1
|
Denzer UW. Endoscopic Resection of Malignancies in the Upper GI Tract: A Clinical Algorithm. Visc Med 2024; 40:116-127. [PMID: 38873624 PMCID: PMC11166903 DOI: 10.1159/000538040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/25/2024] [Indexed: 06/15/2024] Open
Abstract
Background Malignancies in the upper gastrointestinal tract are amenable to endoscopic resection at an early stage. Achieving a curative resection is the most stringent quality criterion, but post-resection risk assessment and aftercare are also part of a comprehensive quality program. Summary Various factors influence the achievement of curative resection. These include endoscopic assessment prior to resection using chromoendoscopy and HD technology. If resectability is possible, it is particularly important to delineate the lateral resection margins as precisely as possible before resection. Furthermore, the correct choice of resection technique depending on the lesion must be taken into account. Endoscopic submucosal dissection is the standard for esophageal squamous cell carcinoma and gastric carcinoma. In Western countries, it is becoming increasingly popular to treat Barrett's neoplasia over 2 cm in size and/or with suspected submucosal infiltration with en bloc resection instead of piece meal resection. After resection, risk assessment based on the histopathological resection determines the patient's individual risk of lymph node metastases, particularly in the case of high-risk lesions. This is categorized according to the current literature. Key Messages This review presents clinical algorithms for endoscopic resection of esophageal SCC, Barrett's neoplasia, and gastric neoplasia. The algorithms include the pre-resection assessment of the lesion and the resection margins, the adequate resection technique for the respective lesion, as well as the post-resection risk assessment with an evidence-based recommendation for follow-up therapy and surveillance.
Collapse
Affiliation(s)
- Ulrike Walburga Denzer
- Section of Endoscopy, Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
| |
Collapse
|
2
|
Stanciu SG, König K, Song YM, Wolf L, Charitidis CA, Bianchini P, Goetz M. Toward next-generation endoscopes integrating biomimetic video systems, nonlinear optical microscopy, and deep learning. BIOPHYSICS REVIEWS 2023; 4:021307. [PMID: 38510341 PMCID: PMC10903409 DOI: 10.1063/5.0133027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/26/2023] [Indexed: 03/22/2024]
Abstract
According to the World Health Organization, the proportion of the world's population over 60 years will approximately double by 2050. This progressive increase in the elderly population will lead to a dramatic growth of age-related diseases, resulting in tremendous pressure on the sustainability of healthcare systems globally. In this context, finding more efficient ways to address cancers, a set of diseases whose incidence is correlated with age, is of utmost importance. Prevention of cancers to decrease morbidity relies on the identification of precursor lesions before the onset of the disease, or at least diagnosis at an early stage. In this article, after briefly discussing some of the most prominent endoscopic approaches for gastric cancer diagnostics, we review relevant progress in three emerging technologies that have significant potential to play pivotal roles in next-generation endoscopy systems: biomimetic vision (with special focus on compound eye cameras), non-linear optical microscopies, and Deep Learning. Such systems are urgently needed to enhance the three major steps required for the successful diagnostics of gastrointestinal cancers: detection, characterization, and confirmation of suspicious lesions. In the final part, we discuss challenges that lie en route to translating these technologies to next-generation endoscopes that could enhance gastrointestinal imaging, and depict a possible configuration of a system capable of (i) biomimetic endoscopic vision enabling easier detection of lesions, (ii) label-free in vivo tissue characterization, and (iii) intelligently automated gastrointestinal cancer diagnostic.
