Review

17 pages, 2113 KiB

Open AccessReview

Malignant Acute Colonic Obstruction: Multidisciplinary Approach for Endoscopic Management

by Aurelio Mauro, Davide Scalvini, Sabrina Borgetto, Paola Fugazzola, Stefano Mazza, Ilaria Perretti, Anna Gallotti, Anna Pagani, Luca Ansaloni and Andrea Anderloni

Cancers 2024, 16(4), 821; https://doi.org/10.3390/cancers16040821 - 18 Feb 2024

Viewed by 641

Abstract

Patients presenting with acute colonic obstruction are usually evaluated in the emergency department and multiple specialties are involved in the patients’ management. Pre-treatment evaluation is essential in order to establish the correct endoscopic indication for stent implantation. Contrast-enhanced imaging could allow the exclusion [...] Read more.

Patients presenting with acute colonic obstruction are usually evaluated in the emergency department and multiple specialties are involved in the patients’ management. Pre-treatment evaluation is essential in order to establish the correct endoscopic indication for stent implantation. Contrast-enhanced imaging could allow the exclusion of benign causes of colonic obstruction and evaluation of the length of malignant stricture. Endoscopic stenting is the gold standard of treatment for palliative indications whereas there are still concerns about its use as a bridge to surgery. Different meta-analyses showed that stenting as a bridge to surgery improves short-term surgical outcomes but has no role in improving long-term outcomes. Multidisciplinary evaluation is also essential in patients that may be started on or are currently receiving antiangiogenic agents because endoscopic stenting may increase the risk of perforation. Evidence in the literature is weak and based on retrospective data. Here we report on how to correctly evaluate a patient with acute colonic malignant obstruction in collaboration with other essential specialists including a radiologist, surgeon and oncologist, and how to optimize the technique of endoscopic stenting. Full article

(This article belongs to the Special Issue The Application of Endoscopy in Gastrointestinal Cancers)

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14 pages, 602 KiB

Open AccessReview

Endoscopic Management of Gastro-Entero-Pancreatic Neuroendocrine Tumours: An Overview of Proposed Resection and Ablation Techniques

by Rocio Chacchi-Cahuin, Edward J. Despott, Nikolaos Lazaridis, Alessandro Rimondi, Giuseppe Kito Fusai, Dalvinder Mandair, Andrea Anderloni, Valentina Sciola, Martyn Caplin, Christos Toumpanakis and Alberto Murino

Cancers 2024, 16(2), 352; https://doi.org/10.3390/cancers16020352 - 13 Jan 2024

Cited by 1 | Viewed by 929

Abstract

A literature search of MEDLINE/PUBMED was conducted with the aim to highlight current endoscopic management of localised gastro-entero-pancreatic NETs. Relevant articles were identified through a manual search, and reference lists were reviewed for additional articles. The results of the research have been displayed [...] Read more.

A literature search of MEDLINE/PUBMED was conducted with the aim to highlight current endoscopic management of localised gastro-entero-pancreatic NETs. Relevant articles were identified through a manual search, and reference lists were reviewed for additional articles. The results of the research have been displayed in a narrative fashion to illustrate the actual state-of-the-art of endoscopic techniques in the treatment of NETs. Localised NETs of the stomach, duodenum and rectum can benefit from advanced endoscopic resection techniques (e.g., modified endoscopic mucosal resection, endoscopic full thickness resection, endoscopic submucosal dissection) according to centre expertise. Radiofrequency thermal ablation can be proposed as an alternative to surgery in selected patients with localised pancreatic NETs. Full article

(This article belongs to the Special Issue The Application of Endoscopy in Gastrointestinal Cancers)

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20 pages, 2336 KiB

Open AccessReview

The Role of Endoscopy in the Palliation of Pancreatico-Biliary Cancers: Biliary Drainage, Management of Gastrointestinal Obstruction, and Role in Relief of Oncologic Pain

by Giacomo Emanuele Maria Rizzo, Lucio Carrozza, Gabriele Rancatore, Cecilia Binda, Carlo Fabbri, Andrea Anderloni and Ilaria Tarantino

Cancers 2023, 15(22), 5367; https://doi.org/10.3390/cancers15225367 - 10 Nov 2023

Viewed by 918

Abstract

Therapeutic endoscopy permits many and various treatments for cancer palliation in patients with bilio-pancreatic cancers, enabling different options, supporting patients during their route to oncologic treatments, and trying to improve their quality of life. Therefore, both endoscopic and endoscopic ultrasound (EUS)-guided techniques are [...] Read more.

