Journal of Clinical Medicine

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13 pages, 3946 KiB

Open AccessArticle

Objective Methods of 5-Aminolevulinic Acid-Based Endoscopic Photodynamic Diagnosis Using Artificial Intelligence for Identification of Gastric Tumors

by Taro Yamashita, Hiroki Kurumi, Masashi Fujii, Takuki Sakaguchi, Takeshi Hashimoto, Hidehito Kinoshita, Tsutomu Kanda, Takumi Onoyama, Yuichiro Ikebuchi, Akira Yoshida, Koichiro Kawaguchi, Kazuo Yashima and Hajime Isomoto

J. Clin. Med. 2022, 11(11), 3030; https://doi.org/10.3390/jcm11113030 - 27 May 2022

Cited by 1 | Viewed by 1900

Abstract

Positive diagnoses of gastric tumors from photodynamic diagnosis (PDD) images after the administration of 5-aminolevulinic acid are subjectively identified by expert endoscopists. Objective methods of tumor identification are needed to reduce potential misidentifications. We developed two methods to identify gastric tumors from PDD [...] Read more.

Positive diagnoses of gastric tumors from photodynamic diagnosis (PDD) images after the administration of 5-aminolevulinic acid are subjectively identified by expert endoscopists. Objective methods of tumor identification are needed to reduce potential misidentifications. We developed two methods to identify gastric tumors from PDD images. Method one was applied to segmented regions in the PDD endoscopic image to determine the region in LAB color space to be attributed to tumors using a multi-layer neural network. Method two aimed to diagnose tumors and determine regions in the PDD endoscopic image attributed to tumors using the convoluted neural network method. The efficiencies of diagnosing tumors were 77.8% (7/9) and 93.3% (14/15) for method one and method two, respectively. The efficiencies of determining tumor region defined as the ratio of the area were 35.7% (0.0–78.0) and 48.5% (3.0–89.1) for method one and method two, respectively. False-positive rates defined as the ratio of the area were 0.3% (0.0–2.0) and 3.8% (0.0–17.4) for method one and method two, respectively. Objective methods of determining tumor region in 5-aminolevulinic acid-based endoscopic PDD were developed by identifying regions in LAB color space attributed to tumors or by applying a method of convoluted neural network. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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11 pages, 1757 KiB

Open AccessArticle

Application of Convolutional Neural Networks for Diagnosis of Eosinophilic Esophagitis Based on Endoscopic Imaging

by Eiko Okimoto, Norihisa Ishimura, Kyoichi Adachi, Yoshikazu Kinoshita, Shunji Ishihara and Tomohiro Tada

J. Clin. Med. 2022, 11(9), 2529; https://doi.org/10.3390/jcm11092529 - 30 Apr 2022

Cited by 8 | Viewed by 2112

Abstract

Subjective symptoms associated with eosinophilic esophagitis (EoE), such as dysphagia, are not specific, thus the endoscopic identification of suggestive EoE findings is quite important for facilitating endoscopic biopsy sampling. However, poor inter-observer agreement among endoscopists regarding diagnosis has become a complicated issue, especially [...] Read more.

Subjective symptoms associated with eosinophilic esophagitis (EoE), such as dysphagia, are not specific, thus the endoscopic identification of suggestive EoE findings is quite important for facilitating endoscopic biopsy sampling. However, poor inter-observer agreement among endoscopists regarding diagnosis has become a complicated issue, especially with inexperienced practitioners. Therefore, we constructed a computer-assisted diagnosis (CAD) system using a convolutional neural network (CNN) and evaluated its performance as a diagnostic utility. A CNN-based CAD system was developed based on ResNet50 architecture. The CNN was trained using a total of 1192 characteristic endoscopic images of 108 patients histologically proven to be in an active phase of EoE (≥15 eosinophils per high power field) as well as 1192 normal esophagus images. To evaluate diagnostic accuracy, an independent test set of 756 endoscopic images from 35 patients with EoE and 96 subjects with a normal esophagus was examined with the constructed CNN. The CNN correctly diagnosed EoE in 94.7% using a diagnosis per image analysis, with an overall sensitivity of 90.8% and specificity of 96.6%. For each case, the CNN correctly diagnosed 37 of 39 EoE cases with overall sensitivity and specificity of 94.9% and 99.0%, respectively. These findings indicate the usefulness of CNN for diagnosing EoE, especially for aiding inexperienced endoscopists during medical check-up screening. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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9 pages, 1641 KiB

