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Application of artificial intelligence for diagnosis of early gastric cancer based on magnifying endoscopy with narrow-band imaging
Yusuke Horiuchi, Toshiaki Hirasawa, Junko Fujisaki
Clin Endosc 2024;57(1):11-17.   Published online January 5, 2024
DOI: https://doi.org/10.5946/ce.2023.173
AbstractAbstract PDFPubReaderePub
Although magnifying endoscopy with narrow-band imaging is the standard diagnostic test for gastric cancer, diagnosing gastric cancer using this technology requires considerable skill. Artificial intelligence has superior image recognition, and its usefulness in endoscopic image diagnosis has been reported in many cases. The diagnostic performance (accuracy, sensitivity, and specificity) of artificial intelligence using magnifying endoscopy with narrow band still images and videos for gastric cancer was higher than that of expert endoscopists, suggesting the usefulness of artificial intelligence in diagnosing gastric cancer. Histological diagnosis of gastric cancer using artificial intelligence is also promising. However, previous studies on the use of artificial intelligence to diagnose gastric cancer were small-scale; thus, large-scale studies are necessary to examine whether a high diagnostic performance can be achieved. In addition, the diagnosis of gastric cancer using artificial intelligence has not yet become widespread in clinical practice, and further research is necessary. Therefore, in the future, artificial intelligence must be further developed as an instrument, and its diagnostic performance is expected to improve with the accumulation of numerous cases nationwide.

Citations

Citations to this article as recorded by  
  • Pitfalls in Endoscopic Submucosal Dissection for Early Gastric Cancer with Papillary Adenocarcinoma
    Gwang Ha Kim
    Gut and Liver.2024; 18(3): 368.     CrossRef
  • 2,469 View
  • 184 Download
  • 1 Web of Science
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Computer-aided polyp characterization in colonoscopy: sufficient performance or not?
Natalie Halvorsen, Yuichi Mori
Clin Endosc 2024;57(1):18-23.   Published online January 5, 2024
DOI: https://doi.org/10.5946/ce.2023.092
AbstractAbstract PDFPubReaderePub
Computer-assisted polyp characterization (computer-aided diagnosis, CADx) facilitates optical diagnosis during colonoscopy. Several studies have demonstrated high sensitivity and specificity of CADx tools in identifying neoplastic changes in colorectal polyps. To implement CADx tools in colonoscopy, there is a need to confirm whether these tools satisfy the threshold levels that are required to introduce optical diagnosis strategies such as “diagnose-and-leave,” “resect-and-discard” or “DISCARD-lite.” In this article, we review the available data from prospective trials regarding the effect of multiple CADx tools and discuss whether they meet these thresholds.
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Role of endoscopy in gastroesophageal reflux disease
Daniel Martin Simadibrata, Elvira Lesmana, Ronnie Fass
Clin Endosc 2023;56(6):681-692.   Published online October 12, 2023
DOI: https://doi.org/10.5946/ce.2023.182
AbstractAbstract PDFPubReaderePub
In general, gastroesophageal reflux disease (GERD) is diagnosed clinically based on typical symptoms and/or response to proton pump inhibitor treatment. Upper gastrointestinal endoscopy is reserved for patients presenting with alarm symptoms, such as dysphagia, odynophagia, significant weight loss, gastrointestinal bleeding, or anorexia; those who meet the criteria for Barrett’s esophagus screening; those who report a lack or partial response to proton pump inhibitor treatment; and those with prior endoscopic or surgical anti-reflux interventions. Newer endoscopic techniques are primarily used to increase diagnostic yield and provide an alternative to medical or surgical treatment for GERD. The available endoscopic modalities for the diagnosis of GERD include conventional endoscopy with white-light imaging, high-resolution and high-magnification endoscopy, chromoendoscopy, image-enhanced endoscopy (narrow-band imaging, I- SCAN, flexible spectral imaging color enhancement, blue laser imaging, and linked color imaging), and confocal laser endomicroscopy. Endoscopic techniques for treating GERD include esophageal radiofrequency energy delivery/Stretta procedure, transoral incisionless fundoplication, and endoscopic full-thickness plication. Other novel techniques include anti-reflux mucosectomy, peroral endoscopic cardiac constriction, endoscopic submucosal dissection, and endoscopic band ligation. Currently, many of the new endoscopic techniques are not widely available, and their use is limited to centers of excellence.

Citations

Citations to this article as recorded by  
  • Long-term efficacy of endoscopic radiofrequency Stretta therapy for patients with refractory gastroesophageal reflux disease
    Sung Eun Kim
    Clinical Endoscopy.2024; 57(1): 48.     CrossRef
  • The role of ghrelin and leptin in the formation of morphological changes esophagus of patients with gastro-esophageal reflux disease against type 2 diabetes
    Olha Bondar-Keleberda
    EUREKA: Health Sciences.2023; (4): 24.     CrossRef
  • 3,414 View
  • 331 Download
  • 1 Web of Science
  • 2 Crossref
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Original Articles
Preclinical study of a novel ingestible bleeding sensor for upper gastrointestinal bleeding
Kimberly F. Schuster, Christopher C. Thompson, Marvin Ryou
Clin Endosc 2024;57(1):73-81.   Published online May 31, 2023
DOI: https://doi.org/10.5946/ce.2022.293
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Upper gastrointestinal bleeding (UGIB) is a life-threatening condition that necessitates early identification and intervention and is associated with substantial morbidity, mortality, and socioeconomic burden. However, several diagnostic challenges remain regarding risk stratification and the optimal timing of endoscopy. The PillSense System is a noninvasive device developed to detect blood in patients with UGIB in real time. This study aimed to assess the safety and performance characteristics of PillSense using a simulated bleeding model.
Methods
A preclinical study was performed using an in vivo porcine model (14 animals). Fourteen PillSense capsules were endoscopically placed in the stomach and blood was injected into the stomach to simulate bleeding. The safety and sensitivity of blood detection and pill excretion were also investigated.
Results
All the sensors successfully detected the presence or absence of blood. The minimum threshold was 9% blood concentration, with additional detection of increasing concentrations of up to 22.5% blood. All the sensors passed naturally through the gastrointestinal tract.
Conclusions
This study demonstrated the ability of the PillSense System sensor to detect UGIB across a wide range of blood concentrations. This ingestible device detects UGIB in real time and has the potential to be an effective tool to supplement the current standard of care. These favorable results will be further investigated in future clinical studies.

Citations

Citations to this article as recorded by  
  • Miniaturized Capsule System Toward Real‐Time Electrochemical Detection of H2S in the Gastrointestinal Tract
    Justin M. Stine, Katie L. Ruland, Luke A. Beardslee, Joshua A. Levy, Hossein Abianeh, Santiago Botasini, Pankaj J. Pasricha, Reza Ghodssi
    Advanced Healthcare Materials.2024;[Epub]     CrossRef
  • 2,187 View
  • 141 Download
  • 1 Web of Science
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Utility of narrow-band imaging with or without dual focus magnification in neoplastic prediction of small colorectal polyps: a Vietnamese experience
Tien Manh Huynh, Quang Dinh Le, Nhan Quang Le, Huy Minh Le, Duc Trong Quach
Clin Endosc 2023;56(4):479-489.   Published online May 24, 2023
DOI: https://doi.org/10.5946/ce.2022.212
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Accurate neoplastic prediction can significantly decrease costs associated with pathology and unnecessary colorectal polypectomies. Narrow band imaging (NBI) and dual-focus (DF) mode are promising emerging optical technologies for recognizing neoplastic features of colorectal polyps digitally. This study aimed to clarify the clinical usefulness of NBI with and without DF assistance in the neoplastic prediction of small colorectal polyps (<10 mm).
Methods
This cross-sectional study included 530 small colorectal polyps from 343 consecutive patients who underwent colonoscopy at the University Medical Center from September 2020 to May 2021. Each polyp was endoscopically diagnosed in three successive steps using white-light endoscopy (WLE), NBI, and NBI-DF and retrieved for histopathological assessment. The diagnostic accuracy of each modality was evaluated with reference to histopathology.
Results
There were 295 neoplastic polyps and 235 non-neoplastic polyps. The overall accuracies of WLE, WLE+NBI, and WLE+NBI+NBI-DF in the neoplastic prediction of colorectal polyps were 70.8%, 87.4%, and 90.8%, respectively (p<0.001). The accuracy of WLE+NBI+NBI-DF was significantly higher than that of WLE+NBI in the polyp size ≤5 mm subgroup (87.3% vs. 90.1%, p<0.001).
Conclusions
NBI improved the real-time neoplastic prediction of small colorectal polyps. The DF mode was especially useful in polyps ≤5 mm in size.

