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Dhali A, Maity R, Rathna RB, Biswas J. Confocal laser endomicroscopy for gastric neoplasm. World J Gastrointest Endosc 2024; 16:540-544. [PMID: 39351178 PMCID: PMC11438582 DOI: 10.4253/wjge.v16.i9.540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 08/22/2024] [Accepted: 08/28/2024] [Indexed: 09/12/2024] Open
Abstract
Confocal laser endomicroscopy (CLE) is a novel endoscopic modality that provides real-time histological information via high-resolution magnified view of the mucosa. CLE has a higher sensitivity, specificity, and diagnostic accuracy in detecting atrophic gastritis as compared to chromoendoscopy and narrow-band imaging. It can even predict low-grade and high-grade intraepithelial neoplasia by analyzing gastric pit patterns. CLE may have some advantages over the standard biopsy protocol, such as higher diagnostic yield and fewer biopsy requirements. Its diagnostic accuracy in detecting superficial gastric cancer is higher than that of white-light endoscopy. Inherent limitations, such as a narrow field of vision, can be surpassed by technological advancements and integration with other detection methods. Artificial intelligence holds promise in automated analysis of histopathological images. Thus, CLE can be helpful in screening for early gastric cancer and may help reduce the risk of complications from repeated biopsies, such as mucosal damage, bleeding, and infection.
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Affiliation(s)
- Arkadeep Dhali
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, United Kingdom
- School of Medicine and Population Health, University of Sheffield, Sheffield S10 2HQ, United Kingdom
| | - Rick Maity
- General Medicine, Institute of Post Graduate Medical Education and Research, Kolkata 700020, India
| | - Roger B Rathna
- Department of Internal Medicine, University Hospitals Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
| | - Jyotirmoy Biswas
- General Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata 700058, India
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2
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Han ML, Wang WL, Lee CT, Hsieh MS, Tsai MC, Chan YC, Chu YL, Wang HP. Feasibility of new-generation endocytoscopy for the real-time diagnosis of ampullary lesions: A pilot study (with video). J Gastroenterol Hepatol 2024; 39:1336-1342. [PMID: 38388021 DOI: 10.1111/jgh.16510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/18/2023] [Accepted: 01/24/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND AIM An early and accurate diagnosis of ampullary neoplasia is crucial; however, sampling bias is still a major concern. New-generation endocytoscopy enables real-time visualization of cellular structures and enables an accurate pathological prediction; however, its feasibility for small ampullary lesions has never been investigated. METHODS We developed a novel endocytoscopic (EC) classification system for ampullary lesions after an expert review and agreement from five experienced endoscopists and one pathologist. We then consecutively enrolled a total of 43 patients with an enlarged ampulla (< 3 cm), all of whom received an endocytoscopic examination. The feasibility of endocytoscopy was evaluated, and the performance of the EC classification system was then correlated with the final histopathology. RESULTS In five cases (11.6%), the endocytoscope could not approach the ampulla, and these cases were defined as technical failure. Among the remaining 38 patients, 8 had histopathology-confirmed adenocarcinoma, 15 had adenoma, and 15 had non-neoplastic lesions. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the EC classification system to diagnose ampullary neoplasias were 95.7%, 86.7%, 91.7%, 92.9%, and 92.1%, respectively. Moreover, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the EC classification to diagnose ampullary cancer were 62.5%, 100%, 100%, 90.9%, and 92.1%, respectively. One case with intra-ampullary papillary-tubular carcinoma was classified as having a non-neoplastic lesion by endocytoscopy. CONCLUSIONS Endocytoscopy and the novel EC classification system demonstrated good feasibility to discriminate ampullary neoplasias from non-neoplastic lesions and may be useful for optical biopsies of clinically suspicious ampullary lesions.
