Endoscopic Diagnosis Research Articles

The interpretation of magnifying endoscopy for the diagnosis of colorectal lesions.

Accurate endoscopic diagnosis is crucial for determining the appropriate treatment strategy for colorectal lesions, which may include cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), or endoscopic submucosal dissection (ESD). While white light imaging (WLI) serves as the basic and initial method for endoscopic diagnosis, additional techniques such as narrow-band imaging (NBI), blue laser/light imaging (BLI), and magnified observation using pit patterns are necessary when WLI results are inconclusive. These advanced diagnostic methods enable precise identification of lesions such as adenoma, T1 cancer, and sessile serrated lesion (SSL). Furthermore, recent advancements in endoscopic systems have enhanced image clarity and detail, thereby improving diagnostic accuracy. This review provides an in-depth discussion on how magnified endoscopy, utilizing the Japan NBI Expert Team (JNET) classification with NBI/BLI and pit pattern classification with chromoendoscopy, aids in the accurate diagnosis of colorectal lesions.

Three-dimensional optically cleared tissue imaging for analyzing endoscopic images of gastrointestinal neoplasms (with video).

To develop a procedure that matches magnifying endoscopic images with narrow-band imaging to 3D tissue structures using a tissue-clearing technique and to qualitatively and quantitatively analyze specified structures in gastrointestinal neoplasms. Endoscopically resected formalin-fixed paraffin-embedded gastrointestinal tissues (three esophagus, four stomach, seven colon) were made transparent by ethyl cinnamate. They were then subjected to fluorescent staining of nuclei and blood vessels followed by 3D imaging using a confocal laser scanning microscope. A one-to-one correspondence between magnifying endoscopic and 3D reconstructed images was established using vessels and crypts with characteristic shapes as guides, and the depth and caliber of specified vessels were measured. All tissues were optically cleared, which allowed 3D visualization of vascular structures and nuclei in all layers. In the esophagus, intraepithelial papillary capillary loops and subepithelial capillary networks were identified. In the upper part of the stomach, polygonal subepithelial capillary loops surrounding the pits were observed, while in the lower part, surface epithelium with ridge-like structures and coiled vessels were observed. A honeycomb pit structure and surrounding vascular structures were identified in the colon. Quantitative analysis showed the various contrasts of a single continuous vessel in the endoscopic image were due to different depths at which the vessel tortuously ran. We established a procedure to allow one-to-one correspondence between magnifying endoscopic and 3D reconstructed images and to measure the depth and caliber of endoscopically visualized vessels of interest. This method is expected to improve endoscopic diagnosis and further the development of endoscopic imaging technologies.

APAGE Position Statements on Green and Sustainability in Gastroenterology, Hepatology, and Gastrointestinal Endoscopy.

The APAGE Position Statements aimed to provide guidance to healthcare practitioners on clinical practices aligned with climate sustainability. A taskforce convened by APAGE proposed provisional statements. Twenty-two gastroenterologists from the Asian Pacific region participated in online voting and consensus was assessed through an anonymized and iterative Delphi process. There were five sections that addressed the rationale for climate action, the importance of adopting principles of waste management, clinical practice, gastrointestinal endoscopy, and issues related to advocacy and research. Sixteen statements achieved consensus and included the following: 1. APAGE recommends adopting prompt measures to reduce the carbon footprint of clinical practice due to the importance of climate action and its health cobenefits. 5. APAGE recommends adherence to professional clinical guidelines to optimize clinical care delivery in gastroenterology and hepatology to avoid the environmental impact of unnecessary procedures and tests. 8. APAGE recommends an emphasis on health promotion, disease prevention, and appropriate screening and surveillance, when resources are available, to reduce the environmental impact of managing more advanced diseases that require more intensive resources. 12. APAGE recommends that technological advances in endoscopic imaging and artificial intelligence, when available, be used to improve the precision of endoscopic diagnosis to reduce the risk of missed lesions and need for unnecessary biopsies. 13. APAGE recommends against the routine use of single-use endoscopes. The position statements provide guidance to healthcare practitioners on clinical practices in gastroenterology, hepatology, and endoscopy that promote climate sustainability.