Citations

Citations to this article as recorded by  
  • Effectiveness of Dual-Focus Magnification on Confidence Levels in Optical Diagnosis of Small Colorectal Polyps
    Tien M Huynh, Quang D Le, Nhan Q Le , Huy M Le , Duc T Quach
    Cureus.2024;[Epub]     CrossRef
  • Implementing narrow banding imaging with dual focus magnification for histological prediction of small rectosigmoid polyps in Vietnamese setting
    Tien Manh Huynh, Quang Dinh Le, Nhan Quang Le, Huy Minh Le, Duc Trong Quach
    JGH Open.2024;[Epub]     CrossRef
  • The role of narrow-band imaging with or without dual focus in the detection of polyps smaller than 10 mm, especially diminutive polyps
    Jin Hwa Park
    Clinical Endoscopy.2023; 56(4): 455.     CrossRef
  • Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
    Yong Soo Kwon, Su Young Kim
    Journal of the Korean Medical Association.2023; 66(11): 652.     CrossRef
  • 2,505 View
  • 83 Download
  • 4 Web of Science
  • 4 Crossref
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Endoscopic and histological characteristics of small bowel tumors diagnosed by double-balloon enteroscopy
Suleyman Dolu, Soner Onem, Zarni Htway, Farid Hajıyev, Ali Bilgen, Hatice Cilem Binicier, Ecem Kalemoglu, Ozgul Sagol, Mesut Akarsu
Clin Endosc 2023;56(1):83-91.   Published online October 27, 2022
DOI: https://doi.org/10.5946/ce.2022.131
AbstractAbstract PDFPubReaderePub
Background
/Aims: Double-balloon enteroscopy (DBE) allows for the diagnoses and treatment of small bowel tumors (SBTs). This study aimed to evaluate the utility of DBE for the diagnosis and treatment of SBTs.
Methods
Patients diagnosed with SBTs who underwent DBE were included in this study. According to their endoscopic appearances, they were categorized as polyps or masses, and according to their histological characteristics, they were categorized as benign or malignant SBTs.
Results
A total of 704 patients were retrospectively analyzed, and 90 (12.8%) were diagnosed with SBTs. According to their endoscopic appearance, 48 (53.3%) had polyps and 42 (46.7%) had masses. Additionally, 53 (58.9%) and 37 (41.1%) patients had malignant and benign SBTs, respectively, depending on their histological characteristics. Patients diagnosed with polyps were younger than those diagnosed with masses (p<0.001). Patients diagnosed with benign SBTs were younger than those diagnosed with malignant SBT (p<0.001). Overall, histological diagnosis was determined using DBE in 73 (81.1%) patients.
Conclusions
DBE is a useful method for diagnosing SBTs. Additionally, the histological type of the lesion can be determined using DBE.
  • 1,823 View
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Optical diagnosis by near-focus versus normal-focus narrow band imaging colonoscopy in colorectal polyps based on combined NICE and WASP classification: a randomized controlled trial
Nisa Netinatsunton, Natcha Cheewasereechon, Tanawat Pattarapuntakul, Jaksin Sottisuporn, Kanet Kanjanapradit, Bancha Ovartlarnporn
Clin Endosc 2022;55(5):645-654.   Published online September 8, 2022
DOI: https://doi.org/10.5946/ce.2022.048
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Narrow Band Imaging (NBI) International Colorectal Endoscopic (NICE) and Workgroup Serrated Polyps and Polyposis (WASP) classifications were developed for optical diagnosis of neoplastic and sessile serrated polyps, respectively. Near-focus NBI with NICE combined with WASP criteria for optical diagnosis of colonic polyps has not yet been evaluated. We aimed to compare the accuracy of near-focus NBI (group A) with normal-focus NBI (group B) in real-time optical diagnosis of colorectal polyps using combined NICE and WASP criteria.
Methods
Among 362 patients, 118 with 227 polyps were recruited. Groups A and B included 62 patients with 130 polyps (three lost polyps) and 56 patients with 106 polyps (six lost polyps), respectively. Optical diagnoses were compared with pathological reports.
Results
The accuracy of optical diagnosis of neoplastic polyps in groups A and B was not significantly different (76% vs. 71%, p=0.52). WASP criteria provided all false positive diagnoses of sessile polyps as serrated polyps in 31 (16.2%) patients.
Conclusions
Near-focus NBI was not superior to normal-focus NBI in optical diagnostics of neoplastic polyps using NICE criteria. In our study, WASP classification yielded all false positives in the diagnosis of sessile serrated adenomas/polyps. Routine real-life optical diagnosis of polyps is still unadvisable.

Citations

Citations to this article as recorded by  
  • Colonoscopy Quality, Innovation, and the Assessment of New Technology
    Sanjay R.V. Gadi, Sriya S. Muralidharan, Jeremy R. Glissen Brown
    Techniques and Innovations in Gastrointestinal Endoscopy.2024; 26(2): 177.     CrossRef
  • Classification and endoscopic diagnosis of colorectal polyps
    Ji Hyun Kim, Sung Chul Park
    Journal of the Korean Medical Association.2023; 66(11): 633.     CrossRef
  • Understanding colorectal polyps to prevent colorectal cancer
    Dong-Hoon Yang
    Journal of the Korean Medical Association.2023; 66(11): 626.     CrossRef
  • AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
    Donghwan Kim, Eunsun Kim
    Journal of the Korean Medical Association.2023; 66(11): 658.     CrossRef
  • Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
    Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
    Clinical Endoscopy.2023; 56(5): 553.     CrossRef
  • 2,343 View
  • 144 Download
  • 5 Web of Science
  • 5 Crossref
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Review
Preparation of image databases for artificial intelligence algorithm development in gastrointestinal endoscopy
Chang Bong Yang, Sang Hoon Kim, Yun Jeong Lim
Clin Endosc 2022;55(5):594-604.   Published online May 31, 2022
DOI: https://doi.org/10.5946/ce.2021.229
AbstractAbstract PDFPubReaderePub
Over the past decade, technological advances in deep learning have led to the introduction of artificial intelligence (AI) in medical imaging. The most commonly used structure in image recognition is the convolutional neural network, which mimics the action of the human visual cortex. The applications of AI in gastrointestinal endoscopy are diverse. Computer-aided diagnosis has achieved remarkable outcomes with recent improvements in machine-learning techniques and advances in computer performance. Despite some hurdles, the implementation of AI-assisted clinical practice is expected to aid endoscopists in real-time decision-making. In this summary, we reviewed state-of-the-art AI in the field of gastrointestinal endoscopy and offered a practical guide for building a learning image dataset for algorithm development.