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Affiliation(s)
- Ming-Lun Han
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Lun Wang
- Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ching-Tai Lee
- Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chang Tsai
- School of Medicine and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Chung Chan
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
| | | | - Hsiu-Po Wang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Canakis A, Bomman S, Twery B, Varghese N, Ji B, Canakis J, Goldberg EM. The diagnostic utility of endocytoscopy for the detection of gastric cancer: a systematic review and meta-analysis. Minerva Gastroenterol (Torino) 2024; 70:225-230. [PMID: 35511654 DOI: 10.23736/s2724-5985.22.03172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Endocytoscopy (ECS) is an evolving technology that utilizes ultra-high power magnification for real time cellular imaging without the need for physical biopsy. Its application for gastric cancer (GC) detection is not well evaluated at the current time, but there is potential that ECS can make a real time histopathological diagnosis to differentiate neoplastic from benign lesions. We aimed to investigate the diagnostic utility of ECS for GC detection. EVIDENCE ACQUISITION Literature searches through multiple databases were performed for studies using ECS for GC detection until November 2021. Measured outcomes included the pooled sensitivity, specificity and accuracy. Quality assessment of diagnostic studies tool was used to assess the risk of bias. EVIDENCE SYNTHESIS Four studies (N.=245) were included. The pooled sensitivity was 83.5% (95% CI: 75-89%, I2: 0) and specificity was 91.7% (95% CI: 79-97%, I2: 58%). The pooled accuracy was 89.2% (95% CI: 83-94%, I2: 38%). There was a low risk of bias. CONCLUSIONS ECS is an accurate diagnostic modality and has the potential to serve as a complimentary tool in screening for GC. Larger prospective studies are needed to validate these findings before its further widespread use.
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Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA -
| | - Shivanand Bomman
- Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA
| | - Benjamin Twery
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nevin Varghese
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Byung Ji
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Justin Canakis
- Department of Medicine, George Washington University, Washington, DC, USA
| | - Eric M Goldberg
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
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Huang Y, Shao Y, Yu X, Chen C, Guo J, Ye G. Global progress and future prospects of early gastric cancer screening. J Cancer 2024; 15:3045-3064. [PMID: 38706913 PMCID: PMC11064266 DOI: 10.7150/jca.95311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/21/2024] [Indexed: 05/07/2024] Open
Abstract
Gastric cancer is a prevalent malignancy that poses a serious threat to global health. Despite advances in medical technologies, screening methods, and public awareness, gastric cancer remains a significant cause of morbidity and mortality worldwide. Early gastric cancer frequently does not present with characteristic symptoms, while advanced stage disease is characterized by a dismal prognosis. As such, early screening in gastric cancer is of great importance. In recent years, advances have been made globally in both clinical and basic research for the screening of early gastric cancer. The current predominant screening methods for early gastric cancer include imaging screening, endoscopic screening and serum biomarker screening. Imaging screening encompasses upper gastrointestinal barium meal, multidimensional spiral computed tomography (MDCT), Magnetic resonance imaging (MRI), and ultrasonography. Endoscopic screening methods include white light endoscopy, chromoendoscopy, computed virtual chromoendoscopy, and other endoscopic techniques like endocytoscopy, confocal laser endomicroscopy, optical coherence tomography and so on. Biomarkers screening involves the assessment of conventional biomarkers such as CEA, CA19-9 and CA72-4 as well as more emerging biomarkers such as peptides (PG, G-17, GCAA, TAAs and others), DNA (cfDNA, DNA methylation, MSI), noncoding RNA (miRNA, lncRNA, circRNA, and tsRNA) and others. Each screening method has its strengths and limitations. This article systematically summarizes worldwide progress and future development of early gastric cancer screening methods to provide new perspectives and approaches for early diagnostic and treatment advancements in gastric cancer worldwide.