Open AccessArticle

The Deployment of a Newly Developed Proximal Release-Type Colonic Stent Is Feasible for Malignant Colorectal Obstruction near the Anal Verge: A Single-Center Preliminary Study

by Kaoru Wada, Toshio Kuwai, Syuhei Sugata, Takuro Hamada, Riho Moriuchi, Yuzuru Tamaru, Ryusaku Kusunoki, Atsushi Yamaguchi, Hirotaka Kouno, Sauid Ishaq and Hiroshi Kohno

J. Clin. Med. 2022, 11(6), 1675; https://doi.org/10.3390/jcm11061675 - 17 Mar 2022

Cited by 2 | Viewed by 2053

Abstract

Introduction: Colonic self-expandable metallic stents are widely used to treat malignant colorectal obstructions. Stent placement in lesions near the dentate line causes problems, including severe pain due to difficulty in positioning the stent accurately. Therefore, a proximal release-type stent was developed to overcome [...] Read more.

Introduction: Colonic self-expandable metallic stents are widely used to treat malignant colorectal obstructions. Stent placement in lesions near the dentate line causes problems, including severe pain due to difficulty in positioning the stent accurately. Therefore, a proximal release-type stent was developed to overcome this issue, and this preliminary study aimed to investigate its efficacy and safety. Patients and Methods: This research enrolled eight patients with malignant colorectal obstructions up to 10 cm from the anal verge who required placement of the newly developed proximal release-type colonic stent. The primary outcome was the clinical success rate, and the secondary outcomes were the technical success and adverse events rates. Results: The technical and clinical success rates were 87.5% each, and the mean procedure time was 25.5 ± 22.0 min. The mean procedure time in the rectosigmoid colon was significantly longer than that in the rectum. Only one (12.5%) patient had stent migration, and neither anal pain nor tenesmus was observed. Discussion: The stent was highly effective in treating lesions near the anal verge, and it might contribute to the expansion of indications for colorectal stents for lesions near the dentate line. However, the indications for rectosigmoid colon lesions should be cautiously considered. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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13 pages, 2150 KiB

Open AccessArticle

Flexible Magnifying Endoscopy with Narrow Band Imaging for Diagnosing Uterine Cervical Neoplasms: A Multicenter Prospective Study

by Hideki Kobara, Kunihisa Uchita, Noriya Uedo, Jun Kunikata, Kenji Yorita, Naoya Tada, Noriko Nishiyama, Yuriko Shigehisa, Chihiro Kuroiwa, Noriko Matsuura, Yohei Takahashi, Yuka Kai, Uiko Hanaoka, Yumiko Kiyohara, Shoji Kamiura, Kenji Kanenishi, Tsutomu Masaki and Koki Hirano

J. Clin. Med. 2021, 10(20), 4753; https://doi.org/10.3390/jcm10204753 - 16 Oct 2021

Cited by 3 | Viewed by 2937

Abstract

We aimed to investigate the diagnostic ability of magnifying endoscopy with narrow band imaging (ME-NBI) for cervical intraepithelial neoplasia grade 2 or worse (CIN2+). This was a multicenter prospective study. Eligible patients had positive Pap smear results or follow-up high-grade cytology or CIN3 [...] Read more.