Collapse
Affiliation(s)
- Stefan G. Stanciu
- Center for Microscopy-Microanalysis and Information Processing, University Politehnica of Bucharest, Bucharest, Romania
| | | | | | - Lior Wolf
- School of Computer Science, Tel Aviv University, Tel-Aviv, Israel
| | - Costas A. Charitidis
- Research Lab of Advanced, Composite, Nano-Materials and Nanotechnology, School of Chemical Engineering, National Technical University of Athens, Athens, Greece
| | - Paolo Bianchini
- Nanoscopy and NIC@IIT, Italian Institute of Technology, Genoa, Italy
| | - Martin Goetz
- Medizinische Klinik IV-Gastroenterologie/Onkologie, Kliniken Böblingen, Klinikverbund Südwest, Böblingen, Germany
| |
Collapse
|
3
|
Tuniyazi A, Mu T, Jiang X, Han F, Li H, Li Q, Gong H, Wang W, Qin B. Snapshot polarized light scattering spectroscopy using spectrally-modulated polarimetry for early gastric cancer detection. JOURNAL OF BIOPHOTONICS 2021; 14:e202100140. [PMID: 34089571 DOI: 10.1002/jbio.202100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 06/12/2023]
Abstract
Polarized light scattering spectroscopy (PLSS) is a promising optical technique developed for the detection of cancer, which extracts the single scattering light to infer morphological information of epithelial cells. However, traditional PLSS uses either a rotatable polarizer or two orthogonal polarizers to purify the single scattering light, which makes it complicated and challenged to build a PLSS endoscope. Herein, we propose a snapshot PLSS with a single optical path to directly get the single scattering light for the first time. The single scattering light is encoded using the spectrally-modulated polarimetry and decoded using the continuous slide iterative method. Both the polystyrene microsphere solutions and the ex vivo gastric cancer samples are used to verify the method. The experimental results of the snapshot PLSS are consistent well with that of the traditional PLSS. The proposed method has a potential for the building of snapshot PLSS endoscope systems in future.
Collapse
Affiliation(s)
- Abudusalamu Tuniyazi
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Tingkui Mu
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Xiaosa Jiang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Feng Han
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Haoyang Li
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Qiuxia Li
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Hang Gong
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Wenjing Wang
- MOE Key Laboratory for Nonequilibrium Synthesis and Modulation of Condensed Matter, School of Physics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for Space Optics and Astronomy, Academy of Physical Science & Technology, Western China Science & Technology Innovation Harbor, Xi'an, Shaanxi, China
| | - Bin Qin
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
4
|
Systematic Review on Optical Diagnosis of Early Gastrointestinal Neoplasia. J Clin Med 2021; 10:jcm10132794. [PMID: 34202001 PMCID: PMC8269336 DOI: 10.3390/jcm10132794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Meticulous endoscopic characterization of gastrointestinal neoplasias (GN) is crucial to the clinical outcome. Hereby the indication and type of resection (endoscopically, en-bloc or piece-meal, or surgical resection) are determined. By means of established image-enhanced (IEE) and magnification endoscopy (ME) GN can be characterized in terms of malignancy and invasion depth. In this context, the statistical evidence and accuracy of these diagnostic procedures should be elucidated. Here, we present a systematic review of the literature. RESULTS 21 Studies could be found which met the inclusion criteria. In clinical prospective trials and meta-analyses, the diagnostic accuracy of >90% for characterization of malignant neoplasms could be documented, if ME with IEE was used in squamous cell esophageal cancer, stomach, or colonic GN. CONCLUSIONS Currently, by means of optical diagnosis, today's gastrointestinal endoscopy is capable of determining the histological subtype, exact lateral spread, and depth of invasion of a lesion. The prerequisites for this are an exact knowledge of the anatomical structures, the endoscopic classifications based on them, and a systematic learning process, which can be supported by training courses. More prospective clinical studies are required, especially in the field of Barrett's esophagus and duodenal neoplasia.