Citations

Citations to this article as recorded by  
  • Use of artificial intelligence in the management of T1 colorectal cancer: a new tool in the arsenal or is deep learning out of its depth?
    James Weiquan Li, Lai Mun Wang, Katsuro Ichimasa, Kenneth Weicong Lin, James Chi-Yong Ngu, Tiing Leong Ang
    Clinical Endoscopy.2024; 57(1): 24.     CrossRef
  • Computer‐aided diagnosis in real‐time endoscopy for all stages of gastric carcinogenesis: Development and validation study
    Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee
    United European Gastroenterology Journal.2024; 12(4): 487.     CrossRef
  • Assessing Endoscopic Response in Locally Advanced Rectal Cancer Treated with Total Neoadjuvant Therapy: Development and Validation of a Highly Accurate Convolutional Neural Network
    Hannah Williams, Hannah M. Thompson, Christina Lee, Aneesh Rangnekar, Jorge T. Gomez, Maria Widmar, Iris H. Wei, Emmanouil P. Pappou, Garrett M. Nash, Martin R. Weiser, Philip B. Paty, J. Joshua Smith, Harini Veeraraghavan, Julio Garcia-Aguilar
    Annals of Surgical Oncology.2024;[Epub]     CrossRef
  • As how artificial intelligence is revolutionizing endoscopy
    Jean-Francois Rey
    Clinical Endoscopy.2024; 57(3): 302.     CrossRef
  • Next-Generation Endoscopy in Inflammatory Bowel Disease
    Irene Zammarchi, Giovanni Santacroce, Marietta Iacucci
    Diagnostics.2023; 13(15): 2547.     CrossRef
  • Public Imaging Datasets of Gastrointestinal Endoscopy for Artificial Intelligence: a Review
    Shiqi Zhu, Jingwen Gao, Lu Liu, Minyue Yin, Jiaxi Lin, Chang Xu, Chunfang Xu, Jinzhou Zhu
    Journal of Digital Imaging.2023; 36(6): 2578.     CrossRef
  • AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
    Donghwan Kim, Eunsun Kim
    Journal of the Korean Medical Association.2023; 66(11): 658.     CrossRef
  • Impact of the Volume and Distribution of Training Datasets in the Development of Deep-Learning Models for the Diagnosis of Colorectal Polyps in Endoscopy Images
    Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee, Young Joo Yang, Gwang Ho Baik
    Journal of Personalized Medicine.2022; 12(9): 1361.     CrossRef
  • 3,395 View
  • 249 Download
  • 8 Web of Science
  • 8 Crossref
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Original Articles
Peroral Pancreatoscopy with Videoscopy and Narrow-Band Imaging in Intraductal Papillary Mucinous Neoplasms with Dilatation of the Main Pancreatic Duct
Yui Kishimoto, Naoki Okano, Ken Ito, Kensuke Takuma, Seiichi Hara, Susumu Iwasaki, Kensuke Yoshimoto, Yuto Yamada, Koji Watanabe, Yusuke Kimura, Hiroki Nakagawa, Yoshinori Igarashi
Clin Endosc 2022;55(2):270-278.   Published online December 6, 2021
DOI: https://doi.org/10.5946/ce.2021.083
Correction in: Clin Endosc 2023;56(2):261
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMNs) is useful in determining whether the lesions are benign or malignant. This study aimed to examine the usefulness of peroral pancreatoscopy (POPS) in determining the prognosis of IPMNs.
Methods
POPS with videoscopy was performed using the mother–baby scope technique. After surgery, computed tomography/magnetic resonance cholangiopancreatography or ultrasonography and blood tests were performed every 6 months during the follow-up.
Results
A total of 39 patients with main pancreatic duct (MPD)–type IPMNs underwent POPS using a videoscope, and the protrusions in the MPD were observed in 36 patients. The sensitivity and specificity of cytology/biopsy performed at the time of POPS were 85% and 87.5%, respectively. Of 19 patients who underwent surgery, 18 (95%) patients had negative surgical margins and 1 (5%) patient had a positive margin.
Conclusions
In IPMNs with dilatation of the MPD, POPS is considered effective if the lesions can be directly observed. The diagnosis of benign and malignant lesions is possible depending on the degree of lesion elevation. However, in some cases, slightly elevated lesions may increase in size during the follow-up or multiple lesions may be simultaneously present; therefore, careful follow-up is necessary.

Citations

Citations to this article as recorded by  
  • Pancreatoscopy-Guided Endotherapies for Pancreatic Diseases
    Yuri Hanada, Raj J. Shah
    Gastrointestinal Endoscopy Clinics of North America.2024;[Epub]     CrossRef
  • Peroral pancreatoscopy with videoscopy and narrow-band imaging in intraductal papillary mucinous neoplasms with dilatation of the main pancreatic duct
    Yui Kishimoto, Naoki Okano, Ken Ito, Kensuke Takuma, Seiichi Hara, Susumu Iwasaki, Kensuke Yoshimoto, Yuto Yamada, Koji Watanabe, Yusuke Kimura, Hiroki Nakagawa, Yoshinori Igarashi
    Clinical Endoscopy.2023; 56(2): 261.     CrossRef
  • Predicting Malignancy by Peroral Pancreatoscopy of an Intraductal Papillary Mucinous Neoplasm with a Dilated Main Pancreatic Duct: Is Seeing Enough?
    Yun Nah Lee, Jong Ho Moon
    Clinical Endoscopy.2022; 55(2): 213.     CrossRef
  • 3,637 View
  • 202 Download
  • 2 Web of Science
  • 3 Crossref
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Value of Fecal Calprotectin Measurement During the Initial Period of Therapeutic Anti-Tubercular Trial
Hyeong Ho Jo, Eun Young Kim, Jin Tae Jung, Joong Goo Kwon, Eun Soo Kim, Hyun Seok Lee, Yoo Jin Lee, Kyeong Ok Kim, Byung Ik Jang, the Crohn’s and Colitis Association in Daegu-Gyeongbuk
Clin Endosc 2022;55(2):256-262.   Published online November 5, 2021
DOI: https://doi.org/10.5946/ce.2021.061
AbstractAbstract PDFPubReaderePub
Background
/Aims: The diagnosis of intestinal tuberculosis (ITB) is often challenging. Therapeutic anti-tubercular trial (TATT) is sometimes used for the diagnosis of ITB. We aimed to evaluate the changing pattern of fecal calprotectin (FC) levels during TATT in patients with ITB.
Methods
A retrospective review was performed on the data of 39 patients who underwent TATT between September 2015 and November 2018 in five university hospitals in Daegu, South Korea. The analysis was performed for 33 patients with serial FC measurement reports.
Results
The mean age of the participants was 48.8 years. The final diagnosis of ITB was confirmed in 30 patients based on complete mucosal healing on follow-up colonoscopy performed after 2 months of TATT. Before starting TATT, the mean FC level of the ITB patients was 170.2 μg/g (range, 11.5-646.5). It dropped to 25.4 μg/g (range, 11.5-75.3) and then 23.3 μg/g (range, 11.5-172.2) after one and two months of TATT, respectively. The difference in mean FC before and one month after TATT was statistically significant (p<0.001), and FC levels decreased to below 100 μg/g in all patients after one month of TATT.
Conclusions
All ITB patients showed FC decline after only 1 month of TATT, and this finding correlated with complete mucosal healing in the follow-up colonoscopy after 2 months of TATT.

Citations

Citations to this article as recorded by  
  • Primary Gastric Tuberculosis in an Immunocompetent Patient: The Truth Lying beneath the Surface
    Fábio Pereira Correia, Luísa Martins Figueiredo, Luís Carvalho Lourenço, Sofia Santos, Rita Theias Manso, David Horta
    GE - Portuguese Journal of Gastroenterology.2024; 31(3): 191.     CrossRef
  • Evidence-based approach to diagnosis and management of abdominal tuberculosis
    Daya Krishna Jha, Mythili Menon Pathiyil, Vishal Sharma
    Indian Journal of Gastroenterology.2023; 42(1): 17.     CrossRef
  • Fecal Calprotectin as a Surrogate Marker for Mucosal Healing After Initiating the Therapeutic Anti-Tubercular Trial
    Satimai Aniwan
    Clinical Endoscopy.2022; 55(2): 210.     CrossRef
  • 3,056 View
  • 281 Download
  • 3 Web of Science
  • 3 Crossref
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Focused Review Series: Image-Enhanced Endoscopy: Update on Clinical Practice
Application of Current Image-Enhanced Endoscopy in Gastric Diseases
Wansik Lee
Clin Endosc 2021;54(4):477-487.   Published online July 28, 2021
DOI: https://doi.org/10.5946/ce.2021.160
AbstractAbstract PDFPubReaderePub
Image-enhanced endoscopy (IEE) plays an integral role in endoscopic diagnosis and treatment. IEE enables an early and accurate detection of cancer and characterization of lesions prior to therapeutic decisions. Ideal IEE can serve as an optical or digital chromoscopic endoscopy, as well as an optical biopsy that predicts exact histopathology. Several IEE modalities have recently been developed and are used in the clinical field. The stomach is a challenging organ for imaging because of its complex secretion function and status of Helicobacter pylori infection. Therefore, understanding the current IEE modalities for their clinical applicability in an evidence-based approach is warranted. Along with technology refinements, the new paradigm will be available for the diagnosis of gastric cancer or other conditions in the stomach in the near future.