Endoscopic grading of gastric intestinal metaplasia using blue light imaging in a low-risk population: Multicenter cross-sectional validation study

AbstractDetecting gastric intestinal metaplasia (GIM) with white light endoscopy (WLE) remains a challenge and virtual chromoendoscopy methods have been shown to increase accuracy. We aimed to externally validate the Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM) using blue light imaging (BLI).First, the reliability of BLI and the EGGIM score was evaluated through assessment of 90 images divided into three sets of 30. A multicenter cross-sectional study was conducted at two Italian centers involving 102 patients (510 biopsies). Both per-biopsy and per-patient analyses were performed to ascertain accuracy of BLI in detecting and staging GIM (vs. histology).BLI significantly enhanced interobserver agreement of endoscopic diagnosis of GIM, with a Fleiss Kappa of 0.4 (95% confidence interval [CI] 0.3–0.5), compared to 0.2 (95% CI 0.2–0.3) with WLE. Concordance was particularly strong in applying the EGGIM score (weighted Kappa 0.7; 95% CI 0.5–0.9). BLI showed significant improvements in sensitivity over WLE, with an increase observed in both per-biopsy analysis (82%; 95%CI 73.7–89.0 vs. 50%;95% CI 40.6–60.3) and per-patient analysis (96%; 95% CI 84.5–99.4 vs. 68%;95% CI 52.4-81.4). The area under the curve of EGGIM in diagnosing OLGIM III/IV was 0.9 (95% CI 0.8–1.0), confirming EGGIM > 4 being the optimal threshold (sensitivity of 80%, specificity of 88%).Our study validates BLI integrated with the EGGIM system as an effective strategy, highlighting its precision in identifying advanced GIM stages. BLI's notable sensitivity enhances its use as a complementary tool to WLE, significantly improving gastric cancer risk assessment.

Evaluating the predictive value of endoscopic findings for residual colorectal cancer following neoadjuvant combination immunotherapy.

Endoscopy allows for the direct observation of primary tumor characteristics and responses after neoadjuvant treatment. However, reports on endoscopic evaluation following neoadjuvant immunotherapy remain limited. To examine the predictive value of endoscopic findings of primary tumors for responses to neoadjuvant immunotherapy. This retrospective study, conducted at a tertiary center in China, evaluated 74 patients with colorectal cancer, including 17 with deficient mismatch repair (dMMR) and 15 with proficient mismatch repair (pMMR) tumors. Patients underwent neoadjuvant immunotherapy followed by surgery. Endoscopic findings before and after neoadjuvant immunotherapy were reviewed and compared with the pathology of the resected specimens. In the pMMR group (n = 57 evaluable patients), endoscopy identified 11/17 patients who achieved a complete response (CR), while misidentifying 1/40 patients with residual disease as CR (64.7% vs 2.5%, P < 0.01). Conversely, 22/40 patients with residual disease were accurately identified as achieving a partial response (PR), with 1/17 patients who achieved CR misclassified as PR (55.0% vs 5.9%, P < 0.01). The sensitivity, specificity, and accuracy of endoscopic diagnosis for pathological CR were 64.7%, 97.5%, and 87.7%, respectively. In the dMMR cohort, endoscopy classified 9/17 patients as CR and 2 of the remaining patients with residual tumors as PR (64.3% vs 66.7%, P = 0.73). The method demonstrated 100% sensitivity and 82.4% accuracy in diagnosing pathological CR. Endoscopic evidence of CR or PR was well correlated with postoperative pathological outcomes in the pMMR cohort. Despite endoscopic indications of tumor residue, a complete pathological response post-surgery was possible in the dMMR cohort.

