Diagnosis Of Gastrointestinal Lesions Research Articles

Endocytoscopy: technology and clinical application in upper gastrointestinal tract.

Over the past few years, the innovative field of magnifying endoscopy has been expanding with various cutting-edge technologies, one of which is endocytoscopy, to facilitate improvement in the detection and diagnosis of gastrointestinal lesions. Endocytoscopy is a novel ultra-high magnification endoscopic technique enabling high-quality in-vivo assessment of lesions found in the gastrointestinal tract with the use of intraprocedural stains. The main scope of this review article is to offer a closer look at the latest endocytoscopic technology and its clinical application in the upper gastrointestinal tract, especially in the esophagus and stomach, as well as to introduce readers to our simplified and up-to-date endocytoscopic classification, specifically developed for the esophagus and stomach, for the in-vivo assessment and diagnosis of esophageal and gastric lesions. Despite the good accuracy of endocytoscopy in the diagnosis of esophageal and gastric lesions in recent studies, some challenges still remain (e.g., staining method and standardized endocytoscopic classification). Through continuous evaluation and improvement of methods and skills, these challenges may be overcome thus establishing current techniques and classification, paving the way for further advances in the field of endocytoscopy and magnifying endoscopy. In all, endocytoscopy seems to aid in the in-vivo diagnosis of gastrointestinal tract lesions and may, in the future, revolutionize the field of in-vivo endoscopic diagnosis of gastrointestinal cancer, representing another step towards the so-called optical biopsy.

The diagnostic efficiency of ultrasound-guided biopsy of gastrointestinal lesions

Objective To explore the diagnostic efficiency of ultrasound-guided biopsy in the diagnosis of gastrointestinal lesions. Methods The study retrospectively analyzed 41 cases who underwent ultrasound-guided biopsy and diagnosis were confirmed as gastrointestinal lesions either by surgery resections or by biopsies in our hospital from January 2006 to April 2018. The detection rate and the safety in the diagnosis of gastrointestinal lesions by ultrasound-guided biopsy were evaluated and they were compared with clinical efficiency of the endoscopic biopsy. Results ⑴ Of the 41 cases underwent ultrasound-guided biopsies, 38 cases were confirmed by pathology. A 92.7% detection rate had achieved by ultrasound-guided biopsies. In the 38 cases, the diagnoses were grouped in benign and malignant, with 29 malignant and 9 benign. ⑵ Among the 13 cases examined by both of the ultrasound-guided biopsy and endoscopic biopsy, the diagnostic accuracy of ultrasound-guided biopsy was 84.6% and 61.5% with endoscopy. No significant difference (P=0.378) between the two modalities. ⑶ No complication occurred with both of methods. Conclusions Ultrasound-guided biopsy of gastrointestinal lesions is a safe and effective method. It would be an alternative solution to provide clinicians with reliable diagnosis, especially when endoscopic diagnosis is not inapplicable or failed. Key words: Ultrasonography; Image-guided biopsy; Gastrointestinal tract

Su1985 Comparative Effectiveness of Novel Fine-Needle Biopsy Device vs Conventional Fine Needle Aspiration for Endoscopic Ultrasound Diagnosis of Gastrointestinal Lesions

Su1985 Comparative Effectiveness of Novel Fine-Needle Biopsy Device vs Conventional Fine Needle Aspiration for Endoscopic Ultrasound Diagnosis of Gastrointestinal Lesions

Confocal endomicroscopy: Is it time to move on?

Confocal laser endomicroscopy permits in-vivo microscopy evaluation during endoscopy procedures. It can be used in all the parts of the gastrointestinal tract and includes: Esophagus, stomach, small bowel, colon, biliary tract through and endoscopic retrograde cholangiopancreatography and pancreas through needles during endoscopic ultrasound procedures. Many researches demonstrated a high correlation of results between confocal laser endomicroscopy and histopathology in the diagnosis of gastrointestinal lesions; with accuracy in about 86% to 96%. Moreover, in spite that histopathology remains the gold-standard technique for final diagnosis of any diseases; a considerable number of misdiagnosis rate could be present due to many factors such as interpretation mistakes, biopsy site inaccuracy, or number of biopsies. Theoretically; with the diagnostic accuracy rates of confocal laser endomicroscopy could help in a daily practice to improve diagnosis and treatment management of the patients. However, it is still not routinely used in the clinical practice due to many factors such as cost of the procedure, lack of codification and reimbursement in some countries, absence of standard of care indications, availability, physician image-interpretation training, medico-legal problems, and the role of the pathologist. These limitations are relative, and solutions could be found based on new researches focused to solve these barriers.

