Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019.

1:  ESGE suggests that high definition endoscopy, and dye or virtual chromoendoscopy, as well as add-on devices, can be used in average risk patients to increase the endoscopist's adenoma detection rate. However, their routine use must be balanced against costs and practical considerations.Weak recommendation, high quality evidence. 2:  ESGE recommends the routine use of high definition systems in individuals with Lynch syndrome.Strong recommendation, high quality evidence. 3:  ESGE recommends the routine use, with targeted biopsies, of dye-based pancolonic chromoendoscopy or virtual chromoendoscopy for neoplasia surveillance in patients with long-standing colitis.Strong recommendation, moderate quality evidence. 4:  ESGE suggests that virtual chromoendoscopy and dye-based chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps and can replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained, as defined in the ESGE curriculum, and audited.Weak recommendation, high quality evidence. 5:  ESGE recommends the use of high definition white-light endoscopy in combination with (virtual) chromoendoscopy to predict the presence and depth of any submucosal invasion in nonpedunculated colorectal polyps prior to any treatment. Strong recommendation, moderate quality evidence. 6:  ESGE recommends the use of virtual or dye-based chromoendoscopy in addition to white-light endoscopy for the detection of residual neoplasia at a piecemeal polypectomy scar site. Strong recommendation, moderate quality evidence. 7:  ESGE suggests the possible incorporation of computer-aided diagnosis (detection and characterization of lesions) to colonoscopy, if acceptable and reproducible accuracy for colorectal neoplasia is demonstrated in high quality multicenter in vivo clinical studies. Possible significant risks with implementation, specifically endoscopist deskilling and over-reliance on artificial intelligence, unrepresentative training datasets, and hacking, need to be considered. Weak recommendation, low quality evidence.

Chromoendoscopy with hematoxylin in the classification of gastric lesions.

BACKGROUND: Hematoxylin is a basic histological stain which stains nuclei. Apparently, it can be used with endoscopy to diagnose malignant lesions due to their increased nucleus-tocytoplasm ratio. The aim of this study was to evaluate the use of hematoxylin in the differentiation of gastric lesions. METHODS: Part 1. In a prospective study, a total of 70 different gastric abnormalities were stained with 1% hematoxylin solution during upper endoscopy. Results of histological examinations were compared with endoscopic findings. Part 2. During a 5-day period, antral mucosa was stained with hematoxylin in all patients (n = 26), independent of the upper endoscopy results. Grades of stained mucosa were compared with the proliferating cell nuclear antigen (PCNA) index, which was examined using an immunohistochemical method. Part 3. Gastric biopsies (total, 12) were obtained from the stained and unstained areas within the limits of one lesion (total, 6) after chromoscopy with hematoxylin and examined with monoclonal (PCNA) antibodies. RESULTS: Using histological findings, the sensitivity and specificity of chromoendoscopy with hematoxylin for detecting gastric neoplasia and adenocarcinoma were determined. A significant positive correlation (r = 0.81; P < 0.001) was found between the PCNA index and grade of endoscopic stained mucosa. The PCNA index was increased in stained areas of gastric abnormalities in comparison to unstained areas within the limits of one lesion in all six patients. CONCLUSION: Chromoendoscopy with hematoxylin increases opportunities for precision biopsy. The grade of endoscopic stained mucosa depends on epithelial cell proliferation and is associated with malignancy. By using histology as the main outcome, the sensitivity and specificity of chromoendoscopy with hematoxylin for diffuse staining in the detection of gastric neoplasia and adenocarcinoma were 92.9% and 89.3%, respectively.