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Ham NS, Myung SJ. Endoscopic molecular imaging in inflammatory bowel disease. Intest Res 2021; 19:33-44. [PMID: 32299156 PMCID: PMC7873406 DOI: 10.5217/ir.2019.09175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
Molecular imaging is a technique for imaging the processes occurring in a living body at a molecular level in real-time, combining molecular cell biology with advanced imaging technologies using molecular probes and fluorescence. Gastrointestinal endoscopic molecular imaging shows great promise for improving the identification of neoplasms, providing characterization for patient stratification and assessing the response to molecular targeted therapy. In inflammatory bowel disease, endoscopic molecular imaging can be used to assess disease severity and predict therapeutic response and prognosis. Endoscopic molecular imaging is also able to visualize dysplasia in the presence of background inflammation. Several preclinical and clinical trials have evaluated endoscopic molecular imaging; however, this area is just beginning to evolve, and many issues have not been solved yet. In the future, it is expected that endoscopic molecular imaging will be of increasing interest among clinicians as a new technology for the identification and evaluation of colorectal neoplasm and colitis-associated cancer.
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Affiliation(s)
- Nam Seok Ham
- Department of Gastroenterology, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Digestive Diseases Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Seung-Jae Myung, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3917, Fax: +82-2- 476-0824, E-mail:
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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: 1.6] [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.
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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
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Wang T, Li Q, Xiao P, Ahn J, Kim YE, Park Y, Kim M, Song M, Chung E, Chung WK, Ahn GO, Kim S, Kim P, Myung SJ, Kim KH. Gradient index lens based combined two-photon microscopy and optical coherence tomography. OPTICS EXPRESS 2014; 22:12962-70. [PMID: 24921493 DOI: 10.1364/oe.22.012962] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
We report a miniaturized probe-based combined two-photon microscopy (TPM) and optical coherence tomography (OCT) system. This system is to study the colorectal cancer in mouse models by visualizing both cellular and structural information of the colon in 3D with TPM and OCT respectively. The probe consisted of gradient index (GRIN) lenses and a 90° reflecting prism at its distal end for side-viewing, and it was added onto an objective lens-based TPM and OCT system. The probe was 2.2 mm in diameter and 60 mm in length. TPM imaging was performed by raster scanning of the excitation focus at the imaging speed of 15.4 frames/s. OCT imaging was performed by combining the linear sample translation and probe rotation along its axis. This miniaturized probe based dual-modal system was characterized with tissue phantoms containing fluorescent microspheres, and applied to image mouse colonic tissues ex vivo as a demonstration. As OCT and TPM provided structural and cellular information of the tissues respectively, this probe based multi-modal imaging system can be helpful for in vivo studies of preclinical animal models such as mouse colonic tumorigenesis.
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Kim SY, Myung SJ. Optical molecular imaging for diagnosing intestinal diseases. Clin Endosc 2013; 46:620-6. [PMID: 24340254 PMCID: PMC3856262 DOI: 10.5946/ce.2013.46.6.620] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 10/12/2013] [Accepted: 10/17/2013] [Indexed: 12/20/2022] Open
Abstract
Real-time visualization of the molecular signature of cells can be achieved with advanced targeted imaging techniques using molecular probes and fluorescence endoscopy. This molecular optical imaging in gastrointestinal endoscopy is promising for improving the detection of neoplastic lesions, their characterization for patient stratification, and the assessment of their response to molecular targeted therapy and radiotherapy. In inflammatory bowel disease, this method can be used to detect dysplasia in the presence of background inflammation and to visualize inflammatory molecular targets for assessing disease severity and prognosis. Several preclinical and clinical trials have applied this method in endoscopy; however, this field has just started to evolve. Hence, many problems have yet to be solved to enable the clinical application of this novel method.
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Affiliation(s)
- Sang-Yeob Kim
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Seltenreich H, Van Den Bogaerde J, Sorrentino D. The race for mainstream gastrointestinal endoscopy: frontrunners. Expert Rev Gastroenterol Hepatol 2012; 6:467-79. [PMID: 22928899 DOI: 10.1586/egh.12.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In recent years, gastrointestinal endoscopy has evolved and branched out from a primary naked-eye diagnostic technique to a multitude of sophisticated investigative and therapeutic procedures. While many of the new endoscopic techniques are currently too complex or expensive to make it to mainstream clinical practice, others are already bringing major progress to the management of digestive diseases. In this review we will discuss a selected group of the emerging techniques and technologies used to increase the diagnostic yield in the colon and small intestine, including Third Eye® Retroscopes®, colon capsule endoscopy, spiral enteroscopy and confocal laser endomicroscopy. We will also discuss over-the-scope clip devices, a relatively simple and inexpensive tool potentially capable of noninvasive closing intestinal perforations and allowing the removal of infiltrating tumors.
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Affiliation(s)
- H Seltenreich
- Department of Gastroenterology, Nambour General Hospital, Nambour, QLD, Australia
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