Nektar Therapeutics

Johanna Moser

The adoption of modern endoscopic technology has improved the probability of precancerous lesions and early-stage cancers being diagnosed.

Gastrointestinal (GI) tumors are the most commonly diagnosed cancer globally, and they are also the second greatest cause of cancer-related death. For the diagnosis of GI tumors, endoscopy is the standard method. Early detection of precancerous or early-stage GI tumors by endoscopy may reduce the prevalence and mortality rate of GI cancers. Endoscopic therapies' preventive role and the limits of traditional white-light endoscopy have spawned a slew of new ideas. Early detection of lesions can be achieved by chromoendoscopy with dye injection. However, chromoendoscopy has drawbacks, such as a long process time and a high learning curve.

Using digital chromoendoscopy technologies, such as flexible spectral-imaging color enhancement, narrow-band imaging, and I-Scan, recent technological breakthroughs in image enhancement have permitted the identification of GI lesions without the requirement for dye injection. Digital endoscopic technologies have expanded the diagnostic utility of endoscopy by combining endoscopic image magnification and high-definition optical equipment. In vivo, endoscopic diagnosis has also improved with the development of confocal laser endomicroscopy.

Endoscopy has undergone dramatic changes in recent years. Kudo et al6 created a chromoendoscopy method that has boosted the diagnosis of early-stage tumors and precancerous lesions. This dye-based approach is time-consuming and difficult to master, necessitating the creation of new technologies.

The generation of endoscopic lesion images without the use of dyes is possible due to the employment of virtual optical filters, magnification, and mobile, high-resolution optical devices and software. The standard white-light endoscopic view option is one of the most fundamental features of these systems. The ability to generate chromoendoscopy-like images in a short amount of time by merely pressing a button on the endoscope is a significant benefit that eliminates the need for dye. Furthermore, endoscopists quickly adapt to digital chromoendoscopy, and the learning curve is minimal.

Confocal laser endomicroscopy (CLE), which uses a laser as a light source rather than white light, is a significant advancement in endoscopy. A tiny microscope can be placed on top of the endoscope to view the mucosa, allowing for simultaneous in vivo histologic identification of lesions. The concept of optical biopsy was born as a result of this technology.

Using a variety of new endoscopic tools, the expected rates of histopathologic diagnosis have grown dramatically. However, endoscopists disagree on how to interpret the images generated by these novel technologies, and no consensus has yet been achieved. Although there are a variety of categories in the literature, most of them are based on the interpretation of superficial lesion patterns and microvasculature architecture. Endoscopic procedures for removing precancerous and early-stage tumors, such as polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection, reduce the incidence of GI cancers, as well as the related mortality and morbidity rates.