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Diagnostics
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The Next Generation of Upper Gastrointestinal Endoscopy
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The Next Generation of Upper Gastrointestinal Endoscopy

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

Deadline for manuscript submissions: closed (31 August 2021) | Viewed by 21497

Special Issue Editor

Prof. Dr. Hajime Isomoto

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Guest Editor
Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
Interests: narrow-band imaging (NBI); blue laser imaging (BLI); linked color imaging (LCI); image-enhanced endoscopies (IEE); artificial intelligence (AI); computer-aided diagnosis (CAD); endoscopic submucosal dissection (ESD); endocytoscopy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue focusses on the latest imaging modalities in the field of gastrointestinal (GI) endoscopy, as well as current innovations, mainly regarding the development of artificial intelligence (AI). Computer-aided diagnosis (CAD) is garnering increased investigation. Tracking suspicious lesions needs to be performed with the aim of screening in real time to afford automated diagnoses during on-going endoscopic procedures. Although AI solutions are at a more advanced stage of development for colonic diseases than for conditions of the upper GI tract, there have been promising reports concerning the use of AI application in upper GI endoscopy. Furthermore, results of hypoxia imaging are enhanced when utilizing an AI system, promising an exciting future for functional endoscopy. Endoscopists should consider finding a balance between AI and hyperspectral imaging that the human eye cannot appreciate or actually cannot see beyond the visible light region, using methods such as photodynamic diagnosis.

Endoscopic procedures for the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) related disease, coronavirus disease 2019 (COVID-19), in particular upper endoscopy procedures could increase the risk of SARS-CoV-2 transmission because coughing, retching, and belching can occur during these procedures, and hence could generate droplets and aerosol. Therefore, there needs to be a restriction on the number of individuals working in procedure rooms, including trainees. Suspension of training would potentially be justified. AI technology could play a significant role to estimate, not only the usefulness of endoscopic performance, but also its educational effectiveness in training. COVID-19 has directed attention to infectious respiratory diseases, prompting us to find ways to improve the working environment and technology for endoscopists.

This Special Issue will be beneficial in disseminating knowledge on how endoscopic imaging is developing and enabling readers to foresee the future of diagnostic luminal endoscopy in which endoscopists should not compromise pre-existing and ever developing diagnostic performance in the GI endoscopic field, while minimizing a decrease in training, yet still enforcing controlling measures to protect from COVID-19.

Dr. Hajime Isomoto
Guest Editor

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. Diagnostics 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 2600 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.

Published Papers (9 papers)

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Editorial

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4 pages, 179 KiB  
Editorial
Special Issue “The Next Generation of Upper Gastrointestinal Endoscopy”
by Hiroki Kurumi and Hajime Isomoto
Diagnostics 2022, 12(1), 152; https://doi.org/10.3390/diagnostics12010152 - 09 Jan 2022
Viewed by 1204
Abstract
Upper gastrointestinal endoscopy is now widely used as a first-line procedure to investigate upper gastrointestinal symptoms in most countries around the world [...] Full article
(This article belongs to the Special Issue The Next Generation of Upper Gastrointestinal Endoscopy)

