Conventional Endoscopy Research Articles

Radial incision and cutting for dilation before endoscopic submucosal dissection in patients with esophageal cancer on the distal side of severe benign esophageal strictures.

We investigated the efficacy and safety of radial incision and cutting as a novel dilation method for strictures just before endoscopic submucosal dissection in patients with metachronous esophageal cancer localized on the distal side of strictures and determined the optimal dilation method. Consecutive patients who underwent endoscopic submucosal dissection for superficial esophageal squamous cell carcinomas localized on the distal side of severe strictures were investigated retrospectively and assigned to a radial incision and cutting (19 patients; 23 lesions) or an endoscopic balloon dilation (20 patients; 20 lesions) group. We evaluated the passage success rates of cap-wearing endoscopes with diameters ≥8.9mm, the procedural success, en bloc resection, complete resection, major adverse event rates, and total procedure times. Compared to the endoscopic balloon dilation group, the passage success rate of a conventional endoscope with a transparent cap (87% vs. 50%) and procedural success rate (96% vs. 63%) were significantly higher in the radial incision and cutting group. The mean procedure time of 'dilation and ESD' was significantly shorter in the radial incision and cutting group than in the endoscopic balloon dilation group. Neither group experienced any serious adverse events. Radial incision and cutting followed by endoscopic submucosal dissection was effective and safe in patients with superficial esophageal squamous cell carcinomas localized on the distal side of severe benign esophageal strictures. Endoscopic submucosal dissection using a cap-wearing endoscope was possible with radial incision and cutting, and the procedure time was shorter than that for endoscopic balloon dilation.

Pediatric Surgery during the COVID-19 Pandemic: An International Survey of Current Practice.

Understanding the challenges experienced by pediatric surgeons in the early phases of the pandemic may help identify key issues and focus research. Two pediatric surgeons from each of the 10 countries most affected by COVID-19 were surveyed over a 10-day period. Data were obtained regarding service provision, infection control, specific surgical conditions, and the surgical workforce. Twenty pediatric surgeons responded. All centers had postponed non-emergency surgery and clinics for nonurgent conditions with virtual consultations being undertaken in 90% of centers. A majority (65%) of centers had not yet knowingly operated on a positive patient. Minimal access surgery was performed in 75% centers but a further 75% had reduced or stopped upper gastrointestinal endoscopy. The management of simple appendicitis was unchanged in 70% centers, patients with intussusception were being referred for radiological reduction in all centers and definitive pull-through surgery for Hirschsprung patients was performed by 95% where washouts were successful. Timing of surgery for reducible neonatal inguinal hernias had changed in 55% of centers and the management of urgent feeding gastrostomy referrals and of inflammatory bowel disease patients failing with biological therapy varied considerably. Service provision has been severely affected by COVID-19 leading to an inevitable increase in untreated surgical pathology. Better understanding of extrapulmonary infectivity, the risk of asymptomatic carriage in children, and the reliability of testing for surgical scenarios may allow appropriate use of conventional surgery, including laparoscopy and endoscopy, and rational development of the novel care pathways needed during the pandemic.

Robotics in flexible endoscopy: current status and future prospects.

Advanced endoscopy procedures are technically challenging and require extensive training. Recent technological advances made in computer science and robotics have the potential to enhance the performance of complex intraluminal and transluminal interventions and potentially optimize precision and safety. This review covers the different technologies used for robot-assisted interventions in the gastrointestinal tract, organized according to their clinical availability, and focusing on flexible endoscopy-based systems. In the curvilinear gastrointestinal anatomy, robotic technology can enhance flexible endoscopes to augment effectiveness, safety, and therapeutic capabilities, particularly for complex intraluminal and transluminal interventions. Increased visual angles, increased degrees of freedom of instrumentation, optimized navigation, and locomotion, which may lead to a reduced physician learning curve and workload, are promising achievements with the promise to ultimately replace conventional endoscopy techniques for screening and therapeutic endoscopy. The majority of these devices are not commercially available yet. The best clinical applications are also currently being researched. Nonetheless, robotic assistance may encourage surgeons to use flexible endoscopes to administer surgical therapies and increase interest among gastroenterologists in advanced therapies. Robotics may be a means to overcome the technical obstacles of incisionless natural orifice procedures and favor an increased adoption of complex endoscopic procedures such as third-space therapies.

Clinical applicability of gastroscopy with narrow-band imaging for the diagnosis of Helicobacter pylori gastritis, precancerous gastric lesion, and neoplasia.

