Endoscopic Imaging Techniques Research Articles

Imaging for upper tract urothelial carcinoma: update of the evidence and a glimpse into the future.

Upper tract urothelial carcinoma (UTUC) is a rare malignancy posing significant diagnostic and management challenges. This review provides an overview of the evidence supporting various imaging modalities and offers insights into future innovations in UTUC imaging. With the growing use of advancements in computed tomography (CT) technologies for both staging and follow-up of UTUC patients, continuous innovations aim to enhance performance and minimize the risk of excessive exposure to ionizing radiation and iodinated contrast medium. In patients unable to undergo CT, magnetic resonance imaging serves as an alternative imaging modality, though its sensitivity is lower than CT. Positron emission tomography, particularly with innovative radiotracers and theranostics, has the potential to significantly advance precision medicine in UTUC. Endoscopic imaging techniques including advanced modalities seem to be promising in improved visualization and diagnostic accuracy, however, evidence remains scarce. Radiomics and radiogenomics present emerging tools for noninvasive tumor characterization and prognosis. The landscape of imaging for UTUC is rapidly evolving, with significant advancements across various modalities promising improved diagnostic accuracy, patient outcomes, and safety.

Point-of-care ultrasound of the inflammatory bowel disease

Background. The widespread use of portable ultrasound scanners has advanced the concept of ultrasound diagnosis (POCUS), namely «ultrasound examination (US) is performed at the bedside and is interpreted directly by a physician». Pocus is not a substitute for complex ultrasound, but rather allows the ultrasound doctor to quickly access clinical images for rapid diagnosis and effective examination and treatment of patients. Purpose – the work to identify ultrasound signs of inflammatory bowel disease (IBD) using POCUS. Materials and Methods. 70 patients aged 18 to 39 years (24 men and 46 women, mean age – 30.3 ± 13.7 years). The first group of patients included 32 people with a morphologically confirmed CD diagnosis, the second group included 38 people with a morphologically confirmed UC diagnosis. The control group consisted of 2 8 patients with no clinical and laboratory data on gastrointestinal lesions. Results. It was shown that the ultrasound can assess the thickness of the intestinal wall with sensitivity – 90.3% and specificity – 87.1% and ROC – 0.882, differentiation of the wall layers, surrounding structures (omentum, mesentery, lymph nodes), as well as the localization of the affected intestinal segment. Color Doppler Mapping (CDM) method with a sensitivity of 86.5% and specificity of 81.5% and ROC of 0.852 allows not only to assume the presence of active inflammation in the wall of the affected intestinal segment, but also to monitor the dynamics of the process during treatment. Conclusion. In this work, the capabilities of POCUS for the diagnosis of IBD were evaluated. Correct and accurate interpretation of POCUS findings is not only an important diagnostic step, but also a complement to other radiation and endoscopic imaging techniques. The main advantage of POCUS over CT and MRI is its fast availability, low cost, and high level of safety. An experienced ultrasound doctor is needed to examine the gastrointestinal tract, so training with ultrasound doctors and mastering practical skills is key to ensuring the effective use of POCUS.

Experimental Measurements of the Length of the Human Colon: A Systematic Review and Meta-Analysis.

Knowledge of the length of the colon is relevant to understanding physiological and pathological function. It also has implications for diagnostic and clinical interventions, as well as for the design of delayed-release drug formulations and drug disposition modeling. Over the years, a range of different experimental methods have been employed to assess colon length. These methods vary from direct measurements on cadavers and during intraoperative procedures to measurements obtained from endoscopic and medical imaging techniques. However, no systematic review or meta-analysis of these findings has yet been carried out. In this systematic review, we identified 31 published experimental studies that measured the length of the human colon and/or its segments. We synthesized the available data, comprising colon length measurements from 5741 adults and 337 children and young people, in a meta-analysis. The data contribute to our understanding of colon morphology and may have implications for clinical practice, particularly for colonoscopy and preoperative planning of surgical resections. Additionally, this review provides potential insights into anatomical correlates of functional diseases, such as constipation. This review highlights that non-invasive, non-destructive diagnostic imaging techniques, such as magnetic resonance imaging (MRI), can provide more physiologically relevant measurements of colon length. However, there is a need for more standardized measurement protocols and for additional pediatric data.