We aimed to investigate the diagnostic ability of magnifying endoscopy with narrow band imaging (ME-NBI) for cervical intraepithelial neoplasia grade 2 or worse (CIN2+). This was a multicenter prospective study. Eligible patients had positive Pap smear results or follow-up high-grade cytology or CIN3 diagnosed in referring hospitals. Patients underwent ME-NBI by a gastrointestinal endoscopist, followed by colposcopy by a gynecologist. One lesion with the worst finding was considered the main lesion. Punch biopsies were collected from all indicated areas and one normal area. The reference standard was the highest histological grade among all biopsy specimens. The primary endpoint was the detection rate of patients with CIN2+ in the main lesion. The secondary endpoints were diagnostic ability for CIN2+ lesions and patients’ acceptability. We enrolled 88 patients. The detection rate of ME-NBI for patients with CIN2+ was 79% (95% CI: 66–88%; p = 1.000), which was comparable to that of colposcopy (79%; p = 1.000). For diagnosing CIN2+ lesions, ME-NBI showed a better sensitivity than colposcopy (87% vs. 74%, respectively; p = 0.302) but a lower specificity (50% vs. 68%, respectively; p = 0.210). Patients graded ME-NBI as having significantly less discomfort and involving less embarrassment than colposcopy. ME-NBI did not show a higher detection ability than colposcopy for patients with CIN2+, whereas it did show a better patient acceptability. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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12 pages, 2895 KiB

Open AccessArticle

Gastrointestinal Residue Removal Using a Balloon Overtube under Ultrathin Endoscopic Navigation: Ex Vivo and In Vivo Experimental Studies

by Kazuhiro Kozuka, Hideki Kobara, Noriko Nishiyama, Shintaro Fujihara, Naoya Tada, Takanori Matsui, Tadayuki Takata, Taiga Chiyo, Nobuya Kobayashi, Tingting Shi, Koji Fujita, Joji Tani, Tatsuo Yachida, Akihiro Kondo, Kensuke Kumamoto, Keiichi Okano, Akira Nishiyama, Kazushi Deguchi and Tsutomu Masaki

J. Clin. Med. 2021, 10(17), 3796; https://doi.org/10.3390/jcm10173796 - 25 Aug 2021

Viewed by 3227

Abstract

Pooled gastric residues involving blood clots and food interrupt appropriate endoscopic intervention, leading to poor outcomes in endoscopic hemostasis and lifesaving. However, procedures and devices that enable the effective removal of gastrointestinal residues remain unsatisfactory. This study aimed to evaluate the efficacy and [...] Read more.

Pooled gastric residues involving blood clots and food interrupt appropriate endoscopic intervention, leading to poor outcomes in endoscopic hemostasis and lifesaving. However, procedures and devices that enable the effective removal of gastrointestinal residues remain unsatisfactory. This study aimed to evaluate the efficacy and safety of our developed suction method in ex vivo and in vivo studies. We created a hand-made device with a large suction diameter, consisting of a balloon overtube and an ultrathin endoscope for navigation. In the ex vivo study, we compared the success rate and the suctioning time for four types of simulated residue between a standard endoscope and our device. Our device had s significantly higher suction ability and a shorter procedure time than the standard endoscope. The subsequent in vivo animal study involved five beagle dogs that were administered with food jelly to mimic gastric residue. Suction was performed twice for five dogs (ten attempts). The outcome measure was the successful procedure rate; secondary outcomes were procedure-associated complications and procedure time. The procedure was successful in all attempts, without any complications. The mean procedure time was 5 min. This novel method enabled the efficient and safe removal of gastric residue, and our findings will likely lead to the development of the instrument. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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12 pages, 2250 KiB

Open AccessArticle

Improved Visibility of Early Gastric Cancer after Successful Helicobacter pylori Eradication with Image-Enhanced Endoscopy: A Multi-Institutional Study Using Video Clips

by Shinya Matsumura, Osamu Dohi, Nobuhisa Yamada, Akihito Harusato, Takeshi Yasuda, Takuma Yoshida, Tsugitaka Ishida, Yuka Azuma, Hiroaki Kitae, Toshifumi Doi, Ryohei Hirose, Ken Inoue, Naohisa Yoshida, Kazuhiro Kamada, Kazuhiko Uchiyama, Tomohisa Takagi, Takeshi Ishikawa, Hideyuki Konishi, Yukiko Morinaga, Mitsuo Kishimoto, Nobuaki Yagi, Yuji Naito and Yoshito Itoh Show full author list Hide full author list

J. Clin. Med. 2021, 10(16), 3649; https://doi.org/10.3390/jcm10163649 - 18 Aug 2021

Cited by 8 | Viewed by 7080

Abstract

The visibility and diagnostic accuracy of early gastric cancer (EGC) after Helicobacter pylori (HP) eradication have been reported to improve using image-enhanced endoscopy (IEE) compared with white light imaging (WLI). The present study clarified the appropriate IEE for the detection and diagnosis of [...] Read more.