Citations

Citations to this article as recorded by  
  • The Diagnostic Performance of Linked Color Imaging Compared to White Light Imaging in Endoscopic Diagnosis of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis
    Jae Gon Lee, In Kyung Yoo, Abdullah Ozgur Yeniova, Sang Pyo Lee
    Gut and Liver.2024; 18(3): 444.     CrossRef
  • Magnifying Endoscopy with Narrow-Band Imaging for Duodenal Neuroendocrine Tumors
    Gwang Ha Kim, Kiyoun Yi, Dong Chan Joo, Moon Won Lee, Hye Kyung Jeon, Bong Eun Lee
    Journal of Clinical Medicine.2023; 12(9): 3106.     CrossRef
  • Endoscopic Resection for Gastric Adenocarcinoma of the Fundic Gland Type: A Case Series
    Hwa Jin Lee, Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
    The Korean Journal of Gastroenterology.2023; 81(6): 259.     CrossRef
  • Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
    Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
    Clinical Endoscopy.2023; 56(5): 553.     CrossRef
  • Role of linked color imaging for upper gastrointestinal disease: present and future
    Sang Pyo Lee
    Clinical Endoscopy.2023; 56(5): 546.     CrossRef
  • Endoscopic submucosal dissection for early gastric cancer: It is time to consider the quality of its outcomes
    Gwang Ha Kim
    World Journal of Gastroenterology.2023; 29(43): 5800.     CrossRef
  • Quality indicators in esophagogastroduodenoscopy
    Sang Yoon Kim, Jae Myung Park
    Clinical Endoscopy.2022; 55(3): 319.     CrossRef
  • Endoscopic treatment for early gastric cancer
    Ji Yong Ahn
    Journal of the Korean Medical Association.2022; 65(5): 276.     CrossRef
  • Endoscopic diagnosis of early gastric cancer
    Dong Chan Joo, Gwang Ha Kim
    Journal of the Korean Medical Association.2022; 65(5): 267.     CrossRef
  • Risk factors for early gastric cancer: focus on Helicobacter pylori gastritis
    Hee Seok Moon
    Journal of the Korean Medical Association.2022; 65(5): 259.     CrossRef
  • Current status of the gastric cancer screening program in Korea
    Young-Il Kim, Il Ju Choi
    Journal of the Korean Medical Association.2022; 65(5): 250.     CrossRef
  • Paneth Cell Carcinoma of the Stomach
    Jun Wan Kim, Gwang Ha Kim, Kyung Bin Kim
    The Korean Journal of Gastroenterology.2022; 80(1): 34.     CrossRef
  • Current Evidence for a Paradigm Shift in Gastric Cancer Prevention From Endoscopic Screening toHelicobacter pyloriEradication in Korea
    Young-Il Kim, Il Ju Choi
    Journal of Gastric Cancer.2022; 22(3): 169.     CrossRef
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Focused Review Series: Application of Artificial Intelligence in GI Endoscopy
Artificial Intelligence in Gastrointestinal Endoscopy
Alexander P. Abadir, Mohammed Fahad Ali, William Karnes, Jason B. Samarasena
Clin Endosc 2020;53(2):132-141.   Published online March 30, 2020
DOI: https://doi.org/10.5946/ce.2020.038
AbstractAbstract PDFPubReaderePub
Artificial intelligence (AI) is rapidly integrating into modern technology and clinical practice. Although in its nascency, AI has become a hot topic of investigation for applications in clinical practice. Multiple fields of medicine have embraced the possibility of a future with AI assisting in diagnosis and pathology applications.
In the field of gastroenterology, AI has been studied as a tool to assist in risk stratification, diagnosis, and pathologic identification. Specifically, AI has become of great interest in endoscopy as a technology with substantial potential to revolutionize the practice of a modern gastroenterologist. From cancer screening to automated report generation, AI has touched upon all aspects of modern endoscopy.
Here, we review landmark AI developments in endoscopy. Starting with broad definitions to develop understanding, we will summarize the current state of AI research and its potential applications. With innovation developing rapidly, this article touches upon the remarkable advances in AI-assisted endoscopy since its initial evaluation at the turn of the millennium, and the potential impact these AI models may have on the modern clinical practice. As with any discussion of new technology, its limitations must also be understood to apply clinical AI tools successfully.

Citations

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  • Artificial intelligence‐aided diagnostic imaging: A state‐of‐the‐art technique in precancerous screening
    Yang‐Bor Lu, Si‐Cun Lu, Fu‐Dong Li, Puo‐Hsien Le, Kai‐Hua Zhang, Zi‐Zheng Sun, Yung‐Ning Huang, Yu‐Chieh Weng, Wei‐Ting Chen, Yi‐Wei Fu, Jun‐Bo Qian, Bin Hu, Hong Xu, Cheng‐Tang Chiu, Qin‐Wei Xu, Wei Gong
    Journal of Gastroenterology and Hepatology.2024; 39(3): 544.     CrossRef
  • Development of convolutional neural network models that recognize normal anatomic structures during real-time radial-array and linear-array EUS (with videos)
    Carlos Robles-Medranda, Jorge Baquerizo-Burgos, Miguel Puga-Tejada, Raquel Del Valle, Juan C. Mendez, Maria Egas-Izquierdo, Martha Arevalo-Mora, Domenica Cunto, Juan Alcívar-Vasquez, Hannah Pitanga-Lukashok, Daniela Tabacelia
    Gastrointestinal Endoscopy.2024; 99(2): 271.     CrossRef
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Review
Endoscopic Ultrasound-Guided Fine Needle Aspiration and Endoscopic Retrograde Cholangiopancreatography-Based Tissue Sampling in Suspected Malignant Biliary Strictures: A Meta-Analysis of Same-Session Procedures
Diogo Turiani Hourneax de Moura, Marvin Ryou, Eduardo Guimarães Hourneaux de Moura, Igor Braga Ribeiro, Wanderlei Marques Bernardo, Christopher C. Thompson
Clin Endosc 2020;53(4):417-428.   Published online November 5, 2019
DOI: https://doi.org/10.5946/ce.2019.053
AbstractAbstract PDFPubReaderePub
Background
/Aims: The diagnosis of biliary strictures can be challenging. There are no systematic reviews studying same-session endoscopic retrograde cholangiopancreatography (ERCP)-based tissue sampling and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for the diagnosis of biliary strictures.
Methods
A systematic review was conducted on studies analyzing same-session EUS and ERCP for tissue diagnosis of suspected malignant biliary strictures. The primary outcome was the accuracy of each method individually compared to the two methods combined. The secondary outcome was the accuracy of each method in pancreatic and biliary etiologies. In the meta-analysis, we used Forest plots, summary receiver operating characteristic curves, and estimates of the area under the curve for intention-to-treat analysis.
Results
Of the 12,132 articles identified, six were included, resulting in a total of 497 patients analyzed. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and accuracy of the association between the two methods were: 86%, 98%, 12.50, 0.17, and 96.5%, respectively. For the individual analysis, the sensitivity, specificity and accuracy of EUS-FNA were 76%, 100%, and 94.5%, respectively; for ERCP-based tissue sampling, the sensitivity, specificity, and accuracy were 58%, 98%, and 78.1%, respectively. For pancreatic lesions, EUS-FNA was superior to ERCP-based tissue sampling. However, for biliary lesions, both methods had similar sensitivities.
Conclusions
Same-session EUS-FNA and ERCP-based tissue sampling is superior to either method alone in the diagnosis of suspected malignant biliary strictures. Considering these results, combination sampling should be performed when possible.

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Original Articles
Comparison of the Diagnostic Ability of Endoscopic Ultrasonography and Abdominopelvic Computed Tomography in the Diagnosis of Gastric Subepithelial Tumors
Sang Yoon Kim, Ki-Nam Shim, Joo-Ho Lee, Ji Young Lim, Tae Oh Kim, A. Reum Choe, Chung Hyun Tae, Hye-Kyung Jung, Chang Mo Moon, Seong-Eun Kim, Sung-Ae Jung
Clin Endosc 2019;52(6):565-573.   Published online July 17, 2019
DOI: https://doi.org/10.5946/ce.2019.019
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasonography (EUS) is the most efficient imaging modality for gastric subepithelial tumors (SETs). However, abdominopelvic computed tomography (APCT) has other advantages in evaluating the characteristics, local extension, or invasion of SETs to adjacent organs. This study aimed to compare the diagnostic ability of EUS and APCT based on surgical histopathology results.
Methods
We retrospectively reviewed data from 53 patients who underwent both EUS and APCT before laparoscopic wedge resection for gastric SETs from January 2010 to December 2017 at a single institution. On the basis of histopathology results, we assessed the diagnostic ability of the 2 tests.
Results
The overall accuracy of EUS and APCT was 64.2% and 50.9%, respectively. In particular, the accuracy of EUS vs. APCT for the diagnosis of gastrointestinal stromal tumors (GISTs), leiomyomas, and ectopic pancreas was 83.9% vs. 74.2%, 37.5% vs. 0.0%, and 57.1% vs. 14.3%, respectively. Most of the incorrect diagnoses with EUS involved hypoechoic lesions originating in the fourth echolayer, with the most common misdiagnosed lesions being GISTs mistaken for leiomyomas and vice versa.
Conclusions
APCT showed a lower overall accuracy than EUS; however, APCT remains a useful modality for malignant/potentially malignant gastric SETs.

