Endoscopic Diagnosis Research Articles

Endoscopic diagnosis and treatment of colorectal tumors and future prospects

Endoscopic diagnosis and treatment of colorectal tumors and future prospects

Histopathology Features of H. pylori Gastritis Associated With Altered Lipid Profile: An Observational Study from a Tertiary Healthcare Center in North West Romania.

H. pylori infection can promote a systemic inflammatory syndrome, eventually leading to intestinal metaplasia and gastric cancer. The aim of our study was to investigate the possible association between dyslipidemia and histopathological features of H. pylori gastritis. An observational, retrospective study was conducted over the period 2017-2022 on symptomatic patients with a positive rapid urease test. A total of 121 patients who underwent upper gastrointestinal endoscopy with stomach biopsy were enrolled in this study. Based on the updated Sydney System, we investigated the association between neutrophils, mononuclear cells, intestinal metaplasia, or gastric atrophy and altered lipid profiles. A high prevalence of H. pylori infection was noticed in the studied group upon the application of the rapid urease test, being associated with dyslipidemia regardless of patient sex. All the endoscopic diagnoses (acute, chronic, or atrophic chronic gastritis, metaplasia) correlated with the histopathological features. Mononuclear cells and metaplasia were more likely to be found in H. pylori-positive patients with dyslipidemia, which is consistent with acute and chronic inflammation caused by H. pylori in the gastric mucosa. Although our study was conducted on a small scale, it offers new insights and details regarding H. pylori infection and histopathological features. Mononuclear cells and metaplasia were associated with an altered lipid profile in H. pylori-positive patients. These findings warrant future investigation, such as the evolution of gastric biopsies and lipid profiles before and after eradication.

Comparison of Endoscopic and Artificial Intelligence Diagnoses for Predicting the Histological Healing of Ulcerative Colitis in a Real-World Clinical Setting.

Artificial intelligence (AI)-assisted colonoscopy systems with contact microscopy capabilities have been reported previously; however, no studies regarding the clinical use of a commercially available system in patients with ulcerative colitis (UC) have been reported. In this study, the diagnostic performance of an AI-assisted ultra-magnifying colonoscopy system for histological healing was compared with that of conventional light non-magnifying endoscopic evaluation in patients with UC. The data of 52 patients with UC were retrospectively analyzed. The Mayo endoscopic score (MES) was determined by 3 endoscopists. Using the AI system, healing of the same spot assessed via MES was defined as a predicted Geboes score (GS) < 3.1. The GS was then determined using pathology specimens from the same site. A total of 191 sites were evaluated, including 159 with a GS < 3.1. The MES diagnosis identified 130 sites as MES0. A total of 120 sites were determined to have healed based on AI. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MES0 for the diagnosis of GS < 3.1 were 79.2%, 90.6%, 97.7%, 46.8%, and 81.2%, respectively. The AI system performed similarly to MES for the diagnosis of GS < 3.1: sensitivity, 74.2%; specificity: 93.8%; PPV: 98.3%; NPV: 42.3%; and accuracy: 77.5%. The AI system also significantly identified a GS of < 3.1 in the setting of MES1 (P = .0169). The histological diagnostic yield the MES- and AI-assisted diagnoses was comparable. Healing decisions using AI may avoid the need for histological examinations.

Multifunctional Ablative Gastrointestinal Imaging Capsule (MAGIC) for Esophagus Surveillance and Interventions.

Objective and Impact Statement: A clinically viable technology for comprehensive esophagus surveillance and potential treatment is lacking. Here, we report a novel multifunctional ablative gastrointestinal imaging capsule (MAGIC) technology platform to address this clinical need. The MAGIC technology could also facilitate the clinical translation and adoption of the tethered capsule endomicroscopy (TCE) technology. Introduction: Recently developed optical coherence tomography (OCT) TCE technologies have shown a promising potential for surveillance of Barrett's esophagus and esophageal cancer in awake patients without the need for sedation. However, it remains challenging with the current TCE technology for detecting early lesions and clinical adoption due to its suboptimal resolution, imaging contrast, and lack of visual guidance during imaging. Methods: Our technology reported here integrates dual-wavelength OCT imaging (operating at 800 and 1300 nm), an ultracompact endoscope camera, and an ablation laser, aiming to enable comprehensive surveillance, guidance, and potential ablative treatment of the esophagus. Results: The MAGIC has been successfully developed with its multimodality imaging and ablation capabilities demonstrated by imaging swine esophagus ex vivo and in vivo. The 800-nm OCT imaging offers exceptional resolution and contrast for the superficial layers, well suited for detecting subtle changes associated with early neoplasia. The 1300-nm OCT imaging provides deeper penetration, essential for assessing lesion invasion. The built-in miniature camera affords a conventional endoscopic view for assisting capsule deployment and laser ablation. Conclusion: By offering complementary and clinically viable functions in a single device, the reported technology represents an effective solution for endoscopic screening, diagnosis, and potential ablation treatment of the esophagus of a patient in an office setting.