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Affiliation(s)
- Yixiao Huang
- Department of Gastroenterology, the First Affiliated Hospital of Ningbo University, Ningbo 315020, China
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Health Science Center, Ningbo University, Ningbo 315211, China
| | - Yongfu Shao
- Department of Gastroenterology, the First Affiliated Hospital of Ningbo University, Ningbo 315020, China
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Health Science Center, Ningbo University, Ningbo 315211, China
| | - Xuan Yu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Health Science Center, Ningbo University, Ningbo 315211, China
| | - Chujia Chen
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Health Science Center, Ningbo University, Ningbo 315211, China
| | - Junming Guo
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Health Science Center, Ningbo University, Ningbo 315211, China
| | - Guoliang Ye
- Department of Gastroenterology, the First Affiliated Hospital of Ningbo University, Ningbo 315020, China
- Institute of Digestive Disease of Ningbo University, Ningbo 315020, China
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Kubo M, Ono S, Yokota I, Matsumoto S, Nishimura Y, Ono M, Yamamoto K, Sakamoto N. Quantitative diagnostic algorithm using endocytoscopy for superficial nonampullary duodenal epithelial tumors. J Gastroenterol Hepatol 2023; 38:1496-1502. [PMID: 37129220 DOI: 10.1111/jgh.16207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/03/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND AND AIM Optical biopsy using endocytoscopy for superficial nonampullary duodenal epithelial tumors (SNADETs) is practical; however, a diagnostic algorithm has not been established. The aim of this study was to determine correlations of endocytoscopic findings of SNADETs with histology using computer analysis and to establish an algorithm. METHODS Endocytoscopic images and histological images of duodenal lesions from 70 patients were retrospectively collected. The numbers of glands and densely stained areas with methylene blue (DSMs) per 1 mm2 and the percentage of DSMs per screen in endocytoscopy were determined. Moreover, correlations in DSMs and glands between endocytoscopy and histological images were analyzed. Histopathological diagnoses were assessed according to the revised Vienna classification. The primary outcome was correlation between the number of glands in endocytoscopy and that in histology. Finally, a diagnostic algorithm for endoscopic intervention of SNADETs with a statistical program command was established. RESULTS The number of glands in endocytoscopic images was correlated with that in histopathological images (ρ 0.64, P < 0.001). There were significant differences in the mean number of glands between category 4/5 and category 3 (P = 0.03) and the mean percentage of DSMs between category 4/5 and category 1 (P < 0.001). When the cutoffs for the number of glands and percentage of DSMs were set at 47 per 1 mm2 and 20.8% in one screen, respectively, the area under the ROC curve was 0.89. CONCLUSIONS Endocytoscopic images of SNADETs reflect histopathological atypia, and computer analysis provides a practical diagnostic algorithm for endoscopic intervention.
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Affiliation(s)
- Marina Kubo
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8638, Japan
| | - Shoko Ono
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, 060-8648, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8638, Japan
| | - Shogo Matsumoto
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8638, Japan
| | - Yusuke Nishimura
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8638, Japan
| | - Masayoshi Ono
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8638, Japan
| | - Keiko Yamamoto
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, 060-8648, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8638, Japan
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Yoo IK, Park JC, Lee H, Yeniova AO, Lee JH, Yon DK, Cho JY, Lee WS. A comparative study of magnifying endoscopy with narrow-band image and endocytoscopy in the diagnosis of gastric neoplasm: a pilot study. Eur J Gastroenterol Hepatol 2023; 35:530-536. [PMID: 37115982 PMCID: PMC10063186 DOI: 10.1097/meg.0000000000002539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/08/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND/AIMS Endoscopic technologies have recently advanced to optimize the detection and diagnosis of gastric lesions. Endocytoscopy aids in the virtual realization of histology. Herein, we aimed to investigate gastric lesions using single-stain endocytoscopy and compare them using magnifying endoscopy with narrow-band imaging (ME-NBI) in terms of diagnostic yield in vivo. METHODS AND METHODS In the present prospective study, we registered 24 patients with gastric neoplasms and retrospectively reviewed their images. Three endoscopists reviewed the images of gastric neoplasms using white light, ME-NBI, and endocytoscopy. The diagnostic yield of endocytoscopy in early gastric cancer (EGC) was assessed using histopathology as the gold standard. RESULTS Endocytoscopy was performed in 24 patients with gastric neoplasms. Of these, 15 patients had adenocarcinomas, while nine patients had low-grade dysplasia. The sensitivity, specificity, and accuracy of endocytoscopy for EGC detection were reported as 80.0% [95% confidence interval (CI), 51.9-95.7], 66.7% (95% CI, 58.4-91.9), and 75.0% (95% CI, 53.3-90.2) by endoscopist A; 80.0% (95% CI, 51.9-95.7), 44.4% (95% CI, 13.7-78.8), and 66.7% (95% CI, 44.7-84.4) by endoscopist B; and 93.3% (95% CI, 68.1-99.8), 55.6% (95% CI, 21.2-86.3), and 79.2% (95% CI, 57.9-92.8) by endoscopist C; these findings were not inferior to NBI. The inter-observer agreement, κ statistic = 0.67 (95% CI, 0.43-0.90) was favorable. CONCLUSION Endocytoscopy aid in the diagnosis of EGC because of its better sensitivity and accuracy compared to NBI or white-light imaging. However, further large-scale studies are required to confirm our findings.