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Accuracy of Endoscopic Diagnosis for Mild Atrophic Gastritis Infected with Helicobacter pylori
Takuma Okamura, Yugo Iwaya, Kei Kitahara, Tomoaki Suga, Eiji Tanaka
Clin Endosc 2018;51(4):362-367.   Published online April 26, 2018
DOI: https://doi.org/10.5946/ce.2017.177
AbstractAbstract PDFPubReaderePub
Background
/Aims: This study examined the accuracy of endoscopic evaluation for determining the Helicobacter pylori infection status in patients with mild atrophy who might not exhibit characteristic endoscopic findings.
Methods
Forty endoscopists determined the H. pylori infection status of 50 randomly presented H. pylori-positive and H. pylorinegative cases on the basis of a list of established findings.
Results
The median clinical endoscopy experience was 7 years (range, 1–35 years), including 22 board-certified endoscopists (55%) of the Japan Gastroenterological Endoscopy Society. The mean accuracy rate of endoscopic diagnosis was 67% and was unrelated to experience status (experienced vs. trainee: 69% vs. 65%, p=0.089) and total years of experience (R2 =0.022). The most frequently selected endoscopic findings were regular arrangement of collecting venules (59%), atrophy (45%), and red streak (22%), which had fair accuracy rates of 67%, 65%, and 73%, respectively. By contrast, the accuracy rates of nodularity (89%) and mucosal swelling (77%) were highest. The 20 endoscopists who more frequently identified these findings diagnosed H. pylori infection significantly more accurately than did the other endoscopists (71% vs. 64%, p=0.008).
Conclusions
Careful attention to nodularity and mucosal swelling in patients with mild atrophy may enhance diagnosis, enable prompt treatment, and avoid possible long-term carcinogenesis.

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Reviews
Raman Spectroscopy for the Endoscopic Diagnosis of Esophageal, Gastric, and Colonic Diseases
Neel Sharma, Nobuyoshi Takeshita, Khek Yu Ho
Clin Endosc 2016;49(5):404-407.   Published online September 22, 2016
DOI: https://doi.org/10.5946/ce.2016.100
AbstractAbstract PDFPubReaderePub
Globally white-light endoscopy with biopsy sampling is the gold standard diagnostic modality for esophageal, gastric, and colonic pathologies. However, there is overwhelming evidence to highlight the deficiencies of an approach based predominantly on eyeball visualization. Biopsy sampling is also problematic due in part to excessive sampling and hence attendant cost. Various innovations are currently taking place in the endoscopic domain to aid operators in diagnosis forming. These include narrow band imaging which aims to enhance the surface anatomy and vasculature, and confocal laser endomicroscopy which provides real time histological information. However, both of these tools are limited by the skill of the operator and the extensive learning curve associated with their use. There is a gap therefore for a new form of technology that relies solely on an objective measure of disease and reduces the need for biopsy sampling. Raman spectroscopy (RS) is a potential platform that aims to satisfy these criteria. It enables a fingerprint capture of tissue in relation to the protein, DNA, and lipid content. This focused review highlights the strong potential for the use of RS during endoscopic gastroenterological examination.

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Endoscopic Ultrasonography in the Diagnosis of Gastric Subepithelial Lesions
Eun Jeong Gong, Do Hoon Kim
Clin Endosc 2016;49(5):425-433.   Published online September 5, 2016
DOI: https://doi.org/10.5946/ce.2016.065
AbstractAbstract PDFPubReaderePub
Subepithelial lesions occasionally found in the stomach of patients undergoing endoscopy may be either benign lesions or tumors with malignant potential. They may also appear due to extrinsic compression. Discrimination of gastric subepithelial lesions begins with meticulous endoscopic examination for size, shape, color, mobility, consistency, and appearance of the overlying mucosa. Accurate diagnosis can be achieved with endoscopic ultrasonography, which provides useful information on the exact size, layer-of-origin, and characteristic morphologic features to support a definitive diagnosis. Endoscopic ultrasonography also aids in the prediction of malignant potential, especially in gastrointestinal stromal tumors. Features of subepithelial lesions identified on endoscopic ultrasonography can be used to determine whether further diagnostic procedures such as endoscopic resection, fine needle aspiration, or core biopsy are required. Endoscopic ultrasonography is a valuable tool for diagnosis and clinical decision making during follow-up of gastric subepithelial lesions.

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Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease
Ji Min Lee, Kang-Moon Lee
Clin Endosc 2016;49(4):370-375.   Published online July 29, 2016
DOI: https://doi.org/10.5946/ce.2016.090
AbstractAbstract PDFPubReaderePub
Patients with inflammatory bowel disease have significantly increased in recent decades in Korea. Intestinal tuberculosis (ITB) and intestinal Behcet’s disease (BD), which should be differentiated from Crohn’s disease (CD), are more frequent in Korea than in the West. Thus, the accurate diagnosis of these inflammatory diseases is problematic in Korea and clinicians should fully understand their clinical and endoscopic characteristics. Ulcerative colitis mostly presents with rectal inflammation and continuous lesions, while CD presents with discontinuous inflammatory lesions and frequently involves the ileocecal area. Involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps are more frequently seen in ITB than in CD. A few ulcers with discrete margins are a typical endoscopic finding of intestinal BD. However, the differential diagnosis is difficult in many clinical situations because typical endoscopic findings are not always observed. Therefore, clinicians should also consider symptoms and laboratory, pathological, and radiological findings, in addition to endoscopic findings.

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  • 26,414 View
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Focused Review Series: Advances in the management of upper GI SET
Advances in the Management of Upper Gastrointestinal Subepithelial Tumor: Pathologic Diagnosis Using Endoscopy without Endoscopic Ultrasound-Guided Biopsy
Hang Lak Lee
Clin Endosc 2016;49(3):216-219.   Published online May 30, 2016
DOI: https://doi.org/10.5946/ce.2016.064
AbstractAbstract PDFPubReaderePub
Until now, biopsy methods for subepithelial tumors (SETs) have focused on endoscopic ultrasound (EUS)-guided biopsy; however, these methods have several limitations. We devised a simple method for pathologic diagnosis of SETs. SETs are occasionally diagnosed during endoscopy, and lesions are generally small and asymptomatic. It can be challenging to decide on a management plan for large asymptomatic SETs. EUS imaging provides information regarding the size, layer, and echo pattern of the lesions. Patient management plans have traditionally been determined based on EUS images, whereby the endoscopist chooses to either monitor or remove the tumor. However, EUS alone cannot diagnose and evaluate upper gastrointestinal SETs with high accuracy. As sufficient tissue samples are required for the accurate diagnosis of SETs, EUS-guided biopsy techniques such as EUS fine-needle aspiration and trucut biopsy are currently used. However, these methods have a relatively low diagnostic accuracy and do not always provide information upon immunohistochemical staining. Endoscopists can easily detect a submucosal mass after creating an iatrogenic mucosal ulcer, after which tissue sampling is performed by using endoscopic biopsy. Furthermore, pathologic results can differentiate between benign and premalignant lesions. Here, we introduce a simple method for the pathologic diagnosis of SETs.

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    Yuzhu Yuan, Lixin Sun, Xiaoying Zhou, Han Chen, Xinmin Si, Weifeng Zhang, Yun Wang, Bixing Ye, Nana Tang, Guoxin Zhang, Xueliang Li, Hongjie Zhang, Chunhua Jiao
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  • Controversies in EUS: Do we need miniprobes?
    Hans Seifert, Pietro Fusaroli, PaoloGiorgio Arcidiacono, Barbara Braden, Felix Herth, Michael Hocke, Alberto Larghi, Bertrand Napoleon, Mihai Rimbas, BogdanSilvio Ungureanu, Adrian Sãftoiu, AnandV Sahai, ChristophF Dietrich
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    Yazan Fahmawi, Patel Krutika, Manoj Kumar, Lindsey Merritt, Meir Mizrahi
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    Ming‐Yan Cai, Francisco Martin Carreras‐Presas, Ping‐Hong Zhou
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Original Article
Mucosal Incision and Forceps Biopsy for Reliable Tissue Sampling of Gastric Subepithelial Tumors
Sa Young Shin, Sang Jin Lee, Jae Hyuck Jun, Jong Kyu Park, Hyun Il Seo, Koon Hee Han, Young Don Kim, Woo Jin Jeong, Gab Jin Cheon
Clin Endosc 2017;50(1):64-68.   Published online March 4, 2016
DOI: https://doi.org/10.5946/ce.2015.094
AbstractAbstract PDFPubReaderePub
Background
/Aims: The diagnostic efficacy of current tissue sampling techniques for gastric subepithelial tumors (SETs) is limited. Better tissue sampling techniques are needed to improve pathological diagnosis. The aim of this study was to evaluate the safety and efficacy of a new technique, mucosal incision and forceps biopsy, for reliable tissue sampling of gastric SETs.
Methods
This study enrolled 12 consecutive patients who underwent mucosal incision and forceps biopsy of gastric SETs between November 2011 and September 2014 at Gangneung Asan Hospital. The medical records of patients were reviewed retrospectively. The safety and diagnostic yield of this method were evaluated.
Results
By performing mucosal incision and forceps biopsy, we were able to provide a definitive histological diagnosis for 11 out of 12 cases. The pathological diagnoses were leiomyoma (3/11), gastrointestinal stromal tumor (GIST; 2/11), lipoma (2/11), schwannoma (1/11), and ectopic pancreas (3/11). In cases of leiomyoma (n=3) and GIST (n=2), tissue samples were of sufficient size to allow immunohistochemical staining. In addition, the mitotic index was evaluated in two cases of GIST. There were no procedure-related complications.
Conclusions
Mucosal incision and forceps biopsy can be used as one of several methods to obtain adequate tissue samples from gastric SETs.