Inflammatory Bowel Disease and Colorectal Cancer.

Patients with inflammatory bowel diseases (IBDs), including both ulcerative colitis (UC) and Crohn's disease (CD), are at a higher risk of developing colorectal cancer (CRC). However, advancements in endoscopic imaging techniques, integrated surveillance programs, and improved medical therapies have led to a decrease in the incidence of CRC among IBD patients. Currently, the management of patients with IBD who have a history of or ongoing active malignancy is an unmet need. This involves balancing the risk of cancer recurrence/progression with the potential exacerbation of IBD if the medications are discontinued. The objective of this review is to provide an updated summary of the epidemiology, causes, risk factors, and surveillance approaches for CRC in individuals with IBD, and to offer practical guidance on managing IBD patients with history of previous or active cancer.

A look inside the gut as a clue to nutritional status.

Malabsorption and malnutrition are common gastrointestinal manifestations clinicians face, requiring diagnostic workup for effective diagnosis and management of the underlying cause. This review discusses recent advances in diagnostic approaches to malabsorption and maldigestion of macronutrients - lipids, proteins, and carbohydrates. We highlight underrecognized causes, available testing modalities, and ongoing diagnostic unmet needs. Innovations in the diagnostic landscape are enhancing our understanding of malabsorption syndromes. Stool collection and handling is uncomfortable and commonly avoided. The objective quantification of stool lipids, bile acids, and gut enzymes is therefore underused in the diagnosis and management of common disorders such as exocrine pancreatic insufficiency, bile acid diarrhea, protein-losing enteropathy, and more. We review the recent advancements in spot quantification of stool fat and bile acid content, endoscopic imaging techniques such as endocytoscopy, confocal laser endomicroscopy, and optical coherence tomography and the future place in clinical practice. Malabsorption and maldigestion represent significant challenges in clinical nutrition and gastroenterology. Through the integration of advanced diagnostic techniques, clinicians will be better equipped to tailor therapy and monitor treatment response, ultimately improving patient health outcomes. This review underscores the critical role of innovative diagnostic tools in accurately detecting and effectively managing gastrointestinal disorders linked to nutritional status.

P1106 Is indoor radon associated with new diagnosis of inflammatory bowel disease patients?

Abstract Background Inflammatory Bowel Diseases (IBD) are a group of pathologies of unknown etiology associated with some environmental factors, only partially identified. The role of indoor radon, a radioactive gas, has not been formally studied and it might play a role on the onset of the disease. The aim of this study is to analyze the role of individual residential radon exposure on the incidence of IBD in a radon-prone area also characterized as a high incidence IBD region. Methods A case-control study was developed in the health area of Santiago de Compostela (Galicia, Spain) between June 2020 and September 2023, including incident cases with IBD. Controls were selected trough a frequency matching based on sex and age and without IBD. All participants had to be living at least 5 years in the same dwelling, those with a change of address in the last 5 years prior to diagnosis were excluded. Endoscopic index, imaging techniques and analytic parameters were collected. Radon levels measured over three months in the participants’ home were compared between cases and controls, and between the different types of IBD. Each individual was provided with a residential radon meter (a RSKS trace detector), given and read by the Galician Radon Laboratory, a certified radon laboratory. Procedure is summarized in Figure 1. Radon concentrations were categorized into three groups, 0-99 Bq/m3, 100-299 Bq/m3 and >299 Bq/m3. Results are expressed as Odds Ratios with their 95%CI obtained through logistic regression. Results 178 incident cases and 178 controls (102 ulcerative colitis, 70 Crohn’s disease and 6 unclassified colitis) were included, with a median age of 51 years old (IQR 40 – 59.5). 51.7% were females. Median radon levels of IBD patients´ homes were 144.5 (IQR 83 – 260) and median radon levels of controls´ homes were 189.5 (IQR 112 – 292.5) (figure 1). Adjusting by age and sex, high radon levels showed a negative association for the development of IBD (taking levels of 0-99 Bq/m3 as reference, OR 100-299 Bq/m3 is 0.5 (95%CI 0.3-0.8), and OR >299 Bq/m3 is 0.5 (95%CI 0.3-0.9). Results are shown in table 1. Analyzing women and men separately, there are no statistically significant differences (p>0.05 in each group). Taking into account the different types of IBD, radon levels show the same negative association but without statistical association. Conclusion High radon levels might be a protective factor for developing IBD overall and its most common types, Crohn’s disease and ulcerative colitis. Further studies in other areas with lower radon concentrations will be necessary to corroborate whether it influences the incidence of IBD.