Premalignant gastric lesions such as atrophic gastritis and intestinal metaplasia frequently occur in subjects with long-term Helicobacter pylori (H. pylori) infection. The regular arrangement of collecting venules (RAC) is seen in the normal gastric corpus, whereas mucosal swelling and redness without RAC are observed in H. pylori-infected mucosa. Despite successful H. pylori eradication, the presence of atrophic gastritis and/or gastric intestinal metaplasia (GIM) is a risk factor for gastric cancer. With the development of advanced imaging technologies, recent studies have reported the usefulness of narrow-band imaging (NBI) for endoscopic diagnosis of atrophic gastritis and GIM. Using NBI endoscopy with magnification (M-NBI), atrophic gastritis is presented as irregular coiled microvessels and loss of gastric pits. Typical M-NBI endoscopic findings of GIM are a light blue crest and a white opaque substance. Based on the microvascular patterns, fine network, core vascular, and unclear patterns are useful for predicting gastric dysplasia in polypoid lesions. For diagnosis of early gastric cancer (EGC), a systematic classification using M-NBI endoscopy has been proposed on the basis of the presence of a demarcation line and an irregular microvascular/microsurface pattern. Furthermore, M-NBI endoscopy has been found to be more accurate for determining the horizontal margin of EGC compared to conventional endoscopy. In this review, we present up-to-date results on the clinical usefulness of gastroscopy with NBI for the diagnosis of H. pylori gastritis, precancerous gastric lesion, and neoplasia.

Utility of narrow band imaging in predicting histology in celiac disease.

Narrow band imaging (NBI) with magnification better visualizes the duodenal microsurface and mucosal vascularity. NBI delineates villous atrophy better than conventional white light endoscopy. This study was conducted to evaluate the diagnostic accuracy of narrow band imaging with magnification(NBI-ME) in celiac disease(CD). In this prospective study, consecutive patients of suspected CD and controls were subjected to tissue transglutaminase antibody test and endoscopic evaluation initially with white light followed by NBI-ME, and biopsies were taken from duodenum. Duodenal villous patterns on NBIwere interpreted as normal, blunted distorted, and absent. Severity of villous atrophy was reported according to the modified Marsh criteria. One hundred andtwenty-two patients (mean age of 27.53 ± 13.37years and a male to female ratio of 1:1.26) and 40 controls were studied. The sensitivity and specificity of NBI-ME in predicting villous atrophy were found to be 95.54% and 90%, respectively. The specificity and negative predictive value of NBI-ME in predicting villous atrophy amongst controls was 100% and 97.5%, respectively. Abnormal findings (blunted and absent villous patterns) combined with elevated transglutaminase antibody (> 5-fold) were found to have high accuracy in predicting villous atrophy. NBI with magnification has high sensitivity and specificity in predicting villous atrophy in patients with celiac disease.

Analysis of current and future technologies of capsule endoscopy: A mini review

Many existing methods of endoscopy can be very uncomfortable and potentially even painful for a patient. Using a conventional endoscope is also limited in its usable range, unable to access a majority of the small bowel. Recent advancements in LEDs, optical design, and MEMS (microelectromechanical systems) technologies have provided the ability to create a wireless endoscope. Since its inception, the capsule endoscope has seen advancements in existing technology as well as the introduction of new components. As the capsule endoscope continues to advance, more application possibilities will grow as well.

Endoscopic ultrasound in chronic liver disease.

Endoscopic ultrasound (EUS) is a minimally invasive diagnostic and therapeutic modality with a number of established as well as evolving uses in patients with chronic liver disease. Compared to other diagnostic tools such as cross-sectional imaging or conventional endoscopy, EUS has been shown to increase diagnostic sensitivity and therapeutic success for many clinical scenarios and applications with a low rate of adverse events. In this review, we discuss and focus on the current and growing role of EUS in the evaluation and/or treatment of hepatobiliary masses, hepatic parenchymal disease, portal hypertension, esophageal and other varices, and indeterminate biliary strictures.

Artificial intelligence for the detection of esophageal and esophagogastric junctional adenocarcinoma.

