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Hicheri C, Azimuddin AM, Kortum A, Bailey J, Tang Y, Schwarz RA, Rosen D, Jain S, Mansour NM, Groth S, Vasavada S, Rao A, Maliga A, Gallego L, Carns J, Anandasabapathy S, Richards-Kortum R. Design and Evaluation of ScanCap: A Low-Cost, Reusable Tethered Capsule Endoscope with Blue-Green Illumination Imaging for Unsedated Screening and Early Detection of Barrett's Esophagus. Bioengineering (Basel) 2024; 11:557. [PMID: 38927792 PMCID: PMC11200367 DOI: 10.3390/bioengineering11060557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024] Open
Abstract
Esophageal carcinoma is the sixth-leading cause of cancer death worldwide. A precursor to esophageal adenocarcinoma (EAC) is Barrett's Esophagus (BE). Early-stage diagnosis and treatment of esophageal neoplasia (Barrett's with high-grade dysplasia/intramucosal cancer) increase the five-year survival rate from 10% to 98%. BE is a global challenge; however, current endoscopes for early BE detection are costly and require extensive infrastructure for patient examination and sedation. We describe the design and evaluation of the first prototype of ScanCap, a high-resolution optical endoscopy system with a reusable, low-cost tethered capsule, designed to provide high-definition, blue-green illumination imaging for the early detection of BE in unsedated patients. The tethered capsule (12.8 mm diameter, 35.5 mm length) contains a color camera and rotating mirror and is designed to be swallowed; images are collected as the capsule is retracted manually via the tether. The tether provides electrical power and illumination at wavelengths of 415 nm and 565 nm and transmits data from the camera to a tablet. The ScanCap prototype capsule was used to image the oral mucosa in normal volunteers and ex vivo esophageal resections; images were compared to those obtained using an Olympus CV-180 endoscope. Images of superficial capillaries in intact oral mucosa were clearly visible in ScanCap images. Diagnostically relevant features of BE, including irregular Z-lines, distorted mucosa, and dilated vasculature, were clearly visible in ScanCap images of ex vivo esophageal specimens.
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Affiliation(s)
- Cheima Hicheri
- Department of Bioengineering, Rice University, Houston, TX 77030, USA; (C.H.); (R.A.S.)
| | - Ahad M. Azimuddin
- Houston Methodist Hospital, Houston, TX 77030, USA;
- Texas A&M School of Medicine, Houston, TX 77030, USA
| | - Alex Kortum
- Department of Bioengineering, Rice University, Houston, TX 77030, USA; (C.H.); (R.A.S.)
| | - Joseph Bailey
- Rice360 Institute for Global Health Technologies, Rice University, Houston, TX 77030, USA
| | - Yubo Tang
- Department of Bioengineering, Rice University, Houston, TX 77030, USA; (C.H.); (R.A.S.)
| | - Richard A. Schwarz
- Department of Bioengineering, Rice University, Houston, TX 77030, USA; (C.H.); (R.A.S.)
| | - Daniel Rosen
- Baylor College of Medicine, Houston, TX 77030, USA (L.G.)
| | - Shilpa Jain
- Baylor College of Medicine, Houston, TX 77030, USA (L.G.)
| | | | - Shawn Groth
- Baylor College of Medicine, Houston, TX 77030, USA (L.G.)
| | | | - Ashwin Rao
- Baylor College of Medicine, Houston, TX 77030, USA (L.G.)
| | | | - Leslie Gallego
- Baylor College of Medicine, Houston, TX 77030, USA (L.G.)
| | - Jennifer Carns
- Department of Bioengineering, Rice University, Houston, TX 77030, USA; (C.H.); (R.A.S.)
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Bar N, Abdelgani S, Lal S, Deutsch L. A look inside the gut as a clue to nutritional status. Curr Opin Clin Nutr Metab Care 2024:00075197-990000000-00157. [PMID: 38837038 DOI: 10.1097/mco.0000000000001049] [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: 06/06/2024]
Abstract
PURPOSE OF REVIEW Malabsorption and malnutrition are common gastrointestinal manifestations clinicians face, requiring diagnostic workup for effective diagnosis and management of the underlying cause. This review discusses recent advances in diagnostic approaches to malabsorption and maldigestion of macronutrients - lipids, proteins, and carbohydrates. We highlight underrecognized causes, available testing modalities, and ongoing diagnostic unmet needs. RECENT FINDINGS Innovations in the diagnostic landscape are enhancing our understanding of malabsorption syndromes. Stool collection and handling is uncomfortable and commonly avoided. The objective quantification of stool lipids, bile acids, and gut enzymes is therefore underused in the diagnosis and management of common disorders such as exocrine pancreatic insufficiency, bile acid diarrhea, protein-losing enteropathy, and more. We review the recent advancements in spot quantification of stool fat and bile acid content, endoscopic imaging techniques such as endocytoscopy, confocal laser endomicroscopy, and optical coherence tomography and the future place in clinical practice. SUMMARY Malabsorption and maldigestion represent significant challenges in clinical nutrition and gastroenterology. Through the integration of advanced diagnostic techniques, clinicians will be better equipped to tailor therapy and monitor treatment response, ultimately improving patient health outcomes. This review underscores the critical role of innovative diagnostic tools in accurately detecting and effectively managing gastrointestinal disorders linked to nutritional status.
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Affiliation(s)
- Nir Bar
- Department of Gastroenterology and Liver diseases, Tel-Aviv Sourasky Medical Center
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Siham Abdelgani
- Department of Gastroenterology and Liver diseases, Tel-Aviv Sourasky Medical Center
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford
- Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Liat Deutsch
- Department of Gastroenterology and Liver diseases, Tel-Aviv Sourasky Medical Center
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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3
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Kitagawa Y, Matsuda S, Gotoda T, Kato K, Wijnhoven B, Lordick F, Bhandari P, Kawakubo H, Kodera Y, Terashima M, Muro K, Takeuchi H, Mansfield PF, Kurokawa Y, So J, Mönig SP, Shitara K, Rha SY, Janjigian Y, Takahari D, Chau I, Sharma P, Ji J, de Manzoni G, Nilsson M, Kassab P, Hofstetter WL, Smyth EC, Lorenzen S, Doki Y, Law S, Oh DY, Ho KY, Koike T, Shen L, van Hillegersberg R, Kawakami H, Xu RH, Wainberg Z, Yahagi N, Lee YY, Singh R, Ryu MH, Ishihara R, Xiao Z, Kusano C, Grabsch HI, Hara H, Mukaisho KI, Makino T, Kanda M, Booka E, Suzuki S, Hatta W, Kato M, Maekawa A, Kawazoe A, Yamamoto S, Nakayama I, Narita Y, Yang HK, Yoshida M, Sano T. Clinical practice guidelines for esophagogastric junction cancer: Upper GI Oncology Summit 2023. Gastric Cancer 2024; 27:401-425. [PMID: 38386238 PMCID: PMC11016517 DOI: 10.1007/s10120-023-01457-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/09/2023] [Indexed: 02/23/2024]
Affiliation(s)
- Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Takuji Gotoda
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ken Kato
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Florian Lordick
- Department of Oncology and University Cancer Center Leipzig, Leipzig University Medical Center, Comprehensive Cancer Center Central, Leipzig, Jena, Germany
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth University Hospital NHS Trust, Portsmouth, UK
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Paul F Mansfield
- Surgical Oncology, University of Texas, MD Anderson Cancer Center, Houston, USA
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Jimmy So
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Stefan Paul Mönig
- Upper-GI-Surgery University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - Kohei Shitara
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Sun Young Rha
- Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yelena Janjigian
- Department of Medicine, Solid Tumor Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Daisuke Takahari
- Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ian Chau
- Department of Medicine, Royal Marsden Hospital, London, UK
| | - Prateek Sharma
- Division of Gastroenterology, School of Medicine and VA Medical Center, University of Kansas, Kansas, USA
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital, Beijing, China
| | - Giovanni de Manzoni
- Department of Surgery, Dentistry, Maternity and Infant, University of Verona, Verona, Italy
| | - Magnus Nilsson
- Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Paulo Kassab
- Gastroesophageal Surgery, Santa Casa of Sao Paulo Medical School, São Paulo, Brazil
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, USA
| | | | - Sylvie Lorenzen
- Department of Hematology and Oncology, Klinikum Rechts Der Isar Munich, Munich, Germany
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Simon Law
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Do-Youn Oh
- Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Khek Yu Ho
- National University of Singapore, Singapore, Singapore
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Lin Shen
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital, Beijing, China
| | - Richard van Hillegersberg
- Department of Upper Gastrointestinal Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hisato Kawakami
- Department of Medical Oncology, Faculty of Medicine, Kindai University, Higashiosaka, Japan
| | - Rui-Hua Xu
- Department of Medical Oncology, Sun YAT-Sen University Cancer Center, Guangzhou, China
| | - Zev Wainberg
- Gastrointestinal Medical Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Naohisa Yahagi
- Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Ryu Ishihara
- Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Zili Xiao
- Digestive Endoscopic Unit, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Chika Kusano
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Heike Irmgard Grabsch
- Department of Pathology, GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
- Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Hiroki Hara
- Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Ken-Ichi Mukaisho
- Education Center for Medicine and Nursing, Shiga University of Medical Science, Otsu, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Motohiko Kato
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Akira Maekawa
- Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan
| | - Akihito Kawazoe
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shun Yamamoto
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Izuma Nakayama
- Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukiya Narita
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University, Seoul, Republic of Korea
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Otawara, Japan
| | - Takeshi Sano
- Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Ebert MP, Fischbach W, Hollerbach S, Höppner J, Lorenz D, Stahl M, Stuschke M, Pech O, Vanhoefer U, Porschen R. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:535-642. [PMID: 38599580 DOI: 10.1055/a-2239-9802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Matthias P Ebert
- II. Medizinische Klinik, Medizinische Fakultät Mannheim, Universitätsmedizin, Universität Heidelberg, Mannheim
- DKFZ-Hector Krebsinstitut an der Universitätsmedizin Mannheim, Mannheim
- Molecular Medicine Partnership Unit, EMBL, Heidelberg
| | - Wolfgang Fischbach
- Deutsche Gesellschaft zur Bekämpfung der Krankheiten von Magen, Darm und Leber sowie von Störungen des Stoffwechsels und der Ernährung (Gastro-Liga) e. V., Giessen
| | | | - Jens Höppner
- Klinik für Allgemeine Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | - Dietmar Lorenz
- Chirurgische Klinik I, Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Darmstadt, Darmstadt
| | - Michael Stahl
- Klinik für Internistische Onkologie und onkologische Palliativmedizin, Evang. Huyssensstiftung, Evang. Kliniken Essen-Mitte, Essen
| | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Oliver Pech
- Klinik für Gastroenterologie und Interventionelle Endoskopie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Udo Vanhoefer
- Klinik für Hämatologie und Onkologie, Katholisches Marienkrankenhaus, Hamburg
| | - Rainer Porschen
- Gastroenterologische Praxis am Kreiskrankenhaus Osterholz, Osterholz-Scharmbeck
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Waddingham W, Graham DG, Banks MR. Latest Advances in Endoscopic Detection of Oesophageal and Gastric Neoplasia. Diagnostics (Basel) 2024; 14:301. [PMID: 38337817 PMCID: PMC10855581 DOI: 10.3390/diagnostics14030301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Endoscopy is the gold standard for the diagnosis of cancers and cancer precursors in the oesophagus and stomach. Early detection of upper GI cancers requires high-quality endoscopy and awareness of the subtle features these lesions carry. Endoscopists performing surveillance of high-risk patients including those with Barrett's oesophagus, previous squamous neoplasia or chronic atrophic gastritis should be familiar with endoscopic features, classification systems and sampling techniques to maximise the detection of early cancer. In this article, we review the current approach to diagnosis of these conditions and the latest advanced imaging and diagnostic techniques.
