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Diagnostics
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Recent Advances and Challenges in Gastrointestinal Endoscopy
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Recent Advances and Challenges in Gastrointestinal Endoscopy

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

Deadline for manuscript submissions: 31 December 2025 | Viewed by 5047

Special Issue Editor

Dr. Toshiro Iizuka

E-Mail Website
Guest Editor
Department of Gastroenterology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
Interests: endoscopic diagnosis and treatment; esophageal cancer; gastric cancer; pharyngeal cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Recent advances in endoscopic devices have facilitated the diagnosis of gastrointestinal cancers. Once thought to have poor prognoses, it is now possible to diagnose esophageal and pancreatic cancers in their early stages. However, the number of early stage cancers detected is still low, and there is a need for innovative developments and methods to overcome this issue. This is an extremely important matter as it will eventually contribute to improving the prognosis of the disease as a whole. 

In this Special Issue, we welcome abstracts on endoscopic approaches with a particular focus on the diagnosis of early stage and superficial cancers, including IEE, AI-assisted techniques, EUS, ERCP, and endoscopic diagnostics combined with CT or MRI. We also welcome reports analyzing the risk factors involved in carcinogenesis, with an emphasis on cancer diagnoses.

We hope, in particular, that many clinicians will contribute to this Special Issue and find it useful in their daily practice.

Dr. Toshiro Iizuka
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.

