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Advances in Gastrointestinal Endoscopy: From Diagnosis to Therapy

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

Deadline for manuscript submissions: 31 July 2026 | Viewed by 11338

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Editors

Prof. Dr. Cristiano Spada

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Guest Editor

1. Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
2. Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
3. Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
Interests: colorectal cancer; endoscopy; capsule endoscopy; gastroenterology; gastrointestinal endoscopy; gastrointestinal diseases; colonoscopy; esophageal diseases

Dr. Daniele Salvi

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Guest Editor Assistant

Department of Gastroenterology and Endoscopy, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy
Interests: gastrointestinal endoscopy; gastrointestinal diseases; capsule endoscopy; disorders of gut–brain interaction

Special Issue Information

Dear Colleagues,

In recent years, the field of gastrointestinal endoscopy has witnessed remarkable progress, driven by technological innovation and the integration of artificial intelligence (AI) into clinical practice. These developments have significantly enhanced both diagnostic accuracy and therapeutic efficacy across a range of GI diseases.

Notably, AI has demonstrated considerable promise in improving the early detection of Barrett’s neoplasia and colonic precancerous lesions. Similarly, the expanding role of endoscopic ultrasound (EUS) is redefining the management of malignant obstructions, offering both diagnostic precision and therapeutic utility. Innovations in small bowel capsule endoscopy have contributed to reduced reading times while maintaining strong diagnostic performance. Furthermore, bariatric endoscopy is emerging as a minimally invasive and effective strategy in weight management, with important clinical implications.

These transformative changes underscore the need for ongoing education and adaptation among endoscopists as the endoscopy suite increasingly incorporates sophisticated tools and technologies.

This Special Issue, "Advances in Gastrointestinal Endoscopy: From Diagnosis to Therapy", will showcase cutting-edge developments across the endoscopic spectrum, from foundational techniques in gastroscopy and colonoscopy to advanced procedures including ERCP, therapeutic EUS, AI-enhanced imaging, and bariatric endoscopic interventions.

We welcome the submission of original research articles and comprehensive reviews. Case reports or series—particularly those featuring literature reviews—or viewpoints will also be considered, so long as they explore novel applications of endoscopic technologies or address underexplored yet clinically relevant topics.

We look forward to reading your valuable contributions to this Special Issue, which should inform, inspire, and support continued advancement in the field of gastrointestinal endoscopy.

Prof. Dr. Cristiano Spada
Guest Editor

Dr. Daniele Salvi
Guest Editor Assistant

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 250 words) can be sent to the Editorial Office for assessment.

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-anonymized 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.

Keywords

gastrointestinal endoscopy
therapeutic endoscopy
endoscopic ultrasound (EUS)
endoscopic retrograde cholangiopancreatography (ERCP)
artificial intelligence
small bowel capsule endoscopy
bariatric endoscopy

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Published Papers (8 papers)

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Research

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12 pages, 2459 KB

Open AccessArticle

Evaluating the Performance of the TOP100 Tool in Detecting Key Small Bowel Findings at Capsule Endoscopy

by Aishwarya Devanand, Cristina Caranfil, Michaela Moore, Nicoletta Nandi, Foong Way David Tai, Melissa Hale, Christian Bentley, Victoria Thurston, Ailish Healy, Mark E. McAlindon and Reena Sidhu

Diagnostics 2026, 16(13), 2005; https://doi.org/10.3390/diagnostics16132005 - 27 Jun 2026

