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Current Status of Endoscopy in Clinical Medicine
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Current Status of Endoscopy in Clinical Medicine

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (15 May 2022) | Viewed by 10034

Special Issue Editor

Dr. Naoki Hosoe

E-Mail Website
Guest Editor
Center for Diagnostic and Therapeutic Endoscopy, Keio University, Tokyo, Japan
Interests: endoscopy; small bowel endoscopy; video capsule endoscopy; therapeutic endoscopy; inflammatory bowel disease

Special Issue Information

Dear Colleagues,

Gastrointestinal endoscopy has made remarkable progress in recent years, with the development of approaches such as image-enhanced endoscopy (IEE) for the diagnosis of gastrointestinal cancers, therapeutic endoscopy using endoscopic submucosal dissection (ESD) and cold polypectomy, and endoscopic hemostasis for gastrointestinal bleeding. Moreover, small bowel endoscopy techniques, such as capsule endoscopy (CE) and device-assisted endoscopy, have shown great progress in the past two decades. In recent years, innovative advances in endoscopy have been made in terms of artificial intelligence-based automated lesion detection, and image-enhanced technologies. In the current Special Issue, we focus on recent advances and the clinical impact of gastrointestinal endoscopy.

Topics of interest include:

  • Image-enhanced endoscopy for gastrointestinal disorders;
  • Therapeutic endoscopy;
  • Endoscopic hemostasis;
  • Device-assisted endoscopy (DAE);
  • Diagnostic yields and clinical impacts of capsule endoscopy (CE);
  • CE and AI (artificial intelligence);
  • Application of colon, gastric and esophageal CE.

Dr. Naoki Hosoe
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gastrointestinal endoscopy
  • video capsule endoscopy
  • small bowel endoscopy
  • inflammatory bowel disease
  • enteroscopy
  • colon capsule endoscopy
  • colon polyp
  • obscure gastrointestinal bleeding
  • gastric cancer

Published Papers (6 papers)

