Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Kaminski, Michal F.; Hassan, Cesare; Bisschops, Raf; Pohl, J; Pellisé, María; Dekker, Evelien; Ignjatovic-Wilson, Ana; Hoffman, Arthur; Longcroft‐Wheaton, Gaius; Héresbach, D.; Dumonceau, Jean‐Marc; East, James E.

doi:10.1055/s-0034-1365348

Cited by 314 publications

(186 citation statements)

References 370 publications

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“…Therefore, it is recommended that the endoscopists involved in performing an EMR meet the highest standards of quality criteria for colonoscopies and that they are fully familiar with the chromoendoscopy techniques (24). In medium-risk subjects, selective indigo carmine staining is recommended in order to assess the lesions detected with a conventional view.…”

Section: Specific Recommendationsmentioning

confidence: 99%

Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions

Albéniz¹,

Pellisé²,

Gimeno–García

et al. 2018

Rev Esp Enferm Dig

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Section: Specific Recommendationsmentioning

confidence: 99%

Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions

Albéniz¹,

Pellisé²,

Gimeno–García

et al. 2018

Rev Esp Enferm Dig

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“…Under current clinical practice, a diminutive polyp identified by conventional WLE would be removed and sent for histopathological examination to determine whether it is adenomatous, hyperplastic or cancerous. 31 However, use of a VCE technology would enable the endoscopist to differentiate between adenomas and hyperplastic polyps during colonoscopy. When the endoscopist has high confidence in the polyp characterisation, adenomas would be removed and discarded, whereas hyperplastic polyps in the rectosigmoid colon would be left in situ (as these would be considered very low risk for colorectal cancer).…”

Section: Care Pathwaymentioning

confidence: 99%

“…There are several different aspects to any decision to implement the new technology, and European 31 and American guidance 32 has been published.…”

Section: Diagnostic Thresholds and Requirements For Use Of Virtual Chmentioning

confidence: 99%

“…The European guidance, 31 produced by the European Society of Gastrointestinal Endoscopy (ESGE) in 2014, makes the recommendation that VCE (NBI, FICE, i-scan) and conventional chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5mm in size) colorectal polyps to replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photo-documented and can be performed only by experienced endoscopists who are adequately trained and audited (ESGE describe this as a weak recommendation based on high-quality evidence).…”

Section: Diagnostic Thresholds and Requirements For Use Of Virtual Chmentioning

confidence: 99%

“…Guidelines recommend that VCE should be performed only under strictly controlled conditions by experienced endoscopists adequately trained in the use of the technology, using validated classification scales. 31 In order for VCE technologies to be incorporated into routine clinical practice for the real-time assessment of colorectal polyps during colonoscopy, there needs to be evidence that the new technology provides an appropriate and efficient standard of care compared with existing practice. Therefore, the decision question for this assessment is 'Does VCE for real-time assessment of diminutive colorectal polyps during colonoscopy represent a cost-effective use of NHS resources?…”

Section: Current Service Provisionmentioning

confidence: 99%

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Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation

