The Application of Endoscopy in Gastrointestinal Cancers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: closed (19 November 2023) | Viewed by 19706

Special Issue Editors


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Guest Editor
Department of Medicine and Surgery, School of Medicine and Surgery, University of Enna "Kore", 94100 Enna, Italy
Interests: endoscopy; gastrointestinal cancers; liver diseases

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Co-Guest Editor
Royal Free Unit for Endoscopy and Centre for Gastroenterology, UCL Institute for Liver and Digestive Health, Royal Free NHS Foundation Trust, London, UK
Interests: endoscopy; ESD; gastrointestinal cancers

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Co-Guest Editor
Department of Western Health, University of Melbourne, Melbourne, VIC 3010, Australia
Interests: colonoscopic endoscopic mucosal resection for large or complex colorectal polyps; endoscopic management of serrated colorectal neoplasia; diagnostic and therapeutic upper GI endoscopic ultrasound (EUS); therapeutic ERCP including cholangioscopy

Special Issue Information

Dear Colleagues,

Gastrointestinal malignancies represent a healthcare concern worldwide. In recent decades, several innovations in gastrointestinal endoscopy have radically changed the approach to digestive neoplasms. As a result, many preneoplastic or neoplastic lesions of the digestive tract are amenable to endoscopic resection through innovative techniques, avoiding the need for surgery. This concerns techniques such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFTR), etc.

Moreover, endoscopy has several applications in the palliative treatment of gastrointestinal cancers unfit for curative therapies.

Finally, for cancers susceptible to population screening, such as colorectal cancer, endoscopy has a crucial role for screening and surveillance, contributing to the reduction in cancer incidence and mortality all over the world.

All these application areas place endoscopy in a leading role in the management and follow-up of gastrointestinal neoplasms.

Aim: This Special Issue aims to summarize all the main applications of endoscopy for digestive neoplasms and the evidence supporting the effectiveness and safety of main endoscopic techniques for the curative or palliative treatment of gastrointestinal cancers.

We are pleased to invite you to contribute by submitting an original research article, a meta-analysis or a narrative review. Research areas may include (but are not limited to) the following: endoscopic screening/surveillance or the endoscopic treatment of gastrointestinal cancers.

I look forward to receiving your contributions.

Prof. Dr. Marcello F. Maida
Dr. Alberto Murino
Prof. Dr. Alan Moss
Guest Editors

Manuscript Submission Information

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

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

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • endoscopy
  • gastrointestinal neoplasms
  • treatment
  • colorectal cancer
  • screening
  • treatment
  • EMR
  • ESD
  • EFTR

Published Papers (10 papers)

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Review

17 pages, 6580 KiB  
Review
Endoscopic Diagnosis of Small Bowel Tumor
by Tomonori Yano and Hironori Yamamoto
Cancers 2024, 16(9), 1704; https://doi.org/10.3390/cancers16091704 - 27 Apr 2024
Viewed by 599
Abstract
Recent technological advances, including capsule endoscopy (CE) and balloon-assisted endoscopy (BAE), have revealed that small intestinal disease is more common than previously thought. CE has advantages, including a high diagnostic yield, discomfort-free, outpatient basis, and physiological images. BAE enabled endoscopic diagnosis and treatment [...] Read more.
Recent technological advances, including capsule endoscopy (CE) and balloon-assisted endoscopy (BAE), have revealed that small intestinal disease is more common than previously thought. CE has advantages, including a high diagnostic yield, discomfort-free, outpatient basis, and physiological images. BAE enabled endoscopic diagnosis and treatment in the deep small bowel. Computed tomography (CT) enterography with negative oral contrast can evaluate masses, wall thickening, and narrowing of the small intestine. In addition, enhanced CT can detect abnormalities outside the gastrointestinal tract that endoscopy cannot evaluate. Each modality has its advantages and disadvantages, and a good combination of multiple modalities leads to an accurate diagnosis. As a first-line modality, three-phase enhanced CT is preferred. If CT shows a mass, stenosis, or wall thickening, a BAE should be selected. If there are no abnormal findings on CT and no obstructive symptoms, CE should be selected. If there are significant findings in the CE, determine the indication for BAE and its insertion route based on these findings. Early diagnosis of small intestinal tumors is essential for favorable outcomes. For early diagnosis, the possibility of small bowel lesions should be considered in patients with unexplained symptoms and signs after examination of the upper and lower gastrointestinal tract. Full article
(This article belongs to the Special Issue The Application of Endoscopy in Gastrointestinal Cancers)
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Graphical abstract

17 pages, 2113 KiB  
Review
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 815
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  
Review
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 1041
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  
Review
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 1015
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  
Review
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 5 | Viewed by 1519
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  
Review
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 1103
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  
Review
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
Cited by 1 | Viewed by 3357
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  
Review
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 1399
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  
Review
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 - 7 Jun 2023
Cited by 5 | Viewed by 3994
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  
Review
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 3932
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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