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Endoscopy in Diagnosis of Gastrointestinal Disorders—2nd Edition
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Endoscopy in Diagnosis of Gastrointestinal Disorders—2nd Edition

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: 31 October 2025 | Viewed by 6121

Special Issue Editor

Prof. Dr. Miguel Mascarenhas

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Guest Editor
1. Gastroenterology Department, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
2. Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
Interests: inflammatory bowel disease; applied artificial intelligence; capsule endoscopy; neurogastroenterology; coloproctology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We invite researchers, clinicians, and experts in the field to contribute to this Special Issue focusing on the crucial role of endoscopy in the diagnosis of gastrointestinal disorders. This Special Issue aims to explore the latest advancements, challenges, and future directions regarding the utilization of endoscopy as a diagnostic tool for various gastrointestinal conditions.

Endoscopy plays a pivotal role in the accurate and targeted diagnosis of gastrointestinal disorders. It allows for the direct visualization and examination of the digestive tract and enables the identification of abnormalities, such as ulcers, polyps, tumors, and inflammation. Furthermore, endoscopy offers the opportunity for biopsy collection, thus aiding in the detection of gastrointestinal cancers and guiding personalized treatment strategies.

We encourage the submission of papers that cover a wide range of topics, including, but not limited to, AI-assisted endoscopy, advanced imaging techniques, innovative endoscopic procedures, therapeutic interventions, and outcome assessments. Original research articles, reviews, and case studies that contribute to our understanding of the role of endoscopy in gastrointestinal disorder diagnosis are welcomed.

Join us in this Special Issue in order to advance our knowledge and contribute to the development of improved diagnostic approaches in gastrointestinal medicine. Submissions should adhere to the journal's guidelines and will undergo a rigorous peer-review process. Together, let us enhance patient care and outcomes by motivating advancements in endoscopy.

Prof. Dr. Miguel Mascarenhas
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

  • endoscopy
  • gastroenterology
  • coloproctology
  • digestive healthcare
  • artificial intelligence
  • digestive oncology
  • colonoscopy
  • capsule endoscopy
  • upper endoscopy

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Published Papers (8 papers)