Status and prospect of esophageal cancer screening

Esophageal cancer is one of the global public health problems, which is a serious threat to life and health. Screening is not only an important main measures to reduce the incidence and mortality of esophageal cancer, but also an effective strategy for early prevention and early treatment. There are significant differences in the screening status of esophageal adenocarcinoma and esophageal squamous cell carcinoma cancer between China and abroad. Internationally, there are several guidelines for screening and monitoring of Barrett's esophagus and esophageal adenocarcinoma, but most guidelines do not recommend screening in the general population. The primary screening by sponge ball then endoscopic diagnosis is a new focus. In China, the screening of esophageal cancer and its precancerous lesions is mainly esophageal squamous cell carcinoma, which has been relatively mature and gradually transformed from population screening to opportunistic screening. However, due to the high cost, high technical difficulty and certain invasiveness, it is difficult to popularize and be applied widely; and the canceration rate of precancerous lesions is low, so it is very important to control the cost of screening and scientific follow-up. Moreover, high-risk population should raise their awareness of cancer prevention, actively take primary prevention and the initiative to participate in screening. About medicine institutions, it is urgent to improve the awareness and capacity of early screening. The multi-disciplinary research cooperation, minimally invasive, simple and economical screening methods and multi-omics biomarkers are still explored to detect and concentrate high-risk populations, which will help to optimize screening programs of esophageal cancer and further reduce the incidence and mortality of esophageal cancer.

P0318 Rapid access clinics for Inflammatory Bowel Disease improve access and outcomes but additional service support is required: Experience from the AWARE-IBD Quality Improvement Programme in the United Kingdom

Abstract Background There is increasing attention to quality of Inflammatory Bowel Disease (IBD) services, which are under pressure from rising disease prevalence, increasing disease complexity and a wide range of treatment options – all within constrained resource and capacity. There is limited information on the impact of patient-led service changes in a ‘real-life’ clinic setting. Methods The Sheffield IBD service (UK) implemented the AWARE-IBD patient-led quality improvement (QI) programme of co-designed service change in a microsystem. Designated clinics were allocated for patients prioritised by the microsystem: 1) those with a suspected flare contacting a telephone advice line; 2) starting or changing advanced treatment; and 3) new IBD diagnosis at endoscopy. Appointments were allocated for each of these groups in 3 clinics per week during 2 tests of change (ToC) (ToC 1: 14/11/22 - 25/11/22; ToC 2: 17/04/23 - 26/05/23) and outcomes compared to a prior baseline interval (01/06/22 - 30/06/22). Qualitative feedback was obtained in semi-structured interviews. Results Group 1. Suspected flare (Figure 1): more patients were seen in defined clinics (baseline 8/202 (4.0%); ToC 62/285 (17.9%; p&amp;lt;0.0001) with reduced admissions (baseline 26/202 (12.9%), during ToC 21/347 (6.1%); p=0.006) and investigation (baseline 57/202 (28.2%), ToC 61/347 (17.6%); p=0.003). Group 2. Advanced therapy: more patients were seen within 14 days of the multi-disciplinary team meeting (MDT) to discuss initiation or change (baseline 7/31 (22.6%); ToC 20/32 (62.5%; p=0.001), but with no difference in numbers starting treatment within 28 days. Group 3. New diagnosis: more patients were seen within 30 days of endoscopic diagnosis (baseline 6/27 (22.2%); ToC 14/20 (70%); p=0.001), but not within 14 days. Time to start treatment was not impacted. Interviews indicated reassurance from rapid help and benefits of in-person consultation, improved trust in the healthcare team, and greater confidence for self-management alongside the clinics. Conclusion Rapid access clinics improve access for defined groups, reducing admission and investigation in those with a suspected flare but a minority were accommodated in clinic. Robust arrangements to train and support staff giving complex advice on an advice line are therefore needed. Additional factors such as patient availability, infusion capacity and screening influence time to start advanced treatments. Rapid review after endoscopic diagnosis supports detailed information provision. Services can use QI programmes and iterative tests of change to inform resource allocation and identify key parts of a pathway to affect outcomes.