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Affiliation(s)
- William Waddingham
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - David G. Graham
- Department of Gastroenterology, University College London NHS Foundation Trust, London NW1 2BU, UK
| | - Matthew R. Banks
- Department of Gastroenterology, University College London NHS Foundation Trust, London NW1 2BU, UK
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Nakayama A, Kato M, Matsuura N, Yahagi N. Endoscopic Diagnosis of Superficial Gastrointestinal Cancer. Gastrointest Endosc Clin N Am 2024; 34:1-17. [PMID: 37973222 DOI: 10.1016/j.giec.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
White light image (WLI) findings are important for detection and characterization in the GI tract. However, magnified endoscopic examination with image enhanced endoscopy (IEE-NE) is becoming increasingly important for qualitative diagnosis of GI neoplastic lesions. IEE-ME is extremely useful for diagnosis of invasion depth in esophageal squamous cell cancer (ESCC) and colorectal cancer, whereas macroscopic findings of WLI are still useful in Barrett's adenocarcinoma (BAC) and gastric cancer. IEE-ME is also useful for diagnosis of tumor extent in BAC and gastric cancer, whereas chromoendoscopy with indigo carmine is useful in colorectal cancer and iodine staining is indispensable in ESCC.
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Affiliation(s)
- Atsushi Nakayama
- Department of Research and Development for Minimal Invasive Treatment, Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Motohiko Kato
- Center for Diagnostic and Therapeutic Endoscopy, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Noriko Matsuura
- Department of Research and Development for Minimal Invasive Treatment, Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Naohisa Yahagi
- Department of Research and Development for Minimal Invasive Treatment, Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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7
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Ikenoyama Y, Goda K, Fujisaki J, Ishihara R, Takeuchi M, Takahashi A, Takaki Y, Hirasawa D, Momma K, Amano Y, Yagi K, Furuhashi H, Hashimoto S, Kanesaka T, Shimizu T, Ono Y, Yamagata T, Fujiwara J, Azumi T, Watanabe G, Ohkura Y, Nishikawa M, Oyama T. A simpler diagnostic algorithm of the Japan Esophageal Society classification for Barrett's esophagus-related superficial neoplasia. Esophagus 2024; 21:22-30. [PMID: 38064022 DOI: 10.1007/s10388-023-01029-5] [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: 07/17/2023] [Accepted: 11/03/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND We previously developed a Japan Esophageal Society Barrett's Esophagus (JES-BE) magnifying endoscopic classification for superficial BE-related neoplasms (BERN) and validated it in a nationwide multicenter study that followed a diagnostic flow chart based on mucosal and vascular patterns (MP, VP) with nine diagnostic criteria. Our present post hoc analysis aims to further simplify the diagnostic criteria for superficial BERN. METHODS We used data from our previous study, including 10 reviewers' assessments for 156 images of high-magnifying narrow-band imaging (HM-NBI) (67 dysplastic and 89 non-dysplastic histology). We statistically analyzed the diagnostic performance of each diagnostic criterion of MP (form, size, arrangement, density, and white zone), VP (form, caliber change, location, and greenish thick vessels [GTV]), and all their combinations to achieve a simpler diagnostic algorithm to detect superficial BERN. RESULTS Diagnostic accuracy values based on the MP of each single criterion or combined criteria showed a marked trend of being higher than those based on VP. In reviewers' assessments of visible MPs, the combination of irregularity for form, size, or white zone had the highest diagnostic performance, with a sensitivity of 87% and a specificity of 91% for dysplastic histology; in the assessments of invisible MPs, GTV had the highest diagnostic performance among the VP of each single criterion and all combinations of two or more criteria (sensitivity, 93%; specificity, 92%). CONCLUSION The present post hoc analysis suggests the feasibility of further simplifying the diagnostic algorithm of the JES-BE classification. Further studies in a practical setting are required to validate these results.
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Affiliation(s)
- Yohei Ikenoyama
- Department of Gastroenterology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Kenichi Goda
- Gastrointestinal Endoscopy Center, Dokkyo Medical University, Tochigi, Japan.
- Department of Gastroenterology, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi, 321-0293, Japan.
| | - Junko Fujisaki
- Department of Gastroenterology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Manabu Takeuchi
- Department of Gastroenterology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Akiko Takahashi
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Yasuhiro Takaki
- Department of Gastroenterology, Medical Corporation Shin-Ai Station Clinic, Fukuoka, Japan
| | - Dai Hirasawa
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Kumiko Momma
- Department of Endoscopy, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Yuji Amano
- Department of Endoscopy, New Tokyo Hospital, Chiba, Japan
| | - Kazuyoshi Yagi
- Department of Gastroenterology and Hepatology, Institute of Community Medicine, Niigata University, Uonuma Kikan Hospital, Niigata, Japan
| | - Hiroto Furuhashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoru Hashimoto
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tomoki Shimizu
- Department of Gastroenterology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Yoichiro Ono
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Taku Yamagata
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Junko Fujiwara
- Department of Endoscopy, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Takane Azumi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Gen Watanabe
- Department of Pathology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yasuo Ohkura
- Pathology and Cytology Center, PCL Japan, Saitama, Japan
| | - Masako Nishikawa
- Clinical Research Support Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Tsuneo Oyama
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan
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8
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Zilberstein N, Godbee M, Mehta NA, Waxman I. Advanced endoscopic imaging for detection of Barrett's esophagus. Clin Endosc 2024; 57:1-10. [PMID: 38178326 PMCID: PMC10834296 DOI: 10.5946/ce.2023.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 07/27/2023] [Accepted: 08/29/2023] [Indexed: 01/06/2024] Open
Abstract
Barrett's esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC), and is caused by chronic gastroesophageal reflux. BE can progress over time from metaplasia to dysplasia, and eventually to EAC. EAC is associated with a poor prognosis, often due to advanced disease at the time of diagnosis. However, if BE is diagnosed early, pharmacologic and endoscopic treatments can prevent progression to EAC. The current standard of care for BE surveillance utilizes the Seattle protocol. Unfortunately, a sizable proportion of early EAC and BE-related high-grade dysplasia (HGD) are missed due to poor adherence to the Seattle protocol and sampling errors. New modalities using artificial intelligence (AI) have been proposed to improve the detection of early EAC and BE-related HGD. This review will focus on AI technology and its application to various endoscopic modalities such as high-definition white light endoscopy, narrow-band imaging, and volumetric laser endomicroscopy.
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Affiliation(s)
- Netanel Zilberstein
- Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Michelle Godbee
- Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Neal A. Mehta
- Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Irving Waxman
- Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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9
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Ratcliffe E, Britton J, Yalamanchili H, Rostami I, Nadir SMH, Korani M, Eruchie I, Wazirdin MA, Prasad N, Hamdy S, McLaughlin J, Ang Y. Dedicated service for Barrett's oesophagus surveillance endoscopy yields higher dysplasia detection and guideline adherence in a non-tertiary setting in the UK: a 5-year comparative cohort study. Frontline Gastroenterol 2024; 15:21-27. [PMID: 38487558 PMCID: PMC10935534 DOI: 10.1136/flgastro-2023-102425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/19/2023] [Indexed: 03/17/2024] Open
Abstract
Objective Barrett's oesophagus (BO) endoscopic surveillance is performed to varying quality, dedicated services may offer improved outcomes. This study compares a dedicated BO service to standard care, specifically dysplasia detection rate (DDR), guideline adherence and use of advanced imaging modalities in a non-tertiary setting. Design/method 5-year retrospective comparative cohort study comparing a dedicated BO endoscopy service with surveillance performed on non-dedicated slots at a non-tertiary centre in the UK. All adult patients undergoing BO surveillance between 1 March 2016 and 1 March 2021 were reviewed and those who underwent endoscopy on a dedicated BO service run by endoscopists with training in BO was compared with patients receiving their BO surveillance on any other endoscopy list. Endoscopy reports, histology results and clinic letters were reviewed for DDR and British society of gastroenterology guideline adherence. Results 921 BO procedures were included (678 patients). 574 (62%) endoscopies were on a dedicated BO list vs 348 (38%) on non-dedicated.DDR was significantly higher in the dedicated cohort 6.3% (36/568) vs 2.7% (9/337) (p=0.014). Significance was sustained when cases with indefinite for dysplasia were excluded: 4.9% 27/533 vs 0.9% 3/329 (p=0.002). Guideline adherence was significantly better on the dedicated endoscopy lists.Factors associated with dysplasia detection in regression analysis included visible lesion documentation (p=0.036), use of targeted biopsies (p=<0.001), number of biopsies obtained (p≤0.001). Conclusions A dedicated Barrett's service showed higher DDR and guideline adherence than standard care and may be beneficial pending randomised trial data.
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Affiliation(s)
- Elizabeth Ratcliffe
- Gastroenterology department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
- Division of Diabetes, Endocrinology and Gastroenterology Faculty of Biology, Medicine and Health School of Medical Sciences, University of Manchester, Manchester, UK
| | - James Britton
- Gastroenterology department, Northern Care Alliance NHS Trust, Salford, UK
| | - Harika Yalamanchili
- Gastroenterology department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Izabela Rostami
- Gastroenterology department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Mohamed Korani
- Gastroenterology department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Ikedichukwu Eruchie
- Gastroenterology department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Neeraj Prasad
- Gastroenterology department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology Faculty of Biology, Medicine and Health School of Medical Sciences, University of Manchester, Manchester, UK
- Gastroenterology department, Northern Care Alliance NHS Trust, Salford, UK
| | - John McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology Faculty of Biology, Medicine and Health School of Medical Sciences, University of Manchester, Manchester, UK
- Gastroenterology department, Northern Care Alliance NHS Trust, Salford, UK
| | - Yeng Ang
- Division of Diabetes, Endocrinology and Gastroenterology Faculty of Biology, Medicine and Health School of Medical Sciences, University of Manchester, Manchester, UK
- Gastroenterology department, Northern Care Alliance NHS Trust, Salford, UK
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Louis H, Van Ouytsel P, Leclercq L, Houinsou Hans M, Devière J, Rio-Tinto R, Huberty V. Pilot study of an endoluminal-suturing device as a treatment for patients with gastroesophageal reflux disease. Endosc Int Open 2023; 11:E1092-E1098. [PMID: 38026783 PMCID: PMC10681806 DOI: 10.1055/a-2185-5947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Background and study aims Endoscopic therapy is a promising option for patients with gastroesophageal reflux disease (GERD). The aim of this study was to assess safety and feasibility of the Endomina suturing platform as a treatment for GERD. Patients and methods This was a two-center study of patients with chronic GERD symptoms that responded at least partially to proton pump inhibitors (PPIs). Primary endpoints were to assess the safety of the procedure and persistence of the sutures. Secondary endpoints were to assess esophageal pH-impedance and manometry parameters changes at 6 months, as well as GERD symptoms and PPI use up to 12 months of follow-up. Results Fourteen patients were treated (13 males, mean of 43±12 years), with a mean number of three plications per patient. Thirteen, 10, and nine patients were analyzed at 3, 6, and 12 months of follow-up, respectively. One device-related adverse event occurred (loss of needle tip requiring endoscopic retrieval 1 week later). A mean of two plications persisted at 3 and 12 months. A decrease in median acid exposure time and reflux episodes was observed after the procedure. Mean Reflux Symptom Index and GERD-Health-Related Quality of Life scores decreased during follow-up visits and 90% of the patients discontinued PPI use at 1 year. Conclusions Endoscopic full-thickness suturing of the esophagogastric junction with the Endomina suturing platform is feasible, allowing persistence of two-thirds of the plications, with promising results for decreasing reflux and improving GERD symptoms.
