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Fluorescence confocal microscopy for rapid evaluation of EUS fine-needle biopsy in pancreatic solid lesions
Fluorescence confocal laser microscopy (FCM) allows imaging of tissues in the fresh state, with minimal preparation and without any damage, distortion, or loss of tissue.1-4 It requires a fluorescent dye applied to the unfixed tissue sample. Two lasers of different wavelengths create 2 distinct images: a fluorescence image and a reflectance image. The device’s software uses an algorithm to translate the acquired image information into colors that resemble hematoxylin and eosin. The pseudo-colored images contain similar information to conventional histology and can be examined at any magnification up to 550-fold (Fig. 1).Flexible fiber cholangioscope for detection of near-infrared fluorescence
Cholangiocarcinoma is a cancer of the bile ducts and is characterized by a high mortality rate and a steadily rising incidence.1 This disease is usually diagnosed at an advanced stage when the prognosis is poor. Biliary intraepithelial neoplasia represents a precursor condition that can result in excellent patient outcomes with surgical resection if detected early. This condition is often suspected in patients with indeterminate biliary strictures.2 Because the bile ducts are small in caliber, conventional biopsy and brushings often do not produce an adequate number of cells for either cytology or histology to make a definitive diagnosis.Low-magnification narrow-band imaging for small gastric neoplasm detection on screening endoscopy
Microsurface patterns of the gastric mucosa can be observed using magnifying narrow-band imaging (M-NBI). However, the efficacy of M-NBI at low-magnification (LM-NBI) screening for detecting small gastric neoplasms is unclear.Novel EUS-guided microwave ablation of an unresectable pancreatic neuroendocrine tumor
Pancreatic neuroendocrine tumors have an incidence of ≤1 case per 100,000 individuals, accounting for up to 2% of all pancreatic neoplasms in the United States. The 5-year overall survival rate ranges from 37.6% to 50%.1 Curative surgical interventions are not feasible for most patients because most cases are detected in advanced unresectable stages, mainly in elderly patients with several comorbidities.2 Therefore, developing safe and effective alternatives for patients unfit for surgery is imperative for clinical practice.Endoscopic submucosal dissection and tunneling procedures using novel image-enhanced technique
Recent innovations in image-enhanced endoscopy allow early detection and management of GI lesions. In this study, we aim to analyze the utility of texture and color enhancement imaging (TXI) and red dichromatic imaging (RDI) during endoscopic submucosal dissection (ESD) and submucosal tunneling procedures.The utility of image-enhanced endoscopy and Lugol’s for the assessment of esophageal squamous carcinoma
Esophageal squamous cell carcinoma (ESCC) is the most commonly diagnosed esophageal cancer.1 Previously, diagnoses in the late stages of disease led to a poor prognosis and limited treatment. However, advancements in optical diagnosis and resection techniques have allowed for improved detection, characterization, and therapy. We present a case that highlights the utility of image-enhanced endoscopy and Lugol’s in the assessment of ESCC (Video 1, available online at www.giejournal.org ).How to trick artificial intelligence: rectal heterotopic gastric lateral spreading tumor
We present the case of a 54-year-old man who came to our attention in January 2020 for a follow-up colonoscopy. He was treated in 2006 with a right hemicolectomy for an adenocarcinoma of the ascending colon. All consecutive follow-up colonoscopies had negative findings until 2016.Direct visualization of drug behaviors in the upper GI tract via magnetically controlled capsule endoscopy
Actual behaviors of drugs in the upper GI tract are not well elucidated. We assess the feasibility of magnetically controlled capsule endoscopy (MCE) in direct and real-time visualization of oral drug behaviors in the stomach.Soft palate findings associated with a high risk of esophageal squamous cell carcinoma using an endoscopic system with enhanced depth-of-field imaging
We previously reported that 3 endoscopic findings of melanosis, whitish epithelium, and vasodilation in the soft palate are associated with a high risk of esophageal squamous cell carcinoma (ESCC). Conventional endoscopic systems require observation under magnification to evaluate vasodilation. This case series aims to present the evaluation of vasodilation without magnification using an endoscopic system with enhanced depth-of-field (EDOF) imaging.Detection of multiple intramucosal signet-ring cell carcinomas by white-light endoscopy and magnifying endoscopy with narrow-band imaging in a hereditary diffuse gastric cancer patient with a CDH1 germline mutation