Keywords

  • diagnosis at an early stage
  • endoscopy
  • precancerous lesion

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

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Research

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11 pages, 1167 KiB  
Article
Differences in the Microvascular Arrangement Lead to Improved Clinical Diagnostics of Esophageal Neoplasms: A Single-Center Retrospective Study
by Ryogo Minami, Eriko Noma, Yoshiaki Moriguchi, Shinichiro Horiguchi and Toshiro Iizuka
Diagnostics 2024, 14(24), 2852; https://doi.org/10.3390/diagnostics14242852 - 18 Dec 2024
Viewed by 615
Abstract
Background/Objectives: Superficial esophageal cancer is diagnosed by evaluating the vascular architecture, including dilation, tortuosity, caliber change, and shape, of a lesion. However, this diagnosis is subjective and requires extensive experience. Endoscopically distinguishing squamous intraepithelial neoplasia (SIN) from esophageal cancer is difficult. Thus far, [...] Read more.
Background/Objectives: Superficial esophageal cancer is diagnosed by evaluating the vascular architecture, including dilation, tortuosity, caliber change, and shape, of a lesion. However, this diagnosis is subjective and requires extensive experience. Endoscopically distinguishing squamous intraepithelial neoplasia (SIN) from esophageal cancer is difficult. Thus far, only a few studies have described the endoscopic findings of SIN. Therefore, the present study aimed to investigate whether endoscopic observation of the vascular architecture of tumors is useful in differentiating SIN from superficial esophageal cancer (SCC). Methods: This study included 141 patients who were histopathologically diagnosed with SIN or SCC between 2007 and 2023. Based on endoscopic images, patients were divided into those with a regular vascular arrangement (regular group) and those with an irregular vascular arrangement (irregular group). After evaluating the clinical characteristics, propensity score matching was used to assess the association between the groups and their pathological diagnoses. Results: Of the 141 patients, 44 and 97 were in the regular and irregular groups, respectively, with a ratio of 1:2. After propensity score matching, 33 and 66 patients were included in the regular and irregular groups, respectively. There were no significant differences between the groups after matching for age, alcohol consumption, smoking status, lesion site, sex, or lesion size. The regular group had significantly more patients with SIN, whereas the irregular group had significantly more patients with esophageal cancer (p < 0.001). Conclusions: The regularity of the vascular architecture may be useful for endoscopically distinguishing between SIN and esophageal cancer. Full article
(This article belongs to the Special Issue Recent Advances and Challenges in Gastrointestinal Endoscopy)
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10 pages, 442 KiB  
Article
Predictive Factors of Significant Findings on Capsule Endoscopy in Patients with Suspected Small Bowel Bleeding
by Ali A. Alali, Reem Alrashidi, Farah Allahow, Abhijit Dangi and Ahmad Alfadhli
Diagnostics 2024, 14(21), 2352; https://doi.org/10.3390/diagnostics14212352 - 22 Oct 2024
Viewed by 752
Abstract
Background: Small bowel capsule endoscopy (SBCE) is an established non-invasive diagnostic modality for a variety of small bowel pathologies and has a significant role in altering the treatment course. The diagnostic yield of SBCE in the published literature varies widely between 45 and [...] Read more.
Background: Small bowel capsule endoscopy (SBCE) is an established non-invasive diagnostic modality for a variety of small bowel pathologies and has a significant role in altering the treatment course. The diagnostic yield of SBCE in the published literature varies widely between 45 and 75%. Furthermore, it is unclear if any patient-related factors predict higher diagnostic yield. The aim of this study is to report the diagnostic yield of SBCE for suspected small bowel disease and identify any predictive factors for identifying significant pathology on SBCE. Method: A retrospective study was conducted at Mubarak Al-Kabeer Hospital in Kuwait for patients who underwent SBCE between October 2013 and February 2022. All patients underwent upper and lower endoscopy prior to referral for SBCE. Patients’ medical records were reviewed to determine SBCE indications, results, and complications. The significance of the SBCE finding was classified according to the Saurin system. A logistic regression was performed to characterize baseline predictors for identifying significant pathology on SBCE. Results: Overall, 210 patients underwent SBCE and were included in the analysis. The mean age was 57.9 years (SD 18.5), and 129 (61.4%) were males. The most common indication for SBCE was obscure occult gastrointestinal bleed (75.7%), obscure overt gastrointestinal bleed (28.6%), and investigating gastrointestinal symptoms (7.6%). Adequate bowel preparation was achieved in most patients (88.1%), imaging of the entire small bowel was achieved in 194 patients (92.4%), and no adverse events were recorded. The overall diagnostic yield of SBCE for small bowel disease was 68.1%. The most common findings were vascular lesions in the small bowel (40.0%), small bowel ulcers (22.9%), and erosions (22.9%). On multivariate regression analysis, melena at baseline was significantly associated with increased odds of identifying high-risk lesions (Saurin class P2) (OR 2.1, 95%CI 1.03–4.30, p = 0.04). Conclusions: SBCE is an effective and safe tool for investigating small bowel pathology with a diagnostic yield of 68.1% in carefully selected patients undergoing such a test. Melena at baseline is the strongest predictor of identifying high-risk lesions, and patients with which should be prioritized for SBCE. Full article
(This article belongs to the Special Issue Recent Advances and Challenges in Gastrointestinal Endoscopy)
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8 pages, 1281 KiB  
Article
The Role of Small-Bowel Capsule Endoscopy in the Diagnostic Algorithm of Complicated Perianal Disease
by Irit Avni-Biron, Ervin Toth, Jacob E. Ollech, Artur Nemeth, Gabriele Wurm Johansson, Hagai Schweinstein, Reuma Yehuda Margalit, Uri Kopylov, Iris Dotan and Henit Yanai
Diagnostics 2024, 14(16), 1733; https://doi.org/10.3390/diagnostics14161733 - 9 Aug 2024
Viewed by 1230
Abstract
Introduction: Complicated perianal disease (cPD) may be the sole presentation of Crohn’s disease (CD). The role of small-bowel capsule endoscopy (SBCE) in the diagnostic algorithm of cPD is unclear. We aimed to evaluate the role of SBCE as a diagnostic tool, in patients [...] Read more.
Introduction: Complicated perianal disease (cPD) may be the sole presentation of Crohn’s disease (CD). The role of small-bowel capsule endoscopy (SBCE) in the diagnostic algorithm of cPD is unclear. We aimed to evaluate the role of SBCE as a diagnostic tool, in patients with cPD, after a negative standard workup for CD. Methods: A multicenter, retrospective, cross-sectional study, in patients with cPD, and negative standard workup for CD (ileocolonoscopy and cross-sectional imaging), who underwent SBCE for suspected CD. Demographics, biomarkers, and the Lewis Score (LS) were recorded and analyzed. An LS ≥ 135 was considered a positive SBCE for diagnosing CD. Results: Ninety-one patients were included: 65 (71.4%) males; median age: 37 (29–51) years; cPD duration: 25.1 (12.5–66.1) months. Positive SBCE: 24/91 (26.4%) patients. Fecal calprotectin (FC) positively correlated with LS (r = 0.81; p < 0.001). FC levels of 100 µg/g and 50 µg/g had a sensitivity of only 40% and 55% to rule out small-bowel CD, with a negative predictive value (NPV) of only 76% and 80%, respectively. Conclusions: SBCE contributed to CD diagnosis in a quarter of patients with cPD after a negative standard workup. FC levels correlated with the degree of inflammation defined by the LS. However, the NPV of FC was low, suggesting that SBCE should be considered for patients with cPD even after a negative standard workup. Full article
(This article belongs to the Special Issue Recent Advances and Challenges in Gastrointestinal Endoscopy)
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11 pages, 953 KiB  
Article
Direct Single-Operator Cholangioscopy and Intraductal Ultrasonography in Patients with Indeterminate Biliary Strictures: A Single Center Experience
by Marco Sacco, Marcantonio Gesualdo, Maria Teresa Staiano, Eleonora Dall’Amico, Stefania Caronna, Simone Dibitetto, Chiara Canalis, Alessandro Caneglias, Federica Mediati, Rosa Claudia Stasio, Silvia Gaia, Giorgio Maria Saracco, Mauro Bruno and Claudio Giovanni De Angelis
Diagnostics 2024, 14(13), 1316; https://doi.org/10.3390/diagnostics14131316 - 21 Jun 2024
Cited by 1 | Viewed by 1232
Abstract
The evaluation of biliary strictures poses a challenge due to the low sensitivity of standard diagnostic approaches, but the advent of direct single-operator cholangioscopy (DSOC) has revolutionized this paradigm. Our study aimed to assess the diagnostic performance of DSOC and DSOC-targeted biopsies, intraductal [...] Read more.
The evaluation of biliary strictures poses a challenge due to the low sensitivity of standard diagnostic approaches, but the advent of direct single-operator cholangioscopy (DSOC) has revolutionized this paradigm. Our study aimed to assess the diagnostic performance of DSOC and DSOC-targeted biopsies, intraductal ultrasound (IDUS), and standard brush cytology in patients with indeterminate biliary strictures (IBS). We reviewed patients who underwent advanced diagnostic evaluation for IBS at our endoscopy unit from January 2018 to December 2022, all of whom had previously undergone at least one endoscopic attempt to characterize the biliary stricture. Final diagnoses were established based on surgical pathology and/or clinical and radiological follow-up spanning at least 12 months. A total of 57 patients, with a mean age of 67.2 ± 10.0 years, were included, with a mean follow-up of 18.2 ± 18.1 months. The majority of IBS were located in the distal common bile duct (45.6%), with malignancy confirmed in 35 patients (61.4%). DSOC and IDUS demonstrated significantly higher accuracies (89.5% and 82.7%, respectively) compared to standard cytology (61.5%, p < 0.05). Both DSOC visualization and IDUS exhibited optimal diagnostic yields in differentiating IBS with an acceptable safety profile. Full article
(This article belongs to the Special Issue Recent Advances and Challenges in Gastrointestinal Endoscopy)
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Review