Precision endoscopy in colorectal polyps' characterization and planning of endoscopic therapy.

Precision endoscopy in the management of colorectal polyps and early colorectal cancer has emerged as the standard of care. It includes optical characterization of polyps and estimation of submucosal invasion depth of large nonpedunculated colorectal polyps to select the appropriate endoscopic resection modality. Over time, several imaging modalities have been implemented in endoscopic practice to improve optical performance. Among these, image-enhanced endoscopy systems and magnification endoscopy represent now well-established tools. New advanced technologies, such as endocytoscopy and confocal laser endomicroscopy, have recently shown promising results in predicting the histology of colorectal polyps. In recent years, artificial intelligence has continued to enhance endoscopic performance in the characterization of colorectal polyps, overcoming the limitations of other imaging modes. In this review we retrace the path of precision endoscopy, analyzing the yield of various endoscopic imaging techniques in personalizing management of colorectal polyps and early colorectal cancer.

Comprehensive advancement in endoscopy: optical design, algorithm enhancement, and clinical validation for merged WLI and CBI imaging.

As endoscopic imaging technology advances, there is a growing clinical demand for enhanced imaging capabilities. Although conventional white light imaging (WLI) endoscopy offers realistic images, it often cannot reveal detailed characteristics of the mucosa. On the other hand, optical staining endoscopy, such as Compound Band Imaging (CBI), can discern subtle structures, serving to some extent as an optical biopsy. However, its image brightness is low, and the colors can be abrupt. These two techniques, commonly used in clinical settings, have complementary advantages. Nonetheless, they require different lighting conditions, which makes it challenging to combine their imaging strengths on living tissues. In this study, we introduce a novel endoscopic imaging technique that effectively combines the advantages of both WLI and CBI. Doctors don't need to manually switch between these two observation modes, as they can obtain the image information of both modes in one image. We calibrated an appropriate proportion for simultaneous illumination with the light required for WLI and CBI. We designed a new illumination spectrum tailored for gastrointestinal examination, achieving their fusion at the optical level. Using a new algorithm that focuses on enhancing specific hemoglobin tissue features, we restored narrow-band image characteristics lost due to the introduction of white light. Our hardware and software innovations not only boost the illumination brightness of the endoscope but also ensure the narrow-band feature details of the image. To evaluate the reliability and safety of the new endoscopic system, we conducted a series of tests in line with relevant international standards and validated the design parameters. For clinical trials, we collected a total of 256 sets of images, each set comprising images of the same lesion location captured using WLI, CBI, and our proposed method. We recruited four experienced clinicians to conduct subjective evaluations of the collected images. The results affirmed the significant advantages of our method. We believe that the novel endoscopic system we introduced has vast potential for clinical application in the future.

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.

Retracted: Diagnostic Value of Endoscopic Narrow-Band Imaging Technique in Early Gastric Cancer and Precancerous Lesions.

[This retracts the article DOI: 10.1155/2022/9205150.].