Collapse
|
5
|
Fernández-Esparrach G, Marín-Gabriel JC, Díez Redondo P, Núñez H, Rodríguez de Santiago E, Rosón P, Calvet X, Cuatrecasas M, Cubiella J, Moreira L, Pardo López ML, Pérez Aisa Á, Sanz Anquela JM. Quality in diagnostic upper gastrointestinal endoscopy for the detection and surveillance of gastric cancer precursor lesions: Position paper of AEG, SEED and SEAP. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 44:448-464. [PMID: 33609597 DOI: 10.1016/j.gastrohep.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/31/2020] [Accepted: 01/14/2021] [Indexed: 02/07/2023]
Abstract
This position paper, sponsored by the Asociación Española de Gastroenterología [Spanish Association of Gastroenterology], the Sociedad Española de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] and the Sociedad Española de Anatomía Patológica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of gastric cancer precursor lesions (GCPL) in low-incidence populations, such as the Spanish population. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates different measures to improve the quality of upper gastrointestinal endoscopy in this setting and makes recommendations on how to evaluate and treat the identified lesions. We recommend that upper gastrointestinal endoscopy for surveillance of GCPL should be performed by endoscopists with adequate training, administering oral premedication and use of sedation. To improve the identification of GCPL, we recommend the use of high definition endoscopes and conventional or digital chromoendoscopy and, for biopsies, NBI should be used to target the most suspicious areas of intestinal metaplasia. Regarding the evaluation of visible lesions, the risk of submucosal invasion should be evaluated with magnifying endoscopes and endoscopic ultrasound should be reserved for those with suspected deep invasion. In lesions amenable to endoscopic resection, submucosal endoscopic dissection is considered the technique of choice.
Collapse
Affiliation(s)
- Glòria Fernández-Esparrach
- Departamento de Gastroenterología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España.
| | - José Carlos Marín-Gabriel
- Servicio de Medicina de Aparato Digestivo, Consulta de Alto Riesgo de Neoplasias Gastrointestinales, Unidad de Endoscopias, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Instituto de Investigación «i+12», Madrid, España
| | - Pilar Díez Redondo
- Servicio de Gastroenterología, Unidad de Endoscopias, Consulta de Alto Riesgo de Neoplasias Digestivas, Hospital Universitario Río Hortega, Valladolid, España
| | - Henar Núñez
- Servicio de Gastroenterología, Unidad de Endoscopias, Consulta de Alto Riesgo de Neoplasias Digestivas, Hospital Universitario Río Hortega, Valladolid, España
| | - Enrique Rodríguez de Santiago
- Departamento de Gastroenterología y Hepatología, Hospital Universitario Ramon y Cajal, Universidad de Alcalá, IRYCIS, Madrid, España
| | - Pedro Rosón
- Servicio de Aparato Digestivo, Hospital Quirón, Málaga, España
| | - Xavier Calvet
- Servei d'Aparell Digestiu, Hospital Universitari Parc Taulí, Departament de Medicina, Universitat Autònoma de Barcelona. CIBERehd, Instituto de Salud CarlosIII, Sabadell, Barcelona, España
| | - Miriam Cuatrecasas
- Servicio de Anatomía Patológica, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España
| | - Joaquín Cubiella
- Servicio de Aparato Digestivo, Hospital Universitario de Ourense, Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Ourense, España
| | - Leticia Moreira
- Departamento de Gastroenterología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España
| | - M Luisa Pardo López
- Servicio de Patología, Hospital Virgen del Mirón, Complejo Hospitalario de Soria, Soria, España
| | - Ángeles Pérez Aisa
- Unidad de Aparato Digestivo, Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Marbella, Málaga, España
| | - José Miguel Sanz Anquela
- Servicio de Anatomía Patológica, Hospital Universitario Príncipe de Asturias, Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, España
| | | |
Collapse
|
6
|
Li L, Chen Y, Shen Z, Zhang X, Sang J, Ding Y, Yang X, Li J, Chen M, Jin C, Chen C, Yu C. Convolutional neural network for the diagnosis of early gastric cancer based on magnifying narrow band imaging. Gastric Cancer 2020; 23:126-132. [PMID: 31332619 PMCID: PMC6942561 DOI: 10.1007/s10120-019-00992-2] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Magnifying endoscopy with narrow band imaging (M-NBI) has been applied to examine early gastric cancer by observing microvascular architecture and microsurface structure of gastric mucosal lesions. However, the diagnostic efficacy of non-experts in differentiating early gastric cancer from non-cancerous lesions by M-NBI remained far from satisfactory. In this study, we developed a new system based on convolutional neural network (CNN) to analyze gastric