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Research

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9 pages, 835 KiB  
Article
Duodenal Biopsies for Coeliac Disease: Does Size Matter?
by Mohamed G. Shiha, Francesca Manza, Suneil A. Raju, Andrew D. Hopper, Simon S. Cross and David S. Sanders
Diagnostics 2025, 15(8), 1000; https://doi.org/10.3390/diagnostics15081000 - 14 Apr 2025
Viewed by 251
Abstract
Background/Objectives: Most adult patients require endoscopy and duodenal biopsies to diagnose coeliac disease. However, individuals who are unwilling or unable to undergo conventional endoscopy are left without diagnostic options or a formal diagnosis. We aimed to determine whether the small-sized biopsy forceps [...] Read more.
Background/Objectives: Most adult patients require endoscopy and duodenal biopsies to diagnose coeliac disease. However, individuals who are unwilling or unable to undergo conventional endoscopy are left without diagnostic options or a formal diagnosis. We aimed to determine whether the small-sized biopsy forceps used during the more tolerable transnasal endoscopy (TNE) can provide adequate duodenal biopsy specimens for diagnosing coeliac disease. Methods: We prospectively recruited adult patients (≥18 years) with suspected coeliac disease between May and July 2024. All patients underwent peroral endoscopy, with four biopsies taken from the second part of the duodenum (D2) and one from the duodenal bulb (D1) using standard 2.8 mm biopsy forceps. The biopsy protocol was then repeated using smaller 2 mm biopsy forceps. Expert pathologists evaluated all samples for size, quality, and Marsh classification. Results: Ten patients (median age 45 years, 50% female) were included in this study, of whom seven (70%) were diagnosed with coeliac disease. In total, 100 duodenal biopsy specimens were collected and analysed (50 using standard biopsy forceps and 50 using smaller biopsy forceps). The size of D2 biopsies was significantly larger when using standard biopsy forceps compared with smaller forceps (4.5 mm vs. 3 mm, p = 0.001). Similarly, biopsies from D1 were also larger with standard forceps (3 mm vs. 2 mm, p = 0.002). Smaller forceps provided sufficient material for accurate classification in all cases, and the agreement between biopsies obtained using both forceps in D2 and D1 was 100% (k = 1.0). Conclusions: This pilot study demonstrates that small-sized biopsy forceps, used during TNE, can provide adequate tissue for histopathological diagnosis in patients with suspected coeliac disease. These findings pave the way for considering TNE as a more tolerable alternative to conventional endoscopy in diagnosing coeliac disease. Full article
(This article belongs to the Special Issue Endoscopy in Diagnosis of Gastrointestinal Disorders—2nd Edition)
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11 pages, 1237 KiB  
Article
Effectiveness of Double Balloon Enteroscopy in the Diagnosis and Treatment of Small Bowel Varices
by Suleyman Dolu, Mehmet Emin Arayici, Soner Onem, Ilker Buyuktorun, Huseyin Dongelli, Goksel Bengi and Mesut Akarsu
Diagnostics 2025, 15(3), 336; https://doi.org/10.3390/diagnostics15030336 - 31 Jan 2025
Cited by 1 | Viewed by 633
Abstract
Background/Aims: Double balloon enteroscopy (DBE) is an innovative method for the diagnosis and management of small bowel (SB) diseases. SB varices are rare disorders, and their diagnosis and treatment can be challenging for clinicians. This study evaluates the use of double balloon enteroscopy [...] Read more.
Background/Aims: Double balloon enteroscopy (DBE) is an innovative method for the diagnosis and management of small bowel (SB) diseases. SB varices are rare disorders, and their diagnosis and treatment can be challenging for clinicians. This study evaluates the use of double balloon enteroscopy (DBE) in diagnosing and treating small bowel varices. Materials and Methods: SB varices were detected in 28 out of 900 double balloon enteroscopy procedures over an 18-year period. Eleven cases of SB varices of various etiologies, diagnosed via DBE, are described. The characteristics of SB varices and endoscopic procedural details were evaluated. Results: A retrospective investigation of 750 patients identified eleven patients (eight males and three females; median age 59 years, range 40–80 years) with small bowel varices. The most common site of SB varices was the jejunum. At least one abdominopelvic surgical procedure had been previously performed on five patients. Endotherapy by DBE was administered to nine patients (seven emergent and two prophylactic). Post-endotherapy, three patients experienced bleeding that required re-endotherapy. Endoscopic therapy for small bowel varices included injection sclerotherapy in eight cases (six with cyanoacrylate and two with polidocanol) and injection sclerotherapy plus hemoclipping in one case. Conclusions: SB varices can present a diagnostic challenge for clinicians. DBE is a valuable tool for both the diagnosis and management of small bowel varices. Full article
(This article belongs to the Special Issue Endoscopy in Diagnosis of Gastrointestinal Disorders—2nd Edition)
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13 pages, 965 KiB  
Article
The Role of Small Bowel Capsule Endoscopy in Determining the Treatment Strategy for Duodenal Follicular Lymphoma: A Single-Center Retrospective Study
by Donghoon Kang, Gi-June Min, Tong Yoon Kim, Young-Woo Jeon, Yukyung Cho, Jae Myung Park, Joo Hyun O, Byung-Ock Choi, Gyeongsin Park and Seok-Goo Cho
Diagnostics 2025, 15(2), 193; https://doi.org/10.3390/diagnostics15020193 - 15 Jan 2025
Viewed by 732
Abstract
Objectives: In this single-center retrospective study, we aimed to verify the extent of duodenal follicular lymphoma (DFL) and investigate the role and clinical significance of video capsule endoscopy (VCE) in the treatment process. Methods: We analyzed the clinical and imaging data [...] Read more.