DSMT-Net: Dual Self-Supervised Multi-Operator Transformation for Multi-Source Endoscopic Ultrasound Diagnosis.

Pancreatic cancer has the worst prognosis of all cancers. The clinical application of endoscopic ultrasound (EUS) for the assessment of pancreatic cancer risk and of deep learning for the classification of EUS images have been hindered by inter-grader variability and labeling capability. One of the key reasons for these difficulties is that EUS images are obtained from multiple sources with varying resolutions, effective regions, and interference signals, making the distribution of the data highly variable and negatively impacting the performance of deep learning models. Additionally, manual labeling of images is time-consuming and requires significant effort, leading to the desire to effectively utilize a large amount of unlabeled data for network training. To address these challenges, this study proposes the Dual Self-supervised Multi-Operator Transformation Network (DSMT-Net) for multi-source EUS diagnosis. The DSMT-Net includes a multi-operator transformation approach to standardize the extraction of regions of interest in EUS images and eliminate irrelevant pixels. Furthermore, a transformer-based dual self-supervised network is designed to integrate unlabeled EUS images for pre-training the representation model, which can be transferred to supervised tasks such as classification, detection, and segmentation. A large-scale EUS-based pancreas image dataset (LEPset) has been collected, including 3,500 pathologically proven labeled EUS images (from pancreatic and non-pancreatic cancers) and 8,000 unlabeled EUS images for model development. The self-supervised method has also been applied to breast cancer diagnosis and was compared to state-of-the-art deep learning models on both datasets. The results demonstrate that the DSMT-Net significantly improves the accuracy of pancreatic and breast cancer diagnosis.

AI in Endoscopic Gastrointestinal Diagnosis: A Systematic Review of Deep Learning and Machine Learning Techniques

AI in Endoscopic Gastrointestinal Diagnosis: A Systematic Review of Deep Learning and Machine Learning Techniques

Endoscopic diagnosis of biliary stricture

Endoscopic diagnosis of biliary stricture

Efficacy evaluation of upper gastrointestinal endoscopy screening for secondary prevention of gastric cancer using the standardized detection ratio during a medical check-up in Japan.

We used standardized detection ratio to evaluate the quality of nasal upper gastrointestinal endoscopy screening for the secondary prevention of gastric cancer, and examined the gastric cancer risk in the era of total Helicobacter pylori (H. pylori) eradication. We performed 21,931 upper gastrointestinal endoscopies, 77 subjects were diagnosed with gastric cancer. Of these, 28 had gastric cancer after H. pylori eradication, 47 had gastric cancer with H. pylori-positive or others, and 2 had H. pylori-negative gastric cancer. The Standardized detection ratios for men and women were 5.33 and 4.82, respectively. Multivariable logistic regression analyses performed exclusively on first endoscopy subjects, excluding H. pylori-negative gastric cancer, revealed that smoking was a risk factor for developing gastric cancer (adjusted odds ratio, 3.31; 95% confidence interval, 1.65-6.64; p = 0.001). A statistically significant interaction was found between daily alcohol consumpption and H. pylori eradication on gastric cancer development (p = 0.005). In conclusion, relatively high standardized detection ratio values suggest that an appropriate endoscopic diagnosis of gastric cancer should be performed during a medical check-up. Smoking is a risk factor for developing gastric cancer, and continued alcohol consumption suggests a possible risk for developing gastric cancer after H. pylori eradication.

Diagnosis of gastric cancer in role of endoscopic imaging techniques in artificial intelligence and machine learning applications: An overview

Gastric cancer is a serious medical issue because its occurrence and death rates are increasing all over the world. Furthermore, obesity, tobacco use, alcohol consumption, and a few dietary defense elements are known cancer-causing agents. In some nations, early detection strategies have been shown to reduce GC-related morbidity and mortality. It offers therapies that are minimally invasive like most effective procedure is endoscopic resection. The most appropriate standard for using a procedure that is typically secure to precisely evaluate the lesions region. It is simple method and it can be expected difficult techniques can be viewed as in early stage of tumour in accurate diagnosis. A few uses of computerized method have arisen in the field of gastric malignant growth. For example, image diagnosis-based prediction conclusion and guess expectation, because of its viable computational power and learning capabilities. As a result, a detailed outline of how artificial intelligence can be used to treat gastric cancer through image-based endoscopic diagnosis and machine learning analysis applications this review, which demonstrates the future developments in this field for the early prediction of gastric cancer, it was also thoroughly discussed the possibility of AI models being over fitted, their accuracy, and their usefulness to clinical research in this field of image processing. In addition, in this review article was been detailed about synopsis of the therapy choices of malignant growth.