Imprint cytology: A diagnostic aid in interpretation of upper gastrointestinal endoscopic biopsies

Abstract Context: Although major advances have occurred in the cytological diagnosis of various organ pathologies, gastrointestinal (GI) cytology has not gained popularity and is only occasionally practiced in the form of brushings and washings. Biopsy touch imprint cytology (IC) is a rapid, simple and inexpensive method of diagnosis of upper GI lesions. Thus, a study to show a correlation of IC and standard histopathology will allow the procedure to be performed routinely as adjunct to histopathology. Aims: To correlate results of imprints made from upper GI biopsies with histopathology in case of suspected upper GI lesions and to compare detection of Helicobacter pylori by IC and histopathology in suspected H. pylori infection. Subjects and Methods: One hundred and ten cases of upper GI endoscopic biopsies were included in the study. Touch imprints were made from the biopsies, stained and studied. The same tissue was put in 10% formalin for histopathological processing. Results of IC were compared with histopathology. Statistical Analysis Used: Chi-square/Fisher exact test were used to find out significance of study parameters. Results: Sensitivity and specificity of IC for neoplastic lesions were 94.3%, 100% for esophageal lesions; 88.2%, 97.14% for gastric lesions and 100%, 100% for duodenal lesions respectively, which correlated with other studies. Imprint smears for H. pylori had sensitivity of 80%, which was higher than that of brush cytology. Conclusions: IC is a valuable diagnostic tool and can be routinely applied as an adjunct to histopathological examination in the diagnosis of GI lesions.

Correlation of endoscopic brush cytology with biopsy in diagnosis of upper gastrointestinal neoplasms

Neoplasms of upper gastrointestinal tract, especially malignancy, are one of the leading causes of death worldwide. The advent of endoscopy has greatly facilitated the detection and diagnosis of gastrointestinal lesions. Although it has been shown that the combined use of cytology and biopsy renders the highest probability of detecting malignancy, the merit of routine brush cytology has been questioned since it appears to duplicate biopsy. This study is undertaken to correlate the findings of brush cytology with tissue biopsy and the feasibility of the procedure as an adjunct in diagnosis of upper gastrointestinal tract neoplasms. Seventy-five patients with upper gastrointestinal tract symptoms were subjected to endoscopy in a period of two years. Brushing was done before the biopsy was taken from the suspected lesions and cytological findings were compared with that of biopsy. Of the 75 cases, brush cytology was positive for malignancy in 65 cases (86.66%) and biopsy was positive in 58 cases (77.33%); the sensitivity of the study was 98.03%. Thus, brush cytology is a useful adjunct to biopsy in the diagnosis of upper gastrointestinal tract malignancy. With the inclusion of a "suspicious" category in the reporting of the smears, malignancy can be detected early, and if possible, patient management can be altered.

4524 Hemodynamics of esophageal varices observed by three-dimensional endoscopic ultrasonography and selection of endoscopic treatment.

Background: Endoscopic variceal sclerotherapy (EVS) and endoscopic variceal ligation (EVL) are known to be equally effective for the treatment of esophageal varices. However, the indications for each type of therapy have not been decided. Endoscopic ultrasonography (EUS) is a well-accepted procedure for the diagnosis of gastrointestinal lesions, and three-dimensional (3D) imaging has recently been developed. Aims: The aim of this study was to observe the hemodynamics of esophageal varices using 3DEUS and to examine the selection of endoscopic treatment. Subjects and Methods: 3D-EUS was done with a 3D ultrasonic image processing system (EU-M30, EU-IP-2, Olympus Optical Co. Ltd.) using a small probe (12 MHz, 3.4 mm in diameter) by the mechanical spiral scanning method (length of 40 mm and pitch of 0.5 mm) with water irrigation. The area from the cardia to the distal esophagus was scanned before treatment, and 3D images were prepared that clearly displayed the architecture of the esophageal varices. The pattern of variceal blood flow detected on 3D images was classified into 4 types according to its architecture. Type 1 was cardial inflow without collateral vessels, Type 2 was cardial inflow with collateral vessels, Type 3 was an azygos-perforating pattern, and Type 4 was a complicated pattern. Thirty-four patients (100%) with esophageal varices underwent 3D-EUS observation. Subsequently, 23 patients were treated by EVS using 5%ethanolamine oleate and 11 patients by EVL, after which the results were assessed. Results: Based on 3D-EUS data, 16 patients (47.1%) were classified as Type 1, 4 patients (11.8%) as type 2, 4 patients (11.8%) as type 3, and 10 patients (29.4%) as Type 4. Three sessions of either EVS or EVL initially eradicated Type 1 esophageal varices, but recurrence was observed in 2 of 11 patients (18.2%) treated by EVS and in 3 of 5 patients (60.0%) treated by EVL. Type 3 varices were eradicated by 2.0 sessions of EVL, with none of the 3 patients showing recurrence. Conclusions: It was easy to assess the architecture of esophageal varices on 3D images. Based on the 3D-EUS findings, varices could be classified into 4 types and this classification was useful for the selection of endoscopic treatment. To treat the cardial inflow type without collateral vessels, obliteration of the feeding vessels is necessary, so EVS is selected. When collateral vessels are present and variceal blood flow can shift to the collateral pathways, EVL is more efficient should be selected.

