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12 pages, 1714 KiB

Open AccessArticle

Evaluation of Crohn’s Disease Small-Bowel Mucosal Healing Using Capsule Endoscopy and Usefulness of Leucine-Rich α2-Glycoprotein

by Hiroto Hiraga, Daisuke Chinda, Keisuke Hasui, Yasuhisa Murai, Takato Maeda, Naoki Higuchi, Kohei Ogasawara, Sae Kudo, Yohei Sawada, Tetsuya Tatsuta, Hidezumi Kikuchi, Mami Ebina, Noriko Hiraga, Tatsuya Mikami, Hirotake Sakuraba and Shinsaku Fukuda

Diagnostics 2023, 13(4), 626; https://doi.org/10.3390/diagnostics13040626 - 8 Feb 2023

Cited by 3 | Viewed by 1816

Abstract

Recently, the importance of achieving clinical and deep remissions with mucosal healing (MH) has been demonstrated as a therapeutic goal to avoid Crohn’s disease (CD) surgical operations. Although ileocolonoscopy (CS) is considered the gold standard, there are increasing reports on the benefits of [...] Read more.

Recently, the importance of achieving clinical and deep remissions with mucosal healing (MH) has been demonstrated as a therapeutic goal to avoid Crohn’s disease (CD) surgical operations. Although ileocolonoscopy (CS) is considered the gold standard, there are increasing reports on the benefits of capsule endoscopy (CE) and serum leucine-rich α2-glycoprotein (LRG) for evaluating small-bowel lesions in CD. We evaluated the data of 20 patients with CD who underwent CE in our department between July 2020 and June 2021 and whose serum LRG level was measured within 2 months. Concerning the mean LRG value, there was no significant difference between the CS-MH and CS-non-MH groups. Conversely, the mean LRG level was 10.0 μg/mL in seven patients in the CE-MH group and 15.2 μg/mL in 11 patients in the CE-non-MH group with a significant difference between the two groups (p = 0.0025). This study’s findings show that CE can sufficiently determine total MH in most cases, and LRG is useful for evaluating CD small-bowel MH because of its correlation with CE-MH. Furthermore, satisfying CS-MH criteria and a cut-off value of 13.4 μg/mL for LRG suggests its usefulness as a CD small-bowel MH marker, which could be incorporated into the treat-to-target strategy. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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11 pages, 2708 KiB

Open AccessArticle

Third-Generation High-Vision Ultrathin Endoscopy Using Texture and Color Enhancement Imaging and Narrow-Band Imaging to Evaluate Barrett’s Esophagus

by Mitsushige Sugimoto, Yusuke Kawai, Yoshika Akimoto, Mariko Hamada, Eri Iwata, Masaki Murata, Hitomi Mizuno, Ryota Niikura, Naoyoshi Nagata, Masakatsu Fukuzawa, Takao Itoi and Takashi Kawai

Diagnostics 2022, 12(12), 3149; https://doi.org/10.3390/diagnostics12123149 - 13 Dec 2022

Cited by 6 | Viewed by 2389

Abstract

It remains unclear whether texture- and color-enhancement imaging (TXI) and narrow-band imaging (NBI) provide an advantage over white-light imaging (WLI) in Barrett’s esophagus. We compared endoscopic findings and color differences between WLI and image-enhanced endoscopy (IEE) using a third-generation ultrathin endoscope. We retrospectively [...] Read more.

It remains unclear whether texture- and color-enhancement imaging (TXI) and narrow-band imaging (NBI) provide an advantage over white-light imaging (WLI) in Barrett’s esophagus. We compared endoscopic findings and color differences between WLI and image-enhanced endoscopy (IEE) using a third-generation ultrathin endoscope. We retrospectively enrolled 40 patients who evaluated Barrett’s esophagus using WLI, TXI, and NBI. Color differences determined using the International Commission on Illumination 1976 (L∗, a∗, b∗) color space among Barrett’s epithelium, esophageal, and gastric mucosa were compared among the endoscopic findings. As the secondary outcome, we assessed the subjective visibility score among three kinds of endoscopic findings. The prevalence of Barrett’s esophagus and gastroesophageal reflux disease (GERD) in WLI was 82.5% and 47.5%, respectively, and similar among WLI, TXI, and NBI. Color differences between Barrett’s epithelium and esophageal or gastric mucosa on NBI were significantly greater than on WLI (all p < 0.05). However, the color difference between Barrett’s epithelium and esophageal mucosa was significantly greater on NBI than TXI (p < 0.001), and the visibility score of Barrett’s epithelium detection was significantly greater on TXI than NBI (p = 0.022), and WLI (p = 0.016). High-vision, third-generation ultrathin endoscopy using NBI and TXI is useful for evaluating Barrett’s epithelium and GERD compared with WLI alone. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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10 pages, 2882 KiB

