Advanced gastrointestinal endoscopic imaging for inflammatory bowel diseases

Gastrointestinal luminal endoscopy is of paramount importance for diagnosis, monitoring and dysplasia surveillance in patients with both, Crohn's disease and ulcerative colitis. Moreover, with the recent recognition that mucosal healing is directly linked to the clinical outcome of patients with inflammatory bowel disorders, a growing demand exists for the precise, timely and detailed endoscopic assessment of superficial mucosal layer. Further, the novel field of molecular imaging has tremendously expanded the clinical utility and applications of modern endoscopy, now encompassing not only diagnosis, surveillance, and treatment but also the prediction of individual therapeutic responses. Within this review, we describe how novel endoscopic approaches and advanced endoscopic imaging methods such as high definition and high magnification endoscopy, dye-based and dye-less chromoendoscopy, confocal laser endomicroscopy, endocytoscopy and molecular imaging now allow for the precise and ultrastructural assessment of mucosal inflammation and describe the potential of these techniques for dysplasia detection

From the surface to the single cell: Novel endoscopic approaches in inflammatory bowel disease

Inflammatory bowel diseases (IBD) comprise the two major entities Crohn's disease and ulcerative colitis and endoscopic imaging of the gastrointestinal tract has always been an integral and central part in the management of IBD patients. Within the recent years, mucosal healing emerged as a key treatment goal in IBD that substantially decides about the clinical outcome of IBD patients, thereby demanding for a precise, timely and detailed endoscopic assessment of the mucosal inflammation associated with IBD. Further, molecular imaging has tremendously expanded the clinical utility and applications of modern endoscopy, now encompassing not only diagnosis, surveillance, and treatment but also the prediction of individual therapy response. Within this review we describe novel endoscopic approaches and advanced endoscopic imaging methods for the diagnosis, treatment and surveillance of IBD patients. We begin by providing an overview over novel and advanced imaging techniques such as magnification endoscopy and dye-based and dye-less chromoendoscopy, endomicroscopy and endocytoscopy. We then describe how these techniques can be utilized for the precise and ultrastructural assessment of mucosal inflammation and dysplasia development associated with IBD and outline how they have enabled the endoscopist to gain insight onto the cellular level in real-time. Finally, we provide an outlook on how molecular imaging has rapidly evolved in the recent past and can be used to make individual predictions about the therapeutic response towards biological treatment

Review article: newer optical and digital chromoendoscopy techniques vs. dye-based chromoendoscopy for diagnosis and surveillance in inflammatory bowel disease

BackgroundRecent innovations in gastrointestinal endoscopy have changed our traditional approach to diagnosis and therapy in patients with inflammatory bowel diseases (IBD). While traditionally used dye-based chromoendoscopy (DBC) techniques suffer from several limitations that reduce their utility in daily routine practice, newer dye-less' chromoendoscopy (DLC) techniques offer a great potential to overcome most of these limitations. AimTo review available optical and digital chromoendoscopy techniques, by critically discussing their potential for diagnostic and surveillance colonoscopy in patients with IBD. MethodsA literature search on the use of dye-less and dye-based chromoendoscopy in IBD patients was performed. ResultsIn long-standing IBD, DBC improves detection of dysplasia (diagnostic odds ratio=17.5, 95% CI=1.2-247.1) as well as prediction of inflammatory disease activity and extent of disease compared with standard video-colonoscopy. Narrow band imaging (NBI) shows no improvement in dysplasia detection rates compared with white-light endoscopy and DBC (P=0.6). Moreover, NBI results in a suboptimal differentiation of dysplastic from nondysplastic lesions. No data regarding digital DLC techniques (i.e. FICE, i-scan) for dysplasia detection in IBD are yet available. Both NBI and i-scan are superior to white-light endoscopy in assessing the activity and extent of colorectal IBD. ConclusionsAlthough the potential benefits of newer optical and digital dye-less chromoendoscopy techniques over traditionally used DBC are substantial, only DBC can currently be recommended to improve dysplasia detection in long-standing IBD. In contrast, DLC has the potential to quantify disease activity and mucosal healing in IBD

Sperimentazione di due gravimetri LaCoste & Romberg in registrazione continua all’Etna con un’alta frequenza di campionamento