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  • Natural history of gastric leiomyoma
    Kwangbeom Park, Ji Yong Ahn, Hee Kyong Na, Kee Wook Jung, Jeong Hoon Lee, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwwon-Yong Jung
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    Cynthia A. Verloop, Jacqueline A.C. Goos, Marco J. Bruno, Rutger Quispel, Lydi M.J.W. van Driel, Lieke Hol
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    Gut and Liver.2022; 16(3): 321.     CrossRef
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    Benjamin Meier, Arthur Schmidt, Nicolas Glaser, Alexander Meining, Benjamin Walter, Andreas Wannhoff, Bettina Riecken, Karel Caca
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    Sang Yoon Kim, Ki-Nam Shim, Joo-Ho Lee, Ji Young Lim, Tae Oh Kim, A. Reum Choe, Chung Hyun Tae, Hye-Kyung Jung, Chang Mo Moon, Seong-Eun Kim, Sung-Ae Jung
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    Eun Young Park, Gwang Ha Kim
    Clinical Endoscopy.2019; 52(6): 519.     CrossRef
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    Eun Young Kim
    Clinical Endoscopy.2017; 50(1): 6.     CrossRef
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Focused Review Series: Current Issues and Future Directions of Small Bowel Endoscopic Evaluation
The Role of Capsule Endoscopy in Patients with Obscure Gastrointestinal Bleeding
Yang Won Min, Dong Kyung Chang
Clin Endosc 2016;49(1):16-20.   Published online January 28, 2016
DOI: https://doi.org/10.5946/ce.2016.49.1.16
AbstractAbstract PDFPubReaderePub
Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases and is often caused by small bowel lesions. Capsule endoscopy (CE), which allows non-invasive visualization of the small bowel mucosa, has revolutionized the evaluation of OGIB. CE is preferred by both patients and physicians mainly because of its non-invasiveness, and is widely used as the first-line diagnostic modality for OGIB. The diagnostic yield of CE in OGIB has been reported to be in the range of 32% to 83%. Although no direct comparison has been made, a meta-analysis showed similar diagnostic yields between CE and double-balloon enteroscopy (DBE) for OGIB. However, CE could enhance the yield of subsequent DBE and serve as a guide for optimizing the insertion route for DBE. Even after negative CE, selected patients could benefit from second-look CE for OGIB. In terms of outcomes, a favorable clinical impact after CE has been reported in several studies. However, observations indicate that CE might not influence clinical outcomes directly, but rather play a role in selecting patients with OGIB who are likely to benefit from subsequent evaluation and intervention.

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  • Experiencia con el uso de videocápsula endoscópica en pacientes con anemia ferropénica inexplicada
    Rosangela Ramirez Barranco, Valeria Atenea Costa Barney, Reinaldo Andres Rincón
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    Sang Pyo Lee, Jin Lee, Sea Hyub Kae, Hyun Joo Jang, Eun Suk Jung
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    Lilli L. Zwinger, Britta Siegmund, Andrea Stroux, Andreas Adler, Winfried Veltzke-Schlieker, Robert Wentrup, Christian Jürgensen, Bertram Wiedenmann, Felix Wiedbrauck, Stephan Hollerbach, Thomas Liceni, Christian Bojarski
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    Sumio Iio, Shiro Oka, Shinji Tanaka, Akiyoshi Tsuboi, Ichiro Otani, Sayoko Kunihara, Kazuaki Chayama
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    Seung Han Kim, Hyuk Soon Choi, Hoon Jai Chun, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim
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    Jung Ho Kim, Kwang An Kwon
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    Chloé Leandri, Benoit Bordacahar, Sophie Ribiere, Ammar Oudjit, Marie-Anne Guillaumot, Bertrand Brieau, Frédéric Prat, Vered Abitbol, Stanislas Chaussade, Romain Coriat
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    Genta Uchida, Masanao Nakamura, Osamu Watanabe, Takeshi Yamamura, Takuya Ishikawa, Kazuhiro Furukawa, Kohei Funasaka, Eizaburo Ohno, Hiroki Kawashima, Ryoji Miyahara, Hidemi Goto, Yoshiki Hirooka
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Original Article
An Ultrathin Endoscope with a 2.4-mm Working Channel Shortens the Esophagogastroduodenoscopy Time by Shortening the Suction Time
Satoshi Shinozaki, Yoshimasa Miura, Yuji Ino, Kenjiro Shinozaki, Alan Kawarai Lefor, Hironori Yamamoto
Clin Endosc 2015;48(6):516-521.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.516
Correction in: Clin Endosc 2016;49(1):100
AbstractAbstract PDFPubReaderePub
Background
/Aims: Poor suction ability through a narrow working channel prolongs esophagogastroduodenoscopy (EGD). The aim of this study was to evaluate suction with a new ultrathin endoscope (EG-580NW2; Fujifilm Corp.) having a 2.4-mm working channel in clinical practice.
Methods
To evaluate in vitro suction, 200 mL water was suctioned and the suction time was measured. The clinical data of 117 patients who underwent EGD were retrospectively reviewed on the basis of recorded video, and the suction time was measured by using a stopwatch.
Results
In vitro, the suction time with the EG-580NW2 endoscope was significantly shorter than that with the use of an ultrathin endoscope with a 2.0-mm working channel (EG-580NW; mean ± standard deviation, 22.7±1.1 seconds vs. 34.7±2.2 seconds; p<0.001). We analyzed the total time and the suction time for routine EGD in 117 patients (50 in the EG-580NW2 group and 67 in the EG-580NW group). In the EG-580NW2 group, the total time for EGD was significantly shorter than that in the EG-580NW group (275.3±42.0 seconds vs. 300.6±46.5 seconds, p=0.003). In the EG-580NW2 group, the suction time was significantly shorter than that in the EG-580NW group (19.2±7.6 seconds vs. 38.0±15.9 seconds, p<0.001).
Conclusions
An ultrathin endoscope with a 2.4-mm working channel considerably shortens the routine EGD time by shortening the suction time, in comparison with an endoscope with a 2.0-mm working channel.

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    Jang Ah Kim, Dominic J Wales, Guang-Zhong Yang
    Progress in Biomedical Engineering.2020; 2(4): 042001.     CrossRef
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    Anna-Livia Schuldt, Holger Kirsten, Jan Tuennemann, Mario Heindl, Florian van Bommel, Juergen Feisthammel, Marcus Hollenbach, Albrecht Hoffmeister
    BMJ Open Gastroenterology.2019; 6(1): e000264.     CrossRef
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Focused Review Series: Image Enhanced Endoscopy
Polyp Detection, Characterization, and Management Using Narrow-Band Imaging with/without Magnification
Takahiro Utsumi, Mineo Iwatate, Wataru Sano, Hironori Sunakawa, Santa Hattori, Noriaki Hasuike, Yasushi Sano
Clin Endosc 2015;48(6):491-497.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.491
AbstractAbstract PDFPubReaderePub
Narrow-band imaging (NBI) is a new imaging technology that was developed in 2006 and has since spread worldwide. Because of its convenience, NBI has been replacing the role of chromoendoscopy. Here we review the efficacy of NBI with/without magnification for detection, characterization, and management of colorectal polyps, and future perspectives for the technology, including education. Recent studies have shown that the next-generation NBI system can detect significantly more colonic polyps than white light imaging, suggesting that NBI may become the modality of choice from the beginning of screening. The capillary pattern revealed by NBI, and the NBI International Colorectal Endoscopic classification are helpful for prediction of histology and for estimating the depth of invasion of colorectal cancer. However, NBI with magnifying colonoscopy is not superior to magnifying chromoendoscopy for estimation of invasion depth. Currently, therefore, chromoendoscopy should also be performed additionally if deep submucosal invasive cancer is suspected. If endoscopists become able to accurately estimate colorectal polyp pathology using NBI, this will allow adenomatous polyps to be resected and discarded; thus, reducing both the risk of polypectomy and costs. In order to achieve this goal, a suitable system for education and training in in vivo diagnostics will be necessary.