Experimenting ‘In Vivo’ with Dynamic Glottal Parameters: Methodological Issues, Technical Tips & Tricks and Preventable Pitfalls

‘In vivo’ studies pertaining to dynamics of vocal fold vibration motion, to vocal fold contact and collision, to vocal onset and offset and to mechanical efficiency all need valid, sensitive and precise measurements of the different mechanical parameters involved. This is also true for investigating the physiological correlates of particular acoustic events like register breaks or diplophonia. The main physical parameters involved are: vocal fold movement and shaping, particularly the velocity of tissue displacement, glottal area, tissue distortion, intraglottal pressure, transglottal air flow, vocal fold contact and collision stress, etc. This article presents a critical review of the instruments and techniques involved in the direct measurements of the glottal dimensions and movements, the transglottal airflow, the VF contact changes, the pressures and the sound acoustic pressure. In each case are analyzed the methodological aspects that are critical for validly calibrating and synchronizing these signals, and correcting them for time delays. Moreover, it is shown how new parameters, like vocal fold velocity, intraglottal pressure, vocal fold collision stress, can be inferred from these (raw or after differentiation) signals by combining them. Finally, the discussion focuses on weighing advantages and limitations of techniques for monitoring the glottal area, i.e. photometry and the high-speed imaging, the latter involving the relevance in this scope of future developments in endoscopic and external imaging techniques, and in image processing software. Our aim is to facilitate the work of future researchers by showing how to solve important technical pitfalls, how to apply the necessary corrective measures - and which ones - where needed, and how to get the most out of combinatorial measures.

Characteristics performance of laryngopharyngeal reflux in narrow band imaging

Objective:To study the application value of narrow-band imaging in the diagnosis of laryngopharyngeal reflux. Methods:A total of 275 patients admitted to the inpatient department or laryngoscopy room of the Otolaryngology Head and Neck Surgery Department of the First Affiliated Hospital of Harbin Medical University from September 2022 to April 2023 due to throat discomfort were selected as the research subjects. All of them completed RSI, RFS scoring scales and electronic laryngoscopy（including ordinary white light and NBI）. According to the expert consensus of LPRD in 2022, RSI and RFS scoring scale were used as diagnostic criteria to divide them into LPR group and non-LPR group. Chi-square test was used to analyze the differences of positive rates of characteristic manifestations under NBI among different groups. The consistency of NBI and scale diagnostic methods was analyzed by Kappa, and RSI and RFS scoring were used as diagnostic criteria, The diagnostic efficiency of NBI method was analyzed. Results:There were 190 people in the LPR group, 157 of whom showed characteristic performance under the NBI mode, with a positive rate of 82.6%（157/190）; there were 85 people in the non-LPR group, with a positive rate of 18.8%（16/85）. There was a statistically significant difference in the positive rate between the two groups（χ²=102.47, P<0.05）. The consistency rate between RSI, RFS and NBI was 82.2%（226/275）. Kappa consistency analysis was used, and Kappa=0.605（P<0.05）, indicating good consistency between the two diagnostic methods. Using RSI and RFS as diagnostic criteria for LPR, the sensitivity of NBI diagnostic method was 82.6%（157/190）, specificity 81.2%（69/85）, positive predictive value 90.8%（157/173） and negative predictive value 67.6%（69/102）. Conclusion:Narrow-band imaging, as a new endoscopic imaging technique, can show small changes in mucosal surface micro vessels and play an important role in the diagnosis of laryngopharyngeal reflux.

Inflammatory Bowel Disease and Colorectal Cancer: Epidemiology, Etiology, Surveillance, and Management.

Patients with inflammatory bowel diseases (IBDs), such as ulcerative colitis and Crohn's disease, have an increased risk of developing colorectal cancer (CRC). Although advancements in endoscopic imaging techniques, integrated surveillance programs, and improved medical therapies have contributed to a decreased incidence of CRC in patients with IBD, the rate of CRC remains higher in patients with IBD than in individuals without chronic colitis. Patients with IBD-related CRCs exhibit a poorer prognosis than those with sporadic CRCs, owing to their aggressive histological characteristics and lower curative resection rate. In this review, we present an updated overview of the epidemiology, etiology, risk factors, surveillance strategies, treatment recommendations, and prognosis of IBD-related CRCs.

Update on Endoscopic Dysplasia Surveillance in IBD.