Open AccessArticle

Endoscopic Grading of Gastric Intestinal Metaplasia Using Magnifying and Nonmagnifying Narrow-Band Imaging Endoscopy

by Masashi Kawamura, Tomoyuki Koike, Yohei Ogata, Ryotaro Matsumoto, Kota Yano, Takashi Hiratsuka, Hideaki Ohyama, Isao Sato, Kimiko Kayada, Suguo Suzuki, Satsuki Hiratsuka and Yumiko Watanabe

Diagnostics 2022, 12(12), 3012; https://doi.org/10.3390/diagnostics12123012 - 1 Dec 2022

Cited by 3 | Viewed by 4439

Abstract

Several endoscopic findings obtained by magnifying image-enhanced endoscopy (IEE) are reportedly correlated with gastric intestinal metaplasia (IM); however, the differences between magnifying and nonmagnifying IEE for the diagnosis of gastric IM remain unknown. This study included 100 consecutive patients who underwent narrow-band imaging [...] Read more.

Several endoscopic findings obtained by magnifying image-enhanced endoscopy (IEE) are reportedly correlated with gastric intestinal metaplasia (IM); however, the differences between magnifying and nonmagnifying IEE for the diagnosis of gastric IM remain unknown. This study included 100 consecutive patients who underwent narrow-band imaging endoscopy. Four areas of the stomach were evaluated using nonmagnifying and magnifying IEE. Light-blue crest (LBC), white opaque substance (WOS), and endoscopic grading of the gastric IM (EGGIM) were assessed. The concordance rates between nonmagnifying and magnifying IEE were 80.5% for LBC and 93.3% for WOS. The strength of agreement between each observation technique showed good reproducibility, with a kappa value of 0.69 and 0.83 for LBC and WOS, respectively. The individual EGGIM score indicated a good correlation between nonmagnifying and magnifying IEE (concordance rate, 75%; kappa value, 0.67). The prevalence of a high EGGIM score in patients with and without gastric cancer (GC) showed a significant difference both with nonmagnifying IEE (odds ratio (OR), 3.3; 95% confidence interval (CI), 1.2–9.0), and magnifying IEE (OR, 3.1; 95% CI, 1.1–8.9). Nonmagnifying IEE has the potential to stratify the individual risk of GC, similar to magnifying IEE, warranting further investigation with histological assessment. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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15 pages, 22473 KiB

Open AccessArticle

Endoscopic Features of Gastric Epithelial Neoplasm of Fundic Gland Mucosa Lineage

by Kohei Matsumoto, Hiroya Ueyama, Takashi Yao, Tomoyo Iwano, Momoko Yamamoto, Hisanori Utsunomiya, Ryota Uchida, Daiki Abe, Shotaro Oki, Nobuyuki Suzuki, Atsushi Ikeda, Noboru Yatagai, Yoichi Akazawa, Tsutomu Takeda, Kumiko Ueda, Daisuke Asaoka, Mariko Hojo and Akihito Nagahara

Diagnostics 2022, 12(11), 2666; https://doi.org/10.3390/diagnostics12112666 - 2 Nov 2022

Cited by 4 | Viewed by 2170

Abstract

The endoscopic features of gastric epithelial neoplasms of fundic gland mucosa lineage (GEN-FGML) have not been well investigated. We aimed to clarify the endoscopic features of GEN-FGML and differences between gastric adenocarcinoma of the fundic gland type (GA-FG) and fundic gland mucosa type [...] Read more.