P0360 Bowel Ultrasonography and Computed Tomography tell the same story using different languages in analizing Crohn’s disease lesions

Abstract Background Inflammatory bowel diseases (IBD) are chronic diseases that require multiple endoscopic and imaging assessments, being diseases that not only involve a multitude of medical resources but patient compliance too. Bowel ultrasonography (BUS) and computed tomography (CT) have similar sensitivities (89.7% and 84.3%) and specificities (95.6% and 95.1%) in assessing IBD patients.Current guidelines recommend BUS altogether with other cross-sectional imaging methods to diagnose, monitor IBD patients and also for detecting complications and post-surgery recurrence Methods 36 Crohn’s disease patients with established endoscopic and histologic diagnosis were included in the study. Patients with moderate and severe disease were prospectively evaluated using two cross-sectional imaging methods (CT and BUS) by two different examiners. Patients with superimposed infection or with surgical history were excluded. The BUS examination was performed using 5-12 MHz micro-convex transducer with no special preparation before, while CT examination was performed using both intra-venous and oral contrasts. Both examiners were blinded to each other’s data. Different bowel wall characteristics were noted using the two methods. A subjective overall assessment of the obtained images was noted according to each examiner. Results A moderate correlation was observed between the measurements of bowel wall thickness using BUS and CT (Spearman’s equation, r= 0.504, p&amp;lt;0.01). Regarding bowel wall stratification, no corrrelation was observed using the two methods. Regarding the comb sign, there was no BUS surrogate for the CT observation. Doppler signal correlated well with the presence of bowel wall stratification observed using CT ( K= 0,36, p p&amp;lt;0.006). A very good agreement was noticed regarding mesenteric fat densification using the two imaging techniques ( k=0,55, p p&amp;lt;0.00006). A low but significantly statistic inter-observer agreement was obtained when lymph nodes were searched ( k=0.28, p p&amp;lt;0.03). When comparing the overall assessment of the examinators, we obtained a good inter-rater agreement (k=0.58, p&amp;lt;0.001) between the two cross-sectional techniques. Conclusion Several BUS and CT observations do not overlap even though the general aspect is similar. This happens when analizing bowel wall stratification that should be understood and applied in clinical pactice differently. The good inter-rater agreement between the two methods prooves that both investigations are useful and should be used according to availability.

P0590 Long term outcomes of biologic therapy for the treatment of prepouch ileitis: a multi-centre multi-national retrospective study

Abstract Background Prepouch ileitis (PPI) is inflammation of the ileum proximal to an ileoanal pouch, usually associated with pouchitis. The treatment of PPI as a specific entity is poorly studied, and long-term follow-up data are lacking. We aimed to describe the long term outcomes of biologic therapy in a large, multi-centre multi-national cohort of PPI patients. Methods This was an observational, retrospective, multi-centre, multi-national study. We included patients with an endoscopic diagnosis of PPI, treated with biologic medications, who had a follow up of at least 1 year. The primary outcome was first line biologic treatment persistence, defined as continuation of the biologic treatment throughout the study period. Secondary outcome was pouch failure, defined by the need for a defunctioning ileostomy or pouch excision. Results There were 55 patients in our cohort. Males comprised 58.2% of our cohort (32/55). Average patient age was 57, and average age at UC diagnosis was 25.1. Average follow up length was 113.2 months (range 20 - 236 months) Infliximab was first line treatment in 33 patients (60%), while 20 (36.3%) initially received Adalimumab and 2 (3.7%) received Vedolizumab treatment. Second line advanced medical treatments in our cohort included infliximab (2 patients), adalimumab (12 patients), vedolizumab (10 patients), ustekinumab (6 patients) and upadacitinib (1 patient). At the end of the study period only 9 out of 55 patients (16.4%) were still on first line biologic treatment. Persistence rates for infliximab (5/33, 15.1%) and adalimumab (3/20, 15%) were similar (p=0.99). Out of the 46 patients failing first line biologic treatment, 22 (40% of the cohort) developed pouch failure, and 24 (43.6% of the cohort) are currently treated with a different medical therapy. Conclusion First line biologic treatment for PPI is associated with low long term persistence rates. A significant percentage of PPI patients initially treated with biologics develop pouch failure.