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Affiliation(s)
- In Kyung Yoo
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si
| | - Jun Chul Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Abdullah Ozgur Yeniova
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine
| | - Joo Young Cho
- Department of Gastroenterology, CHA Gangnam Medical Center, College of Medicine, Cha University, Seoul
| | - Wan-Sik Lee
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Gwangju, Republic of Korea
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Liu Y, Wen H, Wang Q, Du S. Research trends in endoscopic applications in early gastric cancer: A bibliometric analysis of studies published from 2012 to 2022. Front Oncol 2023; 13:1124498. [PMID: 37114137 PMCID: PMC10129370 DOI: 10.3389/fonc.2023.1124498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/13/2023] [Indexed: 04/29/2023] Open
Abstract
Background Endoscopy is the optimal method of diagnosing and treating early gastric cancer (EGC), and it is therefore important to keep up with the rapid development of endoscopic applications in EGC. This study utilized bibliometric analysis to describe the development, current research progress, hotspots, and emerging trends in this field. Methods We retrieved publications about endoscopic applications in EGC from 2012 to 2022 from Web of Science™ (Clarivate™, Philadelphia, PA, USA) Core Collection (WoSCC). We mainly used CiteSpace (version 6.1.R3) and VOSviewer (version 1.6.18) to perform the collaboration network analysis, co-cited analysis, co-occurrence analysis, cluster analysis, and burst detection. Results A total of 1,333 publications were included. Overall, both the number of publications and the average number of citations per document per year increased annually. Among the 52 countries/regions that were included, Japan contributed the most in terms of publications, citations, and H-index, followed by the Republic of Korea and China. The National Cancer Center, based in both Japan and the Republic of Korea, ranked first among institutions in terms of number of publications, citation impact, and the average number of citations. Yong Chan Lee was the most productive author, and Ichiro Oda had the highest citation impact. In terms of cited authors, Gotoda Takuji had both the highest citation impact and the highest centrality. Among journals, Surgical Endoscopy and Other Interventional Techniques had the most publications, and Gastric Cancer had the highest citation impact and H-index. Among all publications and cited references, a paper by Smyth E C et al., followed by one by Gotoda T et al., had the highest citation impact. Using keywords co-occurrence and cluster analysis, 1,652 author keywords were categorized into 26 clusters, and we then divided the clusters into six groups. The largest and newest clusters were endoscopic submucosal dissection and artificial intelligence (AI), respectively. Conclusions Over the last decade, research into endoscopic applications in EGC has gradually increased. Japan and the Republic of Korea have contributed the most, but research in this field in China, from an initially low base, is developing at a striking speed. However, a lack of collaboration among countries, institutions, and authors, is common, and this should be addressed in future. The main focus of research in this field (i.e., the largest cluster) is endoscopic submucosal dissection, and the topic at the frontier (i.e., the newest cluster) is AI. Future research should focus on the application of AI in endoscopy, and its implications for the clinical diagnosis and treatment of EGC.
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Affiliation(s)
- Yuan Liu
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Haolang Wen
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Qiao Wang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Shiyu Du
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Shiyu Du,
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Agrawal LS, Acharya S, Shukla S, Parekh YC. Future of Endoscopy in Inflammatory Bowel Diseases (IBDs). Cureus 2022; 14:e29567. [PMID: 36312686 PMCID: PMC9596090 DOI: 10.7759/cureus.29567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/25/2022] [Indexed: 12/15/2022] Open
Abstract
Gastrointestinal (GI) endoscopy has transformed over the years in scope, safety, accuracy, acceptability, and cost effectiveness of the clinical practice. There has been a reduction in the superiority of the endoscopic devices as innovations have taken place and increased the diagnostic values with certain limitations. There are particular difficulties in striking a balance between the development of new technology and the device's acceptance. The wide use of endoscopy for investigating GI lesions and diagnosis has led to an increase in more advanced methods and their broad application. It can simultaneously diagnose pre-malignant and malignant lesions, and newer interventions have made the biopsy specimen uptake possible. In this review article, we focus on the more recent roles, indications, applications, and usage of the innovative methods of endoscopy.