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Research

10 pages, 253 KiB  
Article
Safety of Nonagenarians Receiving Therapeutic ERCP, Single Center Experience
by Chia-Chang Chen, Wan-Tzu Lin, Chun-Fang Tung, Shou-Wu Lee, Chi-Sen Chang and Yen-Chun Peng
J. Clin. Med. 2022, 11(17), 5197; https://doi.org/10.3390/jcm11175197 - 2 Sep 2022
Cited by 1 | Viewed by 1172
Abstract
(1) Background: The complication rates for nonagenarians receiving therapeutic endoscopic retrograde cholangiopancreatography (ERCP) remain poorly understood. We aimed to determine whether nonagenarians were at an increased risk of ERCP-related complications. (2) Methods: We performed a retrospective study on therapeutic ERCP in nonagenarians from [...] Read more.
(1) Background: The complication rates for nonagenarians receiving therapeutic endoscopic retrograde cholangiopancreatography (ERCP) remain poorly understood. We aimed to determine whether nonagenarians were at an increased risk of ERCP-related complications. (2) Methods: We performed a retrospective study on therapeutic ERCP in nonagenarians from 2011 to 2016 at Taichung Veterans General Hospital. A control group comprising patients aged 65 to 89 years was used to compare demographic data and the outcomes of therapeutic ERCP with the nonagenarians. The risk factors for complications were determined by logistic regression model. (3) Results: There were 35 nonagenarians and 111 patients in the control group. Overall, complication rates were not statistically different between the two groups. However, advanced age was an independent predictor of complications in the multivariate analysis (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.01–1.12; p = 0.049). End stage renal disease (ESRD) was another independent predictor of complications (OR = 4.87; 95% CI = 1.11–21.36; p = 0.036). Post-ERCP pancreatitis and bleeding were more common in ESRD patients than patients without ESRD. (4) Conclusions: Although nonagenarians receiving ERCP did not have more complications compared to elderly patients younger than 90 years, advanced age and comorbidity still affect the outcome of therapeutic ERCP in the elderly patients. Full article
(This article belongs to the Special Issue Current Status of Endoscopy in Clinical Medicine)
10 pages, 2176 KiB  
Article
Development of a Deep-Learning Algorithm for Small Bowel-Lesion Detection and a Study of the Improvement in the False-Positive Rate
by Naoki Hosoe, Tomofumi Horie, Anna Tojo, Hinako Sakurai, Yukie Hayashi, Kenji Jose-Luis Limpias Kamiya, Tomohisa Sujino, Kaoru Takabayashi, Haruhiko Ogata and Takanori Kanai
J. Clin. Med. 2022, 11(13), 3682; https://doi.org/10.3390/jcm11133682 - 26 Jun 2022
Cited by 6 | Viewed by 1747
Abstract
Deep learning has recently been gaining attention as a promising technology to improve the identification of lesions, and deep-learning algorithms for lesion detection have been actively developed in small-bowel capsule endoscopy (SBCE). We developed a detection algorithm for abnormal findings by deep learning [...] Read more.
Deep learning has recently been gaining attention as a promising technology to improve the identification of lesions, and deep-learning algorithms for lesion detection have been actively developed in small-bowel capsule endoscopy (SBCE). We developed a detection algorithm for abnormal findings by deep learning (convolutional neural network) the SBCE imaging data of 30 cases with abnormal findings. To enable the detection of a wide variety of abnormal findings, the training data were balanced to include all major findings identified in SBCE (bleeding, angiodysplasia, ulceration, and neoplastic lesions). To reduce the false-positive rate, “findings that may be responsible for hemorrhage” and “findings that may require therapeutic intervention” were extracted from the images of abnormal findings and added to the training dataset. For the performance evaluation, the sensitivity and the specificity were calculated using 271 detectable findings in 35 cases. The sensitivity was calculated using 68,494 images of non-abnormal findings. The sensitivity and specificity were 93.4% and 97.8%, respectively. The average number of images detected by the algorithm as having abnormal findings was 7514. We developed an image-reading support system using deep learning for SBCE and obtained a good detection performance. Full article
(This article belongs to the Special Issue Current Status of Endoscopy in Clinical Medicine)
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10 pages, 964 KiB  
Article
Serum Leucine-Rich Alpha-2 Glycoprotein in Quiescent Crohn’s Disease as a Potential Surrogate Marker for Small-Bowel Ulceration detected by Capsule Endoscopy
by Teppei Omori, Yu Sasaki, Miki Koroku, Shun Murasugi, Maria Yonezawa, Shinichi Nakamura and Katsutoshi Tokushige
J. Clin. Med. 2022, 11(9), 2494; https://doi.org/10.3390/jcm11092494 - 29 Apr 2022
Cited by 12 | Viewed by 1546
Abstract
Background: Small bowel (SB) lesions in quiescent Crohn’s disease (CD) are sometimes not identified by clinical activity or existing markers. We investigated the usefulness of a novel biomarker, leucine-rich α2-glycoprotein (LRG), for screening for the presence of SB ulcerative lesions detected by small-bowel [...] Read more.
Background: Small bowel (SB) lesions in quiescent Crohn’s disease (CD) are sometimes not identified by clinical activity or existing markers. We investigated the usefulness of a novel biomarker, leucine-rich α2-glycoprotein (LRG), for screening for the presence of SB ulcerative lesions detected by small-bowel capsule endoscopy (SBCE). Methods: We examined patients with a Crohn’s Disease Activity Index (CDAI) value < 150 and a C-reactive protein (CRP) value < 0.5 mg/dL with SB or SB colonic CD. The presence of small-bowel ulcerative lesions (≥0.5 cm) was grouped by SBCE results, and we then compared the groups’ LRG value to establish a cutoff value for screening for the presence of lesions. Results: In 40 patients with CD, the LRG values differed significantly between the patients with and without SB ulcerative lesions (Ul + 14.1 (2.1–16.5) μg/mL vs. Ul − 12.3 (9.3–13.5) μg/mL; p = 0.0105). The respective cutoff LRG values for the presence of SB ulcerative lesions was 14 μg/mL (areas under the ROC curve 0.77), with sensitivity 63.6%, specificity 82.8%, positive predictive values 58.3%, negative predictive values 85.7%, and accuracy 78%. Conclusion: These results indicate that LRG may be useful in predicting the presence of SB inflammation associated in patients with CD with CRP < 0.5 mg/dL and CDAI < 150, and in selecting patients for SBCE. Full article
(This article belongs to the Special Issue Current Status of Endoscopy in Clinical Medicine)
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Graphical abstract