Negli ultimi venti anni, le esperienze condotte all’Etna dal Laboratorio di Gravimetria(GravLab) dell’INGV-Sezione di Catania hanno dimostrato la capacità delle osservazioni discrete di gravità di vincolare gli spostamenti del magma coinvolto nelle principali fasi di attività del vulcano. Le misure gravimetriche in continuo, iniziate dal 1998, hanno aperto la prospettiva di estendere la finestra spettrale di osservazione verso fenomenologie ad evoluzione più rapida e perciò di interesse ancora maggiore ai fini del monitoraggio dello stato di attività dell’Etna. Durante l’estate 2005, nell’ottica di affinare la conoscenza dei rapporti di causa-effetto che legano le variazioni del campo di gravità all’attività di sorgenti vulcaniche, è stato condotto un esperimento di misure ad alta frequenza con due gravimetri installati nello stesso sito....

The Offer of Advanced Imaging Techniques Leads to Higher Acceptance Rates for Screening Colonoscopy : a Prospective Study

BACKGROUND: Colonoscopy plays a fundamental role in early diagnosis and management of colorectal cancer and requires public and professional acceptance to ensure the ongoing success of screening programs. The aim of the study was to prospectively assess whether patient acceptance rates to undergo screening colonoscopy could be improved by the offer of advanced imaging techniques. MATERIALS AND METHODS: Overall, 372 randomly selected patients were prospectively included. A standardized questionnaire was developed that inquired of the patients their knowledge regarding advanced imaging techniques. Second, several media campaigns and information events were organized reporting about advanced imaging techniques, followed by repeated evaluation. After one year the evaluation ended. RESULTS: At baseline, 64% of the patients declared that they had no knowledge about new endoscopic methods. After twelve months the overall grade of information increased significantly from 14% at baseline to 34%. The percentage of patients who decided to undergo colonoscopy because of the offer of new imaging methods also increased significantly from 12% at baseline to 42% after 12 months. CONCLUSIONS: Patients were highly interested in the offer of advanced imaging techniques. Knowledge about these techniques could relatively easy be provided using local media campaigns. The offer of advanced imaging techniques leads to higher acceptance rates for screening colonoscopies

High-definition endoscopy with digital chromoendoscopy for histologic prediction of distal colorectal polyps

Background: Distal diminutive colorectal polyps are common and accurate endoscopic prediction of hyperplastic or adenomatous polyp histology could reduce procedural time, costs and potential risks associated with the resection. Within this study we assessed whether digital chromoendoscopy can accurately predict the histology of distal diminutive colorectal polyps according to the ASGE PIVI statement. Methods: In this prospective cohort study, 224 consecutive patients undergoing screening or surveillance colonoscopy were included. Real time histology of 121 diminutive distal colorectal polyps was evaluated using high-definition endoscopy with digital chromoendoscopy and the accuracy of predicting histology with digital chromoendoscopy was assessed. Results: The overall accuracy of digital chromoendoscopy for prediction of adenomatous polyp histology was 90.1 %. Sensitivity, specificity, positive and negative predictive values were 93.3, 88.7, 88.7, and 93.2 %, respectively. In high-confidence predictions, the accuracy increased to 96.3 % while sensitivity, specificity, positive and negative predictive values were calculated as 98.1, 94.4, 94.5, and 98.1 %, respectively. Surveillance intervals with digital chromoendoscopy were correctly predicted with >90 % accuracy. Conclusions: High-definition endoscopy in combination with digital chromoendoscopy allowed real-time in vivo prediction of distal colorectal polyp histology and is accurate enough to leave distal colorectal polyps in place without resection or to resect and discard them without pathologic assessment. This approach has the potential to reduce costs and risks associated with the redundant removal of diminutive colorectal polyps

Ex vivo experimental study on the Thulium laser system : new horizons for interventional endoscopy (with videos)