The endoscopic features of gastric epithelial neoplasms of fundic gland mucosa lineage (GEN-FGML) have not been well investigated. We aimed to clarify the endoscopic features of GEN-FGML and differences between gastric adenocarcinoma of the fundic gland type (GA-FG) and fundic gland mucosa type (GA-FGM). A total of 62 GEN-FGML lesions, including 52 GA-FG and 10 GA-FGM, were retrospectively analyzed using endoscopic and clinicopathological findings to provide information of diagnostic value using white light imaging (WLI) and magnifying endoscopy with narrow-band imaging (M-NBI). GA-FG frequently presented with a whitish, submucosal tumor (SMT) shape with dilated vessels with branching architecture and background mucosa without atrophic change in WLI, an indistinct demarcation line (DL), dilatation of the crypt opening and intervening part (IP), and microvessels without distinct irregularity in M-NBI. GA-FGM frequently presented as a reddish, elevated lesion in WLI, with a distinct DL, dilatation of the IP, and an irregular microvascular pattern in M-NBI. As for an M-NBI diagnosis, five GA-FGM lesions met the diagnostic criteria for cancer, whereas none of the GA-FG lesions met the same criteria. We highlight the endoscopic features of GEN-FGML, and the differentiation between GA-FG and GA-FGM might be possible by combination of lesion color and morphology in WLI and M-NBI diagnoses. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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10 pages, 1279 KiB

Open AccessArticle

Investigation of the New Advantages of Colonoscope Insertion with an Endoscopic Position Detection Unit

by Takashi Kawai, Yusuke Kawai, Yoshika Akimoto, Mariko Hamada, Eri Iwata, Ryota Niikura, Naoyoshi Nagata, Mitsushige Sugimoto, Kyosuke Yanagisawa, Tetsuya Yamagishi, Masakatsu Fukuzawa and Takao Itoi

Diagnostics 2022, 12(11), 2610; https://doi.org/10.3390/diagnostics12112610 - 27 Oct 2022

Cited by 1 | Viewed by 3147

Abstract

Background: The use of an endoscopic position detection unit (UPD) enables better and more objective understanding of the shape and position of the colonoscope. Here, we investigated the reproducibility of the insertion of a colonoscope with UPD. Materials and Methods: Study participants were [...] Read more.

Background: The use of an endoscopic position detection unit (UPD) enables better and more objective understanding of the shape and position of the colonoscope. Here, we investigated the reproducibility of the insertion of a colonoscope with UPD. Materials and Methods: Study participants were 122 patients who received a colonoscopy with UPD twice for the purpose of large bowel screening and surveillance. The mean age of participants was 69.7 ± 10.4 years, and the male-to-female ratio was 9.2:1. The colonoscope insertion technique was primarily based on the shaft-holding, shortening insertion method. The cecal intubation time was recorded; the method used for passing through the sigmoid/descending colon junction (SDJ) and the hepatic flexure. Results: The mean cecal intubation time was 990 ± 511 s. The cecal intubation time and the patterns for passing through the SDJ and hepatic flexure were significantly correlated between the first and second colonoscopies. Conclusion: Use of a UPD revealed good reproducibility of colonoscope insertion. This is the first time we have proved that both time and pattern are inserted in much the same way for the first and second times. In patients’ conducted UPD combination TCS after the second time, it was suggested that individual tailor-made insertions are possible based on the information from the first time. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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9 pages, 578 KiB

Open AccessArticle

Nature and Clinical Outcomes of Acute Hemorrhagic Rectal Ulcer

by Yasutaka Takahashi, Yosuke Shimodaira, Tamotsu Matsuhashi, Tsuyotoshi Tsuji, Sho Fukuda, Kae Sugawara, Youhei Saruta, Kenta Watanabe and Katsunori Iijima

Diagnostics 2022, 12(10), 2487; https://doi.org/10.3390/diagnostics12102487 - 14 Oct 2022

Cited by 2 | Viewed by 2472

Abstract

Acute hemorrhagic rectal ulcer (AHRU) is a relatively rare disease that can lead to massive hematochezia. Although AHRU is a potentially life-threatening disease, its characteristics and clinical course are not fully understood. In this study, the clinical features were compared between AHRU and [...] Read more.