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Affiliation(s)
- Hubert Louis
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (H.U.B.), C.U.B. Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Pauline Van Ouytsel
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (H.U.B.), C.U.B. Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | - Mélina Houinsou Hans
- Department of Biomedical Research, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Jacques Devière
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (H.U.B.), C.U.B. Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | - Vincent Huberty
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (H.U.B.), C.U.B. Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
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11
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Shen Y, Chen A, Zhang X, Zhong X, Ma A, Wang J, Wang X, Zheng W, Sun Y, Yue L, Zhang Z, Zhang X, Lin N, Kim JJ, Du Q, Liu J, Hu W. Real-Time Evaluation of Helicobacter pylori Infection by Convolution Neural Network During White-Light Endoscopy: A Prospective, Multicenter Study (With Video). Clin Transl Gastroenterol 2023; 14:e00643. [PMID: 37800683 PMCID: PMC10589579 DOI: 10.14309/ctg.0000000000000643] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Convolutional neural network during endoscopy may facilitate evaluation of Helicobacter pylori infection without obtaining gastric biopsies. The aim of the study was to evaluate the diagnosis accuracy of a computer-aided decision support system for H. pylori infection (CADSS-HP) based on convolutional neural network under white-light endoscopy. METHODS Archived video recordings of upper endoscopy with white-light examinations performed at Sir Run Run Shaw Hospital (January 2019-September 2020) were used to develop CADSS-HP. Patients receiving endoscopy were prospectively enrolled (August 2021-August 2022) from 3 centers to calculate the diagnostic property. Accuracy of CADSS-HP for H. pylori infection was also compared with endoscopic impression, urea breath test (URT), and histopathology. H. pylori infection was defined by positive test on histopathology and/or URT. RESULTS Video recordings of 599 patients who received endoscopy were used to develop CADSS-HP. Subsequently, 456 patients participated in the prospective evaluation including 189 (41.4%) with H. pylori infection. With a threshold of 0.5, CADSS-HP achieved an area under the curve of 0.95 (95% confidence interval [CI], 0.93-0.97) with sensitivity and specificity of 91.5% (95% CI 86.4%-94.9%) and 88.8% (95% CI 84.2%-92.2%), respectively. CADSS-HP demonstrated higher sensitivity (91.5% vs 78.3%; mean difference = 13.2%, 95% CI 5.7%-20.7%) and accuracy (89.9% vs 83.8%, mean difference = 6.1%, 95% CI 1.6%-10.7%) compared with endoscopic diagnosis by endoscopists. Sensitivity of CADSS-HP in diagnosing H. pylori was comparable with URT (91.5% vs 95.2%; mean difference = 3.7%, 95% CI -1.8% to 9.4%), better than histopathology (91.5% vs 82.0%; mean difference = 9.5%, 95% CI 2.3%-16.8%). DISCUSSION CADSS-HP achieved high sensitivity in the diagnosis of H. pylori infection in the real-time test, outperforming endoscopic diagnosis by endoscopists and comparable with URT. Clinicaltrials.gov ; ChiCTR2000030724.
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Affiliation(s)
- Yuqin Shen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
- West China Xiamen Hospital, Sichuan University, Xiamen, China
| | - Angli Chen
- Shaoxing University School of Medicine, Shaoxing, Zhejiang, China
| | - Xinsen Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Xingwei Zhong
- Department of Gastroenterology, Deqing County People's Hospital, Huzhou, China
| | - Ahuo Ma
- Department of Gastroenterology, Shaoxing People's Hospital, Shaoxing, China
| | - Jianping Wang
- Department of Gastroenterology, Deqing County People's Hospital, Huzhou, China
| | - Xinjie Wang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Wenfang Zheng
- Department of Gastroenterology, Hangzhou First People's Hospital, Hangzhou, China
| | - Yingchao Sun
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Lei Yue
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Zhe Zhang
- Department of Gastroenterology, Longyou County People's Hospital, Quzhou, China
| | - Xiaoyan Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Ne Lin
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - John J. Kim
- Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, California, USA
| | - Qin Du
- Department of Gastroenterology, The Second Affiliated Hospital, Medical School, Zhejiang University, Hangzhou, China
| | - Jiquan Liu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Weiling Hu
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China
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12
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Iyer PG, Chak A. Surveillance in Barrett's Esophagus: Challenges, Progress, and Possibilities. Gastroenterology 2023; 164:707-718. [PMID: 36746210 PMCID: PMC10079619 DOI: 10.1053/j.gastro.2023.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 02/08/2023]
Abstract
Endoscopic surveillance of Barrett's esophagus, aiming to detect prevalent dysplasia and adenocarcinoma, followed by effective endoscopic treatment, is an integral part of the esophageal adenocarcinoma prevention paradigm. However, several limitations, such as the subtle appearance of dysplasia, sampling error (inherent in current surveillance protocols), and noncompliance with surveillance recommendations, lead to missed dysplasia and neoplasia, reducing the effectiveness of surveillance as currently practiced. Careful endoscopic assessment with high-resolution white-light endoscopy, dye-based or electronic chromoendoscopy, and comprehensive sampling of the BE mucosa, remains the cornerstone of endoscopic surveillance. Emerging innovations in this area span the gamut of more efficient sampling methods, advanced imaging tools, artificial intelligence, and molecular marker-powered approaches as adjuncts, to identify prevalent and predict incident dysplasia or adenocarcinoma. Development and implementation of validated quality indicators will allow additional advancement of this critical field. These approaches will hopefully enable efficient and effective cancer prevention and treatment.
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Affiliation(s)
- Prasad G Iyer
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
| | - Amitabh Chak
- Division of Gastroenterology and Hepatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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13
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Peleg N, Ollech JE, Shamah S, Sapoznikov B. Seattle Protocol Is More Effective in Detection of Dysplasia Compared to Technology-Assisted Targeted Biopsies in Patients with Barrett’s Esophagus. J Clin Med 2023; 12:jcm12072544. [PMID: 37048628 PMCID: PMC10095556 DOI: 10.3390/jcm12072544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Background and aims: With the development of narrow-band imaging (NBI) in the endoscopic evaluation of patients with Barrett’s esophagus (BE), the role of random biopsies according to the Seattle protocol (SP) has been questioned. We aim to compare the utility of advanced imaging to SP in patients with BE. Methods: A prospective cohort of patients with proven BE was retrospectively analyzed. All biopsies were reviewed by an expert GI pathologist. Advanced imaging was tandemly used with SP in each endoscopic procedure. Results: A total of 155 out of 340 patients (45.5%) with BE were diagnosed with dysplasia during a median follow-up of 4.7 years (IQR 3.4–6.1 years) and were part of the statistical analysis. A total of 82 patients had a diagnosis of dysplasia at presentation, whereas 84 patients developed dysplasia during follow up. A total of 67 out of 82 patients with dysplasia at presentation (81.7%), and 65 out of 84 patients that were diagnosed with dysplasia during follow-up (77.4%) were diagnosed using SP. In addition, whereas all the events of EAC were diagnosed using targeted biopsies, 57.1% of the events of HGD and 86.3% of LGD were diagnosed using SP. Conclusion: Our findings demonstrate the significance of SP in the detection of low- and high-grade dysplasia in patients with BE. SP should remain the mainstay of endoscopic surveillance in this population.
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Affiliation(s)
- Noam Peleg
- The Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: or
| | - Jacob E. Ollech
- The Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Steven Shamah
- The Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Boris Sapoznikov
- The Division of Gastroenterology, Rabin Medical Center, Petah-Tikva 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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14
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van der Laan JJH, van der Putten JA, Zhao X, Karrenbeld A, Peters FTM, Westerhof J, de With PHN, van der Sommen F, Nagengast WB. Optical Biopsy of Dysplasia in Barrett's Oesophagus Assisted by Artificial Intelligence. Cancers (Basel) 2023; 15:cancers15071950. [PMID: 37046611 PMCID: PMC10093622 DOI: 10.3390/cancers15071950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Optical biopsy in Barrett's oesophagus (BE) using endocytoscopy (EC) could optimize endoscopic screening. However, the identification of dysplasia is challenging due to the complex interpretation of the highly detailed images. Therefore, we assessed whether using artificial intelligence (AI) as second assessor could help gastroenterologists in interpreting endocytoscopic BE images. First, we prospectively videotaped 52 BE patients with EC. Then we trained and tested the AI pm distinct datasets drawn from 83,277 frames, developed an endocytoscopic BE classification system, and designed online training and testing modules. We invited two successive cohorts for these online modules: 10 endoscopists to validate the classification system and 12 gastroenterologists to evaluate AI as second assessor by providing six of them with the option to request AI assistance. Training the endoscopists in the classification system established an improved sensitivity of 90.0% (+32.67%, p < 0.001) and an accuracy of 77.67% (+13.0%, p = 0.020) compared with the baseline. However, these values deteriorated at follow-up (-16.67%, p < 0.001 and -8.0%, p = 0.009). Contrastingly, AI-assisted gastroenterologists maintained high sensitivity and accuracy at follow-up, subsequently outperforming the unassisted gastroenterologists (+20.0%, p = 0.025 and +12.22%, p = 0.05). Thus, best diagnostic scores for the identification of dysplasia emerged through human-machine collaboration between trained gastroenterologists with AI as the second assessor. Therefore, AI could support clinical implementation of optical biopsies through EC.
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Affiliation(s)
- Jouke J H van der Laan
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Joost A van der Putten
- Department of Electrical Engineering, Video Coding and Architectures, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Xiaojuan Zhao
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Arend Karrenbeld
- Department of Pathology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Frans T M Peters
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Jessie Westerhof
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Peter H N de With
- Department of Electrical Engineering, Video Coding and Architectures, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Fons van der Sommen
- Department of Electrical Engineering, Video Coding and Architectures, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Wouter B Nagengast
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
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15
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Duan QJ, Zhao ZY, Zhang YJ, Fu L, Yuan YY, Du JZ, Wang J. Activatable fluorescent probes for real-time imaging-guided tumor therapy. Adv Drug Deliv Rev 2023; 196:114793. [PMID: 36963569 DOI: 10.1016/j.addr.2023.114793] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 03/26/2023]
Abstract
Surgery and drug therapy are the two principal options for cancer treatment. However, their clinical benefits are hindered by the difficulty of accurate location of the tumors and timely monitoring of the treatment efficacy of drugs, respectively. Rapid development of imaging techniques provides promising tools to address these challenges. Compared with conventional imaging techniques such as magnetic resonance imaging and computed tomography etc., fluorescence imaging exhibits high spatial resolution, real-time imaging capability, and relatively low costs devices. The advancements in fluorescent probes further accelerate the implementation of fluorescence imaging in tumor diagnosis and treatment monitoring. In particular, the emergence of site-specifically activatable fluorescent probes fits the demands of tumor delineation and real-time feedback of the treatment efficacy. A variety of small molecule probes or nanoparticle-based probes have been developed and explored for the above-mentioned applications. This review will discuss recent advances in fluorescent probes with a special focus on activatable nanoprobes and highlight the potential implementation of activatable nanoprobes in fluorescence imaging-guided surgery as well as imaging-guided drug therapy.
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Affiliation(s)
- Qi-Jia Duan
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Zhong-Yi Zhao
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Yao-Jun Zhang
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, China
| | - Liangbing Fu
- School of Biomedical Sciences and Engineering, Guangzhou International Campus, South China University of Technology, Guangzhou 511442, China
| | - You-Yong Yuan
- School of Biomedical Sciences and Engineering, Guangzhou International Campus, South China University of Technology, Guangzhou 511442, China; Guangdong Provincial Key Laboratory of Biomedical Engineering, and Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China
| | - Jin-Zhi Du
- School of Medicine, South China University of Technology, Guangzhou 510006, China; Guangdong Provincial Key Laboratory of Biomedical Engineering, and Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China.
| | - Jun Wang
- School of Biomedical Sciences and Engineering, Guangzhou International Campus, South China University of Technology, Guangzhou 511442, China; National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China.
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16
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Abdelrahim M, Saiko M, Maeda N, Hossain E, Alkandari A, Subramaniam S, Parra-Blanco A, Sanchez-Yague A, Coron E, Repici A, Bhandari P. Development and validation of artificial neural networks model for detection of Barrett's neoplasia: a multicenter pragmatic nonrandomized trial (with video). Gastrointest Endosc 2023; 97:422-434. [PMID: 36283443 DOI: 10.1016/j.gie.2022.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/30/2022] [Accepted: 10/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to develop and externally validate a computer-aided detection (CAD) system for the detection and localization of Barrett's neoplasia and assess its performance compared with that of general endoscopists in a statistically powered multicenter study by using real-time video sequences. METHODS In phase 1, the hybrid visual geometry group 16-SegNet model was trained by the use of 75,198 images and videos (96 patients) of neoplastic and 1,014,973 images and videos (65 patients) of nonneoplastic Barrett's esophagus. In phase 2, image-based validation was performed on a separate dataset of 107 images (20 patients) of neoplastic and 364 images (14 patients) of nonneoplastic Barrett's esophagus. In phase 3 (video-based external validation) we designed a real-time video-based study with 32 videos (32 patients) of neoplastic and 43 videos (43 patients) of nonneoplastic Barrett's esophagus from 4 European centers to compare the performance of the CAD model with that of 6 nonexpert endoscopists. The primary endpoint was the sensitivity of CAD diagnosis of Barrett's neoplasia. RESULTS In phase 2, CAD detected Barrett's neoplasia with sensitivity, specificity, and accuracy of 95.3%, 94.5%, and 94.7%, respectively. In phase 3, the CAD system detected Barrett's neoplasia with sensitivity, specificity, negative predictive value, and accuracy of 93.8%, 90.7%, 95.1%, and 92.0%, respectively, compared with the endoscopists' performance of 63.5%, 77.9%, 74.2%, and 71.8%, respectively (P < .05 in all parameters). The CAD system localized neoplastic lesions with accuracy, mean precision, and mean intersection over union of 100%, 0.62, and 0.54, respectively, when compared with at least 1 of the expert markings. The processing speed of the CAD detection and localization were 5 ms/image and 33 ms/image, respectively. CONCLUSION To our knowledge, this is the first study describing external (multicenter) validation of AI algorithms for the detection of Barrett's neoplasia on real-time endoscopic videos. The CAD system in this study significantly outperformed nonexpert endoscopists on real-time video-based assessment, achieving >90% sensitivity for neoplasia detection. This result needs to be validated during real-time endoscopic assessment.