mucosal lesions observed by M-NBI. METHODS A total of 386 images of non-cancerous lesions and 1702 images of early gastric cancer were collected to train and establish a CNN model (Inception-v3). Then a total of 341 endoscopic images (171 non-cancerous lesions and 170 early gastric cancer) were selected to evaluate the diagnostic capabilities of CNN and endoscopists. Primary outcome measures included diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS The sensitivity, specificity, and accuracy of CNN system in the diagnosis of early gastric cancer were 91.18%, 90.64%, and 90.91%, respectively. No significant difference was spotted in the specificity and accuracy of diagnosis between CNN and experts. However, the diagnostic sensitivity of CNN was significantly higher than that of the experts. Furthermore, the diagnostic sensitivity, specificity and accuracy of CNN were significantly higher than those of the non-experts. CONCLUSIONS Our CNN system showed high accuracy, sensitivity and specificity in the diagnosis of early gastric cancer. It is anticipated that more progress will be made in optimization of the CNN diagnostic system and further development of artificial intelligence in the medical field.
Collapse
Affiliation(s)
- Lan Li
- grid.13402.340000 0004 1759 700XDepartment of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003 China
| | - Yishu Chen
- grid.13402.340000 0004 1759 700XDepartment of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003 China
| | - Zhe Shen
- grid.13402.340000 0004 1759 700XDepartment of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003 China
| | - Xuequn Zhang
- grid.13402.340000 0004 1759 700XDepartment of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003 China
| | - Jianzhong Sang
- Department of Gastroenterology, Yuyao People’s Hospital, Yuyao, China
| | - Yong Ding
- grid.203507.30000 0000 8950 5267Department of Gastroenterology, The Affiliated Hospital of School of Medicine of Ningbo University, Ningbo, China
| | - Xiaoyun Yang
- grid.13402.340000 0004 1759 700XDepartment of Gastroenterology, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Jun Li
- grid.13402.340000 0004 1759 700XDepartment of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ming Chen
- Hithink RoyalFlush Information Network Co., Ltd, Hangzhou, China
| | - Chaohui Jin
- Hithink RoyalFlush Information Network Co., Ltd, Hangzhou, China
| | - Chunlei Chen
- grid.13402.340000 0004 1759 700XState Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chaohui Yu
- grid.13402.340000 0004 1759 700XDepartment of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003 China
| |
Collapse
|
7
|
Chiu PWY, Uedo N, Singh R, Gotoda T, Ng EKW, Yao K, Ang TL, Ho SH, Kikuchi D, Yao F, Pittayanon R, Goda K, Lau JYW, Tajiri H, Inoue H. An Asian consensus on standards of diagnostic upper endoscopy for neoplasia. Gut 2019; 68:186-197. [PMID: 30420400 DOI: 10.1136/gutjnl-2018-317111] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/25/2018] [Accepted: 10/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND This is a consensus developed by a group of expert endoscopists aiming to standardise the preparation, process and endoscopic procedural steps for diagnosis of early upper gastrointestinal (GI) cancers. METHOD The Delphi method was used to develop consensus statements through identification of clinical questions on diagnostic endoscopy. Three consensus meetings were conducted to consolidate the statements and voting. We conducted a systematic literature search on evidence for each statement. The statements were presented in the second consensus meeting and revised according to comments. The final voting was conducted at the third consensus meeting on the level of evidence and agreement. RESULTS Risk stratification should be conducted before endoscopy and high risk endoscopic findings should raise an index of suspicion. The presence of premalignant mucosal changes should be documented and use of sedation is recommended to enhance detection of superficial upper GI neoplasms. The use of antispasmodics and mucolytics enhanced visualisation of the upper GI tract, and systematic endoscopic mapping should be conducted to improve detection. Sufficient examination time and structured training on diagnosis improves detection. Image enhanced endoscopy in addition to white light imaging improves detection of superficial upper GI cancer. Magnifying endoscopy with narrow-band imaging is recommended for characterisation of upper GI superficial neoplasms. Endoscopic characterisation can avoid unnecessary biopsy. CONCLUSION This consensus provides guidance for the performance of endoscopic diagnosis and characterisation for early gastric and oesophageal neoplasia based on the evidence. This will enhance the quality of endoscopic diagnosis and improve detection of early upper GI cancers.