Diagnosis of gastrointestinal lesions during treatment with non-steroidal anti-inflammatory drugs.

Probably all non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of gastrointestinal (GI) mucosal injury. The most frequent lesions are gastric erosions in the pre-pyloric region. Non-steroidal anti-inflammatory drugs also increase the incidence of peptic ulcers, although it is not yet clear whether more gastric ulcers or more duodenal ulcers are produced. Gastrointestinal symptoms are prevalent during NSAID treatment, but there is no correlation between symptoms and lesions. Clinical presentation may therefore vary considerably: many symptomatic patients will have no lesions, whereas others will present with complications but no symptoms. Blood loss is the most frequent complication of NSAID-induced GI lesions. Bleeding is usually 'silent' and occult. Overt haemorrhage, though rare, is more frequent in patients taking NSAIDs. Other complications, such as penetration and perforation, may also occur. Endoscopy is the diagnostic method of choice, as this method can detect even superficial mucosal lesions. However, because of the lack of correlation between symptoms and lesions, it is difficult to ascertain which patients are at risk and thus to avoid unnecessary diagnostic procedures. Future efforts should therefore be directed towards the prevention of NSAID-induced GI lesions.

Thickness of the gastric wall determined by megavoltage roentgenography.

Diagnostic roentgenograms obtained with the use of generators of 1,000 or higher kvp have potential advantages over conventional roentgenograms. The coefficients of absorption of bone and soft tissue are nearly the same when exposed to rays of the megavoltage range. A wide separation, however, still remains between these coefficients and that of air (or other gas). These factors should have the effect of diminishing contrast between soft tissues and bone, thus enhancing the visualization of structures outlined by gas. The enhanced delineation more than compensates for the loss of contrast. The advantages of megavoltage have been observed in films of the chest and mediastinum (6, 7, 9, 10), the skull (4), and the pharynx and trachea, as well as in air myelograms and retroperitoneal air studies (6). A review of the literature revealed that the technic had not been applied in the diagnosis of gastrointestinal lesions, but one author has suggested its use (5). An experiment was designed to determine whether, in examining the air-outlined gastric wall, megavoltage roentgenograms offered advantages over conventional x-ray examinations. More specifically, a comparison was made between plain films, tomograms, and megavoltage roentgenograms. Method One or more artificial tumors were implanted in the gastric wall of 24 New Zealand white rabbits and 10 mongrel cats. The “tumors” were of two types. One was a small Lucite ovoid or sphere, 4 to 6 mm in diameter, sewn into the gastric wall through a small incision in the serosa and intended to simulate a localized tumor. The other was a measured volume (0.5 to 3.0 cc) of a heated, concentrated solution of clear gelatin injected beneath the serosa through a 17-gauge needle and intended to simulate an infiltrating tumor. The distal esophagus and proximal duodenum were ligated with umbilical tape, and the stomach was moderately distended by the introduction of air through a 25-gauge needle. The abdominal incision was sutured in 3 layers to ensure an airtight closure. The peritoneal space was then filled with gas through a 25-gauge needle inserted through the abdominal wall, and conventional films, tomograms, and megavoltage roentgenograms were obtained (Figs. 1, 2). The Massiot-Philips polytome was used with hypocycloidal movement. A 1 MeV-peak Maxitron generator was employed with a lead-screen cassette. DuPont Cronex Safety I film was used for all 3 of the procedures. The precise position of the “tumor” was recorded at the time of its insertion. Roentgenograms obtained by each of the 3 procedures were evaluated by an experienced radiologist. Those of the rabbits were evaluated twice, allowing a thirty-day interval between readings. The presence or absence of tumor, the type of tumor (localized or infiltrating), and the position were noted and recorded. Results In the experiments in rabbits, the “tumors” were detected with equal success on plain and megavoltage roentgenograms during the first reading (Table I).

SIGMOIDOSCOPY VERSUS X-RAYS IN THE DIAGNOSIS OF TERMINAL BOWEL DISEASE

During the period of thirty-five years since Professor Roentgen discovered the x-rays and Howard Kelly introduced standard rectoscopes, refinements in the technic of roentgenology and improvements in proctoscopes havemade these two agents prime factors in the diagnosis of gastro-intestinal diseases. Each method has its indications, advantages and limitations, and frequently the two are mutually helpful in reaching a correct diagnosis. The roentgen ray has a wide range of applicability and has proved its value in the diagnosis of gastrointestinal lesions, notably in the movable portions of the tract, as the stomach and colon; in demonstrating position, contour, function, points of stasis and defects indicating pathologic changes. In the relatively fixed rectum and distal sigmoid colon, however, which are situated largely within the bony pelvic girdle, the x-rays are of comparatively limited value. Prominent defects are that: An important lesion may be missed entirely. Although the site and apparent extent of