Conventional endoscopy for the early detection of esophageal and esophagogastric junctional adenocarcinoma (E/J cancer) is limited because early lesions are asymptomatic, and the associated changes in the mucosa are subtle. There are no reports on artificial intelligence (AI) diagnosis for E/J cancer from Asian countries. Therefore, we aimed to develop a computerized image analysis system using deep learning for the detection of E/J cancers. A total of 1172 images from 166 pathologically proven superficial E/J cancer cases and 2271 images of normal mucosa in esophagogastric junctional from 219 cases were used as the training image data. A total of 232 images from 36 cancer cases and 43 non-cancerous cases were used as the validation test data. The same validation test data were diagnosed by 15 board-certified specialists (experts). The sensitivity, specificity, and accuracy of the AI system were 94%, 42%, and 66%, respectively, and that of the experts were 88%, 43%, and 63%, respectively. The sensitivity of the AI system was favorable, while its specificity for non-cancerous lesions was similar to that of the experts. Interobserver agreement among the experts for detecting superficial E/J was fair (Fleiss' kappa=0.26, z=20.4, P<0.001). Our AI system achieved high sensitivity and acceptable specificity for the detection of E/J cancers and may be a good supporting tool for the screening of E/J cancers.

The value of narrowband imaging using the Ni classification in the diagnosis of laryngeal cancer.

IntroductionNarrowband imaging (NBI) is a special endoscopic optical enhancement setting allowing better visualization of mucosal microvasculature compared to white light endoscopy. This study evaluates the validity of NBI using the Ni classification in the detection and differentiation of severe dysplasia (SD) and glottic squamous cell carcinoma (SCC).MethodsPatients with suspicious vocal cord lesions underwent conventional white light endoscopy followed by clinically indicated biopsy. At the same time, NBI images were obtained and graded independently. Lesions were graded from I to V according to the Ni classification and compared to histopathological findings.ResultsFifty‐two patients were included in this study (40 SCC and 12 SD). The sensitivity and specificity of NBI in diagnosing laryngeal cancer was 95.0% (CI, 83.9%‐99.4%) and 83.3% (CI, 51.6%‐97.9%), respectively. The negative likelihood ratio was 0.06. Higher Ni grades correlated very strongly with more advanced disease.ConclusionsNBI using the Ni classification is a sensitive diagnostic tool for the detection and differentiation of early neoplastic and preneoplastic glottic lesions. As higher Ni classification correlates strongly with advanced disease, it serves as a useful adjunct to white light endoscopy in the diagnosis of laryngeal cancer.Level of Evidence: Level IV.

Serum iron and vitamin B 12 deficiency could indicate celiac disease by flexible spectral imaging color enhancement.

INTRODUCTION Celiac disease (CeD) is an autoimmune disease that can be delayed in diagnosis due to the presence of atypical and asymptomatic cases in adulthood. Herein we aimed to study the frequency of CeD and evaluate whether magnified endoscopy and magnified/FICE (flexible spectral imaging color enhancement) techniques contribute to the diagnosis in patients with serum iron and vitamin B12 deficiency. METHODS We evaluated 50 adult patients (10 males and 40 females) who had serum iron and vitamin B12 deficiency, prospectively. All the patients had undergone upper gastrointestinal system endoscopy by the same endoscopist. The second part of the duodenum was evaluated with white light, magnified, and magnified/FICE endoscopy. Biopsy specimens were evaluated by the same pathologist. The specimens diagnosed as CeD were classified according to the Modified Marsh-Oberhuber criteria. RESULTS 10 of 50 patients (20%) were diagnosed as CeD. The average age was 41±11 years (20-67 years). Thirty percent of CeD diagnosed patients had typical CeD symptoms. Six of 10 patients (60%) who were diagnosed as CeD had typical endoscopic images under white lighted endoscopy. All of these 10 patients (100%) showed villous irregularity, partial villous atrophy, or total villous atrophy consistent with CeD with magnified and magnified/FICE endoscopy. CONCLUSION The practical use of magnified/FICE endoscopy allows us to differentiate mucosal abnormalities of the duodenum and minimize false-negative results that indicate normal mucosal findings with conventional endoscopy.

Interpretation of Benign Gastric Mucosal Lesions Using Narrow-Band Imaging

AbstractThe major drawback of conventional white light endoscopy (WLE) is that it lacks accuracy in diagnosis and differentiation of various benign and premalignant mucosal gastrointestinal lesions. To overcome this, image-enhanced endoscopy techniques, which provide high-definition images with good resolution and contrast enhancement, have been developed. One such technique is narrow-band imaging (NBI). NBI functions by filtering the illumination light. The red component of the standard red, green, and blue filters is rejected and the selected bandwidth of the blue and green light is transmitted. The present review highlights the role of NBI in diagnosis of benign gastric lesions like atrophic gastritis, Helicobacter pylori–related gastritis, intestinal metaplasia, and other rarer conditions. NBI is a simple procedure which does not require any additional equipment and does not have a long learning curve. Use of NBI in daily practice is likely to improve detection of mucosal abnormalities.

