Advanced endoscopic imaging for diagnosis of inflammatory bowel diseases : present and future perspectives

Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) causing severe damage of the luminal gastrointestinal tract. Differential diagnosis between both disease entities is sometimes awkward requiring a multifactorial pathway, including clinical and laboratory data, radiological findings, histopathology and endoscopy. Apart from disease diagnosis, endoscopy in IBD plays a major role in prediction of disease severity and extent (i.e. mucosal healing) for tailored patient management and for screening of colitis-associated cancer and its precursor lesions. In this state-of-the-art review, we focus on current applications of endoscopy for diagnosis and surveillance of IBD. Moreover, we will discuss the latest guidelines on surveillance and provide an overview of the most recent developments in the field of endoscopic imaging and IBD

Feasibility trial of the newly introduced optical enhancement technology in patients with gastroesophageal reflux disease

BACKGROUND: Optical Enhancement technology (OE) combines bandwidth-limited light and image enhancement processing technology to enhance subtle mucosal and vascular details. This is the first study assessing the new technology for the diagnosis of gastroesophageal reflux disease (GERD). PATIENTS AND METHODS: Consecutive patients with GERD and controls were prospectively included. The distal esophagus was examined in all quadrants with high definition white-light endoscopy (HD-WLE) followed by OE and biopsies for histopathological analysis. Features observed only by OE were compared between controls and patients with GERD. RESULTS: A total of 100 areas were evaluated. About 56% of patients had a diagnosis of GERD. The mean age of patients was 53 years (range 27-89 years), 60% were female. Compared to controls, patients with diagnosis of GERD showed significantly more often tortuosity (p = 0.042), dilation (p = 0.0003), and increased number (p = 0.001) of intrapapillary capillary loops (IPCLs). In addition, increased vascularity and mucosal breaks were significantly more often found in patients with GERD as compared to controls (p < 0.05). On multivariate analysis, increased number and dilation of IPCL were the best predictors of GERD. CONCLUSIONS: The newly introduced OE technology significantly improves the diagnosis of GERD compared to HD-WLE. The results should be confirmed in a multicenter trial

MMX® technology and its applications in gastrointestinal diseases

The Multimatrix\uae (MMX\uae) preparation MMX\uae is a recently obtained drug formulation developed to facilitate release of high concentrations of active drugs into the colon, with a homogeneous distribution along all colonic segments, particularly the most distal ones; the distal colonic tracts, indeed, are the most difficult to reach in significant amounts when a drug is given orally. The MMX\uae formulation is characterized by a lipophilic matrix dispersed in a hydrophilic structure. Indeed, in the last few years, MMX\uae technology has been widely used in the development of various drugs for the treatment of inflammatory and infectious gastrointestinal diseases localized in the colon. In particular, MMX\uae mesalamine, budesonide and parnaparin formulations have been investigated in patients with ulcerative colitis, and the first two have reached worldwide registration for the treatment of this disease. Moreover, MMX\uae-rifamycin is being positively tested in the treatment of colonic bacterial infections, including traveler's diarrhea. MMX\uae technology is, thus, proving to be a very effective formulation for the treatment of various colonic diseases. This effectiveness has been related not only to specific colonic delivery, but also to its ability to act in a once-daily dosage, thus favouring patients' adherence to prescribed schedules of treatment. The effective delivery of the active molecule to the site of need in the colon is also associated with very low systemic absorption and very low rates of adverse events (AEs). In this paper, we have reviewed all clinical trials performed with an MMX\uc2\uae-bound drug and all possible real-life reports, in order to give an overall evaluation of MMX\uae

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

Leaving colorectal polyps in place can be achieved with high accuracy using blue light imaging (BLI)

Objectives: A negative predictive value of more than 90% is proposed by the American Society of Gastrointestinal Endoscopy Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) statement for a new technology in order to leave distal diminutive colorectal polyps in place without resection. To our knowledge, no prior prospective study has yet evaluated the feasibility of the most recently introduced blue light imaging (BLI) system for real-time endoscopic prediction of polyp histology for the specific endpoint of leaving hyperplastic polyps in place. Aims: Prospective assessment of real-time prediction of colorectal polyps by using BLI. Material and methods: In total, 177 consecutive patients undergoing screening or surveillance colonoscopy were included. Colorectal polyps were evaluated in real-time by using high-definition endoscopy and the BLI technology without optical magnification. Before resection, the endoscopist described each polyp according to size, shape and surface characteristics (pit and vascular pattern, colour and depression), and histology was predicted with a level of confidence (high or low). Results: Histology was predicted with high confidence in 92.5% of polyps. Sensitivity of BLI for prediction of adenomatous histology was 92.68%, with a specificity and accuracy of 94.87 and 93.75%, respectively. Following the recommendation of the PIVI statement, positive and negative predictive values were calculated with values of 95 and 92.5%, respectively. Prediction of surveillance based on both US and European guidelines was correctly predicted in 91% of patients. Conclusion: The most recently introduced BLI technology is accurate enough to leave distal colorectal polyps in place without resection. BLI also allowed for assignment of postpolypectomy surveillance intervals. This approach therefore has the potential to reduce costs and risks associated with the redundant removal of diminutive colorectal polyps

Dual-focus narrow band imaging for the detection of intestinal metaplasia and atrophic gastritis

Gastric cancer is one of the most common neoplastic diseases in developed Western countries, and is characterized by a poor prognosis when diagnosed at a late stage [1]. Atrophic gastritis and gastric intestinal metaplasia (GIM) are well-known risk factors for the development of gastric cancer. For this reason, endoscopy with multiple biopsies is recommended in patients with atrophic gastritis or GIM, to exclude preneoplastic or neoplastic tissue [1]. Magnifying endoscopy with narrow band imaging (NBI) has been shown to be reliable for in vivo diagnosis of atrophic gastritis and GIM [1] [2] [3] [4]. However, while magnifying endoscopy is routinely used by Asian endoscopists, it is not established in most European and Northern American endoscopy centers. Recently, a novel endoscope with NBI and dual-focus capability has been introduced to improve the quality of endoscopic imaging [5]. Dual focus allows the user to select between two focus settings by pushing a button on the scope. This results in an optimized close view of the tissue up to an 80-fold optical magnification. To the best of our knowledge, no reports exist so far on the use of this new technique for the detection and characterization of gastric lesions. We report a case in which dual-focus narrow band imaging was used to diagnose atrophic gastritis with intestinal metaplasia and obtain targeted biopsies in the same session