Viewed by 197

Abstract

Background/Objectives: Capsule endoscopy (CE) is a non-invasive tool for evaluating small bowel pathology, but prolonged reading times can lead to reader fatigue. Artificial intelligence-integrated reading software has shown promise to overcome this. This study assesses the diagnostic performance of TOP100 against standard human reading (SR) across different clinical indications. Methods: A retrospective single-centre cohort study was conducted at a tertiary referral centre, including patients who underwent PillCam™SB3 CE between January 2023 to August 2025. Initial reading was performed by expert CE readers (>1000 CE experience) considered as SR. Second blinded reading was performed with TOP100. CE findings from SR were compared with those from TOP100. Results: A total of 1382 CE were identified, of which 1374 had complete examinations and TOP100 data for analysis. The most common indications were inflammatory bowel disease (IBD) (51.5%) and iron-deficiency anaemia (IDA) (25.0%). Diagnostic yield was significantly higher with SR than TOP100 (36.0% vs. 27.5%, p < 0.001). TOP100 demonstrated moderate sensitivity but high specificity; 64.0% and 99.0% for active bleeding, 58.2% and 97.5% for angiodysplasia. In overt bleeding and IDA, sensitivity, and specificity for P2 lesions were 61.0% and 94.3%, respectively. Overall sensitivity and specificity were 55.3% and 95.9% for ulcers, 43.1% and 89.0% for erosions. In IBD, ulcer detection was similar, while TOP100 sensitivity for erosions improved by 9.4%. Conclusions: SR remains the reference standard for reading and reporting capsule endoscopies. However, TOP100 may be a useful adjunct to support interpretation and case prioritisation, especially in high-volume centres. Full article

(This article belongs to the Special Issue Advances in Gastrointestinal Endoscopy: From Diagnosis to Therapy)

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12 pages, 7041 KB

Open AccessArticle

Analysis of Risk Factors for Post-ERCP Pancreatitis in Patients with Cholangiocarcinoma

by Takeshi Iizuka, Yusuke Kurita, Yu Honda, Takayuki Oda, Shin Yagi, Sho Hasegawa, Takamitsu Sato, Kunihiro Hosono, Noritoshi Kobayashi, Itaru Endo, Kensuke Kubota and Masato Yoneda

Diagnostics 2026, 16(6), 900; https://doi.org/10.3390/diagnostics16060900 - 18 Mar 2026

Viewed by 826

Abstract

Background/Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed for cholangiocarcinoma and often involves multiple procedures, potentially increasing the risk of post-ERCP pancreatitis (PEP). However, PEP characteristics in cholangiocarcinoma patients remain unclear. This study aimed to assess the incidence and diagnostic procedure-specific risk factors for PEP in patients with cholangiocarcinoma. Methods: We retrospectively reviewed 218 ERCP procedures for cholangiocarcinoma performed at our hospital between January 2017 and March 2022. The incidence of PEP, severe PEP, and fatal PEP was recorded. Risk factors for PEP were analyzed using multivariate analysis, and severe cases were further evaluated. Results: Among the 218 patients, 15 (6.9%) developed PEP, 4 (1.8%) had severe PEP, and 2 (0.9%) died. Multivariate analysis identified the pancreatic guidewire technique (PGW) (OR: 8.18; 95% CI: 2.52–26.53, p < 0.001) and intraductal ultrasonography (IDUS) (OR: 6.53; 95% CI: 2.01–21.25, p = 0.002) as significant risk factors. Both fatal cases involved naïve papilla and PGW and IDUS, with no pancreatic duct stent placement. Conclusions: ERCP for cholangiocarcinoma carries a clinically relevant risk of severe or fatal PEP. In particular, ERCP-specific diagnostic procedures required for cholangiocarcinoma may confer a disease-specific risk profile distinct from that of general ERCP. PGW and IDUS were identified as major risk factors, especially in patients with a naïve papilla, in whom prophylactic pancreatic duct stenting should be considered to reduce the risk of severe or fatal outcomes. Full article

(This article belongs to the Special Issue Advances in Gastrointestinal Endoscopy: From Diagnosis to Therapy)

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15 pages, 1717 KB

Open AccessArticle

Outcomes of Endoscopic Resection of Circumferential Colorectal Laterally Spreading Lesions: A Western Experience

by Gianluca Andrisani, Mattia Brigida, Giulio Antonelli, Cesare Hassan, Chiara Taffon, Andrea D’Amico, Virginia Gregorio, Giovanni Parente, Michele Cicala, Antonio Facciorusso and Francesco Maria Di Matteo

Diagnostics 2025, 15(19), 2534; https://doi.org/10.3390/diagnostics15192534 - 8 Oct 2025