Therapeutic endoscopy permits many and various treatments for cancer palliation in patients with bilio-pancreatic cancers, enabling different options, supporting patients during their route to oncologic treatments, and trying to improve their quality of life. Therefore, both endoscopic and endoscopic ultrasound (EUS)-guided techniques are performed in this scenario. We performed a literature review focusing on the role of endoscopy in the palliation of those advanced pancreatic and biliary cancers developing malignant biliary obstruction (MBO), gastric outlet obstruction (GOO), and pain unresponsive to medical therapies. Therefore, we explored and focused on the clinical outcomes of endoscopic procedures in this scenario. In fact, the endoscopic treatment is based on achieving biliary drainage in the case of MBO through endoscopic retrograde cholangiopancreatography (ERCP) or EUS-guided biliary drainage (EUS-BD), while GOO is endoscopically treated through the deployment of an enteral stent or the creation of EUS-guided gastro-entero-anastomosis (EUS-GEA). Furthermore, untreatable chronic abdominal pain is a major issue in patients unresponsive to high doses of painkillers, so EUS-guided celiac plexus neurolysis (CPN) or celiac ganglia neurolysis (CGN) helps to reduce dosage and have better pain control. Therefore, therapeutic endoscopy in the palliative setting is an effective and safe approach for managing most of the clinical manifestations of advanced biliopancreatic tumors. Full article

(This article belongs to the Special Issue The Application of Endoscopy in Gastrointestinal Cancers)

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16 pages, 318 KiB

Open AccessEditor’s ChoiceReview

The Role of Artificial Intelligence in Colorectal Cancer Screening: Lesion Detection and Lesion Characterization

by Edward Young, Louisa Edwards and Rajvinder Singh

Cancers 2023, 15(21), 5126; https://doi.org/10.3390/cancers15215126 - 24 Oct 2023

Cited by 4 | Viewed by 1248

Abstract

Colorectal cancer remains a leading cause of cancer-related morbidity and mortality worldwide, despite the widespread uptake of population surveillance strategies. This is in part due to the persistent development of ‘interval colorectal cancers’, where patients develop colorectal cancer despite appropriate surveillance intervals, implying [...] Read more.

Colorectal cancer remains a leading cause of cancer-related morbidity and mortality worldwide, despite the widespread uptake of population surveillance strategies. This is in part due to the persistent development of ‘interval colorectal cancers’, where patients develop colorectal cancer despite appropriate surveillance intervals, implying pre-malignant polyps were not resected at a prior colonoscopy. Multiple techniques have been developed to improve the sensitivity and accuracy of lesion detection and characterisation in an effort to improve the efficacy of colorectal cancer screening, thereby reducing the incidence of interval colorectal cancers. This article presents a comprehensive review of the transformative role of artificial intelligence (AI), which has recently emerged as one such solution for improving the quality of screening and surveillance colonoscopy. Firstly, AI-driven algorithms demonstrate remarkable potential in addressing the challenge of overlooked polyps, particularly polyp subtypes infamous for escaping human detection because of their inconspicuous appearance. Secondly, AI empowers gastroenterologists without exhaustive training in advanced mucosal imaging to characterise polyps with accuracy similar to that of expert interventionalists, reducing the dependence on pathologic evaluation and guiding appropriate resection techniques or referrals for more complex resections. AI in colonoscopy holds the potential to advance the detection and characterisation of polyps, addressing current limitations and improving patient outcomes. The integration of AI technologies into routine colonoscopy represents a promising step towards more effective colorectal cancer screening and prevention. Full article

(This article belongs to the Special Issue The Application of Endoscopy in Gastrointestinal Cancers)

19 pages, 3434 KiB

Open AccessReview

Endoscopic Management of Dysplastic Barrett’s Oesophagus and Early Oesophageal Adenocarcinoma

by Leonardo Henry Eusebi, Andrea Telese, Chiara Castellana, Rengin Melis Engin, Benjamin Norton, Apostolis Papaefthymiou, Rocco Maurizio Zagari and Rehan Haidry

Cancers 2023, 15(19), 4776; https://doi.org/10.3390/cancers15194776 - 28 Sep 2023

Cited by 1 | Viewed by 1019

Abstract

Barrett’s oesophagus is a pathological condition whereby the normal oesophageal squamous mucosa is replaced by specialised, intestinal-type metaplasia, which is strongly linked to chronic gastro-oesophageal reflux. A correct endoscopic and histological diagnosis is pivotal in the management of Barrett’s oesophagus to identify patients [...] Read more.