Acute hemorrhagic rectal ulcer (AHRU) is a relatively rare disease that can lead to massive hematochezia. Although AHRU is a potentially life-threatening disease, its characteristics and clinical course are not fully understood. In this study, the clinical features were compared between AHRU and lower gastrointestinal bleeding (LGIB) from other causes (non-AHRU). Then, risk factors for all-cause in-hospital mortality in patients with AHRU were identified. A total of 387 consecutive adult patients with LGIB who were managed at two tertiary academic hospitals in Akita prefecture in Japan were retrospectively enrolled. Subjects were divided into AHRU and non-AHRU groups according to the source of bleeding. Regression analyses were used to investigate significant associations, and the results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs). AHRU was found as the bleeding source in 72 (18.6%) of the patients. In comparison to non-AHRU, having AHRU was significantly associated with in-hospital onset, age > 65 years, and systolic blood pressure < 90 mmHg. The AHRU group had a significantly higher in-hospital mortality rate in comparison to the non-AHRU group (18.0% vs. 8.3, p = 0.02), and hypoalbuminemia (<2.5 g/dL) was significantly associated with in-hospital mortality in the AHRU group (OR, 4.04; 95%CI, 1.11–14.9; p = 0.03). AHRU accounts for a substantial portion (18.6%) of LGIB in our area, where the aging rate is the highest in Japan. Since AHRU is a potentially life-threatening disease that requires urgent identification and management, further studies to identify robust risk factors associated with serious clinical outcomes are required. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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9 pages, 977 KiB

Open AccessArticle

Comparison of the Degree of Gastric Mucosal Injury between Patients Who Are Receiving Dual Antiplatelet Therapy or Single Antiplatelet Therapy

by Yuji Shimada, Mariko Hojo, Yuji Kita, Yuji Ikeda, Sho Sato, Ayato Murata, Shunsuke Sato, Kohei Matsumoto, Yoichi Akazawa, Tsutomu Takeda, Kumiko Ueda, Hiroya Ueyama, Tomoyoshi Shibuya, Takuya Genda and Akihito Nagahara

Diagnostics 2022, 12(10), 2364; https://doi.org/10.3390/diagnostics12102364 - 29 Sep 2022

Cited by 2 | Viewed by 2112

Abstract

Background: Patients taking low-dose aspirin have a higher incidence of gastroduodenal ulcers and higher risk of upper gastrointestinal bleeding than patients who do not. Thienopyridine antiplatelet agents may similarly cause bleeding gastroduodenal erosions and ulcers. The incidence of gastrointestinal bleeding is reported to [...] Read more.

Background: Patients taking low-dose aspirin have a higher incidence of gastroduodenal ulcers and higher risk of upper gastrointestinal bleeding than patients who do not. Thienopyridine antiplatelet agents may similarly cause bleeding gastroduodenal erosions and ulcers. The incidence of gastrointestinal bleeding is reported to be higher when these antithrombotic drugs are used in combination. Until now, most studies have focused on bleeding, and no study has compared the degree of gastric mucosal injury between patients receiving dual antiplatelet therapy (DAPT) and those receiving single antiplatelet therapy (SAPT) in real-world clinical practice. Aim: Our objective was to compare the degree of gastric mucosal injury in patients taking low-dose aspirin in combination with clopidogrel (one of the thienopyridine antiplatelet agents) with that of patients who were taking aspirin or clopidogrel as a single agent. Methods: Patients who were taking aspirin and/or clopidogrel and who underwent scheduled esophagogastroduodenoscopy between April 2015 and March 2020 were enrolled in this study. Endoscopic images were reviewed retrospectively, and the degree of gastric mucosal injury was assessed with the modified Lanza score (m-Lanza score). The m-Lanza score was compared between DAPT patients taking aspirin and clopidogrel and SAPT patients taking either aspirin alone or clopidogrel alone. Results: The m-Lanza scores of the DAPT group, the aspirin group, and the clopidogrel group were 1.67 ± 1.81 (mean ± standard deviation), 0.95 ± 1.61, and 0.72 ± 1.29, respectively. The m-Lanza score of the DAPT group tended to be higher than that of the aspirin group (p = 0.06) and was significantly higher than that of the clopidogrel group (p = 0.03). Conclusion: The degree of gastric mucosal injury in DAPT patients was significantly higher than that in patients using clopidogrel alone and tended to be higher than that in patients using aspirin alone in real-world clinical practice. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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9 pages, 733 KiB