Objectives: In this single-center retrospective study, we aimed to verify the extent of duodenal follicular lymphoma (DFL) and investigate the role and clinical significance of video capsule endoscopy (VCE) in the treatment process. Methods: We analyzed the clinical and imaging data of 40 patients diagnosed with DFL. Results: Imaging workup and bone marrow biopsies revealed DFL only in the gastrointestinal tract (stage I) in 22 patients and in local lymph nodes (stage II1), distant lymph nodes (stage II2), pancreas (stage II2Epancreas), and extranodal regions (stage IV) in 1, 3, 1, and 13 patients, respectively. Fifteen of the 23 patients with localized (stages I and II1) DFL underwent VCE for comprehensive small bowel evaluation, which revealed lesion extension beyond the duodenum in 10 patients (66.7%). A watch-and-wait strategy was implemented for one patient and systemic chemotherapy was administered to the remaining nine. Of the eight patients without VCE, seven and one received radiotherapy and observation, respectively. Nine of the 23 patients (39.1%) received systemic treatment based on positive VCE results. Only one of the 17 patients with advanced-stage DFL (stages II2 and IV) accepted radiotherapy; 16 underwent systemic chemotherapy. During follow-up (median, 48.4 months), two relapse events occurred in the advanced stage, with no lymphoma-associated deaths. DFL tends to be indolent and has favorable outcomes. Conclusions: Proactive VCE for diagnosing DFL is recommended to determine small bowel involvement, which may influence subsequent treatment decisions. Full article
(This article belongs to the Special Issue Endoscopy in Diagnosis of Gastrointestinal Disorders—2nd Edition)
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10 pages, 1271 KiB  
Article
Unsedated or On-Demand Minimally Sedated Water-Aided Outpatient Colonoscopy in Colorectal Cancer Screening and Surveillance: A Step Forward or Backward? Experience from Daily Practice in a Regional (Nonacademic) Hospital
by Stijn Arnaert, Diederik Persyn, Mike Cool, Guy Lambrecht and Guido Deboever
Diagnostics 2024, 14(22), 2596; https://doi.org/10.3390/diagnostics14222596 - 19 Nov 2024
Viewed by 932
Abstract
Background: By using optimal insertion techniques with water infusion and dynamic position changes, pain during colonoscopy is greatly reduced and the procedures can usually be performed without sedation. We investigated whether the excellent results with water-aided colonoscopy reported by experts are reproducible in [...] Read more.
Background: By using optimal insertion techniques with water infusion and dynamic position changes, pain during colonoscopy is greatly reduced and the procedures can usually be performed without sedation. We investigated whether the excellent results with water-aided colonoscopy reported by experts are reproducible in daily practice in a regional hospital. Methods: During the year 2023, 500 consecutive outpatients 50–75 years old presenting for colorectal cancer screening and surveillance could choose between unsedated or on-demand minimally sedated colonoscopy, moderate sedation with midazolam, or deep sedation with propofol. A total of 57% opted for unsedated colonoscopy, and of those patients, 250 consecutive patients were included. The primary outcome was the feasibility of the procedure. Cecal intubation rate (CIR), pain scores, use of midazolam, and willingness to repeat future procedures in the same way were registered periprocedural. Additional outcomes were cecal intubation time (CIT), detection rate of lesions, polyp resection rate, rate of adequate bowel preparation, and volume of water aspirated during insertion. Results: 250 consecutive sedation-free or on-demand minimally sedated water-based colonoscopies were analyzed. The CIR was 98%. A total of 96.5% completed without sedation and 5% of the procedures were perceived as moderately painful, but none had severe pain. The willingness to repeat was 97%. The mean CIT was 8.2 min. Conclusions: Using water-aided insertion techniques, comfortable sedation-free, or on-demand minimally sedated colonoscopy in daily practice in a regional hospital is feasible in the vast majority of patients presenting for colorectal cancer screening and surveillance, and the willingness to repeat is very high. Full article
(This article belongs to the Special Issue Endoscopy in Diagnosis of Gastrointestinal Disorders—2nd Edition)
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10 pages, 6404 KiB  
Article
Feasibility of Peroral Cholangioscopy in the Initial Endoscopic Retrograde Cholangiopancreatography for Malignant Biliary Strictures
by Yuichi Suzuki, Tomohiro Ishii, Haruo Miwa, Takeshi Sato, Yoshihiro Goda, Kuniyasu Irie, Kazuya Sugimori and Shin Maeda
Diagnostics 2024, 14(22), 2589; https://doi.org/10.3390/diagnostics14222589 - 18 Nov 2024
Viewed by 874
Abstract
Background: Peroral cholangioscopy (POCS) is valuable for assessing malignant biliary strictures; however, biliary drainage prior to POCS often hinders accurate diagnosis. Objectives: This retrospective study aimed to investigate the feasibility of POCS using a newly developed cholangioscope, CHF-B290, during initial endoscopic retrograde cholangiopancreatography [...] Read more.
Background: Peroral cholangioscopy (POCS) is valuable for assessing malignant biliary strictures; however, biliary drainage prior to POCS often hinders accurate diagnosis. Objectives: This retrospective study aimed to investigate the feasibility of POCS using a newly developed cholangioscope, CHF-B290, during initial endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary strictures. Methods: This multicenter retrospective study included patients who underwent initial ERCP for malignant biliary strictures at two institutions between January 2018 and March 2022. Patients who underwent initial ERCP with POCS were classified into the POCS group, and those without POCS were classified into the non-POCS group. To prevent post-POCS cholangitis, the original irrigation system for CHF-B290 was used in all POCS examinations. The primary endpoint was the rate of post-ERCP biliary infections, and the secondary endpoints were other ERCP-related complications, including pancreatitis, bleeding, and perforation. Results: Overall, 53 and 94 patients were included in the POCS and non-POCS groups, respectively. For the primary endpoint, the rate of post-ERCP biliary infection was not significantly different between the two groups (1.9% vs. 5.3%, p = 0.42). For the secondary endpoints, no significant differences were observed in the rates of post-ERCP pancreatitis (5.7% vs. 6.4%, p = 1.00) and other ERCP-related complications. The overall complication rate was 9.4% in the POCS group and 13% in the non-POCS group (p = 0.60). Conclusions: POCS during the initial ERCP for malignant biliary strictures is feasible. Full article
(This article belongs to the Special Issue Endoscopy in Diagnosis of Gastrointestinal Disorders—2nd Edition)
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Review

