Rath Timo, Morgenstern Nadine, Vitali Francesco, Atreya Raja, Neurath Markus F
Ludwig Demling Endoscopy Center of Excellence, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.
Visc Med. 2020 Feb;36(1):48-59. doi: 10.1159/000505411. Epub 2020 Jan 21.
Endoscopic imaging is a rapidly evolving field with a constant influx of new concepts and technologies. Since the introduction of video endoscopy and subsequently high-definition imaging as the first revolutions in gastrointestinal endoscopy, several technologies of virtual chromoendoscopy have been developed and brought to the market in the past decade, which have shaped and revolutionized for a second time our approach to endoscopic imaging. In parallel to these developments, microscopic imaging technologies, such as endomicroscopy and endocytoscopy, allow us to examine single cells within the mucosa in real time, thereby enabling histological diagnoses during ongoing endoscopy.
In this review, we provide an overview on the technical background of different technologies of advanced endoscopic imaging, and then review and discuss their role and applications for the diagnosis and management of colorectal neoplasms as well as limitations and challenges that exist despite all technological improvements.
Technologies of advanced endoscopic imaging have profound impact not only on our imaging capabilities, they are also about to fundamentally change our approach to managing lesions in the gastrointestinal tract: not every lesion found during colonoscopy has to be excised or sent for histopathologic evaluation. However, before this becomes widespread reality, major obstacles such as patient acceptance, adoption by less trained endoscopists, and also legal aspects need to carefully addressed. The development of computer-aided diagnosis and artificial intelligence algorithms hold the potential to overcome the obstacles associated with the concept of optical biopsy and will most likely fundamentally facilitate, shape, and change decision making in the management of colorectal lesions.
内镜成像领域发展迅速，新概念和新技术不断涌入。自视频内镜问世以及随后高清成像成为胃肠内镜的首次变革以来，在过去十年中，多种虚拟染色内镜技术得以研发并推向市场，这再次塑造并彻底改变了我们的内镜成像方法。与这些发展并行的是，显微成像技术，如内镜显微镜检查和内镜细胞检查，使我们能够实时检查黏膜内的单个细胞，从而在进行内镜检查时实现组织学诊断。
在本综述中，我们概述了不同先进内镜成像技术的技术背景，然后回顾并讨论了它们在结直肠肿瘤诊断和管理中的作用及应用，以及尽管技术有了诸多改进但仍存在的局限性和挑战。
先进内镜成像技术不仅对我们的成像能力有深远影响，它们还即将从根本上改变我们处理胃肠道病变的方法：并非结肠镜检查中发现的每个病变都必须切除或送去进行组织病理学评估。然而，在这成为普遍现实之前，诸如患者接受度、经验较少的内镜医师采用情况以及法律方面等主要障碍都需要仔细加以解决。计算机辅助诊断和人工智能算法的发展有可能克服与光学活检概念相关的障碍，并很可能从根本上促进、塑造和改变结直肠病变管理中的决策制定。