Hereditary diffuse gastric cancer (HDGC) is an autosomal-dominant syndrome, accounting for approximately 1% of gastric cancers. The germline pathogenic variant of CDH1, encoding for the tumor-suppressor protein E-cadherin, is implicated in the genetic pathogenesis of HDGC.1,2 Patients with a pathogenic variant of CDH1 are recommended to undergo a prophylactic gastrectomy owing to a high cumulative risk of diffuse-type gastric cancer over the age of 80 years: 70% for men and 56% for women.3,4 Thus, it is important to identify this hereditary cancer syndrome to provide an appropriate treatment.Endoscopic submucosal dissection of early-stage rectal cancer using full-time red dichromatic imaging to minimize and avoid significant bleeding
Management of bleeding during endoscopic resections (and even more so in endoscopic submucosal dissection [ESD]) is a critical aspect of the procedure. The low rectum has a higher risk of bleeding because of a rich venous plexus; this can increase procedure time compared with the proximal rectum.1 Red dichromatic imaging (RDI), a novel image-enhanced endoscopy technology, has been reported to improve the visibility of deep vessels and bleeding points compared with white-light imaging (WLI).2-4 WLI can be switched to RDI instantly with the press of a single button on the endoscope.A case of anal condyloma acuminatum observed by endocytoscopy
Condyloma acuminatum (CA) is one of the most common sexually transmitted diseases caused by human papillomavirus (HPV) infection. This virus causes not only inflammation-induced benign squamous hyperplasia, as in anal CA, but also anal intraepithelial neoplasia, which is a precursor of anal squamous cell carcinoma (SCC). Therefore, observation of anal CA with various modalities can help us decide on a treatment strategy and prevent anal SCC. Here, we report a case of anal CA, for which endocytoscopy was used to provide the ultra-high-magnification images at cellular resolution in real time with manipulating zoom lever after staining.Salvage circumferential endoscopic submucosal dissection for refractory dysplastic Barrett’s esophagus
A 64-year-old woman initially underwent endoscopy for reflux symptoms and was found to have C7M8 Barrett’s esophagus with biopsies demonstrating high-grade dysplasia. She was referred to a tertiary esophageal center, which performed endoscopic mucosa resection.Effectiveness of endoscopic Doppler probe ultrasonography for identifying the source of colonic diverticular bleeding
Colonic diverticular bleeding (CDB) is the most common cause of acute lower GI bleeding. The diagnosis of CDB is made through detection of the stigmata of recent hemorrhage (SRH).1,2 To increase the rate of SRH identification, bowel preparation, water-jet endoscope, and transparent hood have been recommended.3 Despite the use of these methods, the rate of SRH identification is only 15% to 40%.1 Even if blood or blood clots are present in the diverticulum, these areas are not always the source of bleeding; in some cases, blood from the bleeding diverticulum flows into other areas.Introducing computer-aided detection to the endoscopy suite
Artificial intelligence (AI) within GI endoscopy is an area of growing interest and ongoing innovation. The use of computer-aided diagnosis (CADx) and computer-aided detection (CADe) technologies based on AI algorithms may help augment endoscopists’ performance if these tools can be effectively incorporated into the endoscopy suite.1Acetic acid spray for better delineation of recurrent sessile serrated adenoma in the colon
Sessile serrated lesions (SSLs) have a high risk of incomplete endoscopic resection.1 The benefit of using acetic acid spray has been reported for SSLs in the colon.2,3 Our previous experience has demonstrated that acetic acid spray, along with indigo carmine, is of substantial benefit for the delineation of SSLs.2 Similarly, the use of acetic acid for a single case of sessile serrated polyposis syndrome was reported and showed clinical usefulness.3Dysplastic Barrett’s lesion with white opaque substance and xanthoma
WOS was first described in 2008 as a deposit within neoplastic gastric epithelium that obscures visualization of the microvasculature.1 It has since been described in esophageal adenocarcinoma, colonic neoplasms, and gastric intestinal metaplasia.2-4 The phenomenon of WOS has been shown to be due to intraepithelial lipid deposition, for which its exact clinical significance has yet to be identified.5Comparison of narrow-band imaging, volumetric laser endomicroscopy, and pathologic findings in Barrett's esophagus