Collapse
Affiliation(s)
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin and Modbury Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Takuji Gotoda
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | | | - Kenshi Yao
- Department of Endoscopy, University Chikushi Hospital, Fukuoka, Japan
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Shiaw Hooi Ho
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Fang Yao
- Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Rapat Pittayanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red Cross, Bangkok, Thailand
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - James Y W Lau
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy Research, Jikei University School of Medicine, Tokyo, Japan
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan
| |
Collapse
|
8
|
Development of Image-enhanced Endoscopy of the Gastrointestinal Tract: A Review of History and Current Evidences. J Clin Gastroenterol 2018; 52:295-306. [PMID: 29210900 DOI: 10.1097/mcg.0000000000000960] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endoscopy imaging of the gastrointestinal (GI) tract has evolved tremendously over the last few decades. Key milestones in the development of endoscopy imaging include the use of various dyes for chromoendoscopy, the application of optical magnification in endoscopy, the introduction of high-definition image capturing and display technology and the application of altered illuminating light to achieve vascular and surface enhancement. Aims of this review paper are to summarize the development and evolution of modern endoscopy imaging and in particular, imaged-enhanced endoscopy (IEE), to promote appropriate usage, and to guide future development of good endoscopy practice. A search of PubMed database was performed to identify articles related to IEE of the GI tract. Where appropriate, landmark trials and high-quality meta-analyses and systematic reviews were used in the discussion. In this review, the developments and evolutions in endoscopy imaging and in particular, IEE, were summarized into discernible eras and the literature evidence with regard to the strengths and weaknesses in term of their detection and characterization capability in each of these eras were discussed. It is in the authors' opinion that IEE is capable of fairly good detection and accurate characterization of various GI lesions but such benefits may not be readily reaped by those who are new in the field of luminal endoscopy. Exposure and training in making confident diagnoses using these endoscopy imaging technologies are required in tandem with these new developments in order to fully embrace and adopt the benefits.
Collapse
|
9
|
Barbeiro S, Libânio D, Castro R, Dinis-Ribeiro M, Pimentel-Nunes P. Narrow-Band Imaging: Clinical Application in Gastrointestinal Endoscopy. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 26:40-53. [PMID: 30675503 DOI: 10.1159/000487470] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/29/2018] [Indexed: 12/11/2022]
Abstract
Narrow-band imaging is an advanced imaging system that applies optic digital methods to enhance endoscopic images and improves visualization of the mucosal surface architecture and microvascular pattern. Narrow-band imaging use has been suggested to be an important adjunctive tool to white-light endoscopy to improve the detection of lesions in the digestive tract. Importantly, it also allows the distinction between benign and malignant lesions, targeting biopsies, prediction of the risk of invasive cancer, delimitation of resection margins, and identification of residual neoplasia in a scar. Thus, in expert hands it is a useful tool that enables the physician to decide on the best treatment (endoscopic or surgical) and management. Current evidence suggests that it should be used routinely for patients at increased risk for digestive neoplastic lesions and could become the standard of care in the near future, at least in referral centers. However, adequate training programs to promote the implementation of narrow-band imaging in daily clinical practice are needed. In this review, we summarize the current scientific evidence on the clinical usefulness of narrow-band imaging in the diagnosis and characterization of digestive tract lesions/cancers and describe the available classification systems.