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12 pages, 1944 KiB  
Review
A Comprehensive Review of Artificial Intelligence and Colon Capsule Endoscopy: Opportunities and Challenges
by Joana Mota, Maria João Almeida, Francisco Mendes, Miguel Martins, Tiago Ribeiro, João Afonso, Pedro Cardoso, Helder Cardoso, Patricia Andrade, João Ferreira, Guilherme Macedo and Miguel Mascarenhas
Diagnostics 2024, 14(18), 2072; https://doi.org/10.3390/diagnostics14182072 - 19 Sep 2024
Cited by 1 | Viewed by 1878
Abstract
Colon capsule endoscopy (CCE) enables a comprehensive, non-invasive, and painless evaluation of the colon, although it still has limited indications. The lengthy reading times hinder its wider implementation, a drawback that could potentially be overcome through the integration of artificial intelligence (AI) models. [...] Read more.
Colon capsule endoscopy (CCE) enables a comprehensive, non-invasive, and painless evaluation of the colon, although it still has limited indications. The lengthy reading times hinder its wider implementation, a drawback that could potentially be overcome through the integration of artificial intelligence (AI) models. Studies employing AI, particularly convolutional neural networks (CNNs), demonstrate great promise in using CCE as a viable option for detecting certain diseases and alterations in the colon, compared to other methods like colonoscopy. Additionally, employing AI models in CCE could pave the way for a minimally invasive panenteric or even panendoscopic solution. This review aims to provide a comprehensive summary of the current state-of-the-art of AI in CCE while also addressing the challenges, both technical and ethical, associated with broadening indications for AI-powered CCE. Additionally, it also gives a brief reflection of the potential environmental advantages of using this method compared to alternative ones. Full article
(This article belongs to the Special Issue Endoscopy in Diagnosis of Gastrointestinal Disorders—2nd Edition)
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Other