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Affiliation(s)
| | - Masahiro Saiko
- Biometrics Research Laboratories, NEC Corporation, Kawasaki, Japan
| | - Naoto Maeda
- Medical AI Research Department, NEC Corporation, Tokyo, Japan
| | - Ejaz Hossain
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | | | - Adolfo Parra-Blanco
- Nottingham Digestive Diseases Biomedical Research Centre, and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Emmanuel Coron
- Centre Hospitalier Universitaire and Faculté de Médecine de Nantes, Nantes, France
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17
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Papaefthymiou A, Basiliya K, Phillpotts S, Webster G. The clinical value of narrow-band imaging in biliary strictures. Gastrointest Endosc 2023; 97:604-605. [PMID: 36801023 DOI: 10.1016/j.gie.2022.10.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 02/23/2023]
Affiliation(s)
- Apostolis Papaefthymiou
- Pancreaticobiliary Medicine Unit, University College London Hospitals, London, United Kingdom
| | - Kirill Basiliya
- Pancreaticobiliary Medicine Unit, University College London Hospitals, London, United Kingdom
| | - Simon Phillpotts
- Pancreaticobiliary Medicine Unit, University College London Hospitals, London, United Kingdom
| | - George Webster
- Pancreaticobiliary Medicine Unit, University College London Hospitals, London, United Kingdom
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18
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Usefulness of Endoscopy for the Detection and Diagnosis of Primary Esophageal Motility Disorders and Diseases Relating to Abnormal Esophageal Motility. Diagnostics (Basel) 2023; 13:diagnostics13040695. [PMID: 36832183 PMCID: PMC9955791 DOI: 10.3390/diagnostics13040695] [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: 11/14/2022] [Revised: 01/09/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
Esophagogastroduodenoscopy (EGD) is performed to rule out organic diseases in the diagnosis of esophageal motility disorders (EMDs). Abnormal endoscopic findings can be observed during EGD, which indicate the presence of EMDs. Several endoscopic findings at both the esophagogastric junction and esophageal body that are related to EMDs have been reported. Gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) could be detected during EGD, and these diseases are often associated with abnormal esophageal motility. Image-enhanced endoscopy (IEE) could improve the detection of these diseases during EGD. Although no report has been published previously on the potential usefulness of IEE in the endoscopic diagnosis of EMDs, IEE can be used to detect disorders that can be associated with abnormal esophageal motility.
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Beveridge CA, Mittal C, Muthusamy VR, Rastogi A, Kushnir V, Wood M, Wani S, Komanduri S. Identification of visible lesions during surveillance endoscopy for Barrett's esophagus: a video-based survey study. Gastrointest Endosc 2023; 97:241-247.e2. [PMID: 36007583 DOI: 10.1016/j.gie.2022.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/17/2022] [Accepted: 08/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Visible lesion (VL) detection is essential in patients with Barrett's esophagus (BE). We sought to assess the rate of VL detection by academic and community endoscopists using high-definition white-light endoscopy (HD-WLE) and narrow-band imaging (NBI) during surveillance endoscopy. METHODS Fifty endoscopists were invited to participate in a prospective video survey study. Participants viewed 25 standardized clips of patients referred for endoscopic therapy. Participants noted identification of anatomic landmarks and VLs using HD-WLE and NBI and reported practice-level data. The criterion standard of VL identification was established by consensus of 5 BE experts. Our primary outcome was the rate of VL identification using HD-WLE and NBI. RESULTS Forty-four of 50 participants completed the study (22 academic and 22 community). Compared with the criterion standard, participants did not identify 28% (HD-WLE) and 31% (NBI) of VLs. Community endoscopists had more experience (>5 years in practice: community 85% vs academic 54.5%, P = .041; >5 surveillance endoscopies a month: community 85% vs academic 31.8%, P = .046). Across all participants, VL detection using NBI improved significantly with a minimum of 5 surveillance endoscopies per month (area under the curve = .72; 95% confidence interval, .56-.85; P = .006). CONCLUSIONS Despite improved endoscope resolution and availability of virtual chromoendoscopy, the overall rate of VL detection remains low. Identification of VLs using NBI may be volume dependent. Further education and training efforts focused on VL detection during BE surveillance endoscopy are needed.
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Affiliation(s)
- Claire A Beveridge
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Chetan Mittal
- Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Parkview Health System, Fort Wayne, Indiana, USA
| | - V Raman Muthusamy
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Amit Rastogi
- Department of Medicine, Division of Gastroenterology, University of Kansas Medical Center, Kansas University School of Medicine, Kansas City, Kansas, USA
| | - Vladimir Kushnir
- Department of Medicine, Division of Gastroenterology, Washington University, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Mariah Wood
- Department of Medicine, Division of Gastroenterology, Northwestern Medical Center, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sachin Wani
- Department of Medicine, Division of Gastroenterology, University of Colorado Anschutz Medical Campus, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Srinadh Komanduri
- Department of Medicine, Division of Gastroenterology, Northwestern Medical Center, Feinberg School of Medicine, Chicago, Illinois, USA
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20
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Han W, Kong R, Wang N, Bao W, Mao X, Lu J. Confocal Laser Endomicroscopy for Detection of Early Upper Gastrointestinal Cancer. Cancers (Basel) 2023; 15:cancers15030776. [PMID: 36765734 PMCID: PMC9913498 DOI: 10.3390/cancers15030776] [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: 11/13/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
Esophageal and gastric cancers are common diseases with high morbidity and mortality; thus, early detection and treatment are beneficial to improve prognosis. Confocal laser endomicroscopy (CLE) is a novel imaging technique that permits the histological analysis of tissues during endoscopy. CLE has been shown to uniquely affect the diagnosis of early upper gastrointestinal cancers. Relevant literature was searched using PubMed and Google Scholar databases. Despite inherent flaws, CLE can reduce tissue damage and improve diagnostic accuracy to a certain extent. CLE in combination with other imaging methods can help enhance the detection rate and avoid unnecessary biopsies in the management of esophageal or gastric cancer and precancerous lesions. CLE is of great significance in the diagnosis and surveillance of early cancers of the upper gastrointestinal tract. Further technical innovations and the standardisation of CLE will make it more responsive to the needs of routine clinical applications.
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Affiliation(s)
- Wei Han
- Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Rui Kong
- Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Nan Wang
- Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Wen Bao
- Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xinli Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Zhejiang 317099, China
- Correspondence: (X.M.); (J.L.)
| | - Jie Lu
- Department of Gastroenterology, Gongli Hospital of Shanghai Pudong New Area, Shanghai 200135, China
- Correspondence: (X.M.); (J.L.)
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21
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Meinikheim M, Messmann H, Ebigbo A. Role of artificial intelligence in diagnosing Barrett's esophagus-related neoplasia. Clin Endosc 2023; 56:14-22. [PMID: 36646423 PMCID: PMC9902686 DOI: 10.5946/ce.2022.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/25/2022] [Indexed: 01/18/2023] Open
Abstract
Barrett's esophagus is associated with an increased risk of adenocarcinoma. Thorough screening during endoscopic surveillance is crucial to improve patient prognosis. Detecting and characterizing dysplastic or neoplastic Barrett's esophagus during routine endoscopy are challenging, even for expert endoscopists. Artificial intelligence-based clinical decision support systems have been developed to provide additional assistance to physicians performing diagnostic and therapeutic gastrointestinal endoscopy. In this article, we review the current role of artificial intelligence in the management of Barrett's esophagus and elaborate on potential artificial intelligence in the future.
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Affiliation(s)
- Michael Meinikheim
- Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany,Correspondence: Michael Meinikheim Department of Gastroenterology, University Hospital of Augsburg, Stenglinstr. 2, D-86156 Augsburg, Germany E-mail:
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
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22
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Ikenoyama Y, Tanaka K, Umeda Y, Hamada Y, Yukimoto H, Yamada R, Tsuboi J, Nakamura M, Katsurahara M, Horiki N, Nakagawa H. Effect of adding acetic acid when performing magnifying endoscopy with narrow band imaging for diagnosis of Barrett's esophageal adenocarcinoma. Endosc Int Open 2022; 10:E1528-E1536. [PMID: 36531673 PMCID: PMC9754883 DOI: 10.1055/a-1948-2910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022] Open
Abstract
Background and study aims Magnifying endoscopy with narrow band imaging (M-NBI) was developed to diagnose Barrett's esophageal adenocarcinoma (BEA); however, this method remains challenging for inexperienced endoscopists. We aimed to evaluate a modified M-NBI technique that included spraying acetic acid (M-AANBI). Patients and methods Eight endoscopists retrospectively examined 456 endoscopic images obtained from 28 patients with 29 endoscopically resected BEA lesions using three validation schemes: Validation 1 (260 images), wherein the diagnostic performances of M-NBI and M-AANBI were compared - the dataset included 65 images each of BEA and non-neoplastic Barrett's esophagus (NNBE) obtained using each modality; validation 2 (112 images), wherein 56 pairs of M-NBI and M-AANBI images were prepared from the same BEA and NNBE lesions, and diagnoses derived using M-NBI alone were compared to those obtained using both M-NBI and M-AANBI; and validation 3 (84 images), wherein the ease of identifying the BEA demarcation line (DL) was scored via a visual analog scale in 28 patients using magnifying endoscopy with white-light imaging (M-WLI), M-NBI, and M-AANBI. Results For validation 1, M-AANBI was superior to M-NBI in terms of sensitivity (90.8 % vs. 64.6 %), specificity (98.5 % vs. 76.9 %), and accuracy (94.6 % vs. 70.4 %) (all P < 0.05). For validation 2, the accuracy of M-NBI alone was significantly improved when combined with M-AANBI (from 70.5 % to 89.3 %; P < 0.05). For validation 3, M-AANBI had the highest mean score for ease of DL recognition (8.75) compared to M-WLI (3.63) and M-NBI (6.25) (all P < 0.001). Conclusions Using M-AANBI might improve the accuracy of BEA diagnosis.
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Affiliation(s)
- Yohei Ikenoyama
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan,Department of Endoscopy, Mie University Hospital, Tsu, Japan
| | - Kyosuke Tanaka
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan,Department of Endoscopy, Mie University Hospital, Tsu, Japan
| | - Yuhei Umeda
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan,Department of Endoscopy, Mie University Hospital, Tsu, Japan
| | - Yasuhiko Hamada
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroki Yukimoto
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Reiko Yamada
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Junya Tsuboi
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Misaki Nakamura
- Department of Endoscopy, Mie University Hospital, Tsu, Japan
| | | | - Noriyuki Horiki
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology and hepatology, Mie University Graduate School of Medicine, Tsu, Japan,Department of Endoscopy, Mie University Hospital, Tsu, Japan
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23
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Third-Generation High-Vision Ultrathin Endoscopy Using Texture and Color Enhancement Imaging and Narrow-Band Imaging to Evaluate Barrett's Esophagus. Diagnostics (Basel) 2022; 12:diagnostics12123149. [PMID: 36553156 PMCID: PMC9777380 DOI: 10.3390/diagnostics12123149] [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: 11/17/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
It remains unclear whether texture- and color-enhancement imaging (TXI) and narrow-band imaging (NBI) provide an advantage over white-light imaging (WLI) in Barrett’s esophagus. We compared endoscopic findings and color differences between WLI and image-enhanced endoscopy (IEE) using a third-generation ultrathin endoscope. We retrospectively enrolled 40 patients who evaluated Barrett’s esophagus using WLI, TXI, and NBI. Color differences determined using the International Commission on Illumination 1976 (L∗, a∗, b∗) color space among Barrett’s epithelium, esophageal, and gastric mucosa were compared among the endoscopic findings. As the secondary outcome, we assessed the subjective visibility score among three kinds of endoscopic findings. The prevalence of Barrett’s esophagus and gastroesophageal reflux disease (GERD) in WLI was 82.5% and 47.5%, respectively, and similar among WLI, TXI, and NBI. Color differences between Barrett’s epithelium and esophageal or gastric mucosa on NBI were significantly greater than on WLI (all p < 0.05). However, the color difference between Barrett’s epithelium and esophageal mucosa was significantly greater on NBI than TXI (p < 0.001), and the visibility score of Barrett’s epithelium detection was significantly greater on TXI than NBI (p = 0.022), and WLI (p = 0.016). High-vision, third-generation ultrathin endoscopy using NBI and TXI is useful for evaluating Barrett’s epithelium and GERD compared with WLI alone.