Magnifying i-scan Imaging for Endoscopic Diagnosis of Helicobacter pylori Infection: A Prospective Study

Abstract Background DEFINA (EPK 3000) plus (with i-scan) is a digital chromoendoscopy. It uses surface/tone/contrast enhancement for detection, demarcation, and characterization of lesions. The aim of this study was to compare the usefulness of i-scan and conventional magnification white light endoscopy (M-WLE) for diagnosing Helicobacter pylori (Hp) infection in stomach. Patients and Methods Subjects undergoing evaluation for functional dyspepsia were prospectively enrolled at Ramaiah Medical College and Hospitals, Bangalore from November 2018 to February 2019. In total, 68 participants underwent gastroscopy with standard M-WLE followed by i-scan. Two biopsies from greater curve at 3 cm from the angulus were collected for histology. Successful diagnosis of Hp using imaging modality with M-WLE and i-scan were compared with histology. Results A total of 68 (36 men and 32 women) patients with a mean age of 47 ± 13 years (range 18–75 years) were enrolled in our study. The prevalence of Hp on the biopsies was 41%; 64% of the patients used proton pump inhibitors, 20% were current smokers; 25% of the patients were consuming alcohol. The sensitivity: 96.4%; specificity: 95%; accuracy: 95.5% of i-scan in diagnosis of Hp gastritis is better than the sensitivity: 50%; specificity: 50%; accuracy: 50% with M-WLE. Conclusion In conclusion, the diagnostic ability of i-scan (95%) for predicting Hp status is acceptable as compared with M-WLE (50%) for accurate diagnosis. The results suggest that i-scan improves endoscopic diagnostic accuracy of Hp infection compared with M-WLE.

Tu1044 IMPACT OF THE SAME DAY, UN-SEDATED, ULTRATHIN DISPOSABLE GASTROSCOPY IN THE MANAGEMENT OF CIRRHOTIC PATIENTS WHO ATTENDED OUTPATIENT CLINIC: A PROSPECTIVE LONGITUDINAL STUDY

Ultrathin disposable gastroscope (TDG) can identify gastro-esophageal varices (GEVs) in cirrhotic patients [1]. The clinical impact of un-sedated TDG on the management of cirrhotic patients in outpatient setting is unknown. This study aimed to evaluate the feasibility, tolerability and clinical outcomes of performing the same day, un-sedated (TDG) for screening or surveillance of GEVs in cirrhotic patients who attend outpatient clinic. Cirrhotic patients who were scheduled to attend liver clinic for evaluation of portal hypertension were approached for the study. Subjects fasted 6 hours prior to the clinic appointment time for a potential upper gastroscopy. Study information was mailed to the patients 3 to 4 weeks prior, and the patient’s participation was confirmed a week prior the appointment. After hepatology consultation, patients who required an upper gastroscopy to assess for the presence of GEVs underwent an un-sedated TDG with oro-laryngeal local anaesthesia in the clinic. Videos were recorded in all patients so that the findings can be validated by an independent endoscopist. Spielberg’s State-Trait Anxiety Inventory (STAI-Y) score (0-100), visual analogue scale (VAS) pain score (0-10), VAS satisfactory score (0-100) and adverse effects were assessed. Clinical outcomes over 12 months after TDG were recorded in all patients. 24 consecutive cirrhotic patients (58.6 ± 1.2 years; 14 M:10F; alcohol =11, NAFLD =9, hepatitis C = 3 and hepatitis B =1) who met the inclusion criteria underwent un-sedated TDG for screening (n = 15) or surveillance (n = 9) of GEVs over 6 months. TDG identified GEVs in 19 (79%) patients, 4 of whom (15%) had high-risk GEVs. Inter-observer agreement for all GEVs was 88% (κ = 0.74), which increased to 94% (κ = 0.82) for high-risk GEVs. There were no adverse events from the TDG. 22(91%) patients were satisfied with the procedure, with low anxiety STAI-Y scores (29.9 ± 6.6) and low VAS pain score (2.2±1.2). All patients completed 12-month follow-up and TDG findings led to immediate change in management of 17 (70.8%) patients, in whom 15 (62.5%) received beta-blocker therapy and 2 (8.3%) underwent variceal band ligation. No patients re-presented earlier to hospital for variceal bleeding other than their annual review. This approach would prevent multiple hospital visits for conventional endoscopy, which is most beneficial for the 9 (38%) country patients. Same day un-sedated TDG to identify the presence of GEVs in cirrhotic patients is highly feasible and tolerable in outpatient setting. The high diagnostic yield (70%) with good inter-observer agreement allowed rapid decision making that can positively impact on the management of most patients and potentially reduces the number of hospital visits.