BACKGROUND AND STUDY AIMS: The Thulium laser system (TLS) is an emerging interventional tool adopted in many surgical specialties. Its 2.0-\u3bcm wavelength allows precise coagulation (0.2\u200a-\u200a0.4\u200amm in depth) and cutting, limiting the possibilities of collateral injuries. We tested the impact of the TLS for gastric endoscopic submucosal dissection (ESD) and per oral endoscopic myotomy (POEM) ex vivo in pigs. MATERIALS AND METHODS: Ex vivo porcine stomach and esophagus models underwent 2 POEMs, and 3 ESDs (mean diameter 3.5\u200acm) with TLS using a 272-\ub5m and a 365-\ub5m thick optical fibers. Both continuous and pulsed laser emission were evaluated. Subsequent histopathological analysis was performed by an expert GI pathologist on the whole porcine models. RESULTS: Complete POEMs and gastric ESDs were successfully performed in all cases in 30 to 70 and 15 to 20 minutes. Both optical fibers were equally effective and precise. The best power output for mucosal incision was 25 to 30\u200aW during ESD and 25\u200aW for POEM using continuous laser emission. During submucosal dissection and tunneling the favorite power output was 20\u200aW and 15 to 20\u200aW, respectively, operating in continuous mode. No transmural perforation occurred throughout the operations and histopathology confirmed the absence of accidental muscular layer damage. CONCLUSIONS: The TLS stands out as a precise and manageable instrument in ex vivo models. This technique appears to be a promising tool for advanced interventional endoscopy

The Marine Technology Liguria District, an opportunity for Collaboration and Training

This work focus on the newly born DLTM, namely the Distretto Ligure delle Tecnologie Marine, based in La Spezia, Liguria Region (IT). The main involved partners are: Ministries, Regione Liguria Council, Spedia SpA Company, Industries, SMEs (SMBs), Universities and National Research Institutes. The DLTM has been created as an answer to the local versus global needs of marine products innovation, technology and science. In order to provide, both the local and international community, effective solutions the DLTM aims to: - promote Innovation and pre-competitiveness of activities related to industrial research; - enhance the value and visibility of excellence areas existing in the Ligurian region (in the big enterprises as well as in SMEs) concerning marine technology; - enhance the value of academic activities focusing their R&D on industrial products/processes, assuring, evaluating and preventing environmental sustainability also in case of extreme events; - harmonize/make sustainable the economy and the society promoting scientific innovation and technological development, by means of Universities, Public and Private Research Institutes (at regional, national and EU level); - help the exchange of ideas and realization of projects aimed at developing the District objectives; - increase the dissemination and valorisation of District results and achievements, build capacity in the sectors of interest to the District. The DLTM is characterized by two main macro-themes .....

Usefulness of panoramic 344°-viewing in Crohn's disease capsule endoscopy : a proof of concept pilot study with the novel PillCam™ Crohn's system

Background: A new capsule endoscopy (CE) system featuring two advanced optics for 344\ub0-viewing and a prolonged operative time has been recently developed for Crohn's disease (CD) patients. Hence, we evaluated, for the first time, the performance of this novel CE and the add-on value of the 344\ub0-viewing in a multi-center real-life setting. Methods: Consecutive patients with suspected or established CD received the PillCam\u2122 Crohn's System as supplementary diagnostic work-up focused on the small-bowel between June 2017 and June 2018. Technical and clinical data, including the panenteric CE diagnostic yield, the Lewis score and the impact of small-bowel findings on clinical management during a 6-months follow-up (new diagnosis, staging or treatment upgrade) were collected, thereby evaluating the added value of the 344\ub0 panoramic-view (lesions detected by camera A and B) over the standard 172\ub0-view (lesions detected by one camera only). Results: Among 41 patients (aged 43 \ub1 20 years), 73% underwent CE for suspected CD and 27% for established CD. The rate of complete enteroscopy was 90%. No technical failure or retention occurred. Compared to the standard 172\ub0 view, the panoramic 344\ub0-view revealed a greater number of patients with a relevant lesion (56.1% vs. 39.0%; P = 0.023), resulting in higher Lewis score (222,8 vs. 185.7; P = 0.031), and improved clinical management (48.8% vs. 31.7%, P = 0.023). Conclusions: The panoramic 344\ub0-view increases small-bowel CE accuracy, thereby improving the clinical management of CD patients with mild small-bowel active disease. This system should be regarded as a new standard for both small-bowel diagnosis and monitoring in inflammatory bowel diseases