Nurse-Led Service Model for Outpatient Pain-Free Management Under Anesthesiologist Supervision: A Single Center, Observational Study in China.

The efficacy of establishing an intensification outpatient center for diagnostic and treatment endoscope services has been documented, but its practical implementation remains limited. Presently, there are two models for outpatient endoscope care services: the clinical specialty-based model and the solitary outpatient model. However, each model has its limitations. In this study, we introduce a nurse-led service model that offers comprehensive care throughout the entire journey for patients undergoing painless endoscopic treatment procedures outside the operating room overseen by anesthesiologist and report its implementation in an university-affiliated hospital. A single-center observational study. Data was collected all of 2013 and 2022 at a tertiary medical hospital center. A total of 168,100 patients undergoing endoscopic anesthesia were included in the analysis. Patients receiving endoscopic diagnosis and treatment were divided into two groups: the Model-2013 (clinical specialty endoscopy service model, from January to December 2013) and the Model-2022 (nurse-led service model under the supervision of anesthesiologists, from January to December 2022). We conducted a retrospective analysis of workload data and compared the nursing quality management index of endoscopy center between Model-2013 and Model-2022. In 2013, the workload for digestive endoscopy was 28,864 procedures, while in 2022, it had significantly increased to 139,236 procedures. Patient satisfaction had risen from 93.99% to 95.25%, and the satisfaction of the collaborative team increased from 91.77% to 98.10%. The endoscopic cancellation rate dropped from 13.56% to 8.75%. The quality indicators for anesthesia nursing and endoscopy nursing had improved significantly without an increase in equipment and nursing costs (p < .05). The nurse-led service model for patients undergoing painless endoscopic procedures outside the operating room can enhance service efficiency and patient safety and satisfaction, and can serve as a viable alternative to the traditional models based on clinical specialty and independent single endoscopy department.

P0241 The DETECTION Study: DETection by Endoscopy of Colitis in Screening ImplementaTION

Abstract Background The National Bowel Screening Program (Bowelscreen), a nationwide initiative program, aims to provide direct access to those aged 55-74 (currently 59-69) for colonoscopy assessment deemed high risk for colorectal cancer via positive faecal immunochemical test (FIT). Inflammatory Bowel Disease (IBD) follows a bimodal distribution of onset with European studies reporting 10-15% diagnosis after age 60. Limited published research exists on IBD incidence in Ireland via FIT-based population screening and associated outcomes. We aim to dtermine incidence rates/severity of incident IBD cases found via FIT-based colorectal screening programme and hRetrospective review was conducted of all index colonoscopes conducted in FIT positive screening participants (aged 59-69) in multiple Irish centres between 2015-2024. Inclusion criteria: histological diagnosis of colitis. Parameters measured: distribution of colitis, histology, clinical sequalae/IBD history, faecal calprotectin (FCP) and treatment escalation based on screening colonoscopyow often screening colonoscopy is performed for patients with known IBD and positive FIT. Methods Retrospective review was conducted of all index colonoscopes conducted in FIT positive screening participants (aged 59-69) in multiple Irish centres between 2015-2024. Inclusion criteria: histological diagnosis of colitis. Parameters measured: distribution of colitis, histology, clinical sequalae/IBD history, faecal calprotectin (FCP) and treatment escalation based on screening colonoscopy. Results 203/8070 (2.52%) of index screening colonoscopies analysed reported endoscopic diagnosis of colitis. 105/8070 (1.3%) satisfied diagnostic criteria for classic IBD (65.7% UC; 34.2% Crohn’s), of which the majority were new diagnosis (73.3%). 32% cases of segmental colitis associated with diverticulosis (SCAD) were identified. 21% cases of NSAID induced colitis were identified. UC Colitis distribution: 18.8% pancolitis, 38.4% proctitis and 42.8% left-sided. Crohn’s distribution: 8.3% small bowel solely; 89% colonic and 2.7% mixed. 48% reported symptoms at endoscopy. Median FCP following diagnostic colonoscopy was 216.5μg/g. 10% of newly diagnosed IBD patients required biologic escalation. Conclusion Incidental diagnosis of colitis occurs in 3% of FIT-positive screening participants in a population based screening programme with new diagnoses of IBD including UC, Crohn’s and SCAD requiring treatment. This is a novel, unintended benefit to FIT-based population screening.

