Department of Endoscopy, Humanitas Research Hospital, IRCCS, Rozzano 20089, Italy.
Department of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ 85054, United States.
World J Gastroenterol. 2022 Mar 21;28(11):1113-1122. doi: 10.3748/wjg.v28.i11.1113.
Barrett's esophagus (BE) is a well-established risk factor for esophageal adenocarcinoma. It is recommended that patients have regular endoscopic surveillance, with the ultimate goal of detecting early-stage neoplastic lesions before they can progress to invasive carcinoma. Detection of both dysplasia or early adenocarcinoma permits curative endoscopic treatments, and with this aim, thorough endoscopic assessment is crucial and improves outcomes. The burden of missed neoplasia in BE is still far from being negligible, likely due to inappropriate endoscopic surveillance. Over the last two decades, advanced imaging techniques, moving from traditional dye-spray chromoendoscopy to more practical virtual chromoendoscopy technologies, have been introduced with the aim to enhance neoplasia detection in BE. As witnessed in other fields, artificial intelligence (AI) has revolutionized the field of diagnostic endoscopy and is set to cover a pivotal role in BE as well. The aim of this commentary is to comprehensively summarize present evidence, recent research advances, and future perspectives regarding advanced imaging technology and AI in BE; the combination of computer-aided diagnosis to a widespread adoption of advanced imaging technologies is eagerly awaited. It will also provide a useful step-by-step approach for performing high-quality endoscopy in BE, in order to increase the diagnostic yield of endoscopy in clinical practice.
巴雷特食管(BE)是食管腺癌的一个明确的危险因素。建议患者定期进行内镜监测,最终目的是在肿瘤进展为浸润性癌之前发现早期肿瘤性病变。检测异型增生或早期腺癌可进行根治性内镜治疗,因此,彻底的内镜评估至关重要,可以改善治疗效果。BE 中漏诊的肿瘤仍然是一个不容忽视的问题,这可能是由于内镜监测不当造成的。在过去的二十年中,已经引入了先进的成像技术,从传统的染料喷雾染色内镜发展到更实用的虚拟染色内镜技术,旨在提高 BE 中肿瘤的检测率。与其他领域一样,人工智能(AI)已经彻底改变了诊断内镜领域,并将在 BE 中发挥关键作用。本评论的目的是全面总结 BE 中先进成像技术和人工智能的现有证据、最新研究进展和未来展望;期待将计算机辅助诊断与广泛应用先进成像技术相结合。它还将为 BE 中的高质量内镜检查提供一个有用的分步方法,以提高内镜在临床实践中的诊断效果。
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