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24
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Wadhwa V, Patel N, Grover D, Ali FS, Thosani N. Interventional gastroenterology in oncology. CA Cancer J Clin 2022; 73:286-319. [PMID: 36495087 DOI: 10.3322/caac.21766] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 12/14/2022] Open
Abstract
Cancer is one of the foremost health problems worldwide and is among the leading causes of death in the United States. Gastrointestinal tract cancers account for almost one third of the cancer-related mortality globally, making it one of the deadliest groups of cancers. Early diagnosis and prompt management are key to preventing cancer-related morbidity and mortality. With advancements in technology and endoscopic techniques, endoscopy has become the core in diagnosis and management of gastrointestinal tract cancers. In this extensive review, the authors discuss the role endoscopy plays in early detection, diagnosis, and management of esophageal, gastric, colorectal, pancreatic, ampullary, biliary tract, and small intestinal cancers.
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Affiliation(s)
- Vaibhav Wadhwa
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Nicole Patel
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Dheera Grover
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Faisal S Ali
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Nirav Thosani
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
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25
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Sugimoto M, Koyama Y, Itoi T, Kawai T. Using texture and colour enhancement imaging to evaluate gastrointestinal diseases in clinical practice: a review. Ann Med 2022; 54:3315-3332. [PMID: 36420822 PMCID: PMC9704096 DOI: 10.1080/07853890.2022.2147992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
White light imaging (WLI) is the most common endoscopic technique used for screening of gastrointestinal diseases. However, despite the advent of a new processor that offers sufficient clear illumination and other advanced developments in endoscopic instrumentation, WLI alone is inadequate for detecting all gastrointestinal diseases with abnormalities in mucosal discoloration and morphological changes to the mucosal surface. The recent development of image-enhanced endoscopy (IEE) has dramatically improved the detection of gastrointestinal diseases. Texture and colour enhancement imaging (TXI) is a new type of IEE that enhances brightness, surface irregularities, such as elevations or depressions, and subtle colour changes. TXI with two modes, namely modes 1 and 2, can selectively enhance brightness in dark areas of an endoscopic image and subtle tissue differences such as slight morphological or colour changes while simultaneously preventing over-enhancement. Several clinical studies have investigated the efficacy of TXI for detecting and visualizing gastrointestinal diseases, including oesophageal squamous cell carcinoma (ESCC), Barret's epithelium, gastric cancer, gastric mucosal atrophy and intestinal metaplasia. Although TXI is often more useful for detecting and visualizing gastrointestinal diseases than WLI, it remains unclear whether TXI outperforms other IEEs, such as narrow-band imaging (NBI), in similar functions, and whether the performance of TXI modes 1 and 2 are comparable. Therefore, large-scale prospective studies are needed to compare the efficacy of TXI to WLI and other IEEs for endoscopic evaluation of patients undergoing screening endoscopy. Here, we review the characteristics and efficacy of TXI for the detection and visualization of gastrointestinal diseases.Key MessagesTXI mode 1 can improve the visibility of gastrointestinal diseases and qualitative diagnosis, especially for diseases associated with colour changes.The enhancement of texture and brightness with TXI mode 2 enables the detection of diseases, and is ideal for use in the first screening of gastrointestinal tract.
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Affiliation(s)
- Mitsushige Sugimoto
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yohei Koyama
- Department of Gastroenterology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
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26
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Kusano C, Singh R, Lee YY, Soh YSA, Sharma P, Ho KY, Gotoda T. Global variations in diagnostic guidelines for Barrett's esophagus. Dig Endosc 2022; 34:1320-1328. [PMID: 35475586 DOI: 10.1111/den.14342] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/25/2022] [Indexed: 02/08/2023]
Abstract
Endoscopic diagnosis of gastroesophageal junction and Barrett's esophagus is essential for surveillance and early detection of esophageal adenocarcinoma and esophagogastric junction cancer. Despite its small size, the gastroesophageal junction has many inherent problems, including marked differences in diagnostic methods for Barrett's esophagus in international guidelines. To define Barrett's esophagus, gastroesophageal junction location should be clarified. Although gastric folds and palisade vessels are landmarks for identifying this junction, they are sometimes difficult to observe due to air entry or reflux esophagitis. The possibility of diagnosing a malignancy associated with Barrett's esophagus <1 cm, identified using palisade vessels, should be re-examined. Nontargeted biopsies of Barrett's esophagus are commonly used to detect intestinal metaplasia, dysplasia, and cancer as described in the Seattle protocol. Barrett's esophagus with intestinal metaplasia has a high risk of becoming cancerous. Furthermore, the frequency of cancer in patients with Barrett's esophagus without intestinal metaplasia is high, and the guidelines differ on whether to include the presence of intestinal metaplasia in the diagnosis of Barrett's esophagus. Use of advanced imaging technologies, including narrow-band imaging with magnifying endoscopy and linked color imaging, is reportedly valid for diagnosing Barrett's esophagus. Furthermore, artificial intelligence has facilitated the diagnosis of Barrett's esophagus through its deep learning and image recognition capabilities. However, it is necessary to first use the endoscopic definition of the gastroesophageal junction, which is common in all countries, and then elucidate the characteristics of Barrett's esophagus in each region, for example, length differences in the risk of carcinogenesis with and without intestinal metaplasia.
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Affiliation(s)
- Chika Kusano
- Division of Gastroenterology and Hepatology, Department of Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Rajvinder Singh
- Department of Gastroenterology, The Lyell McEwin Hospital, Adelaide, Australia.,The University of Adelaide, Adelaide, Australia
| | - Yeong Yeh Lee
- GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia.,School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Yu Sen Alex Soh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Prateek Sharma
- Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, USA.,Gastroenterology, School of Medicine, University of Kansas, Kansas City, USA
| | - Khek-Yu Ho
- Department of Medicine, National University Hospital, Singapore
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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27
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Dobashi A, Li DK, Mavrogenis G, Visrodia KH, Bazerbachi F. Endoscopic Management of Esophageal Cancer. Thorac Surg Clin 2022; 32:479-495. [DOI: 10.1016/j.thorsurg.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Abstract
IMPORTANCE Barrett esophagus is characterized by the replacement of normal esophageal squamous cell epithelium with columnar metaplasia and affects approximately 5% of people in the US and approximately 1% worldwide. Approximately 3% to 5% of patients with Barrett esophagus will be diagnosed with esophageal adenocarcinoma in their lifetime. OBSERVATIONS Barrett esophagus affects approximately 2.3% to 8.3% of people with gastroesophageal reflux disease (GERD) and approximately 1.2% to 5.6% of people without GERD. Characteristics associated with Barrett esophagus include older age (prevalence of approximately 1.1% in individuals older than 50 years compared with 0.3% in those 50 years or younger), male sex, and smoking (prevalence of approximately 12% in people who smoke cigarettes compared with 1.1% in those who do not smoke cigarettes). The histopathology of Barrett esophagus progresses from metaplasia to dysplasia and, without treatment, can progress to adenocarcinoma. People with Barrett esophagus have approximately a 0.2% to 0.5% annual rate of developing esophageal adenocarcinoma. Management of Barrett esophagus primarily consists of acid-suppressive medications to reduce underlying GERD symptoms and surveillance endoscopy every 3 to 5 years. In patients with Barrett esophagus and dysplasia or early cancer, endoscopic therapy consisting of resection and ablation successfully treats 80% to 90% of patients. CONCLUSIONS AND RELEVANCE Barrett esophagus affects approximately 5% of people in the US and approximately 1% worldwide and is associated with an increased risk of esophageal adenocarcinoma. First-line therapy for Barrett esophagus consists of proton-pump inhibitors for control of reflux symptoms, but their role in chemoprevention is unclear. Surveillance with upper endoscopy is recommended by practice guidelines to monitor for progression to esophageal adenocarcinoma, but randomized clinical trials are lacking.
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Affiliation(s)
- Prateek Sharma
- University of Kansas School of Medicine, VA Medical Center, Kansas City, Kansas
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29
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Lerner DG, Mencin A, Novak I, Huang C, Ng K, Lirio RA, Khlevner J, Utterson EC, Harris BR, Pitman RT, Mir S, Gugig R, Walsh CM, Fishman D. Advances in Pediatric Diagnostic Endoscopy: A State-of-the-Art Review. JPGN REPORTS 2022; 3:e224. [PMID: 37168622 PMCID: PMC10158303 DOI: 10.1097/pg9.0000000000000224] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/20/2022] [Indexed: 05/13/2023]
Abstract
Pediatric endoscopy has revolutionized the way we diagnose and treat gastrointestinal disorders in children. Technological advances in computer processing and imaging continue to affect endoscopic equipment and advance diagnostic tools for pediatric endoscopy. Although commonly used by adult gastroenterologists, modalities, such as endomicroscopy, image-enhanced endoscopy, and impedance planimetry, are not routinely used in pediatric gastroenterology. This state-of-the-art review describes advances in diagnostic modalities, including image-enhanced endoscopy, confocal laser endomicroscopy, optical coherence tomography, endo functional luminal imaging probes, wireless motility/pH capsule, wireless colon capsule endoscopy, endoscopic ultrasound, and discusses the basic principles of each technology, including adult indications and pediatric applications, safety cost, and training data.
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Affiliation(s)
- Diana G. Lerner
- From the Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Ali Mencin
- Division of Pediatric Gastroenterology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Inna Novak
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital at Montefiore, Bronx, NY
| | - Clifton Huang
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cook Children’s Medical Center, Fort Worth, TX
| | - Kenneth Ng
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Richard A. Lirio
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, UMASS Memorial Children’s Medical Center/UMASS Medical School, Worcester, MA
| | - Julie Khlevner
- Division of Pediatric Gastroenterology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Elizabeth C. Utterson
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | - Brendan R. Harris
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | - Ryan T. Pitman
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | - Sabina Mir
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, UNC School of Medicine, Chapel Hill, NC
| | - Roberto Gugig
- Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA
| | - Catharine M. Walsh
- Department of Paediatrics and the Wilson Centre, Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Doug Fishman
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, TX
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30
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Rodríguez de Santiago E, Dinis-Ribeiro M, Pohl H, Agrawal D, Arvanitakis M, Baddeley R, Bak E, Bhandari P, Bretthauer M, Burga P, Donnelly L, Eickhoff A, Hayee B, Kaminski MF, Karlović K, Lorenzo-Zúñiga V, Pellisé M, Pioche M, Siau K, Siersema PD, Stableforth W, Tham TC, Triantafyllou K, Tringali A, Veitch A, Voiosu AM, Webster GJ, Vienne A, Beilenhoff U, Bisschops R, Hassan C, Gralnek IM, Messmann H. Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2022; 54:797-826. [PMID: 35803275 DOI: 10.1055/a-1859-3726] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Climate change and the destruction of ecosystems by human activities are among the greatest challenges of the 21st century and require urgent action. Health care activities significantly contribute to the emission of greenhouse gases and waste production, with gastrointestinal (GI) endoscopy being one of the largest contributors. This Position Statement aims to raise awareness of the ecological footprint of GI endoscopy and provides guidance to reduce its environmental impact. The European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) outline suggestions and recommendations for health care providers, patients, governments, and industry. MAIN STATEMENTS 1: GI endoscopy is a resource-intensive activity with a significant yet poorly assessed environmental impact. 2: ESGE-ESGENA recommend adopting immediate actions to reduce the environmental impact of GI endoscopy. 3: ESGE-ESGENA recommend adherence to guidelines and implementation of audit strategies on the appropriateness of GI endoscopy to avoid the environmental impact of unnecessary procedures. 4: ESGE-ESGENA recommend the embedding of reduce, reuse, and recycle programs in the GI endoscopy unit. 5: ESGE-ESGENA suggest that there is an urgent need to reassess and reduce the environmental and economic impact of single-use GI endoscopic devices. 6: ESGE-ESGENA suggest against routine use of single-use GI endoscopes. However, their use could be considered in highly selected patients on a case-by-case basis. 7: ESGE-ESGENA recommend inclusion of sustainability in the training curricula of GI endoscopy and as a quality domain. 8: ESGE-ESGENA recommend conducting high quality research to quantify and minimize the environmental impact of GI endoscopy. 9: ESGE-ESGENA recommend that GI endoscopy companies assess, disclose, and audit the environmental impact of their value chain. 10: ESGE-ESGENA recommend that GI endoscopy should become a net-zero greenhouse gas emissions practice by 2050.