A prospective and comparative study on improving the diagnostic accuracy of early gastric cancer based on deep convolutional neural network real-time diagnosis system (with video).

Endoscopic diagnosis of early gastric cancer (EGC) is a challenge. It is not clear whether deep convolutional neural network (DCNN) model could improve the endoscopists' diagnostic performance. We established a DCNN-assisted system and found that accuracy of diagnosis is higher than endoscopists. We prospectively collected an independent image test set of 1289 images and a video test set of 130 patients from three endoscopic centers to compare the diagnostic efficacy of 12 endoscopists before and after DCNN model assistance. Accuracy, sensitivity, specificity, time, and AUC were the main indicators for comparison. The DCNN model discriminated EGC from the control group (including ulcers and chronic gastritis) with an AUC of 0.917, a sensitivity of 93.38% (95% CI 91.09-95.12%), and a specificity of 90.07% (95% CI 87.59-92.10%) in the image dataset. The video test dataset have an AUC of 0.930, a sensitivity of 96.92% (95% CI 88.83-99.78%), and a specificity of 89.23% (95% CI 79.11-94.98%). The diagnostic performance of novice endoscopists was comparable to those of expert endoscopists with the DCNN model's assistance (accuracy: 95.22 vs. 96.16%) in image test dataset. In the video test, the novice endoscopists, accuracy after DCNN assistance was also improved from 79.36 to 86.41%, and from 86.28 to 91.03% for expert endoscopists. The mean pairwise kappa value of endoscopists was increased significantly with the DCNN model's assistance (0.705-0.753 vs.0.767-0.890) in image testing, and (0.657-0.793 vs. 0.738-0.905) in video testing. The diagnostic duration reduced considerably with the assistance of the DCNN model from 7.09 ± 0.6s to 5.05 ± 0.55s in image test, and from 2392.17 ± 7.77s to2378.34 ± 23.51s in video test. We developed a DCNN-assisted diagnostic system. And the system can improve the diagnostic performance of endoscopists and help novice endoscopists achieve diagnostic accuracy comparable to that of expert endoscopists.

Endoscopic diagnosis and management of eosinophilic esophagitis.

Eosinophilic esophagitis is a chronic allergic inflammatory disease, and its incidence and prevalence have recently increased. Eosinophilic esophagitis has not become a rare disease; thus, knowledge for diagnosing it is needed in current clinical practice. The adequate management of endoscopic procedures is particularly important for the diagnosis and evaluation of inflammatory activity and therapeutic responses. The therapeutic options for eosinophilic esophagitis include anti-acid drugs such as proton pump inhibitors, potassium-competitive acid blockers, swallowed topical corticosteroids, biologics, and dietary elimination therapies. Moreover, endoscopic esophageal dilation is a therapeutic option for fibrotic strictures due to eosinophilic esophagitis to improve obstructive symptoms, such as dysphagia and food impaction. In this review, we describe the endoscopic characteristics of eosinophilic esophagitis, including an endoscopic reference score and an optimal biopsy protocol to diagnose and evaluate the therapeutic response. We also describe a current therapeutic management of eosinophilic esophagitis.