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Wang WL, Wang HP, Han ML, Lee CT. New-generation endocytoscopy for optical characterization of elevated-type early gastric cancer. Endoscopy 2022; 54:E472-E473. [PMID: 34583414 DOI: 10.1055/a-1625-5320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Wen-Lun Wang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Lun Han
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Tai Lee
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
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The development and clinical application of microscopic endoscopy for in vivo optical biopsies: Endocytoscopy and confocal laser endomicroscopy. Photodiagnosis Photodyn Ther 2022; 38:102826. [PMID: 35337998 DOI: 10.1016/j.pdpdt.2022.102826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/21/2022] [Indexed: 12/20/2022]
Abstract
Endoscopies are crucial for detecting and diagnosing diseases in gastroenterology, pulmonology, urology, and other fields. To accurately diagnose diseases, sample biopsies are indispensable and are currently considered the gold standard. However, random 4-quadrant biopsies have sampling errors and time delays. To provide intraoperative real-time microscopic images of suspicious lesions, microscopic endoscopy for in vivo optical biopsy has been developed, including endocytoscopy and confocal laser endomicroscopy. This article reviews recent advances in technology and clinical applications, as well as their shortcomings and future directions.
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Endoscopic Classifications of Early Gastric Cancer: A Literature Review. Cancers (Basel) 2021; 14:cancers14010100. [PMID: 35008263 PMCID: PMC8750452 DOI: 10.3390/cancers14010100] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/04/2021] [Accepted: 12/22/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Throughout the years, endoscopic technologies have advanced to facilitate better assessment of gastric lesions and early detection of gastric cancer. With improvements in conventional white light endoscopy, we have also witnessed the development of newer endoscopic diagnostic modalities, giving rise to several classifications for early gastric cancer. Different endoscopic classifications of early gastric based on several endoscopic diagnostic modalities were included in this review. In addition to this, newer and novel endoscopic classifications that were specifically developed for the stomach for assessing and diagnosing gastric lesions have also been included. Illustrative representations of each classification have also been provided to aid readers in better understanding of these endoscopic classifications of early gastric cancer. Abstract Endoscopic technologies have been continuously advancing throughout the years to facilitate improvement in the detection and diagnosis of gastric lesions. With the development of different endoscopic diagnostic modalities for EGC, several classifications have been advocated for the evaluation of gastric lesions, aiming for an early detection and diagnosis. Sufficient knowledge on the appearance of EGC on white light endoscopy is fundamental for early detection and management. On the other hand, those superficial EGC with subtle morphological changes that are challenging to be detected with white light endoscopy may now be clearly defined by means of image-enhanced endoscopy (IEE). By combining magnifying endoscopy and IEE, irregularities in the surface structures can be evaluated and highlighted, leading to improvements in EGC diagnostic accuracy. The main scope of this review article is to offer a closer look at the different classifications of EGC based on several endoscopic diagnostic modalities, as well as to introduce readers to newer and novel classifications, specifically developed for the stomach, for the assessment and diagnosis of gastric lesions.