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Affiliation(s)
- Enrique Rodríguez de Santiago
- Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Mario Dinis-Ribeiro
- Porto Comprehensive Cancer Center (Porto.CCC), and RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Heiko Pohl
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, and Section of Gastroenterology and Hepatology, VA White River Junction, Vermont, USA
| | - Deepak Agrawal
- Division of Gastroenterology and Hepatology, Dell Medical School, University of Texas Austin, Texas, USA
| | - Marianna Arvanitakis
- Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Robin Baddeley
- King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital, and Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | - Elzbieta Bak
- Department of Gastroenterology and Internal Medicine, Clinical Hospital of Medical University of Warsaw, Warsaw, Poland
| | | | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo, and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Patricia Burga
- Endoscopy Department, University Hospital of Padua, Italy
| | - Leigh Donnelly
- Endoscopy Department, Northumbria Healthcare NHS Trust, Northumberland, United Kingdom
| | - Axel Eickhoff
- Klinik für Gastroenterologie, Diabetologie, Infektiologie, Klinikum Hanau, Hanau, Germany
| | - Bu'Hussain Hayee
- Department of Gastroenterology, University College London Hospitals, London, United Kingdom
| | - Michal F Kaminski
- Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Katarina Karlović
- Clinical Hospital Center Rijeka , Department of Gastroenterology, Endoscopy Unit, Rijeka, Croatia
| | - Vicente Lorenzo-Zúñiga
- Department of Gastroenterology, University and Polytechnic La Fe Hospital/IIS La Fe, Valencia, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Mathieu Pioche
- Endoscopy Unit, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Keith Siau
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, United Kingdom
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - William Stableforth
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, United Kingdom
| | - Tony C Tham
- Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Alberto Tringali
- Digestive Endoscopy Unit, ULSS 2 Marca Trevigiana, Conegliano Hospital, Conegliano, Italy
| | - Andrew Veitch
- Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Andrei M Voiosu
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, Bucharest, Romania
| | - George J Webster
- Department of Gastroenterology, University College London Hospitals, London, United Kingdom
| | | | | | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Catholic University of Leuven (KUL), TARGID, University Hospitals Leuven, Leuven, Belgium
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, and Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, and Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Helmut Messmann
- III Medizinische Klinik Universitätsklinikum Augsburg, Augsburg, Germany
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Sugano K, Spechler SJ, El-Omar EM, McColl KEL, Takubo K, Gotoda T, Fujishiro M, Iijima K, Inoue H, Kawai T, Kinoshita Y, Miwa H, Mukaisho KI, Murakami K, Seto Y, Tajiri H, Bhatia S, Choi MG, Fitzgerald RC, Fock KM, Goh KL, Ho KY, Mahachai V, O'Donovan M, Odze R, Peek R, Rugge M, Sharma P, Sollano JD, Vieth M, Wu J, Wu MS, Zou D, Kaminishi M, Malfertheiner P. Kyoto international consensus report on anatomy, pathophysiology and clinical significance of the gastro-oesophageal junction. Gut 2022; 71:1488-1514. [PMID: 35725291 PMCID: PMC9279854 DOI: 10.1136/gutjnl-2022-327281] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/03/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE An international meeting was organised to develop consensus on (1) the landmarks to define the gastro-oesophageal junction (GOJ), (2) the occurrence and pathophysiological significance of the cardiac gland, (3) the definition of the gastro-oesophageal junctional zone (GOJZ) and (4) the causes of inflammation, metaplasia and neoplasia occurring in the GOJZ. DESIGN Clinical questions relevant to the afore-mentioned major issues were drafted for which expert panels formulated relevant statements and textural explanations.A Delphi method using an anonymous system was employed to develop the consensus, the level of which was predefined as ≥80% of agreement. Two rounds of voting and amendments were completed before the meeting at which clinical questions and consensus were finalised. RESULTS Twenty eight clinical questions and statements were finalised after extensive amendments. Critical consensus was achieved: (1) definition for the GOJ, (2) definition of the GOJZ spanning 1 cm proximal and distal to the GOJ as defined by the end of palisade vessels was accepted based on the anatomical distribution of cardiac type gland, (3) chemical and bacterial (Helicobacter pylori) factors as the primary causes of inflammation, metaplasia and neoplasia occurring in the GOJZ, (4) a new definition of Barrett's oesophagus (BO). CONCLUSIONS This international consensus on the new definitions of BO, GOJ and the GOJZ will be instrumental in future studies aiming to resolve many issues on this important anatomic area and hopefully will lead to better classification and management of the diseases surrounding the GOJ.
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Affiliation(s)
- Kentaro Sugano
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Stuart Jon Spechler
- Division of Gastroenterology, Center for Esophageal Diseases, Baylor University Medical Center, Dallas, Texas, USA
| | - Emad M El-Omar
- Microbiome Research Centre, St George & Sutherland Clinical Campuses, School of Clinical Medicine, Faculty of Medicine & Health, Sydney, New South Wales, Australia
| | - Kenneth E L McColl
- Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kaiyo Takubo
- Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| | - Haruhiro Inoue
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | | | - Hiroto Miwa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Kobe, Japan
| | - Ken-ichi Mukaisho
- Education Center for Medicine and Nursing, Shiga University of Medical Science, Otsu, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Oita University Faculty of Medicine, Yuhu, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hisao Tajiri
- Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | | | - Myung-Gyu Choi
- Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, The Republic of Korea
| | - Rebecca C Fitzgerald
- Medical Research Council Cancer Unit, Hutchison/Medical Research Council Research Centre, University of Cambridge, Cambridge, UK
| | - Kwong Ming Fock
- Department of Gastroenterology and Hepatology, Duke NUS School of Medicine, National University of Singapore, Singapore
| | | | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore
| | - Varocha Mahachai
- Center of Excellence in Digestive Diseases, Thammasat University and Science Resarch and Innovation, Bangkok, Thailand
| | - Maria O'Donovan
- Department of Histopathology, Cambridge University Hospital NHS Trust UK, Cambridge, UK
| | - Robert Odze
- Department of Pathology, Tuft University School of Medicine, Boston, Massachusetts, USA
| | - Richard Peek
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Massimo Rugge
- Department of Medicine DIMED, Surgical Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Jose D Sollano
- Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Friedrich-Alexander University Erlangen, Nurenberg, Germany
| | - Justin Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Duowu Zou
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Peter Malfertheiner
- Medizinixhe Klinik und Poliklinik II, Ludwig Maximillian University Klinikum, Munich, Germany,Klinik und Poliklinik für Radiologie, Ludwig Maximillian University Klinikum, Munich, Germany
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32
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The Use of Confocal Laser Endomicroscopy in Diagnosing Barrett’s Esophagus and Esophageal Adenocarcinoma. Diagnostics (Basel) 2022; 12:diagnostics12071616. [PMID: 35885521 PMCID: PMC9317308 DOI: 10.3390/diagnostics12071616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
Confocal laser endomicroscopy (CLE) is a diagnostic technique that enables real-time microscopic imaging during microscopic examination and evaluation of epithelial structures with 1000-fold magnification. CLE can be used in the diagnosis of various pathologies, in pneumology, and in urology, and it is very widely utilized in gastroenterology, most importantly in the diagnosis of Barrett’s esophagus (BE), esophageal adenocarcinoma (EAC), biliary strictures, and cystic pancreatic lesions. A literature search was made in MEDLINE/PubMed and Google Scholar databases while focusing on diagnostics using CLE of BE and EAC. We then examined randomized and observational studies, systematic reviews, and meta-analyses relating to the utilization of CLE in BE and EAC diagnostics. Here, we discuss whether CLE can be a suitable diagnostic method for surveillance of BE. Even though many studies have proven that CLE increases diagnostic accuracy in detecting neoplastic transformation of BE, CLE is still not used as a standard diagnostic tool in BE surveillance due to a deficiency of scientific evidence. More studies and data are needed if CLE is to find a place as a new technique in BE surveillance.
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Maione F, Chini A, Maione R, Manigrasso M, Marello A, Cassese G, Gennarelli N, Milone M, De Palma GD. Endoscopic Diagnosis and Management of Barrett's Esophagus with Low-Grade Dysplasia. Diagnostics (Basel) 2022; 12:diagnostics12051295. [PMID: 35626450 PMCID: PMC9141542 DOI: 10.3390/diagnostics12051295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 02/05/2023] Open
Abstract
Barrett’s Esophagus is a common condition associated with chronic gastroesophageal reflux disease. It is well known that it has an association with a higher incidence of esophageal adenocarcinoma, but this neoplastic transformation is first preceded by the onset of low and high-grade dysplasia. The evaluation of low grade dysplastic esophageal mucosa is still controversial; although endoscopic surveillance is preferred, several minimally invasive endoscopic therapeutic approaches are available. Endoscopic mucosal resection and radiofrequency ablation are the most used endoscopic treatments for the eradication of low-grade dysplasia, respectively, for nodular and flat dysplasia. Novel endoscopic treatments are cryotherapy ablation and argon plasma coagulation, that have good rates of eradication with less complications and post-procedural pain.
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Affiliation(s)
- Francesco Maione
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.C.); (A.M.); (G.C.); (N.G.); (M.M.); (G.D.D.P.)
- Correspondence: (F.M.); (R.M.)
| | - Alessia Chini
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.C.); (A.M.); (G.C.); (N.G.); (M.M.); (G.D.D.P.)
| | - Rosa Maione
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.C.); (A.M.); (G.C.); (N.G.); (M.M.); (G.D.D.P.)
- Correspondence: (F.M.); (R.M.)
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Alessandra Marello
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.C.); (A.M.); (G.C.); (N.G.); (M.M.); (G.D.D.P.)
| | - Gianluca Cassese
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.C.); (A.M.); (G.C.); (N.G.); (M.M.); (G.D.D.P.)
| | - Nicola Gennarelli
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.C.); (A.M.); (G.C.); (N.G.); (M.M.); (G.D.D.P.)
| | - Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.C.); (A.M.); (G.C.); (N.G.); (M.M.); (G.D.D.P.)
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.C.); (A.M.); (G.C.); (N.G.); (M.M.); (G.D.D.P.)
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Martínez-Domínguez SJ, Lanas Á, Domper-Arnal MJ. Esófago de Barrett, hacia la mejora de la práctica clínica. Med Clin (Barc) 2022; 159:92-100. [DOI: 10.1016/j.medcli.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 02/07/2023]
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Kuribayashi S, Hosaka H, Nakamura F, Nakata K, Sato K, Itoi Y, Hashimoto Y, Kasuga K, Tanaka H, Uraoka T. The role of endoscopy in the management of gastroesophageal reflux disease. DEN OPEN 2022; 2:e86. [PMID: 35310713 PMCID: PMC8828240 DOI: 10.1002/deo2.86] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/14/2021] [Accepted: 11/27/2021] [Indexed: 11/05/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a common disease that may cause a huge economic burden. Endoscopy is performed not only to rule out other organic diseases but also to diagnose reflux esophagitis or Barrett's esophagus. Non‐erosive GERD (non‐erosive reflux disease [NERD]) is called endoscopy‐negative GERD; however, GERD‐related findings could be obtained through histological assessment, image‐enhanced endoscopy, and new endoscopic modalities in patients with NERD. Moreover, endoscopy is useful to stratify the risk for the development of GERD. In addition, endoscopic treatments have been developed. These techniques could significantly improve patients’ quality of life as well as symptoms.