Endoscopic and imaging evaluations of the primary tumor response in patients with proficient mismatch repair colorectal cancer treated with neoadjuvant combination immunotherapy.

Neoadjuvant combination immunotherapy is a potential treatment option for patients with proficient mismatch repair/microsatellite stable colorectal cancer. Preoperative screening via endoscopy and imaging examinations could help identify patients who may potentially achieve a complete response after neoadjuvant combination immunotherapy. This study aims to evaluate the diagnostic accuracy of endoscopic and imaging examinations in predicting pathological complete response after neoadjuvant combination immunotherapy. This single-center, retrospective, observational study included patients diagnosed with colorectal cancer by biopsy between 2015 and 2023 at a tertiary referral center. The main outcome measures included endoscopic examination, imaging findings, and pathological results after neoadjuvant combination immunotherapy. This study included 36 patients with locally advanced proficient mismatch repair colorectal cancer. Postoperative pathology revealed that 17 patients (47.2%) achieved a complete response (ypT0N0). The sensitivity, specificity, and accuracy of the endoscopic ypT0N0 diagnosis were 62.5%, 80.0%, and 80.6%, respectively; those of imaging-based ypT0N0 diagnosis were 43.8%, 100%, and 75.0%, respectively; and those of the combined diagnosis were 37.5%, 100%, and 72.2%, respectively. The areas under the receiver-operating characteristic curve for the endoscopic and imaging ypT0N0 diagnoses were 0.768 and 0.706, respectively. The specificities of endoscopy and imaging for diagnosing complete response after neoadjuvant combination immunotherapy for colorectal cancer were high; however, sensitivities were low. Therefore, radical surgery should still be recommended for patients with an incomplete response based on either examination. Larger scale studies are required to determine if a watch-and-wait strategy is suitable for patients with a complete response based on these two examinations.

Multiplexed Bio‐detection on an Interferometric Optical Waveguide Assembly

AbstractMultiplexed remote bio‐detection is demonstrated through an optical waveguide assembly coated with interferometric layers. Image conduits (IC)s, composed of 3012 individual cores, are coated with interferometric layers of tantalum pentoxide (Ta2O5) and silica (SiO2) to transform each core into a sensitive sensor. The spectral response of the IC as a function of refractive index (RI) changes is obtained and compared with the simulated one. The experimental sensitivities and resolutions of individual cores of the waveguide are assessed in remote detection mode by imaging through the optical assembly. For 75% of the cores, a sensitivity better than 510%. RIU−1 (RI Unit) is obtained, corresponding to a resolution better than 7 × 10−4 RIU. Furthermore, the coated face of IC is functionalized with two localized arrays of hundred‐micrometer droplets containing two different oligonucleotide (ODN) probes using a polymeric 3D‐printed microcantilever. Hybridization of complementary ODN strands is detected for one of the probes, the second being a negative control. Interaction kinetics are monitored in functionalized areas by grouping several cores or on individual cores. Thus, multiplexed bio‐detection on the surface of an interferometric waveguide is demonstrated for the first time paving the way for applications in multiplex in situ biosensing, and, ultimately, in vivo endoscopic diagnosis.

Advancements in Endoscopic Treatment for Gastric Subepithelial Tumors.

Peroral flexible endoscopy is a minimally invasive technique that enables the local resection of gastric subepithelial tumors (SETs) with malignant potential. Resection techniques are mainly chosen on the basis of the lesion size. Minute SETs less than 1 cm should be managed through a watch and wait strategy, with the exception of histologically diagnosed superficial lesions, which require endoscopic mucosal resection or endoscopic submucosal dissection. For 1- to 3-cm small SETs, endoscopic enucleation techniques, such as endoscopic submucosal excavation, submucosal tunneling endoscopic resection, and peroral endoscopic tumor resection, can be used. However, endoscopic full-thickness resection is preferred for histologically complete removal with negative surgical margins. When endoscopic full-thickness resection is considered technically difficult, laparoscopic and endoscopic cooperative surgery (LECS) is a safe and dependable alternative. Moderate-sized SETs (3 to 5 cm) require surgical intervention because the lesions must be removed transabdominally. LECS is a less invasive surgical procedure as it reduces the resection area; however, some LECS techniques that require transoral tumor retrieval are not available. Endoscopic intervention for lesions larger than 5 cm should be used with caution for research purposes. With advancements in endoscopic diagnosis, the indications for endoscopic treatment for SETs are expected to improve, thereby enhancing patients' quality of life.