As medical management of inflammatory bowel disease (IBD) makes great advances, most patients with IBD will have long life expectancies without need for total colectomy. With prolonged disease duration, however, there is increased risk of dysplasia leading to colorectal cancer (CRC). Multiple consensus and guideline documents have been published over the last decade with recommendations to optimize early detection and management of dysplastic lesions. Endoscopic technology has improved tremendously, even over the last few years. Previously invisible dysplasia has become visible in most cases with advanced imaging technologies that now allow for much clearer and more detailed mucosal inspection. New tools to facilitate endoscopic resection of visible lesions has also enabled patients to avoid colectomy, with resulting need to continue colon surveillance. There are limited or conflicting data leading to inconsistent recommendations regarding the need for random biopsies, the preferred endoscopic imaging technique and surveillance intervals after resection of dysplasia. Similarly, there remains significant variability in the application of guidelines into daily practice and availability of and training with advanced imaging technologies. Here, we present a narrative review of which patients are at highest risk for dysplasia, the current guidelines on surveillance colonoscopy, factors affecting optimal mucosal visualization, enhanced imaging techniques, standardized reporting terminologies for surveillance colonoscopy, endoscopic management of dysplasia, indications for colectomy, and briefly on future potential technologies to assist in dysplasia detection.

Peutz-Jeghers syndrome from the point of view of a radiologist and an endoscopist

INTRODUCTION: Peutz-Jeghers syndrome (PJS) is a rare (orphan) hereditary disease with a family history, primarily characterized by massive polyposis of the gastrointestinal tract and its complications. Every year, the syndrome is registered in 1 patient per 25,000–300,000 population. OBJECTIVE: To demonstrate the effectiveness of the combined use of diagnostic radiology and endoscopic imaging techniques in the diagnosis of this syndrome and its complications. A case report of a patient aged 47 years is given. A patient complained of persistent gastrointestinal bleeding, thrombosis of the arteries of the upper extremity, ventral hernia after the elimination of intestinal intussusception. A patient was admitted to the A. V. Vishnevsky NMRC of Surgery of the Ministry of Health of Russia (Moscow) to determine the tactics of treatment. Computed tomography of the abdominal organs and CT angiography of the upper extremities, esophagogastroduodenoscopy and colonoscopy were performed. CONCLUSION: The difficulties of the diagnosis and treatment of PJS and its associated complications were illustrated. A brief review of the literature (21 publications) by Russian and foreign authors on the problems of diagnosis, clinical manifestations and treatment of PJS were performed. According to the performed studies, total gastrointestinal polyposis, thrombosis of the arteries of the upper left limb, ventral postoperative hernia were revealed. Taking into account the ongoing complications of PJS, the patient was prescribed a gastrectomy.

Abstract 6077: Comprehensive multi-omic characterization of genetic changes associated with sinonasal squamous cell carcinoma progression