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Affiliation(s)
- Shiko Kuribayashi
- Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Gunma Japan
| | - Hiroko Hosaka
- Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Gunma Japan
| | - Fumihiko Nakamura
- Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Gunma Japan
| | - Ko Nakata
- Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Gunma Japan
| | - Keigo Sato
- Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Gunma Japan
| | - Yuki Itoi
- Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Gunma Japan
| | - Yu Hashimoto
- Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Gunma Japan
| | - Kengo Kasuga
- Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Gunma Japan
| | - Hirohito Tanaka
- Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Gunma Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Gunma Japan
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36
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Abe S, Tomizawa Y, Saito Y. Can artificial intelligence be your angel to diagnose early gastric cancer in real clinical practice? Gastrointest Endosc 2022; 95:679-681. [PMID: 35177258 DOI: 10.1016/j.gie.2021.12.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 12/31/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Tomizawa
- Division of Gastroenterology, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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37
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Diagnosis and Management of Barrett's Esophagus: An Updated ACG Guideline. Am J Gastroenterol 2022; 117:559-587. [PMID: 35354777 DOI: 10.14309/ajg.0000000000001680] [Citation(s) in RCA: 140] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 02/04/2022] [Indexed: 02/07/2023]
Abstract
Barrett's esophagus (BE) is a common condition associated with chronic gastroesophageal reflux disease. BE is the only known precursor to esophageal adenocarcinoma, a highly lethal cancer with an increasing incidence over the last 5 decades. These revised guidelines implement Grading of Recommendations, Assessment, Development, and Evaluation methodology to propose recommendations for the definition and diagnosis of BE, screening for BE and esophageal adenocarcinoma, surveillance of patients with known BE, and the medical and endoscopic treatment of BE and its associated early neoplasia. Important changes since the previous iteration of this guideline include a broadening of acceptable screening modalities for BE to include nonendoscopic methods, liberalized intervals for surveillance of short-segment BE, and volume criteria for endoscopic therapy centers for BE. We recommend endoscopic eradication therapy for patients with BE and high-grade dysplasia and those with BE and low-grade dysplasia. We propose structured surveillance intervals for patients with dysplastic BE after successful ablation based on the baseline degree of dysplasia. We could not make recommendations regarding chemoprevention or use of biomarkers in routine practice due to insufficient data.
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38
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Ishimura N, Okimoto E, Shibagaki K, Ishihara S. Endoscopic diagnosis and screening of Barrett's esophagus: Inconsistency of diagnostic criteria between Japan and Western countries. DEN OPEN 2022; 2:e73. [PMID: 35310704 PMCID: PMC8828243 DOI: 10.1002/deo2.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/10/2021] [Accepted: 10/16/2021] [Indexed: 11/11/2022]
Abstract
Barrett's esophagus (BE) is an endoscopically identifiable premalignant condition for esophageal adenocarcinoma (EAC). To diagnose BE precisely, careful inspection of the anatomic landmarks, including the esophagogastric junction and the squamocolumnar junction is important. The distal end of the palisade vessels and the proximal end of the gastric folds are used as the landmark of the esophagogastric junction in endoscopic diagnosis, with the latter solely used internationally, except in some Asian countries, including Japan. In addition, the diagnostic criteria adopted internationally for BE are inconsistent, particularly between Japan and Western countries. Recently updated guidelines in Western countries have included length criteria, with a 1‐cm threshold of columnar epithelium by endoscopic observation and/or histologic confirmation of the presence of specialized intestinal metaplasia. Since BE is endoscopically diagnosed at any length without histologic assessment in Japan, the reported prevalence of short‐segment BE is very high in Japan compared with that in Western countries. Although guidelines on screening exist for BE, the current strategies based on the presence of chronic gastroesophageal reflux disease with multiple risk factors may miss the opportunity for early detection of EAC. Indeed, up to 40% of patients with EAC have no history of chronic gastroesophageal reflux disease. To discuss BE on the same footing worldwide, standardization of diagnostic criteria, screening indication, and establishment of effective techniques for detecting dysplastic lesions are eagerly awaited. Japanese guidelines for BE should be revised regarding the length criteria, including the minimum length and long‐segment BE, in line with the recently updated Western guidelines.
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Affiliation(s)
- Norihisa Ishimura
- Second Department of Internal Medicine Shimane University Faculty of Medicine Shimane Japan
| | - Eiko Okimoto
- Second Department of Internal Medicine Shimane University Faculty of Medicine Shimane Japan
| | - Kotaro Shibagaki
- Division of Gastrointestinal Endoscopy Shimane University Hospital Shimane Japan
| | - Shunji Ishihara
- Second Department of Internal Medicine Shimane University Faculty of Medicine Shimane Japan
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39
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Koike T, Saito M, Ohara Y, Hatta W, Masamune A. Current status of surveillance for Barrett's esophagus in Japan and the West. DEN OPEN 2022; 2:e94. [PMID: 35898591 PMCID: PMC9302351 DOI: 10.1002/deo2.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/08/2022] [Accepted: 01/12/2022] [Indexed: 11/06/2022]
Abstract
Prospective studies in western countries have shown that the obvious risk factors for Barrett's esophageal cancer are male sex, smoking habit, a longer length of Barrett's esophagus, and low‐grade dysplasia. However, few reports have prospectively examined risk factors for adenocarcinoma development from Barrett's esophagus in Japan. In the West, where adenocarcinoma is common among esophageal cancer, endoscopic surveillance of Barrett's esophagus every 2–5 years is recommended for early detection of adenocarcinoma. However, there is no established surveillance method in Japan. In recent years, the incidence of adenocarcinoma from long‐segment Barrett's esophagus and short‐segment Barrett's esophagus longer than 2 cm in Japan has been reported to be similar to the West. For surveillance of adenocarcinoma arising from Barrett's esophagus, recognizing the characteristics of superficial adenocarcinoma and carefully observing the entire Barrett's esophagus are needed. It has been reported that representative characteristics of Barrett's adenocarcinoma are a reddish area or a lesion located on the anterior to the right sidewall. It is necessary to establish surveillance methods for Barrett's esophagus sooner in Japan.
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Affiliation(s)
- Tomoyuki Koike
- Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan
| | - Masahiro Saito
- Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan
| | - Yuki Ohara
- Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan
| | - Waku Hatta
- Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan
| | - Atsushi Masamune
- Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan
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40
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Spadaccini M, Vespa E, Chandrasekar VT, Desai M, Patel HK, Maselli R, Fugazza A, Carrara S, Anderloni A, Franchellucci G, De Marco A, Hassan C, Bhandari P, Sharma P, Repici A. Advanced imaging and artificial intelligence for Barrett's esophagus: What we should and soon will do. World J Gastroenterol 2022; 28:1113-1122. [PMID: 35431503 PMCID: PMC8985480 DOI: 10.3748/wjg.v28.i11.1113] [Citation(s) in RCA: 3] [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: 07/19/2021] [Revised: 08/12/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
Barrett’s esophagus (BE) is a well-established risk factor for esophageal adenocarcinoma. It is recommended that patients have regular endoscopic surveillance, with the ultimate goal of detecting early-stage neoplastic lesions before they can progress to invasive carcinoma. Detection of both dysplasia or early adenocarcinoma permits curative endoscopic treatments, and with this aim, thorough endoscopic assessment is crucial and improves outcomes. The burden of missed neoplasia in BE is still far from being negligible, likely due to inappropriate endoscopic surveillance. Over the last two decades, advanced imaging techniques, moving from traditional dye-spray chromoendoscopy to more practical virtual chromoendoscopy technologies, have been introduced with the aim to enhance neoplasia detection in BE. As witnessed in other fields, artificial intelligence (AI) has revolutionized the field of diagnostic endoscopy and is set to cover a pivotal role in BE as well. The aim of this commentary is to comprehensively summarize present evidence, recent research advances, and future perspectives regarding advanced imaging technology and AI in BE; the combination of computer-aided diagnosis to a widespread adoption of advanced imaging technologies is eagerly awaited. It will also provide a useful step-by-step approach for performing high-quality endoscopy in BE, in order to increase the diagnostic yield of endoscopy in clinical practice.
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Affiliation(s)
- Marco Spadaccini
- Department of Endoscopy, Humanitas Research Hospital, IRCCS, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
| | - Edoardo Vespa
- Department of Endoscopy, Humanitas Research Hospital, IRCCS, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
| | | | - Madhav Desai
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO 66045, United States
| | - Harsh K Patel
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA 70124, United States
| | - Roberta Maselli
- Department of Endoscopy, Humanitas Research Hospital, IRCCS, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
| | - Alessandro Fugazza
- Department of Endoscopy, Humanitas Research Hospital, IRCCS, Rozzano 20089, Italy
| | - Silvia Carrara
- Department of Endoscopy, Humanitas Research Hospital, IRCCS, Rozzano 20089, Italy
| | - Andrea Anderloni
- Department of Endoscopy, Humanitas Research Hospital, IRCCS, Rozzano 20089, Italy
| | - Gianluca Franchellucci
- Department of Endoscopy, Humanitas Research Hospital, IRCCS, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
| | - Alessandro De Marco
- Department of Endoscopy, Humanitas Research Hospital, IRCCS, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Roma 00153, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, United Kingdom
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO6 3LY, United Kingdom
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO 66045, United States
| | - Alessandro Repici
- Department of Endoscopy, Humanitas Research Hospital, IRCCS, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
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41
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Wang Y, Lu C. Identification of Barrett's neoplasia: Beyond Seattle protocol. ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13320] [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: 11/11/2022]
Affiliation(s)
- Yen‐Po Wang
- Institute of Brain Science, Faculty of Medicine National Yang Ming Chiao Tung University School of Medicine Taipei Taiwan
- Endoscopy Center for Diagnosis and Treatment Taipei Veterans General Hospital Taipei Taiwan
| | - Ching‐Liang Lu
- Institute of Brain Science, Faculty of Medicine National Yang Ming Chiao Tung University School of Medicine Taipei Taiwan
- Endoscopy Center for Diagnosis and Treatment Taipei Veterans General Hospital Taipei Taiwan
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Upper Gastrointestinal Cancer Surveillance in Lynch Syndrome. Cancers (Basel) 2022; 14:cancers14041000. [PMID: 35205747 PMCID: PMC8869779 DOI: 10.3390/cancers14041000] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Lynch syndrome is the most common cause of hereditary colorectal cancer, but is also associated with increased extracolonic cancer risk, including upper gastrointestinal cancers. While there is agreement regarding the benefit of frequent colonoscopic surveillance in Lynch syndrome, there remains a lack of consensus on the use of upper gastrointestinal cancer surveillance. Here, we review the upper gastrointestinal cancer risks in Lynch syndrome, the varying guideline recommendations in this area, and the published outcomes of upper gastrointestinal cancer surveillance in this high-risk population. Finally, we highlight ongoing controversies in upper gastrointestinal cancer surveillance and opine on how upper gastrointestinal cancer surveillance can be incorporated into a Lynch syndrome risk management program. Upper gastrointestinal cancer surveillance is an increasingly studied area of risk management in Lynch syndrome, and continued research will be vital in determining how to best incorporate this surveillance in these high-risk patients. Abstract Lynch syndrome is a common hereditary cancer predisposition syndrome associated with increased digestive cancer risk including colorectal, gastric, and duodenal cancers. While colorectal cancer surveillance is widely accepted to be an important part of a comprehensive Lynch syndrome risk management plan, the use of upper gastrointestinal cancer surveillance in Lynch syndrome remains more controversial. Currently, upper gastrointestinal cancer surveillance guidelines for Lynch syndrome vary widely, and there is no consensus on who should undergo upper gastrointestinal cancer surveillance, how surveillance should be performed, the age at which to initiate surveillance, or how often individuals with Lynch syndrome should undergo upper gastrointestinal cancer surveillance. Fortunately, research groups around the world have been focusing on upper gastrointestinal cancer surveillance in Lynch syndrome, and recent evidence in this field has demonstrated that upper gastrointestinal cancer surveillance can be performed with identification of precancerous lesions as well as early-stage upper gastrointestinal cancers. In this manuscript, we review the upper gastrointestinal cancer risks in Lynch syndrome, differing guideline recommendations for surveillance, outcomes of upper gastrointestinal cancer surveillance, and controversies in the field, and we provide a framework based on our collective experience with which to incorporate upper gastrointestinal cancer surveillance into a risk management program for individuals with Lynch syndrome.