Research

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12 pages, 1589 KiB  
Article
Texture and Color Enhancement Imaging Increases Color Changes and Improves Visibility for Squamous Cell Carcinoma Suspicious Lesions in the Pharynx and Esophagus
by Akira Dobashi, Shingo Ono, Hiroto Furuhashi, Toshiki Futakuchi, Naoto Tamai, Takashi Yamauchi, Machi Suka and Kazuki Sumiyama
Diagnostics 2021, 11(11), 1971; https://doi.org/10.3390/diagnostics11111971 - 23 Oct 2021
Cited by 20 | Viewed by 2058
Abstract
Texture and color enhancement imaging (TXI) has been developed as an image-enhanced endoscopy technology. TXI mode2 enhances texture and brightness, and TXI mode1 also enhances color. This study aims to assess the color differences in squamous cell carcinoma (SCC) suspicious lesions in the [...] Read more.
Texture and color enhancement imaging (TXI) has been developed as an image-enhanced endoscopy technology. TXI mode2 enhances texture and brightness, and TXI mode1 also enhances color. This study aims to assess the color differences in squamous cell carcinoma (SCC) suspicious lesions in the pharynx and esophagus using white light imaging (WLI), TXI mode1, TXI mode2, and narrow-band imaging (NBI). A total of 59 SCC suspicious lesions from 30 patients were analyzed. The color differences (ΔE) between the lesion and the surrounding mucosa were calculated for each modality. The color value was assessed using the Commission Internationale d’Eclairage L*a*b* color space. The visibility of the lesion in each modality was evaluated and compared to that in the WLI by six endoscopists. The mean ΔE values in the WLI, TXI mode1, TXI mode2, and NBI were 11.6; 18.6; 14.3; and 17.2, respectively, and the ΔE values of TXI mode1, TXI mode2, and NBI were significantly higher than those of the WLI (p < 0.001). No lesions had worse visibility, and 62.5% (37/59) had improved visibility, as assessed by more than half of the endoscopists in TXI mode1. TXI mode1 can enhance color changes and improve the visibility of SCC suspicious lesions in the pharynx and esophagus, compared to WLI. Full article
(This article belongs to the Special Issue The Next Generation of Upper Gastrointestinal Endoscopy)
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11 pages, 1242 KiB  
Article
Comparison of Magnifying Endoscopy with Blue Light Imaging and Narrow Band Imaging for Determining the Invasion Depth of Superficial Esophageal Squamous Cell Carcinoma by the Japanese Esophageal Society’s Intrapapillary Capillary Loop Classification
by Waku Hatta, Tomoyuki Koike, Yohei Ogata, Yutaka Kondo, Nobuyuki Ara, Kaname Uno, Naoki Asano, Akira Imatani and Atsushi Masamune
Diagnostics 2021, 11(11), 1941; https://doi.org/10.3390/diagnostics11111941 - 20 Oct 2021
Cited by 7 | Viewed by 2361
Abstract
Blue light imaging (BLI) and narrow-band imaging (NBI) are two modalities that enable narrow-band light observation. We aimed to compare the diagnostic ability of magnifying endoscopy with BLI (ME-BLI) and NBI (ME-NBI) for determining the invasion depth of superficial esophageal squamous cell carcinoma [...] Read more.
Blue light imaging (BLI) and narrow-band imaging (NBI) are two modalities that enable narrow-band light observation. We aimed to compare the diagnostic ability of magnifying endoscopy with BLI (ME-BLI) and NBI (ME-NBI) for determining the invasion depth of superficial esophageal squamous cell carcinoma (SESCC) by the Japanese Esophageal Society’s intrapapillary capillary loop (IPCL) classification. We enrolled 81 patients between 2014 and 2018, and the still endoscopic images for diagnosing the invasion depth at the same part in ME-BLI and ME-NBI were registered. Two blinded investigators reviewed them and diagnosed the invasion depth by the IPCL classification. Subsequently, the diagnostic yields in two modalities were compared. The overall accuracies for the invasion depth by the IPCL classification in ME-BLI and ME-NBI did not differ significantly (67.9–71.6% vs. 72.8–74.1%). In the analysis based on the invasion depth, the sensitivities and positive predictive values in tumors invading the muscularis mucosa or submucosa ≤200 µm were low (23.1–30.8% and 16.7–25.0%, respectively) in both modalities. In conclusion, the diagnostic ability for determining the invasion depth of SESCC by the IPCL classification was relatively similar in ME-BLI and ME-NBI, but diagnosis by magnifying endoscopy alone might not be satisfactory. Full article
(This article belongs to the Special Issue The Next Generation of Upper Gastrointestinal Endoscopy)
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9 pages, 517 KiB  
