Emerging Endoscopy Techniques

Introduction

Gastrointestinal (GI) cancers rank as the second most prominent contributor to mortality associated with cancer. Endoscopy is widely regarded as the preferred method for both diagnosing and treating gastrointestinal (GI) problems, sometimes considered the benchmark against which other approaches are measured. Conventional endoscopy is commonly employed for the identification of mucous puffy lesions, ulceration masses, and stem polyps. However, its efficacy in detecting small polyps and flat lesions is limited, potentially resulting in the oversight of several lesions of this nature. Due to this factor, the diagnostic efficacy of traditional endoscopy is constrained. The utilization of novel endoscopic technologies has led to a notable rise in the rate of identification and diagnosis of precancerous lesions and malignancies in their early stages.

What Are the Latest Techniques in Endoscopes?

Endoscopy has seen severe advances in recent years. The use of chromoendoscopy has boosted the detection of early-stage malignancies and precancerous lesions. The utilization of endoscopic techniques, including polypectomy (the removal of a polyp), endoscopic mucosal reconstruction (a technique used to restore the integrity and functionality of the mucosal lining through endoscopic procedures), and endoscopic submucosal examination (a diagnostic procedure that involves the use of an endoscope to visualize and evaluate the submucosal layer of a patient's), has been shown to decrease the incidence of gastrointestinal (GI) cancers as well as the rates of morbidity and death associated with precancerous and early-stage malignancies.

What Is Chromoendoscopy?

Chromoendoscopy uses many colors to visualize mucosal lesions and provide histopathologic diagnosis. It sometimes magnifies images several hundred-fold using changeable lenses.

• It is a dye-based approach that is expensive and time-consuming, necessitating the development of new technologies. Endoscopic lesion images can be created without the use of dyes thanks to the use of virtual ocular filters, magnification, and mobile, high-resolution optical devices and software. The ability to generate chromoendoscopy-like images in a short period of time by merely pressing a button on the endoscope is a significant advantage that does not require the use of dye.

• Chromoendoscopy diagnoses intestinal metaplasia, malformations, early-stage GI malignancies, and colorectal polyps. Proper sedation enhances picture quality and patient and endoscopist comfort during the lengthy treatment.

• Aspirate excess mucosal fluid and dye. Pressing the endoscope magnification key magnifies the image several hundred-fold.

• Biopsies are obtained from suspicious sites after tissue examination.

• Surface inspection must be conducted before biopsies since biopsy hemorrhage lowers surface inspection quality.

• Conventional dye application and magnification produce images.

What Is Imaging in a Narrow Band?

Endoscopy has transitioned into the era of high-definition (HD) imaging.

• By employing advanced endoscopes equipped with high-definition LCD screens, it becomes possible to observe the mucosal surfaces of the esophagus, stomach, small intestine, and colon with exceptional clarity and precision.

• The utilization of this technique has the potential to enhance the precision of colonoscopy in the detection of polyps or cancer.

• Additionally, when combined with narrow-band imaging (NBI), it can provide gastroenterologists with improved capabilities to assess the clinical relevance of findings, such as colon polyps or reddened areas in the esophagus. When using regular endoscopy, the white-light parts are mirrored by the mucosal surface in a narrow-band interval.

• NBI is a simple method that can be done with a standard colonoscope; the process is of short duration. Endoscopes that are used today use white light from a xenon lamp.

What Is Confocal Laser Endomicroscopy (CLE)?

The utilization of confocal laser endomicroscopy (CLE) has facilitated the examination of cellular and molecular characteristics of tissues in a non-invasive manner, eliminating the need for tissue dissection.

• The concept of optical biopsy has emerged as a result of this development. The subject under consideration is undergoing rapid transformation and continues to undergo enhancements to accommodate novel applications.

• The proposed modification involves miniaturizing a conventional endomicroscope and integrating it onto the distal end of an endoscope.

• In contrast, probe-based endomicroscopy employs instruments that are inserted through a conventional endoscope in order to capture images.

• It is conceivable to significantly enlarge the dimensions of the image by several hundred times. Contrast media are employed to obtain visual representations at the cellular and molecular scales.

• The ease of usage of a confocal laser camera is comparable to that of conventional endoscopes.

• The administration of contrast media during endoscopic studies might vary depending on the specific characteristics of the mucosal area under investigation.

• The contrast media may be applied throughout the entire body, while in others, it may be localized to the skin via the endoscopic study channel.

• The camera is positioned in close proximity to the mucosal region of interest in order to get a high-quality image.

• The frequency of invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and surgical exploration could be reduced by implementing this examination.

What Is Enhancement of Endoscopy?

The enhancements have augmented the diagnostic efficacy of endoscopy. The magnification endoscopy (ME) permits the amplification of endoscopic images by several hundred times.

• ME has the capability to detect minute lesions that are not detectable through conventional endoscopy.

• ME is superior to conventional endoscopy not only in characterizing upper gastrointestinal lesions but also in identifying pattern changes in colon polyps and mucosal changes associated with inflammatory bowel disease.

• However, image interpretation is complicated by the increased level of detail. Histologic diagnosis of lesions during the examination is facilitated by ME.

• By utilizing movable optics to enlarge the image, magnifying endoscopes enable clear observation of microvascular architecture and mucosal structure. Moreover, elevating gastroscopes are equipped with a focusing mechanism that can be adjusted to produce both traditional and close-up images.

• As with conventional endoscopy, the mucosa is examined initially during the ME procedure; upon locating a suspicious lesion, the image is magnified several hundred times using the magnification key. Following an exhaustive analysis of the demarcation line that separates the lesion from healthy mucosa, specimens are obtained from the suspicious regions characterized by divergent patterns.

• ME ensures that biopsies are obtained from the intended targets and prevents the collection of superfluous biopsies.

Conclusion

The latest endoscopic techniques are the accuracy and specificity in malignant and precancerous lesions. The novel endoscopic methods presented here improve the prognosis of GI malignancies by allowing for early detection and therapy. However, in order to be effective, these new strategies require practice. It improves the usability of their products and increases the acceptance of new technology through continuous innovation. Although these innovative procedures are more expensive than traditional colonoscopy, this disadvantage is offset by their diagnostic benefits, which enhance the prognosis of patients with GI malignancies. According to our clinical experience, chromoendoscopy and endomicroscopy remain limited because, in addition to the requirement for stain application, which carries the risk of allergic reactions, they have a long learning curve, a long treatment duration, and expensive expenses. FICE, NBI, and magnification endoscopy are widely used because there is no need for them, as well as the ease and reduced operation times.