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Pal P, Singh AP, Kanuri ND, Banerjee R. Electronic chromo-endoscopy: technical details and a clinical perspective. Transl Gastroenterol Hepatol 2022; 7:6. [PMID: 35243115 PMCID: PMC8826039 DOI: 10.21037/tgh-19-373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/12/2020] [Indexed: 08/13/2023] Open
Abstract
Precise endoscopic assessment is necessary to detect neoplastic changes in an early stage. Electronic or virtual chromo-endoscopy (ECE) is an alternative to conventional dye-based chromo-endoscopy which markedly improves capillary pattern and hence can detect micro-vessel morphological changes of early neoplasia to target biopsies and aid in diagnosis. The clinical significance increased after the advent of endoscopic treatment modalities like ESD/EMR which requires precise delineation of extent and depth of lesion. Most of the studies have used narrow-band imaging (NBI) (Olympus Medical Systems Tokyo, Japan), although data from i-SCAN (PENTAX Endoscopy, Tokyo, Japan) and flexible spectral imaging color enhancement (FICE) (Fujinon, Fujifilm Medical Co, Saitama, Japan) are emerging. Electronic chromo-endoscopy is convenient compared to dye-based chromo-endoscopy in the sense that it is available at the push of a button in endoscope and reduces procedure time substantially with comparable efficacy. Scope of this review is to discuss available electronic chromo-endoscopy modalities and their role in the diagnosis, surveillance, and management of early GI neoplasia.
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Affiliation(s)
- Partha Pal
- Department of Medical Gastroenterology, AIG hospitals, Hyderabad, India
| | | | - Navya D Kanuri
- Department of Medical Gastroenterology, AIG hospitals, Hyderabad, India
| | - Rupa Banerjee
- Department of Medical Gastroenterology, AIG hospitals, Hyderabad, India
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Visaggi P, de Bortoli N, Barberio B, Savarino V, Oleas R, Rosi EM, Marchi S, Ribolsi M, Savarino E. Artificial Intelligence in the Diagnosis of Upper Gastrointestinal Diseases. J Clin Gastroenterol 2022; 56:23-35. [PMID: 34739406 PMCID: PMC9988236 DOI: 10.1097/mcg.0000000000001629] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Artificial intelligence (AI) has enormous potential to support clinical routine workflows and therefore is gaining increasing popularity among medical professionals. In the field of gastroenterology, investigations on AI and computer-aided diagnosis (CAD) systems have mainly focused on the lower gastrointestinal (GI) tract. However, numerous CAD tools have been tested also in upper GI disorders showing encouraging results. The main application of AI in the upper GI tract is endoscopy; however, the need to analyze increasing loads of numerical and categorical data in short times has pushed researchers to investigate applications of AI systems in other upper GI settings, including gastroesophageal reflux disease, eosinophilic esophagitis, and motility disorders. AI and CAD systems will be increasingly incorporated into daily clinical practice in the coming years, thus at least basic notions will be soon required among physicians. For noninsiders, the working principles and potential of AI may be as fascinating as obscure. Accordingly, we reviewed systematic reviews, meta-analyses, randomized controlled trials, and original research articles regarding the performance of AI in the diagnosis of both malignant and benign esophageal and gastric diseases, also discussing essential characteristics of AI.
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Affiliation(s)
- Pierfrancesco Visaggi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa
| | - Nicola de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa
| | - Brigida Barberio
- Department of Surgery, Oncology, and Gastroenterology, Division of Gastroenterology, University of Padua, Padua
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa
| | - Roberto Oleas
- Ecuadorean Institute of Digestive Diseases, Guayaquil, Ecuador
| | - Emma M. Rosi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa
| | - Santino Marchi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa
| | - Mentore Ribolsi
- Department of Digestive Diseases, Campus Bio Medico University of Rome, Roma, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology, and Gastroenterology, Division of Gastroenterology, University of Padua, Padua
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HAN S, LOW DE. LAPAROSCOPIC ANTIREFLUX SURGERY: ARE OLD QUESTIONS ANSWERED? SHOULD IT BE USED CONJOINED WITH ENDOSCOPIC THERAPY FOR BARRETT’S ESOPHAGUS? ABCD. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA (SÃO PAULO) 2022; 35:e1664. [PMID: 35766609 PMCID: PMC9254380 DOI: 10.1590/0102-672020210002e1664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022]
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46
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Chang K, Jackson CS, Vega KJ. Barrett's Esophagus: Diagnosis, Management, and Key Updates. Gastroenterol Clin North Am 2021; 50:751-768. [PMID: 34717869 DOI: 10.1016/j.gtc.2021.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Barrett's esophagus (BE) is the precursor lesion for esophageal adenocarcinoma (EAC) development. Unfortunately, BE screening/surveillance has not provided the anticipated EAC reduction benefit. Noninvasive techniques are increasingly available or undergoing testing to screen for BE among those with/without known risk factors, and the use of artificial intelligence platforms to aid endoscopic screening and surveillance will likely become routine, minimizing missed cases or lesions. Management of high-grade dysplasia and intramucosal EAC is clear with endoscopic eradication therapy preferred to surgery. BE with low-grade dysplasia can be managed with removal of visible lesions combined with endoscopic eradication therapy or endoscopic surveillance at present.
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Affiliation(s)
- Karen Chang
- Department of Internal Medicine, University of California, Riverside School of Medicine, 900 University Avenue, Riverside, CA 92521, USA
| | - Christian S Jackson
- Section of Gastroenterology, Loma Linda VA Healthcare System, 11201 Benton Street, 2A-38, Loma Linda, CA 92357, USA
| | - Kenneth J Vega
- Division of Gastroenterology & Hepatology, Augusta University-Medical College of Georgia, 1120 15th Street, AD-2226, Augusta, GA 30912, USA.
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47
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Condon A, Muthusamy VR. The evolution of endoscopic therapy for Barrett's esophagus. Ther Adv Gastrointest Endosc 2021; 14:26317745211051834. [PMID: 34708204 PMCID: PMC8543722 DOI: 10.1177/26317745211051834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/21/2021] [Indexed: 12/20/2022] Open
Abstract
Barrett’s esophagus is the condition in which a metaplastic columnar epithelium
replaces the stratified squamous epithelium that normally lines the distal
esophagus. The condition develops as a consequence of chronic gastroesophageal
reflux disease and predisposes the patient to the development of esophageal
adenocarcinoma. The diagnosis and management of Barrett’s esophagus have
undergone dramatic changes over the years and continue to evolve today.
Endoscopic eradication therapy has revolutionized the management of dysplastic
Barrett’s esophagus and early esophageal adenocarcinoma by significantly
reducing the morbidity and mortality associated with the prior gold standard of
therapy, esophagectomy. The purpose of this review is to highlight current
principles in the management and endoscopic treatment of this disease.
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Affiliation(s)
- Ashwinee Condon
- Vatche & Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - V Raman Muthusamy
- Vatche & Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, UCLA, 200 UCLA Medical Plaza, Room 330-37, Los Angeles, CA 90095, USA
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Hajelssedig OE, Zorron Cheng Tao Pu L, Thompson JY, Lord A, El Sayed I, Meyer C, Shaukat Ali F, Abdulazeem HM, Kheir AO, Siepmann T, Singh R. Diagnostic accuracy of narrow-band imaging endoscopy with targeted biopsies compared with standard endoscopy with random biopsies in patients with Barrett's esophagus: A systematic review and meta-analysis. J Gastroenterol Hepatol 2021; 36:2659-2671. [PMID: 34121232 DOI: 10.1111/jgh.15577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/09/2021] [Accepted: 06/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Endoscopic surveillance for dysplasia in Barrett's esophagus (BE) with random biopsies is the primary diagnostic tool for monitoring clinical progression into esophageal adenocarcinoma. As an alternative, narrow-band imaging (NBI) endoscopy offers targeted biopsies that can improve dysplasia detection. This study aimed to evaluate NBI-guided targeted biopsies' diagnostic accuracy for detecting dysplasia in patients undergoing endoscopic BE surveillance compared with the widely used Seattle protocol. METHODS Cochrane DTA Register, MEDLINE/PubMed, EMBASE, OpenGrey, and bibliographies of identified papers were searched until 2018. Two independent investigators resolved discrepancies by consensus, study selection, data extraction, and quality assessment. Data on sensitivity, specificity, and predictive values were pooled and analyzed using a random-effects model. RESULTS Of 9528 identified articles, six studies comprising 493 participants were eligible for quantitative synthesis. NBI-targeted biopsy showed high diagnostic accuracy in detection of dysplasia in BE with a sensitivity of 76% (95% confidence interval [CI]: 0.61-0.91), specificity of 99% (95% CI: 0.99-1.00), positive predictive value of 97% (95% CI: 0.96-0.99), and negative predictive value of 84% (95% CI: 0.69-0.99) for detection of all grades of dysplasia. The receiver-operating characteristic curve for NBI model performance was 0.8550 for detecting all dysplasia. CONCLUSION Narrow-band imaging-guided biopsy demonstrated high diagnostic accuracy and might constitute a valid substitute for random biopsies during endoscopic surveillance for dysplasia in BE.
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Affiliation(s)
- Omer Eljyli Hajelssedig
- Master Program of Clinical Research, Dresden International University, Dresden, Germany.,DRESDEN INTERNATIONAL UNIVERSITAET (Freiberger Str. 37, 01067 Dresden, Germany)
| | | | | | - Anton Lord
- Gut Health Lab, Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Iman El Sayed
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Chase Meyer
- Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Faisal Shaukat Ali
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, Illinois, USA
| | | | - Ammar O Kheir
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden, Germany
| | - Rajvinder Singh
- Department of Gastroenterology, The Lyell McEwin Hospital, Adelaide, South Australia, Australia.,The University of Adelaide, Adelaide, South Australia, Australia
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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: 18] [Impact Index Per Article: 6.0] [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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50
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Waterhouse DJ, Bano S, Januszewicz W, Stoyanov D, Fitzgerald RC, di Pietro M, Bohndiek SE. First-in-human pilot study of snapshot multispectral endoscopy for early detection of Barrett's-related neoplasia. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210159R. [PMID: 34628734 PMCID: PMC8501416 DOI: 10.1117/1.jbo.26.10.106002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/02/2021] [Indexed: 05/04/2023]
Abstract
SIGNIFICANCE The early detection of dysplasia in patients with Barrett's esophagus could improve outcomes by enabling curative intervention; however, dysplasia is often inconspicuous using conventional white-light endoscopy. AIM We sought to determine whether multispectral imaging (MSI) could be applied in endoscopy to improve detection of dysplasia in the upper gastrointestinal (GI) tract. APPROACH We used a commercial fiberscope to relay imaging data from within the upper GI tract to a snapshot MSI camera capable of collecting data from nine spectral bands. The system was deployed in a pilot clinical study of 20 patients (ClinicalTrials.gov NCT03388047) to capture 727 in vivo image cubes matched with gold-standard diagnosis from histopathology. We compared the performance of seven learning-based methods for data classification, including linear discriminant analysis, k-nearest neighbor classification, and a neural network. RESULTS Validation of our approach using a Macbeth color chart achieved an image-based classification accuracy of 96.5%. Although our patient cohort showed significant intra- and interpatient variance, we were able to resolve disease-specific contributions to the recorded MSI data. In classification, a combined principal component analysis and k-nearest-neighbor approach performed best, achieving accuracies of 95.8%, 90.7%, and 76.1%, respectively, for squamous, non-dysplastic Barrett's esophagus and neoplasia based on majority decisions per-image. CONCLUSIONS MSI shows promise for disease classification in Barrett's esophagus and merits further investigation as a tool in high-definition "chip-on-tip" endoscopes.
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Affiliation(s)
- Dale J. Waterhouse
- University of Cambridge, Department of Physics and CRUK Cambridge Institute, Cambridge, United Kingdom
- University College London, Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, United Kingdom
| | - Sophia Bano
- University College London, Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, United Kingdom
| | - Wladyslaw Januszewicz
- Medical Centre for Postgraduate Education, Department of Gastroenterology, Hepatology and Clinical Oncology, Warsaw, Poland
| | - Dan Stoyanov
- University College London, Wellcome/EPSRC Centre for Interventional and Surgical Sciences, London, United Kingdom
| | - Rebecca C. Fitzgerald
- University of Cambridge, MRC Cancer Unit, Hutchison/MRC Research Centre, Cambridge, United Kingdom
| | - Massimiliano di Pietro
- University of Cambridge, MRC Cancer Unit, Hutchison/MRC Research Centre, Cambridge, United Kingdom
| | - Sarah E. Bohndiek
- University of Cambridge, Department of Physics and CRUK Cambridge Institute, Cambridge, United Kingdom
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