Nassani Najib, Alsheikh Mira, Carroll Bobby, Nguyen Diep, Carroll Robert E
Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
Department of Medicine, Zucker SOM at Hofstra/Northwell at Staten Island University Hospital, Staten Island, New York, USA.
Clin Transl Gastroenterol. 2020 Mar;11(3):e00119. doi: 10.14309/ctg.0000000000000119.
Current conventional endoscopes have restricted the accuracy of treatment delivery and monitoring. Over the past decade, there have been major developments in nanotechnology and light triggered therapy, potentially allowing a better detection of challenging lesions and targeted treatment of malignancies in the gastrointestinal tract. Theranostics is a developing form of personalized medicine because it combines diagnosis and targeted treatment delivered in one step using advances in nanotechnology. This review describes the light-triggered therapies (including photodynamic, photothermal, and photoimmunotherapies), nanotechnological advances with nanopowder, nanostent, nanogels, and nanoparticles, enhancements brought to endoscopic ultrasound, in addition to experimental endoscopic techniques, combining both enhanced diagnoses and therapies, including a developed prototype of a "smart" multifunctional endoscope for localized colorectal cancer, near-infrared laser endoscope targeting the gastrointestinal stromal tumors, the concept of endocapsule for obscure gastrointestinal bleed, and a proof-of-concept therapeutic capsule using ultrasound-mediated targeted drug delivery. Hence, the following term has been proposed encompassing these technologies: "Theranostic gastrointestinal endoscopy." Future efforts for integration of these technologies into clinical practice would be directed toward translational and clinical trials translating into a more personalized and interdisciplinary diagnosis and treatment, shorter procedural time, higher precision, higher cost-effectiveness, and less need for repetitive procedures.
目前的传统内窥镜限制了治疗实施和监测的准确性。在过去十年中，纳米技术和光触发疗法取得了重大进展，这可能使人们能更好地检测具有挑战性的病变，并对胃肠道恶性肿瘤进行靶向治疗。治疗诊断学是个性化医疗的一种发展形式，因为它利用纳米技术的进展，将诊断和靶向治疗一步完成。这篇综述描述了光触发疗法（包括光动力、光热和光免疫疗法）、纳米技术在纳米粉末、纳米支架、纳米凝胶和纳米颗粒方面的进展、给内镜超声带来的改进，以及实验性内镜技术，这些技术结合了增强的诊断和治疗，包括用于局部结直肠癌的“智能”多功能内镜的开发原型、针对胃肠道间质瘤的近红外激光内镜、用于不明原因胃肠道出血的内胶囊概念，以及使用超声介导靶向药物递送的概念验证治疗胶囊。因此，已提出以下术语来涵盖这些技术：“治疗诊断性胃肠内镜检查”。将这些技术整合到临床实践中的未来努力将致力于开展转化和临床试验，以实现更个性化和跨学科的诊断与治疗、更短的操作时间、更高的精度、更高的成本效益，以及减少重复操作的需求。