Open AccessArticle

Feasibility of Support by Family Practitioners in Reducing Colorectal Cancer-Related Death among Outpatients Who Have Not Undergone Colorectal Cancer Screening

by Ryo Sugaya, Takeshi Kanno, Hirohisa Yasaka, Misuzu Masu, Masataka Otomo and Tomoyuki Koike

Diagnostics 2022, 12(8), 1782; https://doi.org/10.3390/diagnostics12081782 - 22 Jul 2022

Viewed by 1731

Abstract

We aimed to clarify the effectiveness of interventions in outpatients who did not undergo colorectal cancer (CRC) screening. From September 2012 to August 2013, we conducted a project, which showed that the immunological fecal occult blood test (FOBT) was actively recommended for outpatients [...] Read more.

We aimed to clarify the effectiveness of interventions in outpatients who did not undergo colorectal cancer (CRC) screening. From September 2012 to August 2013, we conducted a project, which showed that the immunological fecal occult blood test (FOBT) was actively recommended for outpatients who were ≥40 years of age, attended the Marumori Hospital regularly, and were not screened for CRC in the previous two years. We evaluated the detection rate of CRC and the disease specific survival ratio in February 2021 among patients with positive FOBT results during the retrospective cohort study. Overall, 388 (91%) out of the 425 outpatients submitted their stool samples. Among 388 outpatients, 66 tested positive for FOBT. While both the positive rate of FOBT and the detection rate of CRC (17% and 0.77%, respectively) were significantly higher than those in the nationwide administrative examination (5.7% and 0.13%, respectively) (p < 0.05), there was no statistically significant difference in the detection rate, compared with the group aged 65 years and older in the nationwide administrative examination. The 7-year CRC-specific survival ratio was 98.5%. Active promotion of FOBT at primary care institutions for outpatients who did not undergo CRC screening may contribute to reducing the frequency of CRC-related deaths. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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Review

Jump to: Research

17 pages, 3129 KiB

Open AccessReview

Usefulness of Endoscopy for the Detection and Diagnosis of Primary Esophageal Motility Disorders and Diseases Relating to Abnormal Esophageal Motility

by Shiko Kuribayashi, Hiroko Hosaka and Toshio Uraoka

Diagnostics 2023, 13(4), 695; https://doi.org/10.3390/diagnostics13040695 - 12 Feb 2023

Cited by 1 | Viewed by 5181

Abstract

Esophagogastroduodenoscopy (EGD) is performed to rule out organic diseases in the diagnosis of esophageal motility disorders (EMDs). Abnormal endoscopic findings can be observed during EGD, which indicate the presence of EMDs. Several endoscopic findings at both the esophagogastric junction and esophageal body that [...] Read more.

Esophagogastroduodenoscopy (EGD) is performed to rule out organic diseases in the diagnosis of esophageal motility disorders (EMDs). Abnormal endoscopic findings can be observed during EGD, which indicate the presence of EMDs. Several endoscopic findings at both the esophagogastric junction and esophageal body that are related to EMDs have been reported. Gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) could be detected during EGD, and these diseases are often associated with abnormal esophageal motility. Image-enhanced endoscopy (IEE) could improve the detection of these diseases during EGD. Although no report has been published previously on the potential usefulness of IEE in the endoscopic diagnosis of EMDs, IEE can be used to detect disorders that can be associated with abnormal esophageal motility. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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13 pages, 1919 KiB

Open AccessReview

Linked Color Imaging for Stomach

by Eiji Umegaki, Hiraku Misawa, Osamu Handa, Hiroshi Matsumoto and Akiko Shiotani

Diagnostics 2023, 13(3), 467; https://doi.org/10.3390/diagnostics13030467 - 27 Jan 2023

Cited by 4 | Viewed by 3079

Abstract

Image-enhanced endoscopy (IEE) plays an important role in the detection and further examination of gastritis and early gastric cancer (EGC). Linked color imaging (LCI) is also useful for detecting and evaluating gastritis, gastric intestinal metaplasia as a pre-cancerous lesion, and EGC. LCI provides [...] Read more.