Collapse
Affiliation(s)
- Sandra Barbeiro
- Department of Gastroenterology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Diogo Libânio
- Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Rui Castro
- Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal
| |
Collapse
|
10
|
Zhang HP, Yang S, Chen WH, Hu TT, Lin J. The diagnostic value of confocal laser endomicroscopy for gastric cancer and precancerous lesions among Asian population: a system review and meta-analysis. Scand J Gastroenterol 2017; 52:382-388. [PMID: 28078907 DOI: 10.1080/00365521.2016.1275770] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of this study is to evaluate the diagnostic value of confocal laser endomicroscopy (CLE) in detection of gastric cancer (GC), gastric intraepithelial metaplasia (GIM), and gastric intraepithelial neoplasia (GIN) lesions. METHOD PubMed, the Cochrane Library, and Wangfang databases were searched to include eligible articles about CLE in detection of gastric lesions. After study selection, quality assessment and data extraction conducted by two reviewers independently, meta-analysis was performed by Meta-Disc 1.4. The pooled sensitivity and specificity was calculated, receiver operating characteristic (ROC) curve was constructed, and the area under ROC curve (AUC) was calculated. RESULTS Twenty-three studies evaluating the diagnostic value of CLE were included. For the diagnosis of GC lesions, the pooled sensitivity, specificity, and AUC were 91% (88-94%), 99% (99-99%), and 0.9513, respectively. For the diagnosis of lesions, the pooled sensitivity, specificity, and AUC were 92% (90-94%), 97% (96-98%), and 0.9774, respectively. For the diagnosis of GIN lesions, the pooled sensitivity, specificity and AUC were 81% (75-85%), 98% (97-98%), and 0.9204, respectively. CONCLUSIONS CLE can provide an accurate diagnosis with high sensitivity and specificity for GC, GIM, and GIN lesions. The results should be confirmed by well-designed, multi-centered, randomized controlled, and double blinded trials with large samples.
Collapse
Affiliation(s)
- Hai-Ping Zhang
- a Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
| | - Sheng Yang
- a Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
| | - Wen-Hua Chen
- a Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
| | - Teng-Teng Hu
- a Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
| | - Jun Lin
- a Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
| |
Collapse
|
11
|
Hussain I, Ang TL. Evidence based review of the impact of image enhanced endoscopy in the diagnosis of gastric disorders. World J Gastrointest Endosc 2016; 8:741-755. [PMID: 28042388 PMCID: PMC5159672 DOI: 10.4253/wjge.v8.i20.741] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/27/2016] [Accepted: 09/22/2016] [Indexed: 02/05/2023] Open
Abstract
Gastric cancer is the third most common cause of cancer-related death. Advanced stages of gastric cancers generally have grim prognosis. But, good prognosis can be achieved if such cancers are detected, diagnosed and resected at early stages. However, early gastric cancers and its precursors often produce only subtle mucosal changes and therefore quite commonly remain elusive at the conventional examination with white light endoscopy. Image-enhanced endoscopy makes mucosal lesions more conspicuous and can therefore potentially yield earlier and more accurate diagnoses. Recent years have seen growing work of research in support of various types of image enhanced endoscopy (IEE) techniques (e.g., dye-chromoendoscopy; magnification endoscopy; narrow-band imaging; flexible spectral imaging color enhancement; and I-SCAN) for a variety of gastric pathologies. In this review, we will examine the evidence for the utilization of various IEE techniques in the diagnosis of gastric disorders.
