Kyoto classification of gastritis,virtual chromoendoscopy and artificial intelligence:Where are we going?What do we need?

Chronic gastritis(CG)is a widespread and frequent disease,mainly caused by Helicobacter pylori infection,which is associated with an increased risk of gastric cancer.Virtual chromoendoscopy improves the endoscopic diagnostic efficacy,which is essential to establish the most appropriate therapy and to enable cancer prevention.Artificial intelligence provides algorithms for the diagnosis of gastritis and,in particular,early gastric cancer,but it is not yet used in practice.Thus,technological innovation,through image resolution and processing,optimizes the diagnosis and management of CG and gastric cancer.The endoscopic Kyoto classification of gastritis improves the diagnosis and management of this disease,but through the analysis of the most recent literature,new algorithms can be proposed.

Virtual chromoendoscopy in small bowel capsule endoscopy: New light or a cast of shadow?

AIM: To evaluate whether virtual chromoendoscopy can improve the delineation of small bowel lesions previously detected by conventional white light small bowel capsule endoscopy(SBCE). METHODS: Retrospective single center study. One hundred lesions selected from forty-nine consecutive conventional white light SBCE(SBCE-WL) examinations were included. Lesions were reviewed at three Flexible Spectral Imaging Color Enhancement(FICE) settings and Blue Filter(BF) by two gastroenterologists with ex-perience in SBCE, blinded to each other's findings, whoranked the quality of delineation as better, equivalent or worse than conventional SBCE-WL. Inter-observer percentage of agreement was determined and analyzed with Fleiss Kappa(k) coefficient. Lesions selected for the study included angioectasias(n = 39), ulcers/ero-sions(n = 49) and villous edema/atrophy(n = 12). RESULTS: Overall, the delineation of lesions was im-proved in 77% of cases with FICE 1, 74% with FICE 2, 41% with FICE 3 and 39% with the BF, with a percent-age of agreement between investigators of 89%(k = 0.833), 85%(k = 0.764), 66%(k = 0.486) and 79%(k = 0.593), respectively. FICE 1 improved the delineation of 97.4% of angioectasias, 63.3% of ulcers/erosions and 66.7% of villous edema/atrophy with a percentage of agreement of 97.4%(k = 0.910), 81.6%(k = 0.714) and 91.7%(k = 0.815), respectively. FICE 2 improved the delineation of 97.4% of angioectasias, 57.1% of ulcers/erosions and 66.7% of villous edema/atrophy, with a percentage of agreement of 89.7%(k = 0.802), 79,6%(k = 0.703) and 91.7%(k = 0.815), respectively. FICE 3 improved the delineation of 46.2% of angioecta-sias, 24.5% of ulcers/erosions and none of the cases of villous edema/atrophy, with a percentage of agreement of 53.8% [k = not available(NA)], 75.5%(k = NA) and 66.7%(k = 0.304), respectively. The BF improved the delineation of 15.4% of angioectasias, 61.2% of ulcers/erosions and 25% of villous edema/atrophy, with a per-centage of agreement of 76.9%(k = 0.558), 81.6%(k = 0.570) and 25.0%(k = NA), respectively.CONCLUSION: Virtual chromoendoscopy can improve the delineation of angioectasias, ulcers/erosions and villous edema/atrophy detected by SBCE, with almost perfect interobserver agreement for FICE 1.

Endoscopic diagnosis and treatment of early esophageal squamous neoplasia

Esophageal cancer is one of the leading causes of cancer-related death and is associated with high morbidity and mortality.It carries a poor prognosis as more than half of patients present with advanced and unresectable disease.One contributing factor is the increased risk of lymph node metastases at early stages of disease.As such,it is essential to detect squamous cell neoplasia (SCN) at an early stage.In order to risk stratify lesions,endoscopists must be able to perform image enhanced endoscopy including magnification and Lugol's chromoendoscopy.The assessment of both the horizontal extent and depth of any lesion is also of utmost importance prior to treatment.Endoscopic mucosal resection and submucosal dissection remain the standard of care with literature supportive their respective use.Radiofrequency ablation and other endoscopic treatments are currently available although should not be considered first line at this time.Our objective is to review the current options for the endoscopic diagnosis and treatment of esophageal SCN.