Diagnostic and Therapeutic Digestive Endoscopy: Progress, Challenges and Opportunities

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Optical Diagnostics".

Deadline for manuscript submissions: 31 July 2024 | Viewed by 2501

Special Issue Editor


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Guest Editor
1. Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
2. Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, Cluj-Napoca, Romania
Interests: chronic pancreatitis; pancreas; pancreatic cancer; acute pancreatitis; endoscopy; EUS; pancreatic diseases; biliary tract diseases; pancreatic ductal carcinoma; gastrointestinal diseases
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Special Issue Information

Dear Colleagues,

Advances in endoscopic imaging technologies have significantly improved the visualization and characterization of gastrointestinal lesions, leading to enhanced diagnostic accuracy. High-definition endoscopy, narrow-band imaging, and confocal laser endomicroscopy are among the notable developments that have revolutionized early lesion detection and tissue characterization. Additionally, the integration of artificial intelligence and computer-aided analysis in endoscopic imaging has exhibited promising results in automated lesion detection and risk stratification.

In the therapeutic realm, endoscopic procedures have evolved to become less invasive alternatives to surgery for various gastrointestinal conditions. Endoscopic mucosal resection and endoscopic submucosal dissection have enabled the en-bloc removal of preneoplastic and early-stage carcinoma, offering favorable outcomes and reduced morbidity. Furthermore, endoscopic techniques, such as stent placement, ablative therapies, and suturing, have expanded the scope of endoscopic interventions in the management of strictures, bleeding, and perforations. Advancements in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, achieved by employing new technologies such as cholangioscopy, endomicroscopy, elastography or contrast enhancement techniques, represent a great benefit for patients with biliopancreatic pathology, improving patient outcomes and their quality of life.

However, several challenges persist in the field. Limited access to specialized training and expertise remains a barrier to the widespread adoption of advanced endoscopic techniques. Moreover, ensuring patient safety and minimizing complications during complex interventions necessitate the continuous refinement of procedural techniques and equipment.

Despite the challenges, opportunities for progress in diagnostic and therapeutic digestive endoscopy abound. Research efforts should focus on refining existing endoscopic technologies, developing novel instruments, and establishing standardized training programs in order to enhance proficiency. Additionally, interdisciplinary collaborations and innovation-driven scientific work are indispensable in shaping the future of endoscopy.

Prof. Dr. Andrada Seicean
Guest Editor

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Published Papers (2 papers)

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Research

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10 pages, 396 KiB  
Article
Faecal Immunochemical Testing to Detect Colorectal Cancer in Symptomatic Patients: A Diagnostic Accuracy Study
by Farzana Rahman, Mihir Trivedy, Christopher Rao, Funmi Akinlade, Ahmer Mansuri, Atul Aggarwal, Faidon-Marios Laskaratos, Nirooshun Rajendran and Saswata Banerjee
Diagnostics 2023, 13(14), 2332; https://doi.org/10.3390/diagnostics13142332 - 10 Jul 2023
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Abstract
(1) Background: NHS England recommended faecal immunochemical testing (FIT) for symptomatic patients in June 2020 to rationalise limited diagnostic services during COVID-19. (2) Aim: to investigate the diagnostic performance of FIT, analysing the proportion of FIT-negative colorectal cancers (CRC) missed in symptomatic patients [...] Read more.
(1) Background: NHS England recommended faecal immunochemical testing (FIT) for symptomatic patients in June 2020 to rationalise limited diagnostic services during COVID-19. (2) Aim: to investigate the diagnostic performance of FIT, analysing the proportion of FIT-negative colorectal cancers (CRC) missed in symptomatic patients and how this risk could be mitigated. (3) Design and Setting: a retrospective study of biochemistry and cancer databases involving patients referred from primary healthcare with suspected CRC to a single secondary care trust in North East London. (4) Methods: a retrospective cohort diagnostic accuracy study was undertaken to determine the performance of FIT for detecting CRC at 10 µgHb/g. (5) Results: between January and December 2020, 7653 patients provided a stool sample for FIT analysis; 1679 (22%) samples were excluded due to inadequate or incorrect specimens; 48% of suspected CRC referrals completed FIT before evaluation; 86 FIT tested patients were diagnosed with histologically proven CRC. At 10 µgHb/g, FIT performance was comparable with the existing literature with a sensitivity of 0.8140 (95% CI 0.7189–0.8821), a specificity of 0.7704 (95% CI 0.7595–0.7809), a positive predictive value (PPV) of 0.04923 (95% CI 0.03915–0.06174), a negative predictive value (NPV) of 0.9965 (95% CI 0.9943–0.9978), and a likelihood ratio (LR) of 3.545; 16 patients with CRC had an FIT of ≤10 µgHb/g (18.6% 95% CI 11.0–28.4%). (6) Conclusions: this study raises concerns about compliance with FIT testing and the incidence of FIT-negative CRC at the NICE recommended threshold and how this risk can be mitigated without colonic imaging. Whilst FIT may have facilitated prioritisation during COVID-19, we must be cautious about using FIT alone to determine which patients are referred to secondary care or receive further investigation. Full article
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Review

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13 pages, 4448 KiB  
Review
The Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound Connection: Unity Is Strength, or the Endoscopic Ultrasonography Retrograde Cholangiopancreatography Concept
by Claudio Giovanni De Angelis, Eleonora Dall’Amico, Maria Teresa Staiano, Marcantonio Gesualdo, Mauro Bruno, Silvia Gaia, Marco Sacco, Federica Fimiano, Anna Mauriello, Simone Dibitetto, Chiara Canalis, Rosa Claudia Stasio, Alessandro Caneglias, Federica Mediati and Rodolfo Rocca
Diagnostics 2023, 13(20), 3265; https://doi.org/10.3390/diagnostics13203265 - 20 Oct 2023
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Abstract
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are both crucial for the endoscopic management of biliopancreatic diseases: the combination of their diagnostic and therapeutic potential is useful in many clinical scenarios, such as indeterminate biliary stenosis, biliary stones, chronic pancreatitis and biliary [...] Read more.
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are both crucial for the endoscopic management of biliopancreatic diseases: the combination of their diagnostic and therapeutic potential is useful in many clinical scenarios, such as indeterminate biliary stenosis, biliary stones, chronic pancreatitis and biliary and pancreatic malignancies. This natural and evident convergence between EUS and ERCP, which by 2006 we were calling the “Endoscopic ultrasonography retrograde colangiopancreatography (EURCP) concept”, has become a hot topic in the last years, together with the implementation of the therapeutic possibilities of EUS (from EUS-guided necrosectomy to gastro-entero anastomoses) and with the return of ERCP to its original diagnostic purpose thanks to ancillary techniques (extraductal ultrasound (EDUS), intraductal ultrasound (IDUS), cholangiopancreatoscopy with biopsies and probe-based confocal laser endomicroscopy (pCLE)). In this literary review, we retraced the recent history of EUS and ERCP, reported examples of the clinical applicability of the EURCP concept and explored the option of performing the two procedures in only one endoscopic session, with its positive implications for the patient, the endoscopist and the health care system. In the last few years, we also evaluated the possibility of combining EUS and ERCP into a single endoscopic instrument in a single step, but certain obstacles surrounding this approach remain. Full article
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