Collapse
|
12
|
Qian W, Bai T, Wang H, Zhang L, Song J, Hou XH. Meta-analysis of confocal laser endomicroscopy for the diagnosis of gastric neoplasia and adenocarcinoma. J Dig Dis 2016; 17:366-76. [PMID: 27129127 DOI: 10.1111/1751-2980.12357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 03/10/2016] [Accepted: 04/25/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Confocal laser endomicroscopy (CLE) is a recently developed technique used to diagnose gastrointestinal diseases. The current meta-analysis aimed to systematically assess the ability of CLE to diagnose neoplasia and gastric adenocarcinoma. METHODS A comprehensive literature search was performed using PubMed, Embase and the Cochrane Library for endomicroscopy, gastric neoplasia and gastric adenocarcinoma. Sensitivity and specificity data on the diagnosis of neoplasia and gastric adenocarcinoma were pooled. A summary receiver operating characteristic (sROC) curve was performed and the area under the curve was calculated. RESULTS In all, 13 studies were included in the current study. The pooled sensitivity and specificity assessing CLE as a method to diagnose gastric neoplasia were 0.81 and 0.98, respectively. For the diagnosis of gastric adenocarcinoma, the pooled sensitivity and specificity were 0.89 and 0.99, respectively. The pooled sensitivity and specificity were 0.82 and 0.95 when differentiating high-grade intraepithelial neoplasia from low-grade intraepithelial neoplasia. Additionally, the pooled sensitivity and specificity were 0.87 and 0.96, respectively, when distinguishing undifferentiated gastric adenocarcinoma from differentiated gastric adenocarcinoma. CONCLUSION CLE has a high sensitivity and specificity for diagnosing gastric intraepithelial neoplasia and gastric adenocarcinoma; therefore, it could be considered an alternative to the endoscopic method used to diagnose gastric intraepithelial neoplasia and gastric adenocarcinoma.
Collapse
Affiliation(s)
- Wei Qian
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Tao Bai
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Huan Wang
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Lei Zhang
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jun Song
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiao Hua Hou
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| |
Collapse
|
13
|
Lahner E, Esposito G, Angeletti S, Corleto VD, Pilozzi E, Di Giulio E, Annibale B. Endoscopic appearances of polypoid type 1 gastric microcarcinoids by narrow-band imaging: a case series in a referral center. Eur J Gastroenterol Hepatol 2016; 28:463-8. [PMID: 26745471 DOI: 10.1097/meg.0000000000000566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Narrow-band imaging (NBI) has been associated with high accuracy for the identification of gastric malignant lesions. This study aimed to investigate for the first time the endoscopic NBI appearances of type 1 gastric carcinoids in a consecutive series of patients with atrophic gastritis. METHODS Seven consecutive patients (five women, median age 61 years) with atrophic gastritis and polypoid type 1 gastric carcinoids were included. After white-light examination, gastric antrum and body were examined by NBI for the examination of polyps and lesions. Digital images of polyps from recorded videos were extracted and reviewed for NBI features. RESULTS Fifteen polypoid type 1 gastric microcarcinoids (median size 3 mm) were detected in the seven patients; four patients had synchronous lesions. Nine (60%) lesions showed a tubulovillous and six lesions (40%) showed an irregular mucosal pattern; a regular circular pattern was never observed. A light-blue crest was observed on six (40%) lesions. The vascular pattern was irregular in eight (53.3%) microcarcinoids. All six type 1 gastric carcinoids with an irregular mucosal pattern showed an irregular vascular pattern without light-blue crest. Of the nine carcinoids with a tubulovillous mucosal pattern, two had an irregular and seven had a regular vascular pattern. CONCLUSION Polypoid type 1 gastric microcarcinoids always show an abnormal NBI mucosal surface pattern, but no specific features to distinguish them from other intraepithelial lesions such as intestinal metaplasia, adenomas, or low-grade and high-grade dysplasia are observed. Thus, target biopsies to diagnose the pathological nature of the lesion are advocated.
Collapse
Affiliation(s)
- Edith Lahner
- Departments of aMedical and Surgical Sciences and Translational Medicine bPathology cDigestive Endoscopy, Sant'Andrea Hospital, Sapienza University Rome, Italy
| | | | | | | | | | | | | |
Collapse
|