Article
Usefulness of a Fork-Tip Needle in Endoscopic Ultrasound-Guided Fine-Needle Biopsy for Gastric Subepithelial Lesions
by Mika Takasumi, Takuto Hikichi, Minami Hashimoto, Jun Nakamura, Tsunetaka Kato, Ryoichiro Kobashi, Takumi Yanagita, Rei Suzuki, Mitsuru Sugimoto, Yuki Sato, Hiroki Irie, Tadayuki Takagi, Masao Kobayakawa, Yuko Hashimoto and Hiromasa Ohira
Diagnostics 2021, 11(10), 1883; https://doi.org/10.3390/diagnostics11101883 - 12 Oct 2021
Cited by 5 | Viewed by 1373
Abstract
The sample adequacy and diagnostic accuracy of an endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) for gastric subepithelial lesions (SELs) have been reported to be imperfect. To resolve these issues, a fork-tip needle as an EUS-guided fine-needle biopsy (FNB) needle has been developed. This [...] Read more.
The sample adequacy and diagnostic accuracy of an endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) for gastric subepithelial lesions (SELs) have been reported to be imperfect. To resolve these issues, a fork-tip needle as an EUS-guided fine-needle biopsy (FNB) needle has been developed. This study was conducted to evaluate the usefulness of a fork-tip needle in an EUS-FNB for gastric SELs. Seventy-nine patients who received an EUS-FNA or FNB using a fork-tip needle for gastric SELs were included in the study. The sample adequacy and diagnostic accuracy were compared between the EUS-FNB with the fork-tip needle group (fork-tip group, n = 13) and the EUS-FNA with FNA needle group (FNA group, n = 66). In addition, a multivariate analysis of the factors influencing diagnostic accuracy was conducted. Regarding sample adequacy, there was no significant difference between the groups (100% vs. 90.9%, respectively; p = 0.582). The diagnostic accuracy of the fork-tip group was numerically higher than that of the FNA group (92.3% vs. 81.8%, respectively; p = 0.682). In a multivariate analysis, the diagnostic accuracy was related to the tumor size and location of the SEL but not to the needle type. In conclusion, this study does not show statistical superiority, but suggests the useful potential of a fork-tip needle. Full article
(This article belongs to the Special Issue The Next Generation of Upper Gastrointestinal Endoscopy)
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9 pages, 2506 KiB  
Article
Usefulness of Endoscopic Ultrasound with the Jelly-Filling Method for Esophageal Varices
by Tsunetaka Kato, Takuto Hikichi, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Ryoichiro Kobashi, Takumi Yanagita, Tadayuki Takagi, Rei Suzuki, Mitsuru Sugimoto, Yuki Sato, Hiroki Irie, Yoshinori Okubo, Masao Kobayakawa and Hiromasa Ohira
Diagnostics 2021, 11(9), 1726; https://doi.org/10.3390/diagnostics11091726 - 20 Sep 2021
Cited by 4 | Viewed by 2222
Abstract
Although the importance of endoscopic ultrasound (EUS) for esophageal varices (EVs) has been demonstrated, it is difficult to obtain sufficient EUS images with the water-filling method because of poor water stagnation in the esophagus. In this study on EVs, we aimed to evaluate [...] Read more.
Although the importance of endoscopic ultrasound (EUS) for esophageal varices (EVs) has been demonstrated, it is difficult to obtain sufficient EUS images with the water-filling method because of poor water stagnation in the esophagus. In this study on EVs, we aimed to evaluate the usefulness of the jelly-filling method for EUS. Consecutive patients who underwent EUS for EVs were included. The quality of EUS images, the diagnostic ability of the presence of blood vessels inside and outside the esophageal wall, and the procedure time were compared between the jelly-filling and water-filling methods. Thirty cases were analyzed (jelly-filling method in 13 and water-filling method in 17). The EUS image quality score was significantly higher in the jelly-filling method (jelly vs. water; three points vs. two points, p < 0.001). Additionally, EUS image quality scores in both nonexperts and experts were significantly higher in the jelly-filling method. The diagnostic ability of the presence of perforation veins was significantly higher in the jelly-filling method (jelly vs. water; 100% vs. 52.9%, p = 0.004). However, the procedure time was significantly longer in the jelly-filling method (p = 0.024). In conclusion, EUS using the jelly-filling method for EVs provided sufficient image quality. Full article
(This article belongs to the Special Issue The Next Generation of Upper Gastrointestinal Endoscopy)
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11 pages, 2202 KiB  
Article