Barrett’s oesophagus is a pathological condition whereby the normal oesophageal squamous mucosa is replaced by specialised, intestinal-type metaplasia, which is strongly linked to chronic gastro-oesophageal reflux. A correct endoscopic and histological diagnosis is pivotal in the management of Barrett’s oesophagus to identify patients who are at high risk of progression to neoplasia. The presence and grade of dysplasia and the characteristics of visible lesions within the mucosa of Barrett’s oesophagus are both important to guide the most appropriate endoscopic therapy. In this review, we provide an overview on the management of Barrett’s oesophagus, with a particular focus on recent advances in the diagnosis and recommendations for endoscopic therapy to reduce the risk of developing oesophageal adenocarcinoma. Full article

(This article belongs to the Special Issue The Application of Endoscopy in Gastrointestinal Cancers)

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11 pages, 7317 KiB

Open AccessReview

Endoscopic Management of Large Non-Pedunculated Colorectal Polyps

by Oliver Cronin and Michael J. Bourke

Cancers 2023, 15(15), 3805; https://doi.org/10.3390/cancers15153805 - 27 Jul 2023

Viewed by 3035

Abstract

Large non-pedunculated colorectal polyps ≥20 mm (LNPCPs) comprise approximately 1% of all colorectal polyps. LNPCPs more commonly contain high-grade dysplasia, covert and overt cancer. These lesions can be resected using several means, including conventional endoscopic mucosal resection (EMR), cold-snare EMR (C-EMR) and endoscopic [...] Read more.

Large non-pedunculated colorectal polyps ≥20 mm (LNPCPs) comprise approximately 1% of all colorectal polyps. LNPCPs more commonly contain high-grade dysplasia, covert and overt cancer. These lesions can be resected using several means, including conventional endoscopic mucosal resection (EMR), cold-snare EMR (C-EMR) and endoscopic submucosal dissection (ESD). This review aimed to provide a comprehensive, critical and objective analysis of ER techniques. Evidence-based, selective resection algorithms should be used when choosing the most appropriate technique to ensure the safe and effective removal of LNPCPs. Due to its enhanced safety and comparable efficacy, there has been a paradigm shift towards cold-snare polypectomy (CSP) for the removal of small polyps (<10 mm). This technique is now being applied to the management of LNPCPs; however, further research is required to define the optimal LNPCP subtypes to target and the viable upper size limit. Adjuvant techniques, such as thermal ablation of the resection margin, significantly reduce recurrence risk. Bleeding risk can be mitigated using through-the-scope clips to close defects in the right colon. Endoscopic surveillance is important to detect recurrence and synchronous lesions. Recurrence can be readily managed using an endoscopic approach. Full article

(This article belongs to the Special Issue The Application of Endoscopy in Gastrointestinal Cancers)

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13 pages, 1117 KiB

Open AccessReview

Using Endoscopy in the Diagnosis of Pancreato-Biliary Cancers

by Julia Chaves, Michael Fernandez Y Viesca and Marianna Arvanitakis

Cancers 2023, 15(13), 3385; https://doi.org/10.3390/cancers15133385 - 28 Jun 2023

Cited by 2 | Viewed by 1326

Abstract

Pancreatic cancer and cholangiocarcinoma are life threatening oncological conditions with poor prognosis and outcome. Pancreatic cystic lesions are considered precursors of pancreatic cancer as some of them have the potential to progress to malignancy. Therefore, accurate identification and classification of these lesions is [...] Read more.