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Abstract

Background: Circumferential or near-circumferential colorectal lesions are challenging to remove endoscopically; therefore, they are often surgically managed. There are limited data on the outcomes of endoscopic submucosal dissection (ESD) for these lesions, usually from Eastern settings, where ESD is more well established. Objective: The objective of the study was to retrospectively analyze the outcomes of circumferential colorectal ESD in a Western center. Methods: Consecutive patients referred for endoscopic resection of colorectal lesions between January 2015 and April 2025 were included if they had undergone ESD for colorectal laterally spreading tumors with ≥90% involvement of the luminal circumference. Results: Overall, 53 patients were enrolled (26 females, 49.1%; 70.6 ± 9.3 years). Mean lesion size was 91.8 ± 25.3 mm. The most frequent lesion location was the rectum (n = 36, 67.9%). Thirty-three lesions (62.3%) were circumferential, and twenty (37.7%) were near-circumferential. Median procedural time was 160.0 min (IQR 112.0–200.0 min). Histological analysis revealed high-grade dysplasia in 25/53 cases (47.2%) and adenocarcinoma in 28 patients (52.8%). Resection was en bloc in 51 cases (96.2%) and R0 in all cases (100%). Curative resection was achieved in 21 out of 28 adenocarcinoma patients (75%). Adverse events were intra-procedural major bleeding (n = 19, 18.9%), post-procedural bleeding (n = 2, 3.8%), delayed bleeding (n = 1, 1.9%), and intra-procedural perforation (n = 3, 5.7%). Post-ESD stricture was observed in 18.9% of cases (10/53); three of these (30%) were asymptomatic. All were successfully managed endoscopically. Patients who developed strictures had a longer median procedural time (206 min vs. 145 min, p = 0.0061) and a larger mean lesion size (110 mm vs. 90 mm, p = 0.035). Conclusions: ESD for colorectal circumferential and near-circumferential lesions was safe and effective in a Western expert center, supporting the use of this technique in this subset of lesions. Strictures are a common consequence that can be effectively managed endoscopically. Full article

(This article belongs to the Special Issue Advances in Gastrointestinal Endoscopy: From Diagnosis to Therapy)

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12 pages, 1633 KB

Open AccessArticle

Kyoto Classification-Based Predictive Factors Associated with the Development of Gastric Cancer After Helicobacter pylori Eradication: A Prospective Multicenter Observational Study

by Shun Takayama, Osamu Dohi, Ryusuke Horie, Takeshi Yasuda, Tomoko Ochiai, Naoto Iwai, Eiko Imamoto, Tomohisa Takagi, Osamu Handa, Hideyuki Konishi, Takashi Ando, Yuji Naito, Toshiki Takemura and Yoshito Itoh

Diagnostics 2025, 15(18), 2376; https://doi.org/10.3390/diagnostics15182376 - 18 Sep 2025

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Abstract

Background/Objectives: This study aimed to identify specific endoscopic findings associated with the development of GC following successful H. pylori eradication. Methods: This prospective multicenter observational study included patients who underwent annual surveillance endoscopy after successful H. pylori eradication therapy between September 2013 and June 2019. Endoscopic findings were evaluated one year after eradication therapy and analyzed using the Kyoto Classification of Gastritis to identify factors associated with GC development. Results: A total of 465 patients were included, including 49 patients with GC and 416 patients without GC. At the initial endoscopic assessment (median, 0.96 years post-eradication), emergence of map-like redness and invisible regular arrangement of collecting venule (RAC) as independent predictors of GC (map-like redness: hazard ratio [HR], 2.561; 95% confidence interval [CI], 1.362–4.572; p = 0.003; invisible RAC: HR, 3.131; 95% CI, 1.078–9.091; p = 0.036). Patients with map-like redness or invisible RAC showed a significantly higher incidence of GC than those without map-like redness or invisible RAC (p < 0.001 and p < 0.001, respectively). Notably, map-like redness and visible RAC appeared in 13% and 28.4% of cases within the first year after eradication, respectively. Conclusions: Map-like redness and invisible RAC were identified as independent predictors of GC following H. pylori eradication and may serve as early predictive indicators, appearing within one year of successful eradication. This finding underscores the importance of early surveillance endoscopy in identifying patients at elevated risk for GC. Full article

(This article belongs to the Special Issue Advances in Gastrointestinal Endoscopy: From Diagnosis to Therapy)