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    Wei Peng, Huan Li, Yun Xu, Li Yan, Zhenzhen Tang, Xiaowei Tang, Xiangsheng Fu
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    Seong Ji Choi, Eun Sun Kim, Kihwan Choi
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    Sandra Barbeiro, Diogo Libânio, Rui Castro, Mário Dinis-Ribeiro, Pedro Pimentel-Nunes
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    John F. Sullivan, John A. Dumot
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    Łukasz Pietrzyk
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    Kyoku Sumimoto, Shinji Tanaka, Kenjiro Shigita, Nana Hayashi, Daiki Hirano, Yuzuru Tamaru, Yuki Ninomiya, Shiro Oka, Koji Arihiro, Fumio Shimamoto, Masaharu Yoshihara, Kazuaki Chayama
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    Céline Audibert, Anna Perlaky, Daniel Glass
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    Chaitanya Pant, Mojtaba S. Olyaee, Amit Rastogi
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Reviews
Diminutive and Small Colorectal Polyps: The Pathologist's Perspective
Yun Kyung Kang
Clin Endosc 2014;47(5):404-408.   Published online September 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.5.404
AbstractAbstract PDFPubReaderePub

Recent progress in advanced endoscopic imaging and electronic chromoendoscopy allows the real-time endoscopic estimation of the histologic type of polyps, mainly for the differentiation of adenomas from hyperplastic polyps. Accordingly, a "resect-and-discard" strategy applied to diminutive colorectal polyps is now one of the emerging issues among gastroenterologists. The strategy has a practical advantage in terms of the potential cost savings. However, it has a number of limitations in the medical, academic, and legal aspects. The major pitfalls include the endoscopic investigation of colorectal polyps with a wide variety of histogenetic origins, including serrated polyps, and the lack of a standardized method for polyp size measurement. Another issue is the importance of the pathologic diagnosis for legal purposes and medical research. Moreover, it is not certain whether the implementation of the strategy has economic benefit in countries with an undervalued reimbursement system for pathologic examination. There is no doubt that a highly confident optical diagnosis of polyp type is a novel valuable tool. It can provide a more steady symbiosis between gastroenterologists and pathologists to allow a more evident diagnosis and management of patients with colorectal polyps.

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  • Colorectal Polyp Image Detection and Classification through Grayscale Images and Deep Learning
    Chen-Ming Hsu, Chien-Chang Hsu, Zhe-Ming Hsu, Feng-Yu Shih, Meng-Lin Chang, Tsung-Hsing Chen
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    Joanna Picot, Micah Rose, Keith Cooper, Karen Pickett, Joanne Lord, Petra Harris, Sophie Whyte, Dankmar Böhning, Jonathan Shepherd
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    Yo Han Jeong, Kyeong Ok Kim, Chan Seo Park, Sung Bum Kim, Si Hyung Lee, Byung Ik Jang
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    Eun Young Kim, Kwang An Kwon, Il Ju Choi, Ji Kon Ryu, Ki Baik Hahm
    Clinical Endoscopy.2014; 47(5): 371.     CrossRef
  • 5,815 View
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Is Image-Enhanced Endoscopy Useful for the Diagnosis and Treatment of Gastrointestinal Tumor?
Kyoung Oh Kim, Yang Suh Ku
Clin Endosc 2013;46(3):248-250.   Published online May 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.3.248
AbstractAbstract PDFPubReaderePub

Since the introduction of endoscopic submucosal dissection method for the treatment of early gastric cancer, endoscopic treatment of early gastric cancer has increased exponentially. Accordingly, early diagnosis of cancerous or precancerous lesion has become one of the most important missions for endoscopists. The desire to improve diagnostic capability of white light endoscopy led to the development of new imaging techniques called "image enhanced endoscopy." The usefulness of these image enhanced endoscopy has not been proven yet, although there are several studies reporting diagnostic superiority of these new imaging methods over white light endoscopy. Among these new imaging modalities, narrow band image (NBI) with magnification endoscopy has been most widely used and studied. This manuscript will be focused on the NBI with magnification endoscopy.

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  • Comparison Trial between I-SCAN-Optical Enhancement and Chromoendoscopy for Evaluating the Horizontal Margins of Gastric Epithelial Neoplasms
    Myeongseok Koh, Jong Yoon Lee, Song-Hee Han, Seong Woo Jeon, Su Jin Kim, Joo Young Cho, Seong Hwan Kim, Jae Young Jang, Gwang Ho Baik, Jin Seok Jang
    Gut and Liver.2023; 17(2): 234.     CrossRef
  • Comparison of the Diagnostic Usefulness of Conventional Magnification and Near-focus Methods with Narrow-band Imaging for Gastric Epithelial Tumors
    Hee Yoon Jang, Su Jin Hong, Jae Pil Han, Se Kyung Park, Han Kyeol Yun, Bong Jin Ko
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2015; 15(1): 39.     CrossRef
  • A comparison of NBI and WLI cystoscopy in detecting non-muscle-invasive bladder cancer: A prospective, randomized and multi-center study
    Zhangqun Ye, Jia Hu, Xiaodong Song, Fan Li, Xuetao Zhao, Shan Chen, Xiaofeng Wang, Dalin He, Jinhai Fan, Dingwei Ye, Jinchun Xing, Tiejun Pan, Dongwen Wang
    Scientific Reports.2015;[Epub]     CrossRef
  • Interobserver Agreement in Using Magnifying Narrow Band Imaging System
    Il Ju Choi
    Clinical Endoscopy.2014; 47(1): 1.     CrossRef
  • Efficacy of i-Scan Imaging for the Detection and Diagnosis of Early Gastric Carcinomas
    Junichi Nishimura, Jun Nishikawa, Munetaka Nakamura, Atsushi Goto, Kouichi Hamabe, Shinichi Hashimoto, Takeshi Okamoto, Masato Suenaga, Yusuke Fujita, Yoshihiko Hamamoto, Isao Sakaida
    Gastroenterology Research and Practice.2014; 2014: 1.     CrossRef
  • Highlights of the 48th Seminar of Korean Society of Gastrointestinal Endoscopy
    Kwang An Kwon, Il Ju Choi, Eun Young Kim, Seok Ho Dong, Ki Baik Hahm
    Clinical Endoscopy.2013; 46(3): 203.     CrossRef
  • Image-Enhanced Endoscopy for Diagnosis and Treatment of Gastrointestinal Tumor
    Viroj Wiwanitkit
    Clinical Endoscopy.2013; 46(4): 423.     CrossRef
  • 5,286 View
  • 67 Download
  • 7 Crossref
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Focused Review Series: Optical Diagnosis and New Management Strategys of Colorectal Polyps
Optical Diagnosis of Small Colorectal Polyp Histology with High-Definition Colonoscopy Using Narrow Band Imaging
Amit Rastogi
Clin Endosc 2013;46(2):120-129.   Published online March 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.2.120
AbstractAbstract PDFPubReaderePub

Optical diagnosis of polyp histology can potentially result in enormous cost savings by way of the "resect and discard" strategy for diminutive polyps and the "do not resect" strategy for diminutive hyperplastic polyps in the distal colon. Narrow Band Imaging (NBI) highlights the surface mucosal and vascular pattern on polyps and has been shown to accurately characterize adenomatous and hyperplastic polyps by experts. However, the results have been a little discouraging amongst lesser experienced endoscopists. Studies have also shown that using the NBI diagnosis of diminutive polyp histology, experts can accurately define the future surveillance colonoscopy intervals. However nonexperts in academic or community setting have as yet failed to achieve the recommended thresholds. The subjectivity in assessment by endoscopists leads to the variable accuracy rates and can be circumvented by computer based automated tools. Although initial experience with a few computer based algorithms have shown accuracies comparable to experts, further refinement and validation will be required before these can be implemented in clinical practice. Incorporation of optical diagnosis of diminutive polyps into clinical practice is bound to face several hurdles. But the potential for enormous cost saving makes it an attractive strategy that can make colonoscopy more cost effective.