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12
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Advances in the Aetiology & Endoscopic Detection and Management of Early Gastric Cancer. Cancers (Basel) 2021; 13:cancers13246242. [PMID: 34944861 PMCID: PMC8699285 DOI: 10.3390/cancers13246242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Gastric adenocarcinoma has remained a highly lethal disease. Awareness and recognition of preneoplastic conditions (including gastric atrophy and intestinal metaplasia) using high-resolution white-light endoscopy as well as chromoendoscopy is therefore essential. Helicobacter pylori, a class I carcinogen, remains the main contributor to the development of sporadic distal gastric neoplasia. Management of early gastric neoplasia with endoscopic resections should be in line with standard indications. A multidisciplinary approach to any case of an early gastric neoplasia is imperative. Hereditary forms of gastric cancer require a tailored approach and individua-lized surveillance. Abstract The mortality rates of gastric carcinoma remain high, despite the progress in research and development in disease mechanisms and treatment. Therefore, recognition of gastric precancerous lesions and early neoplasia is crucial. Two subtypes of sporadic gastric cancer have been recognized: cardia subtype and non-cardia (distal) subtype, the latter being more frequent and largely associated with infection of Helicobacter pylori, a class I carcinogen. Helicobacter pylori initiates the widely accepted Correa cascade, describing a stepwise progression through precursor lesions from chronic inflammation to gastric atrophy, gastric intestinal metaplasia and neoplasia. Our knowledge on He-licobacter pylori is still limited, and multiple questions in the context of its contribution to the pathogenesis of gastric neoplasia are yet to be answered. Awareness and recognition of gastric atrophy and intestinal metaplasia on high-definition white-light endoscopy, image-enhanced endoscopy and magnification endoscopy, in combination with histology from the biopsies taken accurately according to the protocol, are crucial to guiding the management. Standard indications for endoscopic resections (endoscopic mucosal resection and endoscopic submucosal dissection) of gastric dysplasia and intestinal type of gastric carcinoma have been recommended by multiple societies. Endoscopic evaluation and surveillance should be offered to individuals with an inherited predisposition to gastric carcinoma.
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Tang Y, Anandasabapathy S, Richards‐Kortum R. Advances in optical gastrointestinal endoscopy: a technical review. Mol Oncol 2021; 15:2580-2599. [PMID: 32915503 PMCID: PMC8486567 DOI: 10.1002/1878-0261.12792] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/23/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Optical endoscopy is the primary diagnostic and therapeutic tool for management of gastrointestinal (GI) malignancies. Most GI neoplasms arise from precancerous lesions; thus, technical innovations to improve detection and diagnosis of precancerous lesions and early cancers play a pivotal role in improving outcomes. Over the last few decades, the field of GI endoscopy has witnessed enormous and focused efforts to develop and translate accurate, user-friendly, and minimally invasive optical imaging modalities. From a technical point of view, a wide range of novel optical techniques is now available to probe different aspects of light-tissue interaction at macroscopic and microscopic scales, complementing white light endoscopy. Most of these new modalities have been successfully validated and translated to routine clinical practice. Herein, we provide a technical review of the current status of existing and promising new optical endoscopic imaging technologies for GI cancer screening and surveillance. We summarize the underlying principles of light-tissue interaction, the imaging performance at different scales, and highlight what is known about clinical applicability and effectiveness. Furthermore, we discuss recent discovery and translation of novel molecular probes that have shown promise to augment endoscopists' ability to diagnose GI lesions with high specificity. We also review and discuss the role and potential clinical integration of artificial intelligence-based algorithms to provide decision support in real time. Finally, we provide perspectives on future technology development and its potential to transform endoscopic GI cancer detection and diagnosis.
