Dell'Anna Giuseppe, Mandarino Francesco, Centanni Lucia, Lodola Ilaria, Fanizza Jacopo, Fasulo Ernesto, Bencardino Sarah, Fuccio Lorenzo, Facciorusso Antonio, Donatelli Gianfranco, Parigi Tommaso Lorenzo, Furfaro Federica, D'Amico Ferdinando, Massironi Sara, Malesci Alberto, Ungaro Federica, Danese Silvio, Annese Vito
Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy.
Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy.
Int J Mol Sci. 2025 May 18;26(10):4834. doi: 10.3390/ijms26104834.
Molecular endoscopy represents a transformative advance in the detection, diagnosis, and management of gastrointestinal diseases, addressing the critical limitations of conventional techniques. Current diagnostic standards, such as white light endoscopy (WLE), often fail to detect early-stage lesions, particularly in high-risk populations like Barrett's esophagus or inflammatory bowel disease patients. To overcome these challenges, molecular endoscopy, using fluorescent molecular probes, may offer ultimate precision by targeting disease-specific biomarkers. Technologies like Confocal Laser Endomicroscopy (CLE) and Immunoendoscopy are revolutionizing in vivo diagnostics, enabling the real-time visualization of tissue microarchitecture and physiological mechanisms. Fluorescence molecular endoscopy (FME) enhances the detection of precancerous and cancerous lesions, even those undetectable by conventional methods, by highlighting subtle molecular changes. Clinical applications include early tumor detection, therapy response monitoring, and improved lesion characterization. Despite these advancements, challenges persist, including high costs, a lack of standardization, and the need for specialized training. Recent innovations, such as a multi-parametric rigid standard, aim to ensure the reliable performance assessment and quality control of FME systems, addressing subjective variability and improving reproducibility. In addition, the integration of artificial intelligence (AI) with molecular endoscopy offers the potential to further reduce detection errors and significantly enhance diagnostic accuracy. This advancement underscores the potential of molecular endoscopy for personalized GI disease management, while highlighting the need for ongoing research to refine the technology, validate its clinical utility, and overcome the barriers to routine clinical application.
分子内镜检查代表了胃肠疾病检测、诊断和管理方面的变革性进展，解决了传统技术的关键局限性。当前的诊断标准，如白光内镜检查（WLE），往往无法检测到早期病变，尤其是在巴雷特食管或炎症性肠病患者等高风险人群中。为了克服这些挑战，使用荧光分子探针的分子内镜检查可以通过靶向疾病特异性生物标志物提供终极精度。共聚焦激光显微内镜（CLE）和免疫内镜等技术正在彻底改变体内诊断，能够实时可视化组织微结构和生理机制。荧光分子内镜检查（FME）通过突出细微的分子变化，增强了对癌前病变和癌性病变的检测，即使是传统方法无法检测到的病变。临床应用包括早期肿瘤检测、治疗反应监测和改进病变特征描述。尽管取得了这些进展，但挑战依然存在，包括成本高昂、缺乏标准化以及需要专门培训。最近的创新，如多参数刚性标准，旨在确保FME系统的可靠性能评估和质量控制，解决主观变异性并提高可重复性。此外，人工智能（AI）与分子内镜检查的整合有可能进一步减少检测误差并显著提高诊断准确性。这一进展强调了分子内镜检查在个性化胃肠疾病管理中的潜力，同时突出了持续研究以完善该技术、验证其临床效用并克服常规临床应用障碍的必要性。