The visibility and diagnostic accuracy of early gastric cancer (EGC) after Helicobacter pylori (HP) eradication have been reported to improve using image-enhanced endoscopy (IEE) compared with white light imaging (WLI). The present study clarified the appropriate IEE for the detection and diagnosis of EGC in clinical settings. This prospective and cross-sectional study evaluated the visibility of EGC and endoscopic findings of gastric mucosa after successful HP eradication (n = 31) using videos with WLI and IEE. Three endoscopists evaluated high-definition videos in a randomized order. The mean visibility scores (MVSs) on linked color imaging (LCI) for atrophic border, intestinal metaplasia, map-like redness, and EGC were the highest among each modality (3.87 ± 0.34, 3.82 ± 0.49, 3.87 ± 0.50, and 3.35 ± 0.92, respectively). The MVSs with blue laser imaging (BLI) were highest for magnifying view of the demarcation line (DL), microsurface pattern (MSP), and microvascular pattern (MVP) for EGC (3.77 ± 0.49, 3.94 ± 0.25, and 3.92 ± 0.34, respectively). LCI had the highest visibility among findings of gastric mucosa and EGC after HP eradication, and BLI had the highest visibility of MVP, MSP, and DL in magnifying observation. These results suggest that LCI observation in the entire stomach and further magnifying BLI are the best methods for detecting and diagnosing EGCs after HP eradication, respectively. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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8 pages, 1987 KiB

Open AccessArticle

New Closure Method Using Loop and Open–Close Clips after Endoscopic Submucosal Dissection of Stomach and Colon Lesions

by Akira Yoshida, Hiroki Kurumi, Yuichiro Ikebuchi, Koichiro Kawaguchi, Kazuo Yashima, Yu Kamitani, Sho Yasui, Yusuke Nakada, Tsutomu Kanda, Tomoaki Takata and Hajime Isomoto

J. Clin. Med. 2021, 10(15), 3260; https://doi.org/10.3390/jcm10153260 - 23 Jul 2021

Cited by 8 | Viewed by 2833

Abstract

Endoscopic submucosal dissection (ESD) and en bloc resection of stomach and colon tumors have become common. However, mucosal defects resulting from ESD may cause delayed bleeding and perforation. To prevent adverse events, we developed a new clip closure technique, namely, the loop and [...] Read more.

Endoscopic submucosal dissection (ESD) and en bloc resection of stomach and colon tumors have become common. However, mucosal defects resulting from ESD may cause delayed bleeding and perforation. To prevent adverse events, we developed a new clip closure technique, namely, the loop and open–close clip closure method (LOCCM), and aimed to examine its efficacy after ESD for stomach and colon tumors. The LOCCM uses loop and open–close clips. Here, the open–close clip was used to grasp the loop to bring it to the edge of the post-ESD mucosal defect. Another clip with a loop was then inserted into the opposite edge and clipped to the contralateral mucosa to pull both edges together. Once apposed, additional clips facilitated complete closure. The LOCCM was performed in 19 patients after ESD at Tottori University between October 2020 and March 2021. The outcomes retrospectively analyzed were the LOCCM success and adverse event rates. The complete closure rate using LOCCM was 89.5% and none of the patients had post-ESD bleeding or perforation. The results show that LOCCM is an effective and safe closure technique for mucosal defects after stomach and colon ESD to prevent bleeding and perforation. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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11 pages, 2056 KiB

Open AccessArticle

White Spot, a Novel Endoscopic Finding, May Be Associated with Acid-Suppressing Agents and Hypergastrinemia

by Noriko Nishiyama, Hideki Kobara, Maki Ayaki, Shintaro Fujihara, Kaho Nakatani, Naoya Tada, Kazuhiro Koduka, Takanori Matsui, Tadayuki Takata, Taiga Chiyo, Nobuya Kobayashi, Tingting Shi, Koji Fujita, Joji Tani, Tatsuo Yachida, Tsutomu Masaki and Ken Haruma

J. Clin. Med. 2021, 10(12), 2625; https://doi.org/10.3390/jcm10122625 - 15 Jun 2021

Cited by 4 | Viewed by 2558

Abstract

White globe appearance (WGA) is defined as a microendoscopic white lesion with a globular shape underlying the gastric epithelium and is considered a marker of gastric cancer. We recently reported that endoscopically visualized white spot (WS) corresponding to WGA appeared on the nonatrophic [...] Read more.

