal laser endomicroscopy (CLE) is a rapidly emerging tool in endoscopic imaging allowing in-vivo microscopy of examined gastrointestinal mucosa. This review will discuss the most recent advances of confocal laser endomicroscopy in the diagnosis of intestinal neoplasia and inflammatory conditions.
Collapse
Affiliation(s)
- Anna M Buchner
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA
| | | |
Collapse
|
|
39
|
Saligram S, Rastogi A. Methods to become a high performer in characterization of colorectal polyp histology. Best Pract Res Clin Gastroenterol 2015; 29:651-62. [PMID: 26381309 DOI: 10.1016/j.bpg.2015.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/11/2015] [Accepted: 06/08/2015] [Indexed: 01/31/2023]
Abstract
The recent advent of advanced imaging technologies has brought real time characterization of polyp histology to the forefront. This concept of optical diagnosis of diminutive polyp histology can bring about a huge paradigm shift in the management of these lesions. Instead of resecting and sending all the diminutive polyps to pathology, there is the potential to practice "resect and discard" for those predicted to be adenomas and "do not resect" strategy for the recto-sigmoid polyps predicted to be hyperplastic. However, one of the major steps before the clinical implementation of real-time histology can be a reality, will be training endoscopists with varying levels of experience in novel imaging technologies. The two major methods for training include didactic teaching and the computer based method. After the initial training, it is imperative that the endoscopists practice this skill during performance of routine colonoscopy to auto validate and assess their own competency. Both practice and reinforcement can help endoscopists become high performers in the characterization of polyp histology.
Collapse
Affiliation(s)
- Shreyas Saligram
- University of Kansas, Kansas City, KS-66160, USA; Veterans Affairs Medical Center, Kansas City, MO 64128, USA.
| | - Amit Rastogi
- University of Kansas, Kansas City, KS-66160, USA; Veterans Affairs Medical Center, Kansas City, MO 64128, USA.
| |
Collapse
|
|
40
|
High-resolution microendoscopy in differentiating neoplastic from non-neoplastic colorectal polyps. Best Pract Res Clin Gastroenterol 2015; 29:663-73. [PMID: 26381310 PMCID: PMC4578798 DOI: 10.1016/j.bpg.2015.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/16/2015] [Accepted: 05/20/2015] [Indexed: 01/31/2023]
Abstract
Colorectal cancer is one of the leading causes of death worldwide. The progression from adenoma to cancer is a well known phenomenon. Current clinical practice favors colonoscopy as the preferred modality for colorectal cancer screening. Many novel endoscopic technologies are emerging for the purposes of performing "optical biopsy" to allow real-time histologic diagnosis of polyps. High resolution microendoscopy is a low-cost endoscopic technology that has demonstrated high sensitivity and specificity in differentiating neoplastic and non-neoplastic polyps. With the ability to make real-time conclusions based on the endoscopic appearance of polyps, it is becoming increasingly possible to decrease the rate of unnecessary polypectomies and utilize a "resect and discard" strategy to decrease costs of pathology evaluation. Future directions for this technology include surveillance of premalignant conditions such as inflammatory bowel disease. Moreover, the low cost and relative ease of use of this technology lends itself to widespread applicability.
Collapse
|
|
41
|
Wang KK, Carr-Locke DL, Singh SK, Neumann H, Bertani H, Galmiche JP, Arsenescu RI, Caillol F, Chang KJ, Chaussade S, Coron E, Costamagna G, Dlugosz A, Ian Gan S, Giovannini M, Gress FG, Haluszka O, Ho KY, Kahaleh M, Konda VJ, Prat F, Shah RJ, Sharma P, Slivka A, Wolfsen HC, Zfass A. Use of probe-based confocal laser endomicroscopy (pCLE) in gastrointestinal applications. A consensus report based on clinical evidence. United European Gastroenterol J 2015; 3:230-54. [PMID: 26137298 DOI: 10.1177/2050640614566066] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/17/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Probe-based confocal laser endomicroscopy (pCLE) provides microscopic imaging during an endoscopic procedure. Its introduction as a standard modality in gastroenterology has brought significant progress in management strategies, affecting many aspects of clinical care and requiring standardisation of practice and training. OBJECTIVE This study aimed to provide guidance on the standardisation of its practice and training in Barrett's oesophagus, biliary strictures, colorectal lesions and inflammatory bowel diseases. METHODS Initial statements were developed by five group leaders, based on the available clinical evidence. These statements were then voted and edited by the 26 participants, using a modified Delphi approach. After two rounds of votes, statements were validated if the threshold of agreement was higher than 75%. RESULTS Twenty-six experts participated and, among a total of 77 statements, 61 were adopted (79%) and 16 were rejected (21%). The adoption of each statement was justified by the grade of evidence. CONCLUSION pCLE should be used to enhance the diagnostic arsenal in the evaluation of these indications, by providing microscopic information which improves the diagnostic performance of the physician. In order actually to implement this technology in the clinical routine, and to ensure good practice, standardised initial and continuing institutional training programmes should be established.