10 pages, 860 KiB  
Article
Critically-Ill Patients with Biliary Obstruction and Cholangitis: Bedside Fluoroscopic-Free Endoscopic Drainage versus Percutaneous Drainage
by Yi-Jun Liao, Wan-Tzu Lin, Hsin-Ju Tsai, Chia-Chang Chen, Chun-Fang Tung, Sheng-Shun Yang and Yen-Chun Peng
J. Clin. Med. 2022, 11(7), 1869; https://doi.org/10.3390/jcm11071869 - 28 Mar 2022
Cited by 2 | Viewed by 1997
Abstract
Severe acute cholangitis is a life-threatening medical emergency. Endoscopic biliary drainage (EBD) or percutaneous transhepatic biliary drainage (PTBD) is usually used for biliary decompression. However, it can be risky to transport a critical patient to the radiology unit. We aimed to compare clinical [...] Read more.
Severe acute cholangitis is a life-threatening medical emergency. Endoscopic biliary drainage (EBD) or percutaneous transhepatic biliary drainage (PTBD) is usually used for biliary decompression. However, it can be risky to transport a critical patient to the radiology unit. We aimed to compare clinical outcomes between bedside, radiation-free EBD and fluoroscopic-guided PTBD in patients under critical care. Methods: A retrospective study was conducted on critically ill patients admitted to the intensive care unit with biliary obstruction and cholangitis from January 2011 to April 2020. Results: A total of 16 patients receiving EBD and 31 patients receiving PTBD due to severe acute cholangitis were analyzed. In the EBD group, biliary drainage was successfully conducted in 15 (93.8%) patients. Only one patient (6.25%) encountered post-procedure pancreatitis. The 30-day mortality rate was no difference between the 2 groups (32.72% vs. 31.25%, p = 0.96). Based on multivariate analysis, independent prognostic factors for the 30-day mortality were a medical history of malignancy other than pancreatobiliary origin (HR: 5.27, 95% confidence interval [CI]: 1.01–27.57) and emergent dialysis (HR: 7.30, 95% CI: 2.20–24.24). Conclusions: Bedside EBD is safe and as effective as percutaneous drainage in critically ill patients. It provides lower risks in patient transportation but does require experienced endoscopists to perform the procedure. Full article
(This article belongs to the Special Issue Current Status of Endoscopy in Clinical Medicine)
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8 pages, 572 KiB  
Article
Coronavirus Disease Transmission Prevented in an Endoscopy Unit with Universal Protective Measures and No Systematic Preprocedural Testing
by Lucía Guilabert, José Ramón Aparicio, Lucía Medina-Prado, Juan Carlos Rodríguez-Díaz, María Luisa Gomis, Pablo Chico-Sánchez, José Sánchez-Payá and Rodrigo Jover
J. Clin. Med. 2022, 11(6), 1681; https://doi.org/10.3390/jcm11061681 - 18 Mar 2022
Cited by 2 | Viewed by 1431
Abstract
Background and aims: Even after two years of pandemic, there are still uncertainties on how to proceed when we schedule endoscopic procedures. During the COVID-19 pandemic, some scientific societies recommended universal preprocedural testing for all patients. However, other societies recommended against and considered [...] Read more.
Background and aims: Even after two years of pandemic, there are still uncertainties on how to proceed when we schedule endoscopic procedures. During the COVID-19 pandemic, some scientific societies recommended universal preprocedural testing for all patients. However, other societies recommended against and considered enough to maintain strict infection control strategies. Our aim was to evaluate this approach in order to see if it was safe for both patients and healthcare workers to proceed with the endoscopies without performing a systematic PCR on all patients. Methods: Retrospective chart review of all patients undergoing endoscopy without preprocedural COVID testing at our center from March 2020 to May 2021. PCR tests performed in the