Image-enhanced endoscopy (IEE) plays an important role in the detection and further examination of gastritis and early gastric cancer (EGC). Linked color imaging (LCI) is also useful for detecting and evaluating gastritis, gastric intestinal metaplasia as a pre-cancerous lesion, and EGC. LCI provides a clear excellent endoscopic view of the atrophic border and the demarcation line under various conditions of gastritis. We could recognize gastritis as the lesions of the diffuse redness to purple color area with LCI. On the other hand, EGCs are recognized as the lesions of the orange-red, orange, or orange-white color area in the lesion of the purple color area, which is the surround atrophic mucosa with LCI. With further prospective randomized studies, we will be able to evaluate the diagnosis ability for EGC by IEE, and it will be necessary to evaluate the role of WLI/IEE and the additional effects of the diagnostic ability by adding IEE to WLI in future. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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14 pages, 2247 KiB

Open AccessReview

Diagnosis of Cholangiocarcinoma

by Dong Woo Shin, Sung-Hoon Moon and Jong Hyeok Kim

Diagnostics 2023, 13(2), 233; https://doi.org/10.3390/diagnostics13020233 - 8 Jan 2023

Cited by 14 | Viewed by 5426

Abstract

Cholangiocarcinoma (CCA), a tumor of the bile duct epithelium, is increasing in incidence. CCA remains a highly fatal malignancy because early diagnosis is difficult. Based on its anatomical location, CCA can be categorized into the following three groups: perihilar, intrahepatic, and extrahepatic. Patients [...] Read more.

Cholangiocarcinoma (CCA), a tumor of the bile duct epithelium, is increasing in incidence. CCA remains a highly fatal malignancy because early diagnosis is difficult. Based on its anatomical location, CCA can be categorized into the following three groups: perihilar, intrahepatic, and extrahepatic. Patients with CCA complain of asymptomatic jaundice, weight loss, and right upper quadrant abdominal discomfort. Imaging modalities, including transabdominal ultrasound, computed tomography, and magnetic resonance imaging, play an important role in detecting tumors as well as guiding biopsy procedures and staging workups in CCA. Characteristically, extrahepatic CCA shows abrupt changes in ductal diameter with upstream ductal dilation. Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are recommended as the next step in the evaluation of extrahepatic CCA. Tissue is obtained through EUS-FNA or ERCP (biopsy, brush cytology), and therapeutic intervention (such as stent insertion) is performed with ERCP. Moreover, several serum tumor markers (carbohydrate antigen 19-9 and carcinoembryonic antigen) can be useful in diagnosing CCA in some patients. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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8 pages, 1192 KiB

Open AccessReview

Small Bowel Endoscopic Features of Eosinophilic Gastroenteritis

by Yu Sasaki, Yasuhiko Abe, Naoko Mizumoto, Eiki Nomura and Yoshiyuki Ueno

Diagnostics 2023, 13(1), 113; https://doi.org/10.3390/diagnostics13010113 - 30 Dec 2022

Cited by 4 | Viewed by 2413

Abstract

Eosinophilic gastroenteritis (EoGE) is a rare digestive disorder characterized by eosinophilic infiltration of the stomach and intestines. In the diagnosis of EoE, it is extremely important to recognize distinctive endoscopic findings and accurately detect increased eosinophilia in gastrointestinal tissues. However, endoscopic findings of [...] Read more.

Eosinophilic gastroenteritis (EoGE) is a rare digestive disorder characterized by eosinophilic infiltration of the stomach and intestines. In the diagnosis of EoE, it is extremely important to recognize distinctive endoscopic findings and accurately detect increased eosinophilia in gastrointestinal tissues. However, endoscopic findings of EoGE in the small intestine remain poorly understood. Therefore, we conducted a literature review of 16 eligible papers. Redness or erythema was the most common endoscopic finding in the small bowel, followed by villous atrophy, erosion, ulceration, and edema. In some cases, stenosis due to circumferential ulceration was observed, which led to retention of the capsule during small bowel capsule endoscopy. Although many aspects of small bowel endoscopic findings in EoGE remain elusive, the findings presented in this review are expected to contribute to the further development of EoGE practice. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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18 pages, 2690 KiB