Collapse
Affiliation(s)
- Kenneth K Wang
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - David L Carr-Locke
- Division of Digestive Diseases, Beth Israel Medical Center, New York City, NY, USA
| | - Satish K Singh
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Helmut Neumann
- The Ludwig Demling Endoscopy Center of Excellence, Erlangen, Germany
| | - Helga Bertani
- Endoscopy Unit, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy
| | | | | | - Fabrice Caillol
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Kenneth J Chang
- H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine, CA, USA
| | - Stanislas Chaussade
- Division of Gastroenterology, Hopital Cochin and Paris-Descartes University, Paris, France
| | - Emmanuel Coron
- Division of Gastroenterology and Hepatology, Nantes CHU, Rouen, France
| | | | - Aldona Dlugosz
- Karolinska Institutet, Department of Medicine, Division of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden
| | - S Ian Gan
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Marc Giovannini
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Frank G Gress
- Division of Digestive and Liver disease, Columbia University Medical Center, New York City, NY, USA
| | - Oleh Haluszka
- Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Khek Y Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York City, NY, USA
| | - Vani J Konda
- Center for Endoscopic Research and Therapeutics, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Frederic Prat
- Division of Gastroenterology, Hopital Cochin and Paris-Descartes University, Paris, France
| | - Raj J Shah
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, MI, USA ; Department of Gastroenterology and Hepatology, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Adam Slivka
- Division of Gastroenterology & Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Alvin Zfass
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| |
Collapse
|
|
42
|
Nakai Y, Iwashita T, Park DH, Samarasena JB, Lee JG, Chang KJ. Diagnosis of pancreatic cysts: EUS-guided, through-the-needle confocal laser-induced endomicroscopy and cystoscopy trial: DETECT study. Gastrointest Endosc 2015; 81:1204-14. [PMID: 25634486 DOI: 10.1016/j.gie.2014.10.025] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 10/20/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND The diagnosis of pancreatic cystic neoplasms (PCNs), which now depends on morphology, cytology, and fluid analysis, is still challenging. A novel confocal laser endomicroscopy probe that can be inserted through a 19-gauge FNA needle allows needle-based confocal laser endomicroscopy (nCLE), and the feasibility of nCLE has been reported in PCNs. The combination of cystoscopy by using a through-the-needle fiberoptic probe in combination with nCLE under EUS guidance may improve the diagnosis of PCNs. OBJECTIVE To assess the feasibility, safety, and diagnostic yield of the combination of cystoscopy and nCLE in the clinical diagnosis of PCNs. DESIGN A prospective feasibility study. SETTING An academic tertiary referral center. PATIENTS Thirty patients with PCNs. INTERVENTIONS EUS-guided dual through-the-needle imaging (cystoscopy and nCLE) for PCNs. MAIN OUTCOME MEASUREMENTS Technical feasibility and safety. Associations of cystoscopy and nCLE findings with clinical diagnosis of PCNs. RESULTS The procedure was technically successful with the exception of 1 probe exchange failure. In 2 patients (7%), postprocedure pancreatitis developed. Specific features associated with the clinical diagnosis of mucinous cysts were identified: mucin on cystoscopy and papillary projections and dark rings on nCLE. The sensitivity of cystoscopy was 90% (9/10), and that of nCLE was 80% (8/10), and the combination was 100% (10/10) in 18 high-certainty patients. LIMITATIONS A single-center study and lack of complete pathologic correlation. CONCLUSION The combination of dual through-the-needle imaging (cystoscopy and nCLE) of pancreatic cysts appears to have strong concordance with the clinical diagnosis of PCN. ( CLINICAL TRIAL REGISTRATION NUMBER NCT01447238.).