White globe appearance (WGA) is defined as a microendoscopic white lesion with a globular shape underlying the gastric epithelium and is considered a marker of gastric cancer. We recently reported that endoscopically visualized white spot (WS) corresponding to WGA appeared on the nonatrophic mucosa of patients with acid-suppressing agents (A-SA) use. We evaluated patients undergoing routine esophagogastroduodenoscopy and divided the patients into an A-SA group (n = 112) and a control group (n = 158). We compared the presence of WS in both groups. We also compared WS-positive- (n = 31) and -negative (n = 43) groups within the A-SA group regarding these patients’ backgrounds and serum gastrin concentrations. Comparing the A-SA group with controls, the prevalence of WS was significantly higher (31/112 vs. 2/158; p < 0.001). The number of patients with high serum gastrin concentrations was significantly higher in the WS-positive group (18/31) vs. the WS-negative group (5/43) (p < 0.001). Within the A-SA group, the prevalence of WS was also significantly higher in patients taking potassium-competitive acid blockers vs. proton-pump inhibitors (21/31 vs. 10/31, p < 0.001). The WS-positive group had a significantly greater percentage of patients, with a high serum gastrin level (p < 0.001). WS may be associated with hypergastrinemia and potassium-competitive acid blockers. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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7 pages, 901 KiB

Open AccessArticle

Neutrophil-to-Lymphocyte Ratio Is a Useful Marker for Predicting Histological Types of Early Gastric Cancer

by Sho Yasui, Tomoaki Takata, Yu Kamitani, Yukari Mae, Hiroki Kurumi, Yuichiro Ikebuchi, Akira Yoshida, Koichiro Kawaguchi, Kazuo Yashima and Hajime Isomoto

J. Clin. Med. 2021, 10(4), 791; https://doi.org/10.3390/jcm10040791 - 16 Feb 2021

Cited by 8 | Viewed by 2415

Abstract

Background: The indications for endoscopic submucosal dissection (ESD) for gastric cancer are based on preoperative histological assessment; however, examination of tissue biopsy is not always reliable as only a limited portion of the lesion can be obtained. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte [...] Read more.

Background: The indications for endoscopic submucosal dissection (ESD) for gastric cancer are based on preoperative histological assessment; however, examination of tissue biopsy is not always reliable as only a limited portion of the lesion can be obtained. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of inflammatory response and are potentially associated with the grade of malignancy in gastric cancer. We aimed to investigate the association between NLR and PLR and the histology of gastric cancer. Methods: This study included 218 patients who underwent ESD for gastric cancer. The relationship between NLR/PLR and histological diagnosis was investigated. Results: Patients with adenocarcinomas showed significantly higher NLR and PLR than those with adenomas (p < 0.001 and p < 0.05, respectively). Further, patients with undifferentiated adenocarcinoma showed a significantly higher NLR (p < 0.05) than those with differentiated adenocarcinoma. Conclusion: This study suggests that NLR could be a useful marker for assessing early gastric cancer. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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13 pages, 23382 KiB

Open AccessArticle

Peroral Cholangioscopy-Guided Forceps Mapping Biopsy for Evaluation of the Lateral Extension of Biliary Tract Cancer

by Takumi Onoyama, Wataru Hamamoto, Yuri Sakamoto, Shiho Kawahara, Taro Yamashita, Hiroki Koda, Soichiro Kawata, Yohei Takeda, Kazuya Matsumoto and Hajime Isomoto

J. Clin. Med. 2021, 10(4), 597; https://doi.org/10.3390/jcm10040597 - 5 Feb 2021

Cited by 4 | Viewed by 2291

Abstract

Background: Peroral cholangioscopy (POCS)-guided forceps mapping biopsy (FMB) is a method for the accurate preoperative identification of the extent of the disease of biliary tract cancer (BTC). However, the diagnostic value of POCS-FMB is still uncertain. Objectives: We evaluated the diagnostic utility of [...] Read more.

