Recent advances in diagnostic upper endoscopy

Abstract

Background: Esophageo-gastro-duodenoscopy (EGD) is an important procedure used for detection and diagnosis of esophago-gastric lesions. There exists no consensus on the technique of examination.

Aim: To identify recent advances in diagnostic EGDs to improve diagnostic yield.

Methods: We queried the PubMed database for relevant articles published between January 2001 and August 2019 as well as hand searched references from recently published endoscopy guidelines. Keywords used included free text and MeSH terms addressing quality indicators and technological innovations in EGDs. Factors affecting diagnostic yield and EGD quality were identified and divided into the follow segments: Pre endoscopy preparation, sedation, examination schema, examination time, routine biopsy, image enhanced endoscopy and future developments.

Results: We identified 120 relevant abstracts of which we utilized 67 of these studies in our review. Adequate pre-endoscopy preparation with simethicone and pronase increases gastric visibility. Proper sedation, especially with propofol, increases patient satisfaction after procedure and may improve detection of superficial gastrointestinal lesions. There is a movement towards mandatory picture documentation during EGD as well as dedicating sufficient time for examination improves diagnostic yield. The use of image enhanced endoscopy and magnifying endoscopy improves detection of squamous cell carcinoma and gastric neoplasm. The magnifying endoscopy simple diagnostic algorithm is useful for diagnosis of early gastric cancer.

Conclusion: There is a steady momentum in the past decade towards improving diagnostic yield, quality and reporting in EGDs. Other interesting innovations, such as Raman spectroscopy, endocytoscopy and artificial intelligence may have widespread endoscopic applications in the near future.

Keywords: Gastric cancer; Gastroscopy; Quality indicators; Upper endoscopy.

Figure 1

PRISMA diagram of literature review.

Figure 2

White light endoscopy and narrow band imaging of superficial esophageal squamous cell carcinoma. A: White light endoscopy of superficial esophageal squamous cell carcinoma; B: Narrow band imaging of superficial esophageal squamous cell carcinoma.

Figure 3

Magnifying endoscopy simple diagnostic algorithm for diagnosis of early gastric cancer. Adapted from Muto et al[59]’s magnifying endoscopy simple diagnostic algorithm of early gastric cancer. IMVP: Irregular microvascular pattern; IMSP: Irregular microsurface pattern.

Figure 4

Raman spectroscopy probe and different Raman spectrum according to normal tissue, intestinal metaplasia, high grade dysplasia and tumor tissue. A: Raman spectroscopy probe; B: Different Raman spectrum according to normal tissue, intestinal metaplasia, high grade dysplasia and tumor tissue.