1111 SECOND-GENERATION MAGNETICALLY CONTROLLED CAPSULE GASTROSCOPY FOR BETTER DIAGNOSIS OF UPPER GASTROINTESTINAL TRACT: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Compared to conventional endoscopy, magnetically controlled capsule gastroscopy (MCCG) can be further optimized in gastric examination time and complete visualization of upper gastrointestinal (UGI) mucosa. The second-generation MCCG (MCCG-2) was developed with higher image resolution and adaptive frame rate, and we aimed to evaluate its clinical availability for UGI examination in this study. Consecutive patients undergoing MCCG examination between May to June 2019 were prospectively enrolled and randomized to swallow the first-generation MCCG (MCCG-1) or MCCG-2 in a 1:1 ratio. The main outcomes included visualization of the esophagus and duodenum, operation related parameters, image quality, maneuverability, detection of lesions, as well as safety evaluation. Eighty patients were enrolled. In MCCG-2 group, frames captured for esophageal mucosa and Z-line were 171.00 and 2.00, significantly increased from those in MCCG-1 group with 97.00 and 0.00 (P=0.002 and 0.028). The gastric examination time was shortened from 7.78±0.97 min to 5.27±0.74 min (P<0.001), with the total running time of capsule extended from 702.83 min to 1001.99 min (P<0.001). MCCG-2 also greatly improved the image quality (P<0.001) and maneuverability (P<0.01). No statistical difference existed in the detection of lesions between the two groups, and no adverse events occurred. MCCG-2 showed better performance in mucosal visualization, examination duration and maneuverability, making better diagnosis of UGI diseases a possibility.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Extended Depth-of-Field of a Miniature Optical Endoscope Using Wavefront Coding

Endoscopic imaging is an indispensable tool for visual inspection of surfaces in hard-to-access places. The conventional optical endoscope only enables imaging the regions that lie close to the focal plane, and therefore improving the depth of field (DOF) of an endoscopic system has recently attracted much attention. Here, we propose and demonstrate a simple, cost-effective, and easily available industrial endoscopic system, which is composed of a rigid tube and group of optical lenses. The outer diameter of the designed endoscopic modality presented in this article is 3 mm. By employing the wavefront coding technique, the DOF of newly-designed endoscope was extended to 2.7 mm in the proof-of-concept experiment, which is an increase of almost 10 times compared to the initial counterpart.

Magnifying endoscopy with narrow-band image for diagnosing diffuse type of gastric antral vascular ectasia in cirrhotic patients.

Gastric antral vascular ectasia (GAVE) and portal hypertensive gastropathy (PHG) can cause gastrointestinal bleeding in cirrhotic patients. Distinguishing diffuse-type GAVE and severe PHG is important but difficult by conventional endoscopy and endoscopic biopsy. The aim of this study is to evaluate the value of magnifying endoscopy with narrow-band image for diagnosing diffuse-type GAVE in cirrhotic patients. From January 2010 to December 2013, cirrhotic patients with diffuse red spots of stomach in suspicion of diffuse-type GAVE on conventional endoscopy in a tertiary medical center were included. The detection of diffuse red spots on magnifying endoscopy with narrow-band image (NBI) was classified into ring-pattern which suggested GAVE and mosaic-pattern which suggested non-GAVE. The golden diagnosis of GAVE was based on histological criteria of GAVE score ≥3 by any one of two endoscopic sessions. Total 27 cirrhotic patients were included. Twenty-two patients reached the diagnosis of GAVE and five patients were diagnosed of non-GAVE by histology. The diagnostic rate of conventional endoscopy was 81.5% (22/27). The positive rate of initial endoscopic biopsy was 77.2%. On magnifying endoscopy with NBI, the sensitivity, specificity, positive, negative predicted rate and accuracy of ring-pattern for the diagnosis of GAVE were 100, 90, 96.4, 100 and 97.3%. Kappa coefficient of inter-observer agreement for differentiating the ring and mosaic-pattern was 0.92. The efficacy and accuracy of magnifying endoscopy with NBI for diagnosing diffuse-type GAVE in cirrhotic patients have been demonstrated. It can avoid repeated endoscopy to confirm diagnosis and obviate the invasive biopsy in cirrhotic patients.