patients receiving an endoscopic procedure were analyzed, and patients who tested positive between 14 days before and after the endoscopic procedure were selected. The registry of the endoscopy unit members participating in these procedures was also analyzed. Results: A total of 10,132 procedures were performed in the unit with 26 patients infected with SARS-CoV-2. Nineteen of these procedures were performed in patients with unknown SARS-CoV-2 carrier status. In 23 (88.5%) cases, transmission occurred through social or familial contact, and in 3 (11.5%), transmission occurred in the hospital. Four health care workers became infected during this period and none of them were related to the endoscopic procedures performed in patients with COVID-19. Conclusions: SARS-CoV-2 positive testing in asymptomatic ambulatory patients is rare and the adequate use of individual protective measures emerges as the main way to control the spread of COVID-19 infection in endoscopy centers. Full article
(This article belongs to the Special Issue Current Status of Endoscopy in Clinical Medicine)
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7 pages, 240 KiB  
Article
Risk for Surgery in Patients with Polyposis Syndrome after Therapy by Device-Assisted Enteroscopy (DAE): Long-Term Follow Up
by Clelia Marmo, Annalisa Tortora, Guido Costamagna, Rebecca Nicolò and Maria Elena Riccioni
J. Clin. Med. 2022, 11(4), 899; https://doi.org/10.3390/jcm11040899 - 9 Feb 2022
Viewed by 1324
Abstract
Background and aim of the study: Polyposis syndromes such as Peutz–Jeghers (PJ) and familial adenomatous polyposis (FAP) are associated with the growth of small bowel polyps; the risk is approximately 60–90% for PJ and 40–70% for FAP. The primary aim of this study [...] Read more.
Background and aim of the study: Polyposis syndromes such as Peutz–Jeghers (PJ) and familial adenomatous polyposis (FAP) are associated with the growth of small bowel polyps; the risk is approximately 60–90% for PJ and 40–70% for FAP. The primary aim of this study was to evaluate the efficacy of device-assisted enteroscopy (DAE) in the detection and treatment of small bowel polyps to reduce the risk of surgery. The secondary objective was to study complications and mortality. Methods: We conducted a retrospective cohort study by analyzing a structured database. Between September 2006 and October 2019, we observed and followed 42 consecutive patients with polyposis syndromes; they underwent device-assisted enteroscopy and three were excluded from elective surgery after the exam. The endoscopic exams were performed for diagnostic and therapeutic purposes. Results: Thirty-nine patients were evaluated with a mean follow up of 6.7 years (±SD 2.7), 79.5% were female with a mean age of 43.8 years (±SD 15.02), and 68 enteroscopies were performed with the removal of 64 polypoid lesions. One bleeding episode occurred after operative enteroscopy, and the need for subsequent surgery occurred in six patients with PJ and in five patients with FAP. The surgical indications in PJ patients were the presence of large polyps (three patients) and three cases of intussusception, one of which was a patient with a polyp in the proximal ileum, not reachable with the scope. One patient with PJ died from pancreatic cancer during follow up. The surgical indications in patients with FAP were the presence of four large polyps with high-grade dysplasia and one ampullary neoplasia recurrence. Conclusions: In PJ patients, the endoscopic treatment of small bowel polyps was safe. During the follow-up period, the patients with successful endoscopic treatment did not need surgery. In FAP patients treated with DAE, none developed cancer. Full article
(This article belongs to the Special Issue Current Status of Endoscopy in Clinical Medicine)
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