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32 pages, 2995 KiB  
Review
Hereditary Colorectal Cancer Syndromes: Small Bowel Cancer Risk and Endoscopic Surveillance Strategies
by Edoardo Borsotti, Francesca Laura Nava, Felice Benedicenti, Laura Cini, Andrea Magarotto, Davide Ferrari, Paolo Cantù, Marco Vitellaro, Emanuele Rausa and Federica Cavalcoli
Diagnostics 2025, 15(7), 819; https://doi.org/10.3390/diagnostics15070819 - 24 Mar 2025
Viewed by 560
Abstract
Background: Hereditary colorectal cancer syndromes, including familial adenomatous polyposis (FAP), Lynch syndrome (LS), and Peutz–Jeghers syndrome (PJS), are associated with an increased risk of small bowel cancer (SBC). Due to the low incidence and non-specific presentation of SBC, effective surveillance strategies are essential [...] Read more.
Background: Hereditary colorectal cancer syndromes, including familial adenomatous polyposis (FAP), Lynch syndrome (LS), and Peutz–Jeghers syndrome (PJS), are associated with an increased risk of small bowel cancer (SBC). Due to the low incidence and non-specific presentation of SBC, effective surveillance strategies are essential for early detection and management. This review aims to evaluate and compare current endoscopic techniques for small bowel surveillance in these patients. Methods: A comprehensive review was conducted using peer-reviewed studies sourced from PubMed. Various endoscopic modalities, including capsule endoscopy (CE), device-assisted enteroscopy (DAE), and intraoperative enteroscopy (IOE), were assessed for their diagnostic yield, safety, and clinical utility. Surveillance recommendations of the different syndromes were also examined. Results: CE offers high sensitivity but lacks histological sampling capability. DAE, including double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE), enables direct visualization, biopsy, and therapeutic interventions, albeit with greater procedural complexity. In FAP, duodenal surveillance follows the Spigelman classification to stratify cancer risk, while jejunal and ileal polyps remain less studied. LS patients have an increased SBC risk, warranting tailored endoscopic approaches. In PJS, surveillance aims to mitigate intussusception risks and allow early malignancy detection. Conclusions: Optimized surveillance strategies in hereditary colorectal cancer syndromes require a multimodal approach, integrating advanced endoscopic techniques with genetic risk stratification. Centralized care in tertiary centers improves outcomes by ensuring standardized surveillance protocols and enhancing early cancer detection. Artificial intelligence (AI) applied to CE and DAE is shaping promising prospects for the future surveillance of small bowel polyps by enhancing diagnostic accuracy and reducing the duration of the diagnostic process. Further research should investigate AI-assisted imaging and molecular biomarkers to optimize screening strategies. Full article
(This article belongs to the Special Issue Recent Advances and Challenges in Gastrointestinal Endoscopy)
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