Assessment of Helicobacter pylori infection in Lebanon: Endoscopic and histopathological findings.

Helicobacter pylori (H. pylori), a pervasive pathobiont, colonizes the gastric mucosa and plays a crucial role in the pathogenesis of several gastroduodenal pathologies ranging from chronic gastritis to more severe disorders including peptic ulcer disease, gastric mucosa-associated lymphoid tissue lymphoma, and gastric adenocarcinoma. In symptomatic patients, endoscopy and histological examination of the gastric mucosa are the preferred tests for diagnosing H. pylori. Our study aimed to identify the frequency of H. pylori and its association with endoscopic and histopathological findings in adult Lebanese patients. Thus, 332 symptomatic adult patients, attending the Endoscopy unit of Makassed General Hospital in Beirut, were enrolled in this cross-sectional study. Overall, 14.16 % of the patients were infected with H. pylori, with male predominance. The most common endoscopic findings were gastritis and gastropathy. Moreover, H. pylori infection was significantly associated with gastric ulcers and duodenitis. On the other hand, active gastritis and chronic gastritis were the most common histopathological findings. Chronic gastritis was more frequent in H. pylori-positive patients. The association between endoscopic diagnosis and histopathological findings was then assessed. It was shown that gastropathy was significantly associated with chronic gastritis. In addition, gastric ulcer was significantly related to active gastritis and chronic gastritis. In conclusion, this study reported various endoscopic findings in H. pylori-positive patients based on the Kyoto classification. This highlights the importance of invasive diagnosis in symptomatic patients. Therefore, a combination-based approach including endoscopic and histopathological findings remains crucial in clinical practice for a definitive and accurate diagnosis of H. pylori infection and related disorders, especially in resource-limited settings.

Advances in Endoscopic Ultrasonography-Based Diagnosis of Pancreatic Lesions: Narrative Review.

Pancreatic cancer is the fourth deadliest cancer in the U [...].

Current Status of Computer Aided Diagnosis in Gastrointestinal Endoscopy

Current Status of Computer Aided Diagnosis in Gastrointestinal Endoscopy

Neoplasms in the Nasal Cavity Identified and Tracked with an Artificial Intelligence-Assisted Nasal Endoscopic Diagnostic System.

We aim to construct an artificial intelligence (AI)-assisted nasal endoscopy diagnostic system capable of preliminary differentiation and identification of nasal neoplasia properties, as well as intraoperative tracking, providing an important basis for nasal endoscopic surgery. We retrospectively analyzed 1050 video data of nasal endoscopic surgeries involving four types of nasal neoplasms. Using Deep Snake, U-Net, and Att-Res2-UNet, we developed a nasal neoplastic detection network based on endoscopic images. After deep learning, the optimal network was selected as the initialization model and trained to optimize the SiamMask online tracking algorithm. The Att-Res2-UNet network demonstrated the highest accuracy and precision, with the most accurate recognition results. The overall accuracy of the model established by us achieved an overall accuracy similar to that of residents (0.9707 ± 0.00984), while slightly lower than that of rhinologists (0.9790 ± 0.00348). SiamMask's segmentation range was consistent with rhinologists, with a 99% compliance rate and a neoplasm probability value ≥ 0.5. This study successfully established an AI-assisted nasal endoscopic diagnostic system that can preliminarily identify nasal neoplasms from endoscopic images and automatically track them in real time during surgery, enhancing the efficiency of endoscopic diagnosis and surgery.