Collapse
Affiliation(s)
- Yousuke Nakai
- H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, USA
| | - Takuji Iwashita
- H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, USA
| | - Do Hyun Park
- H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, USA
| | - Jason B Samarasena
- H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, USA
| | - John G Lee
- H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, USA
| | - Kenneth J Chang
- H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, USA
| |
Collapse
|
|
43
|
Abu Dayyeh BK, Thosani N, Konda V, Wallace MB, Rex DK, Chauhan SS, Hwang JH, Komanduri S, Manfredi M, Maple JT, Murad FM, Siddiqui UD, Banerjee S. 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. Gastrointest Endosc 2015; 81:502.e1-502.e16. [PMID: 25597420 DOI: 10.1016/j.gie.2014.12.022] [Citation(s) in RCA: 237] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 02/08/2023]
Abstract
In vivo real-time assessment of the histology of diminutive (≤5 mm) colorectal polyps detected at colonoscopy can be achieved by means of an "optical biopsy" by using currently available endoscopic technologies. This systematic review and meta-analysis was performed by the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee to specifically assess whether acceptable performance thresholds outlined by an ASGE Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) document for clinical adoption of these technologies have been met. We conducted direct meta-analyses calculating the pooled negative predictive value (NPV) for narrow-band imaging (NBI), i-SCAN, and Fujinon Intelligent Color Enhancement (FICE)-assisted optical biopsy for predicting adenomatous polyp histology of small/diminutive colorectal polyps. We also calculated the pooled percentage agreement with histopathology when assigning postpolypectomy surveillance intervals based on combining real-time optical biopsy of colorectal polyps 5 mm or smaller with histopathologic assessment of polyps larger than 5 mm. Random-effects meta-analysis models were used. Statistical heterogeneity was evaluated by means of I(2) statistics. Our meta-analyses indicate that optical biopsy with NBI, exceeds the NPV threshold for adenomatous polyp histology, supporting a "diagnose-and-leave" strategy for diminutive predicted nonneoplastic polyps in the rectosigmoid colon. The pooled NPV of NBI for adenomatous polyp histology by using the random-effects model was 91% (95% confidence interval [CI], 88-94). This finding was associated with a high degree of heterogeneity (I(2) = 89%). Subgroup analysis indicated that the pooled NPV was greater than 90% for academic medical centers (91.8%; 95% CI, 89-94), for experts (93%; 95% CI, 91-96), and when the optical biopsy assessment was made with high confidence (93%; 95% CI, 90-96). Our meta-analyses also indicate that the agreement in assignment of postpolypectomy surveillance intervals based on optical biopsy with NBI of diminutive colorectal polyps is 90% or greater in academic settings (91%; 95% CI, 86-95), with experienced endoscopists (92%; 95% CI, 88-96) and when optical biopsy assessments are made with high confidence (91%; 95% CI, 88-95). Our systematic review and meta-analysis confirms that the thresholds established by the ASGE PIVI for real-time endoscopic assessment of the histology of diminutive polyps have been met, at least with NBI optical biopsy, with endoscopists who are expert in using this advanced imaging technology and when assessments are made with high confidence.
Collapse
|
|
44
|
Sinh P, Gupta N, Rao DS, Wani S, Sharma P, Bansal A, Allen J, Ketover SR, Rastogi A. Community gastroenterologists can learn diminutive colon polyp histology characterization with narrow band imaging by a computer-based teaching module. Dig Endosc 2015; 27:374-80. [PMID: 25382541 DOI: 10.1111/den.12403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/04/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM The aim of the present study was to evaluate the impact of a computer-based teaching module on the performance of community gastroenterologists for characterization of diminutive polyps (≤5 mm) using narrow band imaging video clips. METHODS Eighty videos were distributed in pre- and post-test DVD along with a 20-min audiovisual teaching presentation detailing endoscopic features differentiating adenomas from hyperplastic polyps using narrow band imaging. Each participant first reviewed pretest video clips and entered their responses for polyp histology and their confidence in diagnosis: high: ≥90% or low: <90%. Following this, they reviewed the teaching module and assessed the post-test videos. Performance characteristics were calculated for pre- and post-test videos by comparing predicted histology with actual histology. Fisher's exact test was used for analysis and the kappa statistic was calculated for interobserver agreement. RESULTS Fifteen gastroenterologists in community practice completed the study. Sensitivity, specificity, accuracy and negative predictive value in characterization of polyp histology improved significantly post-test compared to pretest. In post-test, accuracy was 92% for high-confidence diagnoses and the proportion of these increased with training from 46% (pretest) to 64% (post-test); P < 0.001. Interobserver agreement for diagnosis improved from fair (kappa = 0.23) in pretest to moderate (kappa = 0.56) in post-test. CONCLUSIONS A teaching module using video clips can be used to teach community gastroenterologists polyp histology characterization by narrow band imaging. Whether this translates into real-time high accuracy in polyp detection needs to be further evaluated.