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Affiliation(s)
- Yubo Tang
- Department of BioengineeringRice UniversityHoustonTXUSA
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Inoue H, Fujiyoshi MRA, Toshimori A, Fujiyoshi Y, Shimamura Y, Tanabe M, Nishikawa Y, Mochizuki Y, Sakaguchi T, Kimura R, Izawa S, Ikeda H, Onimaru M, Uragami N. Unified magnifying endoscopic classification for esophageal, gastric and colonic lesions: a feasibility pilot study. Endosc Int Open 2021; 9:E1306-E1314. [PMID: 34466352 PMCID: PMC8367430 DOI: 10.1055/a-1499-6638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
Background and study aims Image-enhanced magnifying endoscopy allows optimization of the detection and diagnosis of lesions found in the gastrointestinal tract. Current organ-specific classifications are well-accepted by specialized endoscopists but may pose confusion for general gastroenterologists. To address this, our group proposed the Unified Magnifying Endoscopic Classification (UMEC) which can be applied either in esophagus, stomach, or colon. The aim of this study was to evaluate the diagnostic performance and clinical applicability of UMEC. Patients and methods A single-center, feasibility pilot study was conducted. Two endoscopists with experience in magnifying narrow band imaging (NBI), blinded to white-light and non-magnifying NBI findings as well as histopathological diagnosis, independently reviewed and diagnosed all images based on UMEC. In brief, UMEC is divided into three categories: non-neoplasia, intramucosal neoplasia, and deep submucosal invasive cancer. The diagnostic performance of UMEC was assessed while using the gold standard histopathology as a reference. Results A total of 303 gastrointestinal lesions (88 esophageal squamous lesions, 90 gastric lesions, 125 colonic lesions) were assessed. The overall accuracy for both endoscopists in the diagnosis of esophageal squamous cell cancer, gastric cancer, and colorectal cancer were 84.7 %, 89.5 %, and 83.2 %, respectively. The interobserver agreement for each organ, Kappa statistics of 0.51, 0.73, and 0.63, was good. Conclusions UMEC appears to be a simple and practically acceptable classification, particularly to general gastroenterologists, due to its good diagnostic accuracy, and deserves further evaluation in future studies.
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Affiliation(s)
- Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | | | - Akiko Toshimori
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yusuke Fujiyoshi
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yuto Shimamura
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Mayo Tanabe
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yohei Nishikawa
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yuichiro Mochizuki
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Takuki Sakaguchi
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Ryusuke Kimura
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Shinya Izawa
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Haruo Ikeda
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Manabu Onimaru
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Naoyuki Uragami
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
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15
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Lee W. Application of Current Image-Enhanced Endoscopy in Gastric Diseases. Clin Endosc 2021; 54:477-487. [PMID: 34315196 PMCID: PMC8357595 DOI: 10.5946/ce.2021.160] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/08/2021] [Indexed: 12/12/2022] Open
Abstract
Image-enhanced endoscopy (IEE) plays an integral role in endoscopic diagnosis and treatment. IEE enables an early and accurate detection of cancer and characterization of lesions prior to therapeutic decisions. Ideal IEE can serve as an optical or digital chromoscopic endoscopy, as well as an optical biopsy that predicts exact histopathology. Several IEE modalities have recently been developed and are used in the clinical field. The stomach is a challenging organ for imaging because of its complex secretion function and status of Helicobacter pylori infection. Therefore, understanding the current IEE modalities for their clinical applicability in an evidence-based approach is warranted. Along with technology refinements, the new paradigm will be available for the diagnosis of gastric cancer or other conditions in the stomach in the near future.
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Affiliation(s)
- Wansik Lee
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
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Abstract
This article explores advances in endoscopic neoplasia detection with supporting clinical evidence and future aims. The ability to detect early gastric neoplastic lesions amenable to curative endoscopic submucosal dissection provides the opportunity to decrease gastric cancer mortality rates. Newer imaging techniques offer enhanced views of mucosal and microvascular structures and show promise in differentiating benign from malignant lesions and improving targeted biopsies. Conventional chromoendoscopy is well studied and validated. Narrow band imaging demonstrates superiority over magnified white light. Autofluorescence imaging, i-scan, flexible spectral imaging color enhancement, and bright image enhanced endoscopy show promise but insufficient evidence to change current clinical practice.
