Design and Evaluation of ScanCap: A Low-Cost, Reusable Tethered Capsule Endoscope with Blue-Green Illumination Imaging for Unsedated Screening and Early Detection of Barrett's Esophagus.

Esophageal carcinoma is the sixth-leading cause of cancer death worldwide. A precursor to esophageal adenocarcinoma (EAC) is Barrett's Esophagus (BE). Early-stage diagnosis and treatment of esophageal neoplasia (Barrett's with high-grade dysplasia/intramucosal cancer) increase the five-year survival rate from 10% to 98%. BE is a global challenge; however, current endoscopes for early BE detection are costly and require extensive infrastructure for patient examination and sedation. We describe the design and evaluation of the first prototype of ScanCap, a high-resolution optical endoscopy system with a reusable, low-cost tethered capsule, designed to provide high-definition, blue-green illumination imaging for the early detection of BE in unsedated patients. The tethered capsule (12.8 mm diameter, 35.5 mm length) contains a color camera and rotating mirror and is designed to be swallowed; images are collected as the capsule is retracted manually via the tether. The tether provides electrical power and illumination at wavelengths of 415 nm and 565 nm and transmits data from the camera to a tablet. The ScanCap prototype capsule was used to image the oral mucosa in normal volunteers and ex vivo esophageal resections; images were compared to those obtained using an Olympus CV-180 endoscope. Images of superficial capillaries in intact oral mucosa were clearly visible in ScanCap images. Diagnostically relevant features of BE, including irregular Z-lines, distorted mucosa, and dilated vasculature, were clearly visible in ScanCap images of ex vivo esophageal specimens.

Prevalence of esophageal inlet patch and clinical characteristics of the patients. / Prevalencia y características clínicas de pacientes con parche de mucosa gástrica ectópica en esófago.

INTRODUCTION AND AIMS: An inlet patch (IP) is the presence of gastric columnar epithelium outside of the stomach. No studies have been conducted in Mexico on that pathology. The aim of the present study was to determine the prevalence of esophageal IP and the clinical characteristics of the patients that present it. MATERIALS AND METHODS: A cross-sectional study was conducted that included consecutive patients referred for endoscopy within the time frame of September 2015 to May 2016. The patients answered a questionnaire, and high-definition endoscopy with digital chromoendoscopy was performed. The prevalence of IP was identified. The chi-square test was used to compare the clinical characteristics between patients that presented with esophageal IP and those without it. RESULTS: A total of 239 patients were included in the study. Their mean age was 53 years, and 130 (54.4%) were women. IP was found in 26 patients (10.9%), 15 of whom were men (57.7%). The main reason for referral to endoscopy was gastroesophageal reflux disease, present in 69.2% of the patients with IP and in 55.9% without IP (p=.19). The most common symptoms were heartburn and regurgitation. The former was present in 69.2% of the patients with IP and in 59.1% without IP (p=.32), and the latter was present in 65.4% of the patients with IP and 69.1% without IP (p=.7). Extraesophageal manifestation distribution was: cough in 46.2% of the patients with IP and 38% without IP (p=.45) and dysphonia in 54% with IP and 47% without IP (p=.53). Twenty-three percent of the patients with IP had Barrett's esophagus, as did 23% without IP (p=.99). CONCLUSIONS: The prevalence of IP was high. The primary referral diagnosis was gastroesophageal reflux disease. No differences were found in relation to symptoms or the presence of Barrett's esophagus between the patients with and without IP.

Evaluation of New Technologies in Gastrointestinal Endoscopy.

Gastrointestinal (GI) tumors are the most commonly diagnosed cancers worldwide and the second leading cause of cancer-related death. Endoscopy is the gold standard for diagnosis of GI cancers. Early diagnosis of GI tumors by endoscopy at the precancerous or early stage may decrease the prevalence and mortality rate of GI cancers. The preventive role of endoscopic interventions and the limitations of conventional white-light endoscopy have given rise to myriad innovations. Chromoendoscopy with dye injection can be used to detect lesions at an early stage. However, the prolonged procedure duration and steep learning curve are disadvantages of chromoendoscopy. Recent technological advances in imaging enhancement have enabled detection of GI lesions without the need for dye injection, using digital chromoendoscopy systems, of which flexible spectral-imaging color enhancement, narrow-band imaging, and I-Scan are the most frequently used. The combination of endoscopic image magnification and high-definition optical systems using digital endoscopic methods has increased the diagnostic value of endoscopy. The development of confocal laser endomicroscopy has also improved in vivo endoscopic diagnosis. This review focuses on the latest technological innovations in endoscopy.

Ancillary imaging techniques and adenoma detection.

Advancements in image technology have allowed recognition of mucosal architecture in more detail and may improve adenoma detection. This review provides a technical overview on individual imaging technologies and their effect on detection of adenomas. Only high-definition endoscopy has been shown to improve detection of small adenomas. None of the digital chromoendoscopy technologies improves adenoma detection. Limited studies on autoimmunfluorescence imaging in conjunction with high-definition endoscopy may improve detection of small adenomas.