Collapse
Affiliation(s)
- Preetika Sinh
- Department of Gastroenterology, University of Kansas School of Medicine, Kansas City, USA; Department of Gastroenterology, Veterans Affairs Medical Center, Kansas City, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
|
45
|
Rodriguez-Diaz E, Huang Q, Cerda SR, O’Brien MJ, Bigio IJ, Singh SK. Endoscopic histological assessment of colonic polyps by using elastic scattering spectroscopy. Gastrointest Endosc 2015; 81:539-47. [PMID: 25257128 PMCID: PMC5533077 DOI: 10.1016/j.gie.2014.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 07/08/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Elastic-scattering spectroscopy (ESS) can assess in vivo and in real-time the scattering and absorption properties of tissue related to underlying pathologies. OBJECTIVES To evaluate the potential of ESS for differentiating neoplastic from non-neoplastic polyps during colonoscopy. DESIGN Pilot study, retrospective data analysis. SETTING Academic practice. PATIENTS A total of 83 patients undergoing screening/surveillance colonoscopy. INTERVENTIONS ESS spectra of 218 polyps (133 non-neoplastic, 85 neoplastic) were acquired during colonoscopy. Spectral data were correlated with the classification of biopsy samples by 3 GI pathologists. High-dimensional methods were used to design diagnostic algorithms. MAIN OUTCOME MEASUREMENTS Diagnostic performance of ESS. RESULTS Analysis of spectra from polyps of all sizes (N = 218) resulted in a sensitivity of 91.5%, specificity of 92.2%, and accuracy of 91.9% with a high-confidence rate of 90.4%. Restricting analysis to polyps smaller than 1 cm (n = 179) resulted in a sensitivity of 87.0%, specificity of 92.1%, and accuracy of 90.6% with a high-confidence rate of 89.3%. Analysis of polyps 5 mm or smaller (n = 157) resulted in a sensitivity of 86.8%, specificity of 91.2%, and accuracy of 90.1% with a high-confidence rate of 89.8%. LIMITATIONS Sample size, retrospective validation used to obtain performance estimates. CONCLUSION Results indicate that ESS permits accurate, real-time classification of polyps as neoplastic or non-neoplastic. ESS is a simple, low cost, clinically robust method with minimal impact on procedure flow, especially when integrated into standard endoscopic biopsy tools. Performance on polyps 5 mm or smaller indicates that ESS may, in theory, achieve Preservation and Incorporation of Valuable Endoscopic Innovations performance thresholds. ESS may one day prove to be a useful tool used in endoscopic screening and surveillance of colorectal cancer.
Collapse
Affiliation(s)
- Eladio Rodriguez-Diaz
- Department of Medicine, Section of Gastroenterology, Boston University School of Medicine Medical Service, Gastroenterology Unit, VA Boston Healthcare System, Boston MA
| | - Qin Huang
- Department of Pathology, VA Boston Healthcare System, Boston MA
| | - Sandra R. Cerda
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine
| | - Michael J. O’Brien
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine
| | - Irving J. Bigio
- Department of Biomedical Engineering, College of Engineering, Boston University Department of Medicine, Section of Gastroenterology, Boston University School of Medicine
| | - Satish K. Singh
- Department of Medicine, Section of Gastroenterology, Boston University School of Medicine Department of Biomedical Engineering, College of Engineering, Boston University Medical Service, Gastroenterology Unit, VA Boston Healthcare System, Boston MA
| |
Collapse
|
|
46
|
|
|
47
|
Affiliation(s)
- Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida.
| | - Maria Vazquez-Roque
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida
| | - Christian Bojarski
- Department of Gastroenterology, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Jörg-Dieter Schulzke
- Institute of Clinical Physiology, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany
| |
Collapse
|
|
48
|
Karstensen JG, Klausen PH, Saftoiu A, Vilmann P. Molecular confocal laser endomicroscopy: A novel technique for in vivo cellular characterization of gastrointestinal lesions. World J Gastroenterol 2014; 20:7794-7800. [PMID: 24976717 PMCID: PMC4069308 DOI: 10.3748/wjg.v20.i24.7794] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/15/2014] [Accepted: 03/19/2014] [Indexed: 02/06/2023] Open
Abstract
While flexible endoscopy is essential for macroscopic evaluation, confocal laser endomicroscopy (CLE) has recently emerged as an endoscopic method enabling visualization at a cellular level. Two systems are currently available, one based on miniprobes that can be inserted via a conventional endoscope or via a needle guided by endoscopic ultrasound. The second system has a confocal microscope integrated into the distal part of an endoscope. By adding molecular probes like fluorescein conjugated antibodies or fluorescent peptides to this procedure (either topically or systemically administered during on-going endoscopy), a novel world of molecular evaluation opens up. The method of molecular CLE could potentially be used for estimating the expression of important receptors in carcinomas, subsequently resulting in immediate individualization of treatment regimens, but also for improving the diagnostic accuracy of endoscopic procedures by identifying otherwise invisible mucosal lesions. Furthermore, studies have shown that fluorescein labelled drugs can be used to estimate the affinity of the drug to a target organ, which probably can be correlated to the efficacy of the drug. However, several of the studies in this research field have been conducted in animal facilities or in vitro, while only a limited number of trials have actually been carried out in vivo. Therefore, safety issues still needs further evaluations. This review will present an overview of the implications and pitfalls, as well as future challenges of molecular CLE in gastrointestinal diseases.