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Affiliation(s)
- Andrew Canakis
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, USA. https://twitter.com/AndrewCanakis
| | - Raymond Kim
- Division of Gastroenterology & Hepatology, University of Maryland Medical Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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Mallath MK. Gastric Cancer. GERIATRIC GASTROENTEROLOGY 2021:1829-1880. [DOI: 10.1007/978-3-030-30192-7_77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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AL-Kandari A, Neumann H. Endocytoscopy for Luminal Gastrointestinal Diseases: A Systematic Review. TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY 2021; 23:77-86. [DOI: 10.1016/j.tige.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Abad MRA, Shimamura Y, Fujiyoshi Y, Seewald S, Inoue H. Endocytoscopy: technology and clinical application in upper gastrointestinal tract. Transl Gastroenterol Hepatol 2020; 5:28. [PMID: 32258532 DOI: 10.21037/tgh.2019.11.12] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022] Open
Abstract
Over the past few years, the innovative field of magnifying endoscopy has been expanding with various cutting-edge technologies, one of which is endocytoscopy, to facilitate improvement in the detection and diagnosis of gastrointestinal lesions. Endocytoscopy is a novel ultra-high magnification endoscopic technique enabling high-quality in-vivo assessment of lesions found in the gastrointestinal tract with the use of intraprocedural stains. The main scope of this review article is to offer a closer look at the latest endocytoscopic technology and its clinical application in the upper gastrointestinal tract, especially in the esophagus and stomach, as well as to introduce readers to our simplified and up-to-date endocytoscopic classification, specifically developed for the esophagus and stomach, for the in-vivo assessment and diagnosis of esophageal and gastric lesions. Despite the good accuracy of endocytoscopy in the diagnosis of esophageal and gastric lesions in recent studies, some challenges still remain (e.g., staining method and standardized endocytoscopic classification). Through continuous evaluation and improvement of methods and skills, these challenges may be overcome thus establishing current techniques and classification, paving the way for further advances in the field of endocytoscopy and magnifying endoscopy. In all, endocytoscopy seems to aid in the in-vivo diagnosis of gastrointestinal tract lesions and may, in the future, revolutionize the field of in-vivo endoscopic diagnosis of gastrointestinal cancer, representing another step towards the so-called optical biopsy.
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Affiliation(s)
| | - Yuto Shimamura
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yusuke Fujiyoshi
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Stefan Seewald
- Center of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
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Teh JL, Shabbir A, Yuen S, So JBY. Recent advances in diagnostic upper endoscopy. World J Gastroenterol 2020; 26:433-447. [PMID: 32063692 PMCID: PMC7002908 DOI: 10.3748/wjg.v26.i4.433] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/10/2020] [Accepted: 01/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageo-gastro-duodenoscopy (EGD) is an important procedure used for detection and diagnosis of esophago-gastric lesions. There exists no consensus on the technique of examination.
AIM To identify recent advances in diagnostic EGDs to improve diagnostic yield.
METHODS We queried the PubMed database for relevant articles published between January 2001 and August 2019 as well as hand searched references from recently published endoscopy guidelines. Keywords used included free text and MeSH terms addressing quality indicators and technological innovations in EGDs. Factors affecting diagnostic yield and EGD quality were identified and divided into the follow segments: Pre endoscopy preparation, sedation, examination schema, examination time, routine biopsy, image enhanced endoscopy and future developments.
RESULTS We identified 120 relevant abstracts of which we utilized 67 of these studies in our review. Adequate pre-endoscopy preparation with simethicone and pronase increases gastric visibility. Proper sedation, especially with propofol, increases patient satisfaction after procedure and may improve detection of superficial gastrointestinal lesions. There is a movement towards mandatory picture documentation during EGD as well as dedicating sufficient time for examination improves diagnostic yield. The use of image enhanced endoscopy and magnifying endoscopy improves detection of squamous cell carcinoma and gastric neoplasm. The magnifying endoscopy simple diagnostic algorithm is useful for diagnosis of early gastric cancer.
CONCLUSION There is a steady momentum in the past decade towards improving diagnostic yield, quality and reporting in EGDs. Other interesting innovations, such as Raman spectroscopy, endocytoscopy and artificial intelligence may have widespread endoscopic applications in the near future.
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Affiliation(s)
- Jun-Liang Teh
- Department of Surgery, National University Hospital System, Singapore 119228, Singapore
- Department of Surgery, Jurong Health Campus, National University Health System, Singapore 609606, Singapore
| | - Asim Shabbir
- Department of Surgery, National University Hospital System, Singapore 119228, Singapore
| | - Soon Yuen
- Department of Surgery, National University Hospital System, Singapore 119228, Singapore
- Department of Surgery, Jurong Health Campus, National University Health System, Singapore 609606, Singapore
| | - Jimmy Bok-Yan So
- Department of Surgery, National University Hospital System, Singapore 119228, Singapore
- Department of Surgery, National University of Singapore, Singapore 119074, Singapore
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