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3 pages, 2972 KiB  
Interesting Images
Preoperative Diagnosis of an Esophageal Duplication Cyst by Endoscopic Ultrasound Examination
by Akane Shimakura, Kosuke Takahashi, Eisuke Ozawa and Hisamitsu Miyaaki
Diagnostics 2025, 15(9), 1107; https://doi.org/10.3390/diagnostics15091107 - 27 Apr 2025
Viewed by 53
Abstract
A 78-year-old woman was referred to our hospital for close examination of an extramural submucosal tumor in the gastroesophageal region, suspected based on an imaging test performed for a chief complaint of epicardial pain while eating. Contrast-enhanced computed tomography revealed a 3 cm [...] Read more.
A 78-year-old woman was referred to our hospital for close examination of an extramural submucosal tumor in the gastroesophageal region, suspected based on an imaging test performed for a chief complaint of epicardial pain while eating. Contrast-enhanced computed tomography revealed a 3 cm sized mass with well-defined margins and a homogeneous interior near the gastroesophageal junction. Endoscopic ultrasonography (EUS) revealed a large (28 mm) unilocular cystic lesion with a heterogeneous hypoechoic internal structure. The cyst wall was layered with a hypoechoic layer that appeared to be muscular and continuous with the external longitudinal muscle of the esophagus. Based on the EUS findings, an esophageal duplication cyst was diagnosed. Cystectomy was performed because the patient was symptomatic. Pathological examination revealed that the specimen was covered with columnar and pseudostratified ciliated epithelium without atypia and that the cyst wall comprised two layers of smooth muscle. No cartilaginous tissue was present, which is consistent with esophageal duplication cysts. Retrospectively, the EUS findings were consistent with the pathological findings. Full article
(This article belongs to the Special Issue Endoscopy in Diagnosis of Gastrointestinal Disorders—2nd Edition)
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14 pages, 2670 KiB  
Systematic Review
Evidence Report on the Safety of Gastrointestinal Endoscopy in Patients on Glucagon-like Peptide-1 Receptor Agonists: A Systematic Review and Meta-Analysis
by Zahid Ijaz Tarar, Umer Farooq, Ahtshamullah Chaudhry, Mustafa Gandhi, Abdallah El Alayli, Mark Ayoub, Baltej Singh, Ebubekir Daglilar and Nirav Thosani
Diagnostics 2025, 15(6), 770; https://doi.org/10.3390/diagnostics15060770 - 19 Mar 2025
Viewed by 490
Abstract
Background/Objectives: Glucagon-like peptide-1 receptor agonists are increasingly used worldwide for weight and hyperglycemia management. There is an ongoing debate on the presence of increased gastric residue, leading to complications such as aspiration and overall safety in patients receiving upper gastrointestinal endoscopy. We [...] Read more.
Background/Objectives: Glucagon-like peptide-1 receptor agonists are increasingly used worldwide for weight and hyperglycemia management. There is an ongoing debate on the presence of increased gastric residue, leading to complications such as aspiration and overall safety in patients receiving upper gastrointestinal endoscopy. We aimed to study the effect of GLP-RAs on endoscopy outcomes. Methods: We conducted a detailed search of online databases to select the studies which provided details of the effects of GLP-RAs on patients undergoing endoscopy. The outcomes of interest were odds of retained gastric content (RGC), aspiration risk, and aborted and repeated procedures. A random effect model was used to calculate the pooled odds of outcomes with a 95% CI. We further calculated the pooled odds of predictive factors associated with an increased rate of retained gastric residues in the study population. Results: We included 12 studies with a total of 105,515 patients, of which 32,144 were on GLP-1 RAs and 73,273 were in the control group. A total of 234 (0.73%) aspiration events in GLP-RA users were noted compared to 257 (0.35%) events in the control group. No increased odds (1.26, 95% CI 0.86–1.87, I2 34%) of aspiration were found in GLP-1 users compared to the non-GLP-1 group. Patients on GLP-1 RA had increased RGC compared to the control group (OR 6.30, 95% CI 5.30–7.49, I2 0%). The pooled odds of aborted (OR 5.50, 95% CI 3.25–9.32, I2 0%) and repeated procedures (OR 2.19, 95% CI 1.42–3.38, I2 0%) were significantly higher in GLP-1 RA users. Patients taking Tirazepatide had the highest percentage of RGC (18.9%), while exenatide users had the lowest rate (6.2%) of food retention. Patients undergoing concomitant colonoscopy were found to have significantly low pooled odds of RGC (OR 0.26, 95% CI 0.04–0.48). GLP-1 RAs use was independently associated with increased odds of RGC (3.91, 95% CI 3.21–4.62, I2 0%). The results were homogenous and stayed consistent in the sensitivity analysis. Conclusions: Although the odds of RGC and aborted procedures are high in the GLP-1 RAs group compared to the control, no significant difference in the odds of aspiration was found between the two groups. Simple measures such as a clear liquid diet for 24 h, as routinely set for patients undergoing colonoscopy, may reduce the risk of retaining gastric residue in these patient populations. Full article
(This article belongs to the Special Issue Endoscopy in Diagnosis of Gastrointestinal Disorders—2nd Edition)
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