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    Rui Castro, Diogo Libânio, Inês Pita, Mário Dinis-Ribeiro
    World Journal of Gastroenterology.2019; 25(7): 777.     CrossRef
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    红梅 于
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  • Randomized Controlled Trial of Self-directed Versus In-Classroom Education of Narrow Band Imaging in Diagnosing Colorectal Polyps Using the NICE Criteria
    James E. Allen, Prashanth Vennalaganti, Neil Gupta, Benjamin Hornung, Abhishek Choudhary, Mohammad Titi, Benjamin R. Alsop, Diego Lim, Prateek Sharma
    Journal of Clinical Gastroenterology.2018; 52(5): 413.     CrossRef
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    Experimental and Therapeutic Medicine.2017; 13(1): 49.     CrossRef
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    Nadim Mahmud, Jonah Cohen, Kleovoulos Tsourides, Tyler M. Berzin
    Gastroenterology Report.2015; 3(3): 179.     CrossRef
  • New Paradigms in Polypectomy
    Ana Ignjatovic Wilson, Brian P. Saunders
    Gastrointestinal Endoscopy Clinics of North America.2015; 25(2): 287.     CrossRef
  • Optical diagnosis of small colorectal polyps during colonoscopy: When to resect and discard?
    Ana Wilson
    Best Practice & Research Clinical Gastroenterology.2015; 29(4): 639.     CrossRef
  • Tools for Polyp Histology Prediction
    Shreyas Saligram, Amit Rastogi
    Gastrointestinal Endoscopy Clinics of North America.2015; 25(2): 261.     CrossRef
  • Advances in the removal of diminutive colorectal polyps
    Silvia Paggi, Franco Radaelli, Alessandro Repici, Cesare Hassan
    Expert Review of Gastroenterology & Hepatology.2015; 9(2): 237.     CrossRef
  • Comparison of Narrow Band Imaging and Fujinon Intelligent Color Enhancement in Predicting Small Colorectal Polyp Histology
    Hae Yeon Kang, Young Sun Kim, Seung Joo Kang, Goh Eun Chung, Ji Hyun Song, Sun Young Yang, Seon Hee Lim, Donghee Kim, Joo Sung Kim
    Digestive Diseases and Sciences.2015; 60(9): 2777.     CrossRef
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    Helmut Neumann, Shin‐Ei Kudo, Ralf Kiesslich, Markus F. Neurath
    Digestive Endoscopy.2015; 27(2): 232.     CrossRef
  • Small Colorectal Polyps
    Rainer Schoefl, Alexander Ziachehabi, Friedrich Wewalka
    Digestive Diseases.2015; 33(1): 38.     CrossRef
  • Diminutive and Small Colorectal Polyps: The Pathologist's Perspective
    Yun Kyung Kang
    Clinical Endoscopy.2014; 47(5): 404.     CrossRef
  • Highlights of the 48th Seminar of Korean Society of Gastrointestinal Endoscopy
    Kwang An Kwon, Il Ju Choi, Eun Young Kim, Seok Ho Dong, Ki Baik Hahm
    Clinical Endoscopy.2013; 46(3): 203.     CrossRef
  • 11,992 View
  • 114 Download
  • 14 Crossref
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Introduction: What Are New Roles of Current Colonoscopy?
Hyung Wook Kim
Clin Endosc 2013;46(2):118-119.   Published online March 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.2.118
AbstractAbstract PDFPubReaderePub

The recent advances in endoscopic imaging technologies make great changes in the management of colorectal polyps. These changes include optical histologic diagnosis with high definition colonscopy, new management strategies such as resect and discard or do not resect, and differentiation of depth of submucosal invasion. In this focused review series, these new paradigms in management of colorectal polyps are discussed by three, world famous authors. First, Amit Rastogi explained optical diagnosis of small colorectal polyp with high definition colonoscopy using narrow band imaging. Second, Cesare Hassan explained new paradigms for colonoscopic management of diminutive colorectal polyps: resect and discard or do not resect. In the last, Shinji Tanaka described, in detail, endoscopic assessment of invasive colorectal cancer: slight vs. deep submucosal invasion. These focused review series introduce the new roles of current colonoscopy to readers and will help the readers to know how to use the new imaging technologies and paradigms in clinical practices.

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  • Protein-Based Nanoplatform for Detection of Tumorigenic Polyps in the Colon Via Noninvasive Mucosal Routes
    Chun-Chieh Chen, Mo A Baikoghli, R Holland Cheng
    Pharmaceutical Patent Analyst.2021; 10(1): 13.     CrossRef
  • 4,435 View
  • 31 Download
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Special Issue Articles of IDEN 2012
Differential Diagnosis of Inflammatory Bowel Disease: What Is the Role of Colonoscopy?
Sung-Ae Jung
Clin Endosc 2012;45(3):254-262.   Published online August 22, 2012
DOI: https://doi.org/10.5946/ce.2012.45.3.254
AbstractAbstract PDFPubReaderePub

Colonoscopy plays a crucial role in the diagnosis, treatment and follow-up monitoring of inflammatory bowel disease (IBD). Practitioners should be well informed of the colonoscopic findings of IBD to prevent the misdiagnosis, overtreatment or delayed treatment. Distinguishing between Crohn's disease and ulcerative colitis is essential in terms of pharmacological treatment, surgical decision-making, and prognosis. But there are still lesions with difficulty in differentiation that approximately 10% of the patients fall into the category of indeterminate colitis. Efforts are needed to carefully select treatment approach appropriate for each patient by providing a precise diagnosis on the extent and degree of lesions as well as to accurately delineate the lesions to assure that they are compared in subsequent rounds of follow-up monitoring in order to allow redetermination and adjustment of the treatment.

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    Dae Sung Kim, Jeeyoung Hong, Kihyun Ryu, Sang Hyuk Lee, Hwanhyi Cho, Jehyeong Yu, Jieun Lee, Jong-Yeup Kim
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
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  • Development and Validation of a Deep Neural Network for Accurate Identification of Endoscopic Images From Patients With Ulcerative Colitis and Crohn's Disease
    Guangcong Ruan, Jing Qi, Yi Cheng, Rongbei Liu, Bingqiang Zhang, Min Zhi, Junrong Chen, Fang Xiao, Xiaochun Shen, Ling Fan, Qin Li, Ning Li, Zhujing Qiu, Zhifeng Xiao, Fenghua Xu, Linling Lv, Minjia Chen, Senhong Ying, Lu Chen, Yuting Tian, Guanhu Li, Zho
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    Rhiannon T Filippone, Lauren Sahakian, Vasso Apostolopoulos, Kulmira Nurgali
    Inflammatory Bowel Diseases.2019; 25(7): 1140.     CrossRef
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    PLOS ONE.2017; 12(4): e0175099.     CrossRef
  • Combining TNFSF15 and ASCA IgA can be used as a predictor for the stenosis/perforating phenotype of Crohn's disease
    Chien‐Chih Tung, Jau‐Min Wong, Wen‐Chung Lee, Heng‐Hsiu Liu, Chin‐Hao Chang, Ming‐Chu Chang, Yu‐Ting Chang, Ming‐Jium Shieh, Cheng‐Yi Wang, Shu‐Chen Wei
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  • Highlights of the 48th Seminar of Korean Society of Gastrointestinal Endoscopy
    Kwang An Kwon, Il Ju Choi, Eun Young Kim, Seok Ho Dong, Ki Baik Hahm
    Clinical Endoscopy.2013; 46(3): 203.     CrossRef
  • 18,805 View
  • 175 Download
  • 11 Crossref
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Barrett's Esophagus - With Emphasis on Endoscopic Disgnosis
Jun Haeng Lee, M.D.
Korean J Gastrointest Endosc 2009;39(4):185-198.   Published online October 30, 2009
AbstractAbstract PDF
Barrett's esophagus is a metaplastic change of the esophageal mucosa, such that the normal squamous epithelium is replaced by specialized columnar epithelium. During the last decades, there has been a significant change in the definition, endoscopic diagnosis, pathologic diagnosis, surveillance and management of Barrett's esophagus. Because of the rising prevalence of gastroesophgeal reflux disease in Korea, problems related to Barrett's esophagus are expected to be much more common in the near future. In this review, methods of endoscopic diagnosis of Barrett's esophagus are discussed in detail. Management strategies in the context of Korean epidemiology are also suggested. (Korean J Gastrointest Endosc 2009; 39:185-198)
  • 2,212 View
  • 12 Download
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Diagnostic Tips for Making the Diagnosis of Inflammatory Bowel Disease
Dong Soo Han, M.D.
Korean J Gastrointest Endosc 2009;38(4):181-187.   Published online April 30, 2009
AbstractAbstract PDF
The incidence and prevalence of inflammatory bowel disease (IBD) in Korea and Asian countries is rapidly rising. There are no specific diagnostic tools for this malady and the diagnosis of IBD is based on the clinical, radiologic, endoscopic, pathologic findings. Endoscopy plays an important role for the diagnosis, follow-up, cancer surveillance and therapeutic interventions for IBD. This article reviews the utility of endoscopy for making the diagnosis of IBD and the key points of observation during the endoscopic procedures. (Korean J Gastrointest Endosc 2009;38:181-187)
  • 1,748 View
  • 11 Download
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