The role of the Kyoto classification in the endoscopic diagnosis of gastritis associated with Helicobacter pylori infection

The role of the Kyoto classification in the endoscopic diagnosis of gastritis associated with Helicobacter pylori infection

THE RESULTS OF THE JAPANESE GASTRIC CANCER SOCIETY MORPHOLOGICAL&#x0D; CLASSIFICATION ADAPTATION FOR THE KAZAKH POPULATION

Relevance: Gastric cancer (GC) morbidity is growing in Kazakhstan every year. In 2022, 2 915 new GC cases were detected (15 per 100,000&#x0D; population), making GC the third most common cancer. The early detection rate of GC does not exceed 10-20%, and advanced forms of GC are&#x0D; over 40%. Mortality increases in the first year after the diagnosis (up to 40%).&#x0D; The best way of solving early detection of gastric cancer is carrying out diagnostics at the stage of pre-tumor stomach diseases. Timely diagnosis and treatment of surgical and borderline diseases of the upper gastrointestinal tract (metaplastic and dysplastic changes in the mucous&#x0D; ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ&#x0D; Онкология и Радиология Казахстана, №4 (70) 2023 17&#x0D; membrane of the esophagus, stomach, and duodenum and adenocarcinomas and early cancer arising against this background) are a complex&#x0D; medical and social problem.&#x0D; Endoscopic methods for diagnosing esophagus, stomach, and duodenum diseases are the most highly informative nowadays. However, precancerous changes (atrophy, metaplasia, and dysplasia) in conventional endoscopic examination may not have specific features. It is necessary&#x0D; to improve the results of endoscopic diagnosis. The chromoscopy method may be one of the methods used to identify precancerous pathology&#x0D; and GC methods.&#x0D; The study aimed to increase the efficiency of gastric cancer early detection by adapting the morphological classification of the Japanese&#x0D; Gastric Cancer Society (JGCA) for the Kazakh population.&#x0D; Methods: We conducted endoscopic studies of 500 residents of the Republic of Kazakhstan using chromoscopy and morphological studies of&#x0D; the biopsy obtained during endoscopic examination. These patients had digestive system problems but previously did not have a GC diagnosis.&#x0D; We formed the risk groups according to JGCA (editions 13th and 14th).&#x0D; Results: We identified 3(0.6%) morbidity of severe dysplasia according to the results of 500 patients’ biopsy samples morphological study.&#x0D; This morphological structure is classified as a well-differentiated adenocarcinoma. We recommended a surgical treatment for identified patients.&#x0D; Conclusion: The identified cases of obligate pre-cancer with an extremely high probability of degeneration into a malignant neoplasm&#x0D; prove the importance of using JGCA for the early diagnosis of gastric cancer and allow us to recommend the use of chromoscopy in stomach&#x0D; endoscopic examination.

Endoscopic ultrasonography in diagnosis of digestive diseases. Review of clinical cases

Endoscopic ultrasound (EUS) is a high-tech ultrasound examination that simultaneously combines the options of endoscopic and ultrasound diagnosis of diseases of the gastrointestinal tract, pancreas, bile ducts and liver. The advantages of endoscopic ultrasound over traditional transabdominal ultrasound are that the ultrasound transducer can be guided directly through the lumen of the gastrointestinal tract to the object under visual control. The EUS is the method of choice for the study of submucosal lesions in the upper gastrointestinal tract. It is the most accurate method for the detection and diagnosis of submucosal formations due to its high sensitivity, specificity, is used as the next research method after endoscopy and can provide information about the origin, size, borders, homogeneity, as well as the choice of treatment method: endoscopic or surgical one. A more important application of EUS is the determination of the stage of malignant neoplasms of the gastrointestinal tract, as it determines the treatment and predicts the disease. And the real-time strain elastography, which allows analyzing the stiffness of tissues, helps in this. The high accuracy of this study allows for the differential diagnosis of benign and malignant neoplasms. The article presents cases of examination of patients with submucosal neoplasms of the stomach who were treated in the SI “Institute of Gastroentero­logy of the National Academy of Medical Sciences of Ukraine”.