Pancreatic cancer and cholangiocarcinoma are life threatening oncological conditions with poor prognosis and outcome. Pancreatic cystic lesions are considered precursors of pancreatic cancer as some of them have the potential to progress to malignancy. Therefore, accurate identification and classification of these lesions is important to prevent the development of invasive cancer. In the biliary tract, the accurate characterization of biliary strictures is essential for providing appropriate management and avoiding unnecessary surgery. Techniques have been developed to improve the diagnosis, risk stratification, and management of pancreato-biliary lesions. Endoscopic ultrasound (EUS) and associated techniques, such as elastography, contrasted-enhanced EUS, and EUS-guided needle confocal laser endomicroscopy, may improve diagnostic accuracy. In addition, intraductal techniques applied during endoscopic retrograde cholangiopancreatography (ERCP), such as new generation cholangioscopy and in vivo cellular evaluation through probe-based confocal laser endomicroscopy, can increase the diagnostic yield in characterizing indeterminate biliary strictures. Both EUS-guided and intraductal approaches can provide the possibility for tissue sampling with new tools, such as needles, biopsies forceps, and brushes. At the molecular level, novel biomarkers have been explored that provide new insights into diagnosis, risk stratification, and management of these lesions. Full article

(This article belongs to the Special Issue The Application of Endoscopy in Gastrointestinal Cancers)

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19 pages, 1853 KiB

Open AccessEditor’s ChoiceReview

Endoscopic Resection of Early Gastric Cancer and Pre-Malignant Gastric Lesions

by Ana Clara Vasconcelos, Mário Dinis-Ribeiro and Diogo Libânio

Cancers 2023, 15(12), 3084; https://doi.org/10.3390/cancers15123084 - 07 Jun 2023

Cited by 4 | Viewed by 3646

Abstract

Early gastric cancer comprises gastric malignancies that are confined to the mucosa or submucosa, irrespective of lymph node metastasis. Endoscopic resection is currently pivotal for the management of such early lesions, and it is the recommended treatment for tumors presenting a very low [...] Read more.

Early gastric cancer comprises gastric malignancies that are confined to the mucosa or submucosa, irrespective of lymph node metastasis. Endoscopic resection is currently pivotal for the management of such early lesions, and it is the recommended treatment for tumors presenting a very low risk of lymph node metastasis. In general, these lesions consist of two groups of differentiated mucosal adenocarcinomas: non-ulcerated lesions (regardless of their size) and small ulcerated lesions. Endoscopic submucosal dissection is the technique of choice in most cases. This procedure has high rates of complete histological resection while maintaining gastric anatomy and its functions, resulting in fewer adverse events than surgery and having a lesser impact on patient-reported quality of life. Nonetheless, approximately 20% of resected lesions do not fulfill curative criteria and demand further treatment, highlighting the importance of patient selection. Additionally, the preservation of the stomach results in a moderate risk of metachronous lesions, which underlines the need for surveillance. We review the current evidence regarding the endoscopic treatment of early gastric cancer, including the short-and long-term results and management after resection. Full article

(This article belongs to the Special Issue The Application of Endoscopy in Gastrointestinal Cancers)

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15 pages, 3342 KiB

Open AccessReview

Endoscopic Imaging for the Diagnosis of Neoplastic and Pre-Neoplastic Conditions of the Stomach

by Bruno Costa Martins, Renata Nobre Moura, Angelo So Taa Kum, Carolina Ogawa Matsubayashi, Sergio Barbosa Marques and Adriana Vaz Safatle-Ribeiro

Cancers 2023, 15(9), 2445; https://doi.org/10.3390/cancers15092445 - 25 Apr 2023

Cited by 2 | Viewed by 3696

Abstract

Gastric cancer is an aggressive disease with low long-term survival rates. An early diagnosis is essential to offer a better prognosis and curative treatment. Upper gastrointestinal endoscopy is the main tool for the screening and diagnosis of patients with gastric pre-neoplastic conditions and [...] Read more.

Gastric cancer is an aggressive disease with low long-term survival rates. An early diagnosis is essential to offer a better prognosis and curative treatment. Upper gastrointestinal endoscopy is the main tool for the screening and diagnosis of patients with gastric pre-neoplastic conditions and early lesions. Image-enhanced techniques such as conventional chromoendoscopy, virtual chromoendoscopy, magnifying imaging, and artificial intelligence improve the diagnosis and the characterization of early neoplastic lesions. In this review, we provide a summary of the currently available recommendations for the screening, surveillance, and diagnosis of gastric cancer, focusing on novel endoscopy imaging technologies. Full article

(This article belongs to the Special Issue The Application of Endoscopy in Gastrointestinal Cancers)

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