Clinical Efficacy of Novel Patient-Covering Negative-Pressure Box for Shielding Virus Transmission during Esophagogastroduodenoscopy: A Prospective Observational Study
by Shintaro Fujihara, Hideki Kobara, Noriko Nishiyama, Naoya Tada, Kazuhiro Kozuka, Takanori Matsui, Taiga Chiyo, Nobuya Kobayashi, Tingting Shi, Tatsuo Yachida, Toshio Uchida, Taichi Nagatomi, Haruo Oba and Tsutomu Masaki
Diagnostics 2021, 11(9), 1679; https://doi.org/10.3390/diagnostics11091679 - 14 Sep 2021
Cited by 4 | Viewed by 2109
Abstract
Esophagogastroduodenoscopy (EGD) has a high risk of virus transmission during the current coronavirus disease 2019 era, and preventive measures are under investigation. We investigated the effectiveness of a newly developed patient-covering negative-pressure box system (Endo barrier®) (EB) for EGD. Eighty consecutive [...] Read more.
Esophagogastroduodenoscopy (EGD) has a high risk of virus transmission during the current coronavirus disease 2019 era, and preventive measures are under investigation. We investigated the effectiveness of a newly developed patient-covering negative-pressure box system (Endo barrier®) (EB) for EGD. Eighty consecutive unsedated patients who underwent screening EGD with EB use were prospectively enrolled. To examine the aerosol ratio before, during, and after EGD, 0.3- and 0.5-μm aerosols were measured every 60 s using an optical counter. Moreover, the degree of contamination of the examiners’ goggles and vinyl gowns was assessed before and after EGD using a rapid adenosine triphosphate (ATP) test for simulated droplets. Data were available in 73 patients and showed that 0.3- and 0.5-μm particles did not increase in 95.8% (70/73) and 94.5% (69/73) of patients during EGD under EB. There were no significant differences in the total 0.3- or 0.5-μm particle counts before versus after EGD. The difference in the ATP levels before and after EGD was −0.6 ± 16.6 relative light units (RLU) on goggles and 1.59 ± 19.9 RLU on gowns (both within the cutoff value). EB use during EGD may provide a certain preventive effect against aerosols and droplets, decreasing examiners’ exposure to viruses. Full article
(This article belongs to the Special Issue The Next Generation of Upper Gastrointestinal Endoscopy)
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7 pages, 5557 KiB  
Article
Efficacy and Safety of a Novel Mouthpiece for Esophagogastroduodenoscopy: A Multi-Center, Randomized Study
by Yuichiro Ikebuchi, Kazuya Matsumoto, Naoki Ueda, Taro Yamashita, Hiroki Kurumi, Takumi Onoyama, Yohei Takeda, Akira Yoshida, Koichiro Kawaguchi, Kazuo Yashima, Kazunori Fujiwara, Ryu Imamoto, Hisashi Noma, Masaru Ueki and Hajime Isomoto
Diagnostics 2021, 11(3), 538; https://doi.org/10.3390/diagnostics11030538 - 17 Mar 2021
Cited by 2 | Viewed by 1787
Abstract
This randomized trial aimed to compare the safety and efficacy of the GAGLESS mouthpiece for esophagogastroduodenoscopy (EGD) with that of the conventional mouthpiece. In all, 90 participants were divided into the GAGLESS mouthpiece and conventional mouthpiece groups. The primary endpoint was the severity [...] Read more.
This randomized trial aimed to compare the safety and efficacy of the GAGLESS mouthpiece for esophagogastroduodenoscopy (EGD) with that of the conventional mouthpiece. In all, 90 participants were divided into the GAGLESS mouthpiece and conventional mouthpiece groups. The primary endpoint was the severity of pain using the visual analog scale (VAS), and secondary endpoints were examination time, past history of endoscopy, success of the procedure, systolic (SBP) and diastolic (DBP) blood pressure, oxygen saturation, pulse rate before and after EGD, and adverse events. Endoscopy was completed in all cases, and no complications were observed. VAS, when passing the scope through the pharynx, was 2.5 ± 2.4 and 2.0 ± 1.9 cm (p = 0.24) in the conventional and GAGLESS groups, respectively, and that, throughout the examination, was 2.5 ± 2.4 and 1.7 ± 1.5 cm (p = 0.06), respectively. The difference in blood pressure between the GAGLESS and conventional groups was not significant for SBP (p = 0.08) and significant for DBP (p = 0.03). The post-EGD difference in DBP was significantly lower in the GAGLESS group than in the conventional group. The results indicate that GAGLESS mouthpieces had a lower VAS during endoscopy than the conventional mouthpieces, and the changes in blood pressure were smaller with the GAGLESS mouthpiece. Full article
(This article belongs to the Special Issue The Next Generation of Upper Gastrointestinal Endoscopy)
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Review