Endoscopic diagnosis and treatment for proximal biliary obstruction of tumor origin (literature review)

Proximal biliary obstruction occurs in Klatskin tumor, intrahepatic cholangiocarcinoma, gallbladder cancer or metastatic lesion of the portal fissure and implies poor prognosis. Endoscopic techniques have been advanced towards more accurate diagnosis and safer drainage. Transpapillary brush and forceps biopsy are widely used for morphologic diagnosis. Development of diagnostic techniques includes peroral cholangioscopy and confocal laser endomicroscopy. Due to the development of various tools and advances in ERCP and EUS technologies, a number of technically and clinically successful procedures for high biliary obstruction is increasing. Nevertheless, stent parameters, potential of locoregional palliative care and some other aspects remain disputable. The literature review presents best practices of endoscopic diagnosis and treatment for proximal malignant biliary obstruction, obtained from the analysis of recent scientific publications.

Role of Endoscopy in Diagnosis of Adult Patients with Dysphagia

Role of Endoscopy in Diagnosis of Adult Patients with Dysphagia

Assessment of the Severity and the Remission Criteria in Eosinophilic Esophagitis.

Eosinophilic esophagitis (EoE) is an immune-mediated disease that manifests with dysphagia and is characterized by the predominantly eosinophilic infiltration of the esophageal mucosa. Several instruments have been developed to assess the symptoms of EoE: the Daily Symptom Questionnaire (DSQ), EoE Activity Index (EEsAI), Pediatric EoE Symptom Severity (PEESSv2), etc. The use of the EREFS is a gold standard for endoscopic diagnosis. The EoE histologic scoring system (EoEHSS) was elaborated for the assessment of histological features in EoE. However, the remission criteria are not clearly defined and vary greatly in different studies. Gastroenterologists establish the severity of EoE mainly based on endoscopic findings. At the same time, EoE requires a multidisciplinary approach. The recently developed Index of Severity of Eosinophilic Esophagitis (I-SEE) that is built on symptoms, endoscopic findings, and histological features is promising.

Application of narrow band imaging and Lugol's iodine staining in screening for nasopharyngeal carcinoma

BackgroundTo investigate the diagnostic value of conventional white light endoscopy (WLE), narrow band imaging (NBI) endoscopy, and Lugol's iodine staining under WLE (endoscopic iodine staining) in the screening and early diagnosis of nasopharyngeal carcinoma.MethodsPatients with nasopharyngeal lesions requiring biopsy attending the Department of Otolaryngology Head and Neck Surgery in our hospital between January 2021 and April 2023 were included in this study. Before biopsy, all subjects underwent conventional WLE, NBI endoscopy, and endoscopic iodine staining. On WLE, according to nasopharyngeal lesion morphology and color, patients were diagnosed with nasopharyngeal carcinoma ( +) or chronic hyperplastic nasopharyngitis (-). On NBI endoscopy, according to nasopharyngeal lesion vascular morphology, patients with type V manifestations (nasopharyngeal carcinoma) were categorized as NBI ( +) and patients with type I-IV manifestations (chronic hyperplastic nasopharyngitis) were categorized as NBI (-). Endoscopic iodine staining (1.6% Lugol's iodine solution) was positive ( +) if the mucosal surface was brown with no white patches, or negative (-) if there was no or light brown staining of the mucosal surface. Patients were divided into 2 groups based on histopathological diagnosis: nasopharyngeal carcinoma or chronic hyperplastic nasopharyngitis. Endoscopic diagnoses were compared with histopathological findings. The diagnostic performance of WLE, NBI endoscopy and endoscopic iodine staining for nasopharyngeal carcinoma were determined.ResultsThis study included 159 patients. On histopathology, 29 patients were diagnosed with nasopharyngeal carcinoma, and 130 patients were diagnosed with chronic hyperplastic nasopharyngitis. There were no significant differences in the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the receiver operating characteristic (ROC) curve (AUC) of conventional WLE, NBI endoscopy or endoscopic iodine staining for differentiating nasopharyngeal carcinoma and chronic hyperplastic nasopharyngitis. The diagnostic performance of the combination of conventional WLE, NBI endoscopy and endoscopic iodine staining was significantly improved compared to any procedure alone.ConclusionsConventional WLE, NBI endoscopy or endoscopic iodine staining had good diagnostic performance for differentiating nasopharyngeal carcinoma and chronic hyperplastic nasopharyngitis. In particular, NBI endoscopy and endoscopic iodine staining alone or combined had clinical utility for identifying patients with nasopharyngeal lesions that are eligible for a watch-and-wait strategy.