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Review

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17 pages, 2302 KB

Open AccessReview

Early Rectal Cancer: Diagnostic Challenges and the Role of Endoscopic Intermuscular Dissection Within the Therapeutic Algorithm

by Rossella Maresca, Giulio Calabrese, Franziska Deutschbein, Valentina Blasi, Tommaso Schepis, Daniele Salvi, Silvia Pecere, Paola Cesaro, Cristiano Spada, Sandro Sferrazza and Federico Barbaro

Diagnostics 2026, 16(12), 1936; https://doi.org/10.3390/diagnostics16121936 - 22 Jun 2026

Viewed by 449

Abstract

Early rectal cancer represents a challenging setting in which accurate locoregional staging is essential to guide appropriate treatment. Current diagnostic strategies primarily include magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). However, both modalities show significant limitations in early-stage disease, particularly in T staging. This diagnostic gap impacts therapeutic decision-making, particularly in patients with lesions suggestive of deep submucosal invasion. In these cases, endoscopic submucosal dissection (ESD) may be insufficient to achieve adequate vertical negative margins, whereas radical surgery is associated with considerable morbidity and potential impairment of quality of life. In this gray zone, endoscopic intermuscular dissection (EID) has recently emerged as a novel therapeutic approach designed to overcome the limitations of standard endoscopic resection. By enabling dissection within the deeper intermuscular plane, it can achieve curative resections while preserving rectal wall integrity. This narrative review aims to explore the current diagnostic gaps in early rectal cancer and to define the potential role of EID within the current therapeutic algorithm. Full article

(This article belongs to the Special Issue Advances in Gastrointestinal Endoscopy: From Diagnosis to Therapy)

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27 pages, 1492 KB

Open AccessReview

High-Frequency Miniprobe Endoscopic Ultrasonography Across the Gastrointestinal Tract

by Francesco Bombaci, Angelo Bruni, Margherita Pavanato, Giuseppe Dell’Anna, Francesco Vito Mandarino, Giulio Calabrese, Andrea Lisotti, Pietro Fusaroli, Leonardo Henry Eusebi, Giovanni Barbara and Paolo Cecinato

Diagnostics 2026, 16(9), 1316; https://doi.org/10.3390/diagnostics16091316 - 28 Apr 2026

Viewed by 623

Abstract

Miniprobe endoscopic ultrasonography (mEUS) combines high-resolution imaging of the gastrointestinal (GI) wall and bile ducts with ease of applicability during routine endoscopy. This narrative review aims to provide an overview of known and emerging fields of application for mEUS in gastrointestinal endoscopy. After its initial development in pancreatobiliary scenarios in the early 1990s, mEUS has been recently reconsidered a third-space endoscopic technique that is progressively developing and spreading for the treatment of early gastrointestinal neoplastic lesions. The high spatial resolution of mEUS provides an accurate assessment of the degree of submucosal invasion in early esophageal, gastric, and colorectal neoplasia, while the small caliber of catheters allows for mEUS employment in settings where standard echoendoscopes are impractical (e.g., severe stenoses or proximal colonic lesions). Beyond cancer staging, mEUS offers point-of-care characterization of subepithelial lesions by defining the layer of origin and echo-pattern, eventually defining endoscopic resectability, but definitive diagnosis remains histological. In pancreatobiliary diseases, miniprobe intraductal ultrasonography (IDUS) shows its strongest application for indeterminate biliary strictures when endoscopic retrograde cholangiopancreatography (ERCP)-based sampling strategies and brushing cytology show inconclusive diagnoses, and in choledocholithiasis, particularly for the detection of small stones/sludge and confirmation of duct clearance. IDUS is also valuable for the staging of ampullary tumors, for longitudinal extension mapping in hilar cholangiocarcinoma and for selected portal biliopathy scenarios. Overall, mEUS and IDUS are high-resolution adjuncts that can meaningfully refine local decision-making in the treatment of superficial epithelial/subepithelial tumors or lesions involving the bile ducts. Limitations include shallow penetration, lack of tissue acquisition capability, a relative increase in post-ERCP pancreatitis risk for intraductal use, and substantial cost with limited availability in lower-volume centers. Full article

(This article belongs to the Special Issue Advances in Gastrointestinal Endoscopy: From Diagnosis to Therapy)