Duodenal tumors on cross-sectional imaging with emphasis on multidetector computed tomography: a pictorial review.

Duodenal tumours are uncommon, but they can cause significant morbidity and mortality. As stomach and colon are a more common site of gastrointestinal malignancies, radiologists sometimes neglect the duodenum. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) can accurately locate and characterize mass-forming duodenal lesions, making them invaluable for the differential diagnosis and determining management strategies such as biopsy or surgery. Although conventional endoscopy continues to play an important role in the diagnosis of duodenal tumors, MDCT and MRI are very useful for evaluating the duodenal wall, extraduodenal space, and surrounding viscera, as well as the intraluminal content seen on endoscopy. This pictorial review aims to illustrate the most common benign and malignant mass-forming duodenal lesions and to focus on the imaging features that are most helpful in reaching the correct diagnosis.

Semi-automatic Knob System for Assisting Flexible Endoscope Steering

In this paper, a semi-automatic knob system for assisting control of flexible endoscope is introduced. For conventional flexible endoscope, the torque to bend the bending part is increased proportionally to the curvature of the insertion tube. As the bending angle increases, the required torque is increased. This characteristic makes a surgeon tired. The proposed semi-automatic knob system consists of a knob controller, a power generation unit, and a bending part. The knob controller includes four FSR (force sensitive resistor) sensors to measure external force applied by the operator. The power generation unit generates the power depending on the signal level of FSR sensors. Using the semi-automatic knob system, a user can control the steering of the flexible endoscope with less power as compared to conventional flexible endoscope. The usefulness of the proposed system is verified through experiments.

3D reconstruction of small bowel lesions using stereo camera-based capsule endoscopy

Three-dimensional (3D) reconstruction of capsule endoscopic images has been attempted for a long time to obtain more information on small bowel structures. Due to the limited hardware resources of capsule size and battery capacity, software approaches have been studied but have mainly exhibited inherent limitations. Recently, stereo camera-based capsule endoscopy, which can perform hardware-enabled 3D reconstruction, has been developed. We aimed to evaluate the feasibility of newly developed 3D capsule endoscopy in clinical practice. This study was a prospective, single-arm, feasibility study conducted at two university-affiliated hospitals in South Korea. Small bowel evaluation was performed using a newly developed 3D capsule endoscope for patients with obscure gastrointestinal bleeding, suspected or established Crohn’s disease, small bowel tumors, and abdominal pain of unknown origin. We assessed the technical limitations, performance, and safety of the new capsule endoscope. Thirty-one patients (20 men and 11 women; mean age: 44.5 years) were enrolled. There was no technical defect preventing adequate visualization of the small bowel. The overall completion rate was 77.4%, the detection rate was 64.5%, and there was no capsule retention. All capsule endoscopic procedures were completed uneventfully. In conclusion, newly developed 3D capsule endoscopy was safe and feasible, showing similar performance as conventional capsule endoscopy. Newly added features of 3D reconstruction and size measurement are expected to be useful in the characterization of subepithelial tumours.

Barrett-Screening: Rational, current concepts and perspectives

Though showing an increasing incidence over the past 20years, esophageal adenocarcinoma (EAC) remains a rather uncommon cancer (i. e., compared to colorectal and gastric cancer). Once detected, the prognosis of this cancer entity is still very poor. Hence, in spite of some unfavorable prerequisites to systematic screening, the development of a screening concept for Barrett's esophagus (BE) and EAC seems worthwhile. Nowadays, screening for BE and EAC is based on conventional endoscopy, mostly conducted individually in patients with reflux complaints (gastroesophageal reflux disease-GERD). Biopsies are taken obligatorily and are the centerpiece of diagnosis and scheduling of surveillance. So far, endoscopy is the diagnostic gold standard, but it is expensive and obviously lacks effectiveness - 8 of 10 cases of EAC are not detected in endoscopic screening (and surveillance) but by an opportunistic first-time endoscopy. Therefore, new methods for BE/EAC screening are strongly desirable. Research must be concentrated to favor procedures applicable for a screening of the population in a primary care setting. For that, the first step needs to consist of identifying a subgroup of people "at risk", which in a second step can be risk assessed and followed up by endoscopy and biopsy. From all screening variants, which have been actually tested in clinical application and experimental research, biomarker-based techniques seem to be most promising. Among those-under the aspect of costs and practicability-the Cytosponge, in addition with a panel of biomarkers, seemed to be promising in clinical trials.