Endoscopic diagnosis, management, and outcome of early colorectal cancer

Endoscopic diagnosis, management, and outcome of early colorectal cancer

Advances in Endoscopic Diagnosis and Treatment of Gastric Neuroendocrine Neoplasms.

Gastric neuroendocrine neoplasms refer to a group of diseases that are relatively rare. They can be classified into three subtypes based on their clinical and histopathological features, and there are significant differences in diagnosis, treatment, and prognosis among the different subtypes. The incidence of gastric neuroendocrine neoplasms has been increasing globally in recent years with the localized disease being particularly evident. Gastrointestinal endoscopy is of irreplaceable importance for the diagnosis and management of g-NENs. Endoscopy with biopsy is the gold standard for the diagnosis of g-NENs. Ultrasound endoscopy can assess the depth of tumor invasion and the presence of lymphatic metastases, which is important for the development of treatment strategies. Meanwhile, for some small and low-risk lesions, endoscopic surveillance or endoscopic resection has satisfactory therapeutic results and prognosis. This means that even though the incidence has increased, advances in endoscopic techniques have allowed more patients to adopt a relatively conservative treatment strategy. However, the criteria for patients suitable for endoscopic surveillance or endoscopic resection remain controversial.

Endoscopic and surgical treatment of non-neoplastic proximal duodenal ulceration in dogs, and anatomical study of proximal duodenal vascularisation.

Proximal duodenal ulceration is often characterised by continuous bleeding, and treatment is challenging. The aims of this study were to investigate the role of vascularisation in proximal duodenal ulceration and describe clinical aspects, endoscopic features and treatment in dogs. Polyurethane foam casts of gastroduodenal vessels were obtained from five dogs which had died from disorders unrelated to the digestive system. In addition, 12 dogs having proximal duodenal ulcers diagnosed by endoscopic examination were enrolled in a treatment trial. After the endoscopic diagnosis of a duodenal ulcer, all the dogs were treated medically and, in the absence of resolution, were subsequently treated by endoscopic electrocauterisation or by surgery. A submucosal vascular network was evident in all the casts, with a prominent venous plexus seen exclusively in the first half inch of the duodenum. In clinical cases, on endoscopic examination, the duodenal ulcer was located at the proximal part of the duodenum, involving the mesenteric portion of the wall. The dogs not responding to medical treatment (6/12) were treated with endoscopic electrocauterisation, surgical coagulation or resection of the proximal duodenal portion. All the dogs survived until discharge, and the median survival time following discharge was 107.5 days. Based on the anatomical details highlighted in this study, the continuous bleeding observed in our patients may have been due to the prominent venous plexus evidenced at the level of the proximal duodenum. Surgical and endoscopic treatments in six patients resolved the ulcer bleeding with no recurrences noted during follow-up.

Classification and endoscopic diagnosis of colorectal polyps

Background: Colorectal cancer is a common malignancy and a major health concern in Korea. The increased use of screening colonoscopies has led to improved survival of patients with colorectal cancer despite its high prevalence; this highlights the importance of early detection and removal of neoplastic polyps such as adenoma and sessile serrated lesions. Therefore, optical diagnosis of colorectal polyps is crucial in deciding whether the lesion requires removal and if endoscopic procedures can be used for its removal.Current Concepts: Several image-enhanced endoscopy (IEE) techniques and classifications can be used to improve the optical diagnosis of different polyps that match the histopathologic findings. Kudo’s pit pattern classification is based on features of pit patterns observed from different types of polyps via chromoendoscopy. The Narrow-Band Imaging (NBI) International Colorectal Endoscopic (NICE) classification is an international classification based on patterns observed from NBI findings. The Japan NBI Expert Team (JNET) classification identifies different patterns observed from magnified images with NBI. The Workgroup serrAted polypS and Polyposis (WASP) classification helps to differentiate hyperplastic polyps from sessile serrated lesions. Endoscopy manufacturers have also developed IEE techniques such as I-scan, flexible spectral imaging color enhancement, and blue laser imaging/linked color imaging to highlight, delineate, and differentiate various polyps.Discussion and Conclusion: Optical diagnosis of colorectal polyps using IEE such as NBI with different classifications such as NICE, JNET, and WASP is important for differentiating neoplastic polyps and removing them with an appropriate method.