Background: Peroral cholangioscopy (POCS)-guided forceps mapping biopsy (FMB) is a method for the accurate preoperative identification of the extent of the disease of biliary tract cancer (BTC). However, the diagnostic value of POCS-FMB is still uncertain. Objectives: We evaluated the diagnostic utility of POCS-FMB for the identification of lateral extension—superficial intraductal spread longitudinally and continuously from the main lesion—of BTC. Methods: In the retrospective study, patients who received POCS-FMB and surgery for curative resection of BTC between September 2016 and August 2019 at our medical institution were enrolled. The diagnostic accuracy of POCS-FMB for the identification of lateral extension of BTC was evaluated. Furthermore, we also evaluated the factors affecting the diagnostic accuracy of POCS-FMB. Results: A total of 23 patients with BTC were enrolled, and 24 procedures of POCS-FMB from 96 sites of biliary tracts were performed. The sensitivity, specificity, and accuracy of POCS-FMB were 53.8%, 63.9%, and 63.1%, respectively. In the multivariate logistic regression analyses, the biopsy from the bifurcation of biliary tracts was a significant factor affecting the diagnostic accuracy of POCS-FMB (odds ratio 3.538, 95%; confidence interval 1.151–10.875, p = 0.027). Conclusions: The diagnostic accuracy of POCS-FMB for the identification of lateral extension of BTC was insufficient. The biopsy from the bifurcation of biliary tracts was a positive factor affecting the diagnostic accuracy of POCS-FMB. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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Review

Jump to: Research

12 pages, 5377 KiB

Open AccessReview

Endoscopic Features of Autoimmune Gastritis: Focus on Typical Images and Early Images

by Maiko Kishino and Kouichi Nonaka

J. Clin. Med. 2022, 11(12), 3523; https://doi.org/10.3390/jcm11123523 - 19 Jun 2022

Cited by 12 | Viewed by 8678

Abstract

Autoimmune gastritis (AIG) is chronic atrophic gastritis caused by an autoimmune mechanism of unknown etiology and presents with various pathological conditions by causing an achlorhydria state through parietal cell damage. The most characteristic endoscopic finding in AIG is advanced corpus-dominant mucosal atrophy. A [...] Read more.

Autoimmune gastritis (AIG) is chronic atrophic gastritis caused by an autoimmune mechanism of unknown etiology and presents with various pathological conditions by causing an achlorhydria state through parietal cell damage. The most characteristic endoscopic finding in AIG is advanced corpus-dominant mucosal atrophy. A recent study that examined several cases in Japan revealed the presence of endoscopic features other than corpus-dominant advanced atrophy. Remnants of oxyntic mucosa and sticky adherent dense mucus were found in ≥30% of cases, and hyperplastic polyps were found in ≥20% of cases. In image-enhanced endoscopy (IEE), white globe appearance (WGA) was observed in 32% of AIG cases. Additionally, some reports have stated that the findings in AIG cases using IEE showed cast-off skin appearance (CSA) and foveola type mucosa; however, a consensus is yet to be achieved. These endoscopic results were found in cases of advanced-stage AIG. There have been few reports concerning early-stage AIG cases. In these few reports, all of the cases were pathologically diagnosed as early AIG. In all of the cases, the pathological findings almost always showed neither parietal cell destruction nor atrophy. Endoscopic findings such as “mosaic pattern with slight swelling of the areae gastricae”, “diffuse reddened and edematous gastric fundic gland mucosa”, and “pseudopolyp-like nodules” may be common characteristics of early images. In such early cases, high antibody titers, no atrophic changes, and few clinical abnormal findings were shown. Endoscopists are expected to update their knowledge regarding AIG diagnosis with the evolution of imaging equipment. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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14 pages, 3609 KiB