Abstract Approximately 50-80% of sinonasal tract cancers are sinonasal squamous cell carcinoma (SNSCC), a rare malignancy which occur in the nasal cavity and maxillary sinus. These lesions possess a propensity for local invasion into adjacent structures including the skull base, brain, and orbit. Owing to relatively mild symptoms during early stages, which resemble benign sinonasal disease, most patients are already in clinically advanced stages when diagnosed. Therefore, despite improvements in endoscopic surgical approaches, radiotherapy and imaging techniques, the 5-year overall survival for advanced SNSCC patients remains poor (~40%). Inverted sinonasal papilloma (IP) is a locally aggressive, benign epithelial neoplasm arising in the paranasal sinuses which has a high recurrence rate and transforms to SNSCC in 10%-25% of cases. As some IP evolve to malignant neoplasms, it has been presumed that they represent an intermediate step in SNSCC progression. However, the current tools for detecting altered epithelial cells, such as clinical examination and histological characteristics, have limited prognostic value for predicting which IP will progress to malignancy, and the link between IP and invasive disease remains unclear. Activating mutations in EGFR and PIK3CA genes as well as loss-of-function mutations in TP53 have been reported in a few very small cohorts of IP and SNSCC lesions, suggesting their role in IP pathogenesis and progression to invasive malignancy. Other observed alterations potentially associated with malignant transition include KRAS mutations, loss of heterozygosity (LOH) at the 9p21 locus (containing p16INK4a), mismatch repair genes deficiency, amplification of FGFR1 and SOX2 genes, as well as NFκB, COX2 and HOXA9 overexpression. While these studies provide a snapshot of molecular changes in SNSCC, genetic alterations critical to the development of SNSCC are poorly understood, and the exact mechanism underlying malignant transformation remains unknown. In this study we have used PandaOmic, a multi-omic data analysis and visualization algorithm, to perform a first comprehensive integrative analysis of WES, mitochondrial sequencing and transcriptomic data obtained from 11 IP lesions, matched invasive SNSCC tumors and histologically normal paranasal sinus epithelium collected from the same patients. Our analysis reveals heterogeneous mutational patterns, gene expression changes and signaling pathways features associated with SNSCC pathogenesis, and provides crucial insights that may aid in the development of novel means of prevention, diagnosis, and treatment of this rare, aggressive and poorly characterized malignancy. Citation Format: Alka Singh, Nikita Babushkin, Michael Korzinkin, Viktoria Sarkisova, Vasudha Mishra, Ari Rosenberg, Mark Lingen, Justin Bishop, Alex Zhavoronkov, Nyall London, Nishant Agrawal, Xuanyao Liu, Evgeny Izumchenko. Comprehensive multi-omic characterization of genetic changes associated with sinonasal squamous cell carcinoma progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6077.

Endoscopic diagnosis and treatment in gastric cancer: Current evidence and new perspectives.

Gastric cancer is the fifth most common cause of cancer related deaths worldwide. Despite advancement in endoscopic techniques, the majority of the cases are diagnosed at late stage, when the curative treatment options are very limited. The early gastric cancer (EGC) on the other side is potentially curable, and in selected cases endoscopic resection techniques offer similar survival rates then surgical resection. The detection of EGC is endoscopically challenging and requires high quality examination. Recent data show that close to 10% of the gastric cancer cases had a previous negative endoscopy. This highlights the urgent need to improve the quality of the endoscopy services, what can be achieved by increasing the awareness of gastroenterologists and continuously monitoring the key performance indicators of upper gastrointestinal endoscopy. Newer endoscopic imaging techniques are also becoming commonly available to aid the detection of gastric premalignant lesions and EGC. High-definition endoscopy with image enhancement techniques is preferred over white light endoscopy to recognize these lesions, and they are also useful to determine the invasion depth of EGC. The endoscopic optical characterization of lesions is necessary for the selection of proper resection method and decide whether endoscopic resection techniques can be considered. Artificial intelligence systems aid the detection of EGC and can help to determine the depth of invasion. Endoscopic mucosal resection and endoscopic submucosal dissection requires centralized care and tertiary referral centers with appropriate expertise to ensure proper patient selection, high success rate and low adverse event rate. Appropriately scheduled endoscopic surveillance of high-risk patients, premalignant lesions and after resection of EGC is also important in the early detection and successful treatment of gastric cancer.

Diagnostic Value of Endoscopic Narrow-Band Imaging Technique in Early Gastric Cancer and Precancerous Lesions.