Picot

Rose

Cooper

et al. 2017

Health Technol Assess

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BackgroundCurrent clinical practice is to remove a colorectal polyp detected during colonoscopy and determine whether it is an adenoma or hyperplastic by histopathology. Identifying adenomas is important because they may eventually become cancerous if untreated, whereas hyperplastic polyps do not usually develop into cancer, and a surveillance interval is set based on the number and size of adenomas found. Virtual chromoendoscopy (VCE) (an electronic endoscopic imaging technique) could be used by the endoscopist under strictly controlled conditions for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps to replace histopathological diagnosis.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of the VCE technologies narrow-band imaging (NBI), flexible spectral imaging colour enhancement (FICE) and i-scan for the characterisation and management of diminutive (≤ 5 mm) colorectal polyps using high-definition (HD) systems without magnification.DesignSystematic review and economic analysis.ParticipantsPeople undergoing colonoscopy for screening or surveillance or to investigate symptoms suggestive of colorectal cancer.InterventionsNBI, FICE and i-scan.Main outcome measuresDiagnostic accuracy, recommended surveillance intervals, health-related quality of life (HRQoL), adverse effects, incidence of colorectal cancer, mortality and cost-effectiveness of VCE compared with histopathology.Data sourcesElectronic bibliographic databases including MEDLINE, EMBASE, The Cochrane Library and Database of Abstracts of Reviews of Effects were searched for published English-language studies from inception to June 2016. Bibliographies of related papers, systematic reviews and company information were screened and experts were contacted to identify additional evidence.Review methodsSystematic reviews of test accuracy and economic evaluations were undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-analyses were conducted, where possible, to inform the independent economic model. A cost–utility decision-analytic model was developed to estimate the cost-effectiveness of VCE compared with histopathology. The model used a decision tree for patients undergoing endoscopy, combined with estimates of long-term outcomes (e.g. incidence of colorectal cancer and subsequent morbidity and mortality) derived from University of Sheffield School of Health and Related Research’s bowel cancer screening model. The model took a NHS perspective, with costs and benefits discounted at 3.5% over a lifetime horizon. There were limitations in the data on the distribution of adenomas across risk categories and recurrence rates post polypectomy.ResultsThirty test accuracy studies were included: 24 for NBI, five for i-scan and three for FICE (two studies assessed two interventions). Polyp assessments made with high confidence were associated with higher sensitivity and endoscopists experienced in VCE achieved better results than those without experience. Two economic evaluations were included. NBI, i-scan and FICE are cost-saving strategies compared with histopathology and the number of quality-adjusted life-years gained was similar for histopathology and VCE. The correct surveillance interval would be given to 95% of patients with NBI, 94% of patients with FICE and 97% of patients with i-scan.LimitationsLimited evidence was available for i-scan and FICE and there was heterogeneity among the NBI studies. There is a lack of data on longer-term health outcomes of patients undergoing VCE for assessment of diminutive colorectal polyps.ConclusionsVCE technologies, using HD systems without magnification, could potentially be used for the real-time assessment of diminutive colorectal polyps, if endoscopists have adequate experience and training.Future workFuture research priorities include head-to-head randomised controlled trials of all three VCE technologies; more research on the diagnostic accuracy of FICE and i-scan (when used without magnification); further studies evaluating the impact of endoscopist experience and training on outcomes; studies measuring adverse effects, HRQoL and anxiety; and longitudinal data on colorectal cancer incidence, HRQoL and mortality.Study registrationThis study is registered as PROSPERO CRD42016037767.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Advances in optical gastrointestinal endoscopy: a technical review

2020

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Optical endoscopy is the primary diagnostic and therapeutic tool for management of gastrointestinal (GI) malignancies. Most GI neoplasms arise from precancerous lesions; thus, technical innovations to improve detection and diagnosis of precancerous lesions and early cancers play a pivotal role in improving outcomes. Over the last few decades, the field of GI endoscopy has witnessed enormous and focused efforts to develop and translate accurate, user‐friendly, and minimally invasive optical imaging modalities. From a technical point of view, a wide range of novel optical techniques is now available to probe different aspects of light–tissue interaction at macroscopic and microscopic scales, complementing white light endoscopy. Most of these new modalities have been successfully validated and translated to routine clinical practice. Herein, we provide a technical review of the current status of existing and promising new optical endoscopic imaging technologies for GI cancer screening and surveillance. We summarize the underlying principles of light–tissue interaction, the imaging performance at different scales, and highlight what is known about clinical applicability and effectiveness. Furthermore, we discuss recent discovery and translation of novel molecular probes that have shown promise to augment endoscopists' ability to diagnose GI lesions with high specificity. We also review and discuss the role and potential clinical integration of artificial intelligence‐based algorithms to provide decision support in real time. Finally, we provide perspectives on future technology development and its potential to transform endoscopic GI cancer detection and diagnosis.

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Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Cited by 314 publications

References 370 publications

Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions

Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions

Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation

Advances in optical gastrointestinal endoscopy: a technical review

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