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| 1 | Recent advances in diagnostic upper endoscopy显示文摘BACKGROUND Esophageo-gastro-duodenoscopy(EGD)is an important procedure used for detection and diagnosis of esophago-gastric lesions.There exists no consensus on the technique of examination.AIM To identify recent advances in diagnostic EGDs to improve diagnostic yield.METHODS We queried the PubMed database for relevant articles published between January 2001 and August 2019 as well as hand searched references from recently published endoscopy guidelines.Keywords used included free text and MeSH terms addressing quality indicators and technological innovations in EGDs.Factors affecting diagnostic yield and EGD quality were identified and divided into the follow segments:Pre endoscopy preparation,sedation,examination schema,examination time,routine biopsy,image enhanced endoscopy and future developments.RESULTS We identified 120 relevant abstracts of which we utilized 67 of these studies in our review.Adequate pre-endoscopy preparation with simethicone and pronase increases gastric visibility.Proper sedation,especially with propofol,increases patient satisfaction after procedure and may improve detection of superficial gastrointestinal lesions.There is a movement towards mandatory picture documentation during EGD as well as dedicating sufficient time for examination improves diagnostic yield.The use of image enhanced endoscopy and magnifying endoscopy improves detection of squamous cell carcinoma and gastric neoplasm.The magnifying endoscopy simple diagnostic algorithm is useful for diagnosis of early gastric cancer.CONCLUSION There is a steady momentum in the past decade towards improving diagnostic yield,quality and reporting in EGDs.Other interesting innovations,such as Raman spectroscopy,endocytoscopy and artificial intelligence may have widespread endoscopic applications in the near future. | Jun-Liang Teh Asim Shabbir Soon Yuen Jimmy Bok-Yan So | 2020 | World Journal of Gastroenterology2020，26，4： | 15 |
| 2 | Barrett's oesophagus: Evidence from the current metaanalyses显示文摘Guidelines have been published regarding the management of Barrett's oesophagus(columnar-lined oesophagus). These have examined the role of surveillance in an effort to detect dysplasia and early cancer. The guidelines have provided criteria for enrolment into surveillance and some risk stratification with regard to surveillance interval. The research basis for the decisions reached with regard to cancer risk is weak and this manuscript has examined the available data published from meta-analyses up to 25 th April 2013(much of which has been published since the guidelines and their most recent updates have been written). There were 9 meta-analyses comparing patients with Barrett's oesophagus to control populations. These have demonstrated that Barrett's oesophagus is more common in males than females, in subjects who have ever smoked, in subjects with obesity, in subjects with prolonged symptoms of gastro-oesophageal reflux disease, in subjects who do not have infection with Helicobacter pylori and in subjects with hiatus hernia. These findings should inform public health measures in reducing the risk of Barrett's oesophagus and subsequent surveillance burden and cancer risk. There were 8 meta-analyses comparing different groups of patients with Barrett's oesophagus with regard to cancer risk. These have demonstrated that there was no statistically significant benefit of antireflux surgery over medical therapy, that endoscopic ablative therapy was effective in reducing cancer risk that there was similar cancer risk in patients with Barrett's oesophagus independent of geographic origin, that the adenocarcinoma incidence in males is twice the rate in females, that the cancer risk in long segment disease showed a trend to be higher than in short segment disease, that there was a trend for higher cancer risk in low-grade dysplasia over non-dysplastic Barrett's oesophagus, that there is a lower risk in patients with Helicobacter pylori infection and that there is a significant protective effect of aspirin and statins. There were no meta-analyses examining the role of intestinal metaplasia. These results demonstrate that guidance regarding surveillance based on the presence of intestinal metaplasia, segment length and the presence of low-grade dysplasia has a weak basis, and further consideration should be given to gender and helicobacter status, ablation of the metaplastic segment as well as the chemoprotective role of aspirin and statins. | Piers Gatenby Yuen Soon | 2014 | World Journal of Gastrointestinal Pathophysiology2014，5，3： | 1 |
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