Objective To investigate the diagnostic value of endoscopic narrow-band imaging technique in early gastric cancer and precancerous lesions. Methods A total of 100 patients with recurrent upper gastrointestinal symptoms in our hospital from January 2017 to January 2022 were selected and divided into group A and group B according to the random number table method, with 50 cases in each group. Group A received white light endoscopy, and group B received narrow-band imaging technology combined with endoscopy. Narrow-band imaging combined with magnifying endoscopy was used to stain the area with suspicious mucosal lesions with indigo carmine and magnified observation. Results The endoscopic image clarity of group B was significantly better than that of group A in terms of lesion outline, gastric pit, and microvascular morphology (P < 0.05). There were 10 cases of early gastric cancer, 18 cases of benign lesions, and 9 cases of gastric cancer (nonearly stage); 17 cases of precancerous lesions, 12 cases of early gastric cancer, 13 cases of benign lesions, and 6 cases of gastric cancer (nonearly stage) were diagnosed by ordinary white light endoscopy. Pathological results confirmed that among the 50 patients in group B, there were 15 cases of precancerous lesions, 11 cases of early gastric cancer, 17 cases of benign lesions, and 7 cases of gastric cancer (nonearly stage). Among the 50 patients in group A, 16 were precancerous lesions, 11 were early gastric cancer, 15 were benign lesions, and 8 were gastric cancer (non early stage). In the diagnosis of precancerous lesions and early gastric cancer, the diagnostic consistency, sensitivity, and specificity of group B were better than those of group A (P < 0.05); NBI combined with endoscopy in the diagnosis of precancerous lesions and early gastric cancer (kappa = 0.860, kappa = 0.883) was more consistent with pathological diagnosis than common white light endoscopy (kappa = 0.433, kappa = 0.535). Conclusion The value of narrow-band imaging technology combined with endoscopy in the diagnosis of precancerous lesions and early gastric cancer is better than that of ordinary white light endoscopy, and it can be widely used in clinical practice.

Pneumoperitoneum: A rare life threatening complication post ERCP!

Respected Editor, Endoscopic Retrograde Cholangiopancreatography (ERCP) is an invasive medical procedure commonly used to identify and treat biliary system and pancreatic disorders. It is the combination of both endoscopic and radiologic imaging techniques that, although widely used, and usually a safe procedure, it can rarely lead to life threatening complications including but not limited to pancreatitis, cholangitis, hemorrhage and perforation leading to pneumoperitoneum. The occurrence of free air in the peritoneal cavity post-ERCP is a rare event (&lt; 1%), which is usually the result of duodenal or ductal perforation related to therapeutic ERCP with sphincterotomy.[1] Our discussion is based on the incidence of pneumoperitoneum occurring in patients post ERCP. According to a case report, a 29- year- old female was diagnosed with postpartum jaundice and biliary stones. Consequently, she was investigated using ERCP and treated with biliary stenting and bile flow restoration. Post ERCP, the patient developed severe epigastric pain radiating to the right shoulder and x-ray revealed air under the diaphragm, i.e. pneumoperitoneum.[2] In another report, a 72 year old woman who underwent ERCP to treat biliary stricture and provide stenting was found to have pneumobilia and pneumoperitoneum due to rupture of intrahepatic bile ducts during ERCP.[3] Another case has been reported with the same issue in which an 84 year old known case of pancreatic carcinoma with hepatic and lung metastasis underwent multiple ERCPs due to obstructive jaundice, performed an urgent CT scan, the very next day, which showed the presence of free air in the peritoneal cavity.[4] Therefore, in light of the cases mentioned above-, physicians should be mindful of this rare, life- threatening complication of ERCP and take great care and warn the patient before performing the procedure. A useful strategy to combat this complication, a nasogastric tube for bowel decompression immediately after ERCP can greatly reduce the chances of developing a pneumoperitoneum.

Drug instillation in the management of urinary tract urothelial carcinoma.

This article aimed to investigate the efficacy of drug instillation therapy in preventing the recurrence of postsurgical upper urinary tract urothelial carcinoma (UTUC) by reviewing recently published research articles. Several clinical trials have shown new potential forms of postsurgical intracavitary and intravesical drug instillation methodologies with better efficacy and less toxicity for use in UTUC. With the improvement of endoscopic imaging techniques and laser sciences, diverse attempts in drug instillation have shown an improved recurrence rate after kidney-sparing surgery in low-grade, low-tumor burden cancers in the upper urinary tract. A gel-form type of mitomycin-C in intracavitary instillation further reduced recurrence rates in UTUC. Other studies have compared different drug instillation methodologies with varying initiation times and timed instillation. They have shown that early instillation with multiple rounds resulted in better protective effects for recurrence rates before, during, and after surgery. A new gel-form of intracavitary instillation of mitomycin-C, the timing of drug instillation, and refining techniques can result in better recurrence-free survival of patients with UTUC after surgery. Further large-scale prospective clinical trials are needed to validate these new forms of drugs and methodologies to change the therapeutic guidelines of UTUC.