Volumetric laser endomicroscopy (VLE) (Ninepoint Medical, Bedford, Mass, USA) is a balloon-based second-generation optical coherence tomography technology that provides high-resolution esophageal imaging.1-4 The novel algorithm of computer-enhanced visualization (intelligent real-time image segmentation, IRIS) of VLE highlights features previously associated with suspected dysplasia, including hyperreflective tissue surface signal (pink) and hyporeflective cystic structures above the submucosal layer (blue).A small adenocarcinoma in the cervical esophagus
A 72-year-old man underwent EGD during an annual health checkup. Endoscopy showed an irregularly shaped small elevated lesion with a central depression in the cervical esophagus (Fig. 1; Video 1, available online at www.VideoGIE.org ). Magnifying endoscopy with narrow-band imaging revealed irregular microvessels (Fig. 2). After the lesion was sprayed with acetic acid, magnifying endoscopy with narrow-band imaging clearly revealed an irregular microstructure in the lesion (Fig. 3). EUS showed a low echoic lesion that was confined to the mucosa and shallow submucosa (Fig. 4).Successful ex-vivo probe-based confocal laser endomicroscopy of a superficial nonampullary duodenal epithelial tumor with dripping of food additives: a case of tubular adenocarcinoma
Endoscopic qualitative diagnosis of a superficial nonampullary duodenal epithelial tumor (SNADET) is difficult. The accuracy of biopsy sampling for SNADET also is not perfect.1 At present, endoscopic diagnosis of SNADETs is still controversial, and early establishment of standards for endoscopic diagnosis is awaited. Meanwhile, probe-based confocal laser endomicroscopy (pCLE) is an innovative endoscopic technique that enables “optical biopsy” by enabling real-time imaging of biotissue by the intravenous injection of a fluorescent dye.Endoscopic findings of checkpoint inhibitor–induced ileitis with use of the latest advanced endoscopic optical diagnosis: near-focus narrow-band imaging
Cancer immunotherapy with the use of checkpoint inhibitors, ipilimumab (anti-cytotoxic T lymphocyte antigen) or nivolumab, pembrolizumab, and atezolizumab (anti-programmed death-1) may induce colitis, an increasingly recognized immune-mediated adverse event (IrAE). The spectrum of endoscopic findings at colonoscopy has not been defined comprehensively; Crohn’s-like and ulcerative colitis–like changes have been described.1,2 Colitis is most commonly described, although ileoscopy is not always conducted.Simultaneous detection and characterization of diminutive polyps with the use of artificial intelligence during colonoscopy
The application of artificial intelligence (AI) in colonoscopy is attracting a growing amount of attention because it has the potential to improve the quality of colonoscopy.1,2 The main focuses of research in this field comprise automated polyp detection3,4 and characterization5,6 (ie, pathologic prediction), which may respectively contribute to a higher rate of adenoma detection and a reduction of the costs related to unnecessary polypectomy. However, there has not yet been any report of technology capable of simultaneous polyp detection and characterization, which is the optimal situation for fully automated colonoscopic observation.Application of linked color imaging for detecting a previously bleeding colonic diverticulum
Colonic diverticular bleeding is common, but we often encounter difficulties in diagnosing the bleeding site because the bleeding is intermittent. Endoscopic identification of a nonbleeding visible vessel, which is critical evidence of colonic diverticular bleeding, may be technically difficult after spontaneous cessation of bleeding. The slightly reddened lesion may be easily missed among similar-colored mucosa.Jejunal GI tumor using probe-based confocal laser endomicroscopy
A 63-year-old woman was admitted to our hospital with overt obscure GI bleeding (melena) and anemia (Hb, 4.8 g/dL) treated with multiple blood transfusions. She had undergone plain CT, EGD, and total colonoscopy, which revealed no bleeding sources. Her medical history included abdominal hysterectomy performed because of uterine leiomyoma. On examination, there were no abnormalities other than palpebral conjunctiva anemia. An early arterial phase contrast-enhanced multidetector CT image demonstrated a 14-mm hypervascular tumor in the intrapelvic jejunum (Fig. 1).EUS imaging of splenic artery pseudoaneurysm
A 32-year-old man was admitted with massive hematemesis of approximately 700 mL of blood associated with melena. His hemoglobin was 6 g/dL, and he was hemodynamically unstable. He had experienced an episode of alcoholic acute pancreatitis 2 weeks earlier. After hemodynamic resuscitation and blood transfusion, upper-GI endoscopy in a search for the cause of the GI bleeding showed normal results. CT of the abdomen with angiography revealed features of acute pancreatitis and no source of upper-GI bleeding.
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