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32 pages, 8447 KB

Open AccessReview

Advances and Opportunities in NIR-II Endoscopy: From Diagnosis to Therapeutic Applications

by Jing Luo, Xiaofan Du, Sijia Wang, Cuiping Yao and Jing Wang

Diagnostics 2026, 16(7), 986; https://doi.org/10.3390/diagnostics16070986 - 25 Mar 2026

Viewed by 1420

Abstract

Endoscopy refers to the minimally invasive optical visualization and examination of internal structures within the body. Its significance lies in diagnosing intraluminal tissue abnormalities and assisting therapeutics, especially in the gastrointestinal tract. However, conventional optical endoscopes are limited by their insufficient penetration depth. Although endoscopic ultrasound achieves deeper penetration of up to 10 cm, it suffers from compromised spatial resolution. Recent advances have expanded the role of endoscopy from basic mucosal visualization to precision diagnostics, therapeutic assistance, and even intelligent, remote-assisted procedures. An emerging modality, second near-infrared window (NIR-II, 1000–1700 nm) endoscopy, offers deep tissue penetration, reduced scattering, and a high signal-to-noise ratio. This review discusses the clinical requirements of endoscopy across screening, diagnostics and therapeutics. It provides a comparative assessment of current methodologies, and a particular focus is placed on discussing the promising developments in NIR-II endoscopy. Furthermore, we investigate the transformative potential of integrating artificial intelligence and fifth-generation wireless networks into endoscopic practice. The continued evolution and clinical translation of these technologies, particularly NIR-II endoscopy, hold the promise to fundamentally enhance precision medicine in gastroenterology. Full article

(This article belongs to the Special Issue Advances in Gastrointestinal Endoscopy: From Diagnosis to Therapy)

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23 pages, 364 KB

Open AccessReview

Optical Imaging Technologies and Clinical Applications in Gastrointestinal Endoscopy

by Khyati Bidani, Vishali Moond, Madhvi Nagar, Arkady Broder and Nirav Thosani

Diagnostics 2025, 15(20), 2625; https://doi.org/10.3390/diagnostics15202625 - 17 Oct 2025

Cited by 3 | Viewed by 2831

Abstract

Optical imaging technologies expand gastrointestinal endoscopy beyond white-light endoscopy (WLE), improving visualization of mucosal, vascular, and subsurface features. They are applied to the detection of neoplastic and premalignant lesions, inflammatory diseases, and small bowel and pancreatic disorders, though their validation and readiness for routine practice vary. This review critically evaluates both guideline-endorsed and investigational optical imaging techniques across major gastrointestinal indications, highlighting diagnostic performance, level of validation, current guideline recommendations, and practical challenges to adoption. In Barrett’s esophagus, narrow-band imaging (NBI) is guideline-endorsed, while acetic acid chromoendoscopy is validated in expert centers. For gastric intestinal metaplasia and early gastric cancer, magnifying NBI achieves diagnostic accuracies exceeding 90% and is guideline-recommended, with acetic acid chromoendoscopy aiding in margin delineation. In inflammatory bowel disease, dye-spray chromoendoscopy is the reference standard for dysplasia surveillance, with virtual methods such as NBI, FICE, and i-SCAN serving as practical alternatives when dye application is not feasible. In the colorectum, NBI supports validated optical diagnosis strategies (resect-and-discard, diagnose-and-leave), while dye-based chromoendoscopy improves detection of flat and serrated lesions. Capsule endoscopy remains the standard for small bowel evaluation of bleeding, Crohn’s disease, and tumors, with virtual enhancement, intelligent chromo capsule endoscopy, and AI-assisted interpretation emerging as promising adjuncts. Pancreaticobiliary applications of optical imaging are also advancing, though current evidence is still preliminary. Investigational modalities including confocal laser endomicroscopy, optical coherence tomography, autofluorescence, Raman spectroscopy, and fluorescence molecular imaging show potential but remain largely restricted to research or expert settings. Guideline-backed modalities such as NBI and dye-based chromoendoscopy are established for clinical practice and supported by robust evidence, whereas advanced techniques remain investigational. Future directions will rely on broader validation, integration of artificial intelligence, and adoption of molecularly targeted probes and next-generation capsule technologies, which together may enhance accuracy, efficiency, and standardization in gastrointestinal endoscopy. Full article

(This article belongs to the Special Issue Advances in Gastrointestinal Endoscopy: From Diagnosis to Therapy)

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