Open AccessReview

Current Status and Future Perspectives of Artificial Intelligence in Colonoscopy

by Yu Kamitani, Kouichi Nonaka and Hajime Isomoto

J. Clin. Med. 2022, 11(10), 2923; https://doi.org/10.3390/jcm11102923 - 22 May 2022

Cited by 19 | Viewed by 4912

Abstract

The early endoscopic identification, resection, and treatment of precancerous adenoma and early-stage cancer has been shown to reduce not only the prevalence of colorectal cancer but also its mortality rate. Recent advances in endoscopic devices and imaging technology have dramatically improved our ability [...] Read more.

The early endoscopic identification, resection, and treatment of precancerous adenoma and early-stage cancer has been shown to reduce not only the prevalence of colorectal cancer but also its mortality rate. Recent advances in endoscopic devices and imaging technology have dramatically improved our ability to detect colorectal lesions and predict their pathological diagnosis. In addition to this, rapid advances in artificial intelligence (AI) technology mean that AI-related research and development is now progressing in the diagnostic imaging field, particularly colonoscopy, and AIs (i.e., devices that mimic cognitive abilities, such as learning and problem-solving) already approved as medical devices are now being introduced into everyday clinical practice. Today, there is an increasing expectation that sophisticated AIs will be able to provide high-level diagnostic performance irrespective of the level of skill of the endoscopist. In this paper, we review colonoscopy-related AI research and the AIs that have already been approved and discuss the future prospects of this technology. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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12 pages, 4395 KiB

Open AccessReview

Fundamentals, Diagnostic Capabilities, and Perspective of Narrow Band Imaging for Early Gastric Cancer

by Hiroki Kurumi, Kouichi Nonaka, Yuichiro Ikebuchi, Akira Yoshida, Koichiro Kawaguchi, Kazuo Yashima and Hajime Isomoto

J. Clin. Med. 2021, 10(13), 2918; https://doi.org/10.3390/jcm10132918 - 29 Jun 2021

Cited by 11 | Viewed by 3658

Abstract

The development of image-enhanced endoscopy has dramatically improved the qualitative and quantitative diagnosis of gastrointestinal tumors. In particular, narrow band imaging (NBI) has been widely accepted by endoscopists around the world in their daily practice. In 2009, Yao et al. proposed vessel plus [...] Read more.

The development of image-enhanced endoscopy has dramatically improved the qualitative and quantitative diagnosis of gastrointestinal tumors. In particular, narrow band imaging (NBI) has been widely accepted by endoscopists around the world in their daily practice. In 2009, Yao et al. proposed vessel plus surface (VS) classification, a diagnostic algorithm for early gastric cancer using magnifying endoscopy with NBI (ME-NBI), and in 2016, Muto et al. proposed a magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G) based on VS classification. In addition, the usefulness of ME-NBI in the differential diagnosis of gastric cancer from gastritis, diagnosis of lesion extent, inference of histopathological type, and diagnosis of depth has also been investigated. In this paper, we narrative review the basic principles, current status, and future prospects of NBI. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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13 pages, 2679 KiB

Open AccessReview

Systematic Review on Optical Diagnosis of Early Gastrointestinal Neoplasia

by Andrej Wagner, Stephan Zandanell, Tobias Kiesslich, Daniel Neureiter, Eckhard Klieser, Josef Holzinger and Frieder Berr

J. Clin. Med. 2021, 10(13), 2794; https://doi.org/10.3390/jcm10132794 - 25 Jun 2021

Cited by 9 | Viewed by 2743

Abstract

Background: Meticulous endoscopic characterization of gastrointestinal neoplasias (GN) is crucial to the clinical outcome. Hereby the indication and type of resection (endoscopically, en-bloc or piece-meal, or surgical resection) are determined. By means of established image-enhanced (IEE) and magnification endoscopy (ME) GN can be [...] Read more.