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12 pages, 2180 KiB  
Review
Current Status of Photodynamic Diagnosis for Gastric Tumors
by Hiroki Kurumi, Tsutomu Kanda, Yuichiro Ikebuchi, Akira Yoshida, Koichiro Kawaguchi, Kazuo Yashima and Hajime Isomoto
Diagnostics 2021, 11(11), 1967; https://doi.org/10.3390/diagnostics11111967 - 22 Oct 2021
Cited by 8 | Viewed by 1898
Abstract
Although the recent development and widespread use of image-enhanced endoscopy and magnifying endoscopy have improved endoscopic diagnosis of gastric cancer, it is somewhat complicated, requires a higher level of expertise, and is still subjective. Photodynamic endoscopic diagnosis (PDED) is based on the fluorescence [...] Read more.
Although the recent development and widespread use of image-enhanced endoscopy and magnifying endoscopy have improved endoscopic diagnosis of gastric cancer, it is somewhat complicated, requires a higher level of expertise, and is still subjective. Photodynamic endoscopic diagnosis (PDED) is based on the fluorescence of photosensitizers that accumulate in tumors, which enables objective evaluation independent of the endoscopist’s experience, and is useful for tumor detection. The objective of this work was to perform a narrative review of PDED for gastric tumors and to introduce our approach to PDED in gastric tumors in our hospital. In our review there have been case reports of PDED for gastric cancer, but its usefulness has not been established because no prospective studies evaluating its usefulness have been performed. In our previous study, 85.7% (42/49) of gastric tumors exhibited fluorescence in PDED. PDED may be useful in the diagnosis of early gastric cancer. Our previous studies were pilot studies in cancer patients; therefore, future prospective studies are required to verify the usefulness of PDED. Full article
(This article belongs to the Special Issue The Next Generation of Upper Gastrointestinal Endoscopy)
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22 pages, 1597 KiB  
Review
A New Dawn for the Use of Artificial Intelligence in Gastroenterology, Hepatology and Pancreatology
by Akihiko Oka, Norihisa Ishimura and Shunji Ishihara
Diagnostics 2021, 11(9), 1719; https://doi.org/10.3390/diagnostics11091719 - 19 Sep 2021
Cited by 9 | Viewed by 4720
Abstract
Artificial intelligence (AI) is rapidly becoming an essential tool in the medical field as well as in daily life. Recent developments in deep learning, a subfield of AI, have brought remarkable advances in image recognition, which facilitates improvement in the early detection of [...] Read more.
Artificial intelligence (AI) is rapidly becoming an essential tool in the medical field as well as in daily life. Recent developments in deep learning, a subfield of AI, have brought remarkable advances in image recognition, which facilitates improvement in the early detection of cancer by endoscopy, ultrasonography, and computed tomography. In addition, AI-assisted big data analysis represents a great step forward for precision medicine. This review provides an overview of AI technology, particularly for gastroenterology, hepatology, and pancreatology, to help clinicians utilize AI in the near future. Full article
(This article belongs to the Special Issue The Next Generation of Upper Gastrointestinal Endoscopy)
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