Open AccessReview

Endoscopic Diagnosis of Eosinophilic Esophagitis: Basics and Recent Advances

by Yasuhiko Abe, Yu Sasaki, Makoto Yagi, Naoko Mizumoto, Yusuke Onozato, Matsuki Umehara and Yoshiyuki Ueno

Diagnostics 2022, 12(12), 3202; https://doi.org/10.3390/diagnostics12123202 - 16 Dec 2022

Cited by 5 | Viewed by 7177

Abstract

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease, characterized by esophageal dysfunction and intense eosinophil infiltration localized in the esophagus. In recent decades, EoE has become a growing concern as a major cause of dysphagia and food impaction in adolescents and adults. [...] Read more.

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease, characterized by esophageal dysfunction and intense eosinophil infiltration localized in the esophagus. In recent decades, EoE has become a growing concern as a major cause of dysphagia and food impaction in adolescents and adults. EoE is a clinicopathological disease for which the histological demonstration of esophageal eosinophilia is essential for diagnosis. Therefore, the recognition of the characteristic endoscopic features with subsequent biopsy are critical for early definitive diagnosis and treatment, in order to prevent complications. Accumulating reports have revealed that EoE has several non-specific characteristic endoscopic findings, such as rings, furrows, white exudates, stricture/narrowing, edema, and crepe-paper esophagus. These findings were recently unified under the EoE endoscopic reference score (EREFS), which has been widely used as an objective, standard measurement for endoscopic EoE assessment. However, the diagnostic consistency of those findings among endoscopists is still inadequate, leading to underdiagnosis or misdiagnosis. Some endoscopic findings suggestive of EoE, such as multiple polypoid lesions, caterpillar sign, ankylosaurus back sign, and tug sign/pull sign, will aid the diagnosis. In addition, image-enhanced endoscopy represented by narrow band imaging, endocytoscopy, and artificial intelligence are expected to render endoscopic diagnosis more efficient and less invasive. This review focuses on suggestions for endoscopic assessment and biopsy, including recent advances in optical technology which may improve the diagnosis of EoE. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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15 pages, 414 KiB

Open AccessReview

Current Status of Artificial Intelligence-Based Computer-Assisted Diagnosis Systems for Gastric Cancer in Endoscopy

by Kentaro Ochiai, Tsuyoshi Ozawa, Junichi Shibata, Soichiro Ishihara and Tomohiro Tada

Diagnostics 2022, 12(12), 3153; https://doi.org/10.3390/diagnostics12123153 - 13 Dec 2022

Cited by 11 | Viewed by 2697

Abstract

Artificial intelligence (AI) is gradually being utilized in various fields as its performance has been improving with the development of deep learning methods, availability of big data, and the progression of computer processing units. In the field of medicine, AI is mainly implemented [...] Read more.

Artificial intelligence (AI) is gradually being utilized in various fields as its performance has been improving with the development of deep learning methods, availability of big data, and the progression of computer processing units. In the field of medicine, AI is mainly implemented in image recognition, such as in radiographic and pathologic diagnoses. In the realm of gastrointestinal endoscopy, although AI-based computer-assisted detection/diagnosis (CAD) systems have been applied in some areas, such as colorectal polyp detection and diagnosis, so far, their implementation in real-world clinical settings is limited. The accurate detection or diagnosis of gastric cancer (GC) is one of the challenges in which performance varies greatly depending on the endoscopist’s skill. The diagnosis of early GC is especially challenging, partly because early GC mimics atrophic gastritis in the background mucosa. Therefore, several CAD systems for GC are being actively developed. The development of a CAD system for GC is considered challenging because it requires a large number of GC images. In particular, early stage GC images are rarely available, partly because it is difficult to diagnose gastric cancer during the early stages. Additionally, the training image data should be of a sufficiently high quality to conduct proper CAD training. Recently, several AI systems for GC that exhibit a robust performance, owing to being trained on a large number of high-quality images, have been reported. This review outlines the current status and prospects of AI use in esophagogastroduodenoscopy (EGDS), focusing on the diagnosis of GC. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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18 pages, 1149 KiB