Background: Meticulous endoscopic characterization of gastrointestinal neoplasias (GN) is crucial to the clinical outcome. Hereby the indication and type of resection (endoscopically, en-bloc or piece-meal, or surgical resection) are determined. By means of established image-enhanced (IEE) and magnification endoscopy (ME) GN can be characterized in terms of malignancy and invasion depth. In this context, the statistical evidence and accuracy of these diagnostic procedures should be elucidated. Here, we present a systematic review of the literature. Results: 21 Studies could be found which met the inclusion criteria. In clinical prospective trials and meta-analyses, the diagnostic accuracy of >90% for characterization of malignant neoplasms could be documented, if ME with IEE was used in squamous cell esophageal cancer, stomach, or colonic GN. Conclusions: Currently, by means of optical diagnosis, today’s gastrointestinal endoscopy is capable of determining the histological subtype, exact lateral spread, and depth of invasion of a lesion. The prerequisites for this are an exact knowledge of the anatomical structures, the endoscopic classifications based on them, and a systematic learning process, which can be supported by training courses. More prospective clinical studies are required, especially in the field of Barrett’s esophagus and duodenal neoplasia. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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12 pages, 5720 KiB

Open AccessReview

Prevention and Management of Complications and Education in Endoscopic Submucosal Dissection

by Yoshitsugu Misumi and Kouichi Nonaka

J. Clin. Med. 2021, 10(11), 2511; https://doi.org/10.3390/jcm10112511 - 6 Jun 2021

Cited by 10 | Viewed by 3408

Abstract

Endoscopic submucosal dissection (ESD) is considered superior to endoscopic mucosal resection as an endoscopic resection because of its higher en bloc resection rate, but it is more difficult to perform. As ESD techniques have become more common, and the range of treatment by [...] Read more.

Endoscopic submucosal dissection (ESD) is considered superior to endoscopic mucosal resection as an endoscopic resection because of its higher en bloc resection rate, but it is more difficult to perform. As ESD techniques have become more common, and the range of treatment by ESD has expanded, the number of possible complications has also increased, and endoscopists need to manage them. In this report, we will review the management of critical complications, such as hemorrhage, perforation, and stenosis, and we will also discuss educational methods for acquiring and improving ESD skills. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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17 pages, 2907 KiB

Open AccessReview

Prevention of Stricture after Endoscopic Submucosal Dissection for Superficial Esophageal Cancer: A Review of the Literature

by Takuto Hikichi, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Tadayuki Takagi, Rei Suzuki, Mitsuru Sugimoto, Yuki Sato, Hiroki Irie, Yoshinori Okubo, Masao Kobayakawa and Hiromasa Ohira

J. Clin. Med. 2021, 10(1), 20; https://doi.org/10.3390/jcm10010020 - 23 Dec 2020

Cited by 22 | Viewed by 4319

Abstract

Endoscopic resection has been the standard treatment for intramucosal esophageal cancers (ECs) because of the low risk of lymph node metastases in the lesions. In recent years, endoscopic submucosal dissection (ESD), which can resect large ECs, has been performed. However, the risk of [...] Read more.

Endoscopic resection has been the standard treatment for intramucosal esophageal cancers (ECs) because of the low risk of lymph node metastases in the lesions. In recent years, endoscopic submucosal dissection (ESD), which can resect large ECs, has been performed. However, the risk of esophageal stricture after ESD is high when the mucosal defect caused by the treatment exceeds 3/4 of the circumference of the lumen. Despite the subsequent high risk of luminal stricture, ESD has been performed even in cases of circumferential EC. In such cases, it is necessary to take measures to prevent stricture. Therefore, in this review, we aimed to clarify the current status of stricture prevention methods after esophageal ESD based on previous literature. Although various prophylactic methods have been reported to have stricture-preventing effects, steroid injection therapy and oral steroid administration are mainstream. However, in cases of circumferential EC, both steroid injection therapy and oral steroid administration cannot effectively prevent luminal stricture. To solve this issue, clinical applications, such as tissue shielding methods with polyglycolic acid sheet, autologous oral mucosal epithelial sheet transplantation, and stent placement, have been developed. However, effective prophylaxis of post-ESD mucosal defects of the esophagus is still unclear. Therefore, further studies in this research field are needed. Full article

(This article belongs to the Special Issue Latest Advances in Endoscopic Imaging and Therapy—Part I)

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