Gastroenterology Special Issue on Endoscopy

A special issue of GastroenterologyAdvances in Endoscopic Therapy, presents the latest advances in gastrointestinal endoscopy, including endoscopic images and videos.

Images of flat (type 0-IIb) early carcinoma in patients with Barrett’s esophagus, obtained with different generation endoscopes (Fujinon): standard video endoscope (EG-530) white light image (A), first generation HD endoscope (EG-600) white light image (B), Fujifilm intelligent chromo-endoscopy image (D), the new generation endoscope (EG-760) white light (C), Blue Laser Imaging (E), and Linked Color Imaging (F).

In their introductory article, Jacques J. Bergman and Patrick S. Yachimski explain that endoscopy is central to gastroenterology clinical practice and research, allowing examination of healthy and diseased tissue from the organ level, to the mucosa, to cellular structures. Advances in endoscopic imaging technologies are improving not only diagnosis but also treatment of gastrointestinal disorders.

This special issue comprises 12 essential articles for trainees, clinicians, and scientists.

Sri Komanduri et al discuss best practices and controversies in endoscopic eradication therapy for Barrett’s Esophagus, covering opportunities to improve disease staging, risk stratification, selection criteria for intervention, therapeutic algorithms, and quality metrics for endotherapy.

Fons van der Sommen et al report the latest developments in endoscopic imaging of the mucosa, including high-definition imaging, preprocessing, and post-processing techniques. Web-based training tools can improve the ability of endoscopists to enhance detection and classification of lesions, and computer-aided detection can increase the quality of captured data. These systems will aid in interpreting the increasing amount of visual information in endoscopic images providing real-time objective second reading (see figure).

Michael J. Bourke et al discuss regional differences in incorporation of endoscopic submucosal dissection (ESD) into practice. They describe the types of lesions that are best treated by ESD (see video).

Mouen A. Khashab et al describe endoscopic myotomy for foregut motility disorders, including per-oral esophageal myotomy for achalasia and other esophageal motility disorders, and gastric myotomy for gastroparesis. Uzma D. Siddiqui et al review practical aspects of EUS-guided transluminal interventions, including endoscopic management of pancreatic pseudocysts and walled-off necrosis, endoscopic ultrasound (EUS)-guided biliary and pancreatic duct interventions, EUS-guided angiotherapy, and EUS gastrojejunostomy.

Elizabeth Rajan and Louis M. Wong Kee Song provide an overview of techniques for full-thickness resection and provide a framework for consideration of clinical indications, while Willem A. Bemelman and Todd H. Baron discuss endoscopic management of transmural defects, including leaks, perforations and fistulae. They state that selection of the appropriate technique (based on anatomic location and clinical situation) could position endoscopic closure strategies as a first-line alternative to surgery.

Andrew Y. Wang and Patrick S. Yachimski explain endoscopic management of pancreatobiliary neoplasms, summarizing endoscopic retrograde cholangiopancreatography- and EUS-guided techniques for treatment of pancreatic and biliary tract neoplasms. Mostafa Ibrahim et al discuss management of patients with acute esophageal variceal bleeding and the role of cyanoacrylate injection for treatment of gastric varices.

Evelien Dekker and Douglas K. Rex propose the optimal use of colonoscopy for colorectal cancer prevention. They consider noninvasive tests and incorporation of advanced endoscopic tools for lesion detection and characterization. Dekker and Rex state the importance of defining, capturing, and reporting metrics pertaining to the quality of colonoscopy. Kevin A. Waschke and Walter Coyle discuss challenges to training endoscopists to achieve and maintain competency with continuous advancements in endoscopic tools and techniques.

Nicholas J. Shaheen et al propose the question: although new technologies allow us to see more and do more, how can we ensure that we are performing the appropriate volume of endoscopy for the appropriate indications? These authors offer challenges to established habits, practice norms, and society guidelines.

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