Collapse
|
|
49
|
Tutticci N, Bourke MJ. Advances in colonoscopy. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2014; 12:119-139. [PMID: 24615389 DOI: 10.1007/s11938-014-0009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Colonoscopy with polypectomy has been established as the major prevention and detection strategy for colorectal cancer for over a decade. Over this period advances in colonoscopic imaging, polyp detection, prediction of histopathology and polypectomy techniques have all been seen; however, the true magnitude of the limitations of colonoscopy has only recently been widely recognized. The rate and location of missed or interval cancers after complete colonoscopy appears to be influenced by the operator-dependency of colonoscopy and failure of conventional practices to detect and treat adenomatous, and possibly more importantly, non-adenomatous colorectal cancer precursors. Consequently, studies that expand our understanding of these factors and advances that aim to improve colonoscopy, polypectomy, and cancer protection are of critical importance.
Collapse
Affiliation(s)
- Nicholas Tutticci
- Department of Gastroenterology and Hepatology, Westmead Hospital, 106A/151 Hawkesbury Road, Westmead, NSW, 2145, Australia,
| | | |
Collapse
|
|
50
|
Oh G, Yoo SW, Jung Y, Ryu YM, Park Y, Kim SY, Kim KH, Kim S, Myung SJ, Chung E. Intravital imaging of mouse colonic adenoma using MMP-based molecular probes with multi-channel fluorescence endoscopy. BIOMEDICAL OPTICS EXPRESS 2014; 5:1677-89. [PMID: 24877024 PMCID: PMC4026906 DOI: 10.1364/boe.5.001677] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/19/2014] [Accepted: 04/21/2014] [Indexed: 05/18/2023]
Abstract
Intravital imaging has provided molecular, cellular and anatomical insight into the study of tumor. Early detection and treatment of gastrointestinal (GI) diseases can be enhanced with specific molecular markers and endoscopic imaging modalities. We present a wide-field multi-channel fluorescence endoscope to screen GI tract for colon cancer using multiple molecular probes targeting matrix metalloproteinases (MMP) conjugated with quantum dots (QD) in AOM/DSS mouse model. MMP9 and MMP14 antibody (Ab)-QD conjugates demonstrate specific binding to colonic adenoma. The average target-to-background (T/B) ratios are 2.10 ± 0.28 and 1.78 ± 0.18 for MMP14 Ab-QD and MMP9 Ab-QD, respectively. The overlap between the two molecular probes is 67.7 ± 8.4%. The presence of false negative indicates that even more number of targeting could increase the sensitivity of overall detection given heterogeneous molecular expression in tumors. Our approach indicates potential for the screening of small or flat lesions that are precancerous.
Collapse
Affiliation(s)
- Gyungseok Oh
- School of Mechatronics, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Su Woong Yoo
- Department of Medical System Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Yebin Jung
- Department of Chemistry, Pohang University of Science and Technology, Pohang, South Korea
| | - Yeon-Mi Ryu
- Asan Institute for Life sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Youngrong Park
- Department of Chemistry, Pohang University of Science and Technology, Pohang, South Korea
| | - Sang-Yeob Kim
- Asan Institute for Life sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Deparment of Medicine, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ki Hean Kim
- Division of Integrative Biosciences and Biotechnology and Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, South Korea
| | - Sungjee Kim
- Department of Chemistry, Pohang University of Science and Technology, Pohang, South Korea
| | - Seung-Jae Myung
- Asan Institute for Life sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Gastroenterology, Asan Medical Center,University of Ulsan College of Medicine, Seoul, South Korea
| | - Euiheon Chung
- School of Mechatronics, Gwangju Institute of Science and Technology, Gwangju, South Korea
- Department of Medical System Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
| |
Collapse
|