Open AccessReview

Development of Advanced Imaging and Molecular Imaging for Barrett’s Neoplasia

by Kaname Uno, Tomoyuki Koike, Waku Hatta, Masahiro Saito, Mizuki Tanabe and Atsushi Masamune

Diagnostics 2022, 12(10), 2437; https://doi.org/10.3390/diagnostics12102437 - 8 Oct 2022

Cited by 4 | Viewed by 1975

Abstract

Barrett esophagus (BE) is a precursor to a life-threatening esophageal adenocarcinoma (EAC). Surveillance endoscopy with random biopsies is recommended for early intervention against EAC, but its adherence in the clinical setting is poor. Dysplastic lesions with flat architecture and patchy distribution in BE [...] Read more.

Barrett esophagus (BE) is a precursor to a life-threatening esophageal adenocarcinoma (EAC). Surveillance endoscopy with random biopsies is recommended for early intervention against EAC, but its adherence in the clinical setting is poor. Dysplastic lesions with flat architecture and patchy distribution in BE are hardly detected by high-resolution endoscopy, and the surveillance protocol entails issues of time and labor and suboptimal interobserver agreement for diagnosing dysplasia. Therefore, the development of advanced imaging technologies is necessary for Barrett’s surveillance. Recently, non-endoscopic or endoscopic technologies, such as cytosponge, endocytoscopy, confocal laser endomicroscopy, autofluorescence imaging, and optical coherence tomography/volumetric laser endomicroscopy, were developed, but most of them are not clinically available due to the limited view field, expense of the equipment, and significant time for the learning curve. Another strategy is focused on the development of molecular biomarkers, which are also not ready to use. However, a combination of advanced imaging techniques together with specific biomarkers is expected to identify morphological abnormalities and biological disorders at an early stage in the surveillance. Here, we review recent developments in advanced imaging and molecular imaging for Barrett’s neoplasia. Further developments in multiple biomarker panels specific for Barrett’s HGD/EAC include wide-field imaging systems for targeting ‘red flags’, a high-resolution imaging system for optical biopsy, and a computer-aided diagnosis system with artificial intelligence, all of which enable a real-time and accurate diagnosis of dysplastic BE in Barrett’s surveillance and provide information for precision medicine. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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10 pages, 3639 KiB

Open AccessReview

Endocytoscopic Observation of Esophageal Lesions: Our Own Experience and a Review of the Literature

by Youichi Kumagai, Kaiyo Takubo, Kenro Kawada, Masayuki Ohue, Morihiro Higashi, Toru Ishiguro, Satoshi Hatano, Yoshitaka Toyomasu, Takatoshi Matsuyama, Erito Mochiki and Hideyuki Ishida

Diagnostics 2022, 12(9), 2222; https://doi.org/10.3390/diagnostics12092222 - 14 Sep 2022

Cited by 4 | Viewed by 2021

Abstract

This review outlines the process of the development of the endocytoscope (EC) with reference to previously reported studies including our own. The EC is an ultra-high-magnification endoscope capable of imaging at the cellular level. The esophagus is the most suitable site for EC [...] Read more.

This review outlines the process of the development of the endocytoscope (EC) with reference to previously reported studies including our own. The EC is an ultra-high-magnification endoscope capable of imaging at the cellular level. The esophagus is the most suitable site for EC observation because it is amenable to vital staining. The diagnosis of esophageal lesions using EC is based on nuclear density and nuclear abnormality, allowing biopsy histology to be omitted. The observation of nuclear abnormality requires a magnification of ×600 or higher using digital technology. Several staining methods have been proposed, but single staining with toluidine blue or methylene blue is most suitable because the contrast at the border of a cancerous area can be easily identified. A three-tier classification of esophageal lesions visualized by EC is proposed: Type 1 (non-cancerous), Type 2 (endocytoscopic borderline), and Type 3 (cancerous). Since characteristic EC images reflecting pathology can be obtained from non-cancerous esophageal lesions, a modified form of classification with four additional characteristic non-cancerous EC features has also been proposed. Recently, deep-learning AI for analysis of esophageal EC images has revealed that its diagnostic accuracy is comparable to that of expert pathologists. Full article

(This article belongs to the Special Issue Advanced Endoscopic Imaging in Gastrointestinal Diseases)

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