Vani J.A. Konda M.D.

Gupta, N., V. Konda and U. Siddiqui (2017). “Gastric cardia lesion with abnormal volumetric laser endomicroscopy imaging.” Gastrointest Endosc: 2017 Aug [Epub ahead of print].

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A 71-year-old male with a history of epigastric pain and dyspepsia had previously been found to have Barrett’s esophagus (BE) with low-grade dysplasia. He presented to our institution for repeat EGD to thoroughly assess the Barrett’s segment. EGD showed short-segment BE with a 2-cm area of nodular, polypoid-appearing mucosa on the gastric cardia side of the gastroesophageal junction (A). The area was examined by high-definition white-light endoscopy (WLE) and narrow-band imaging (NBI) with near focus (A). Volumetric laser endomicroscopy (VLE) was also used (NVisionVLE, NinePoint Medical) and showed suspicious features including irregular surface (blue arrow) and atypical glands (red circle) in the area corresponding to the nodular mucosa (B).

Konda, V. J. A. (2017). “Computer-aided diagnosis: Further eliminating the human factor in endoscopy?” Endoscopy 49(8): 734-735.

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Advanced imaging modalities in endoscopy provide visualization of the tissue in greater detail than what can be obtained by gross visualization through white-light endoscopy. Magnifying chromoendoscopy, digital chromoendoscopy with magnification, confocal laser endomicroscopy, and ultra-high endocytoscopy provide images that enhance mucosal, vascular, or even cellular visualization. Advanced imaging technologies provide an image, but that image is only useful if it can be correctly interpreted in a clinically meaningful way. In the colon, advanced imaging has the potential to improve a range of clinical outcomes. For example, the use of narrowband imaging may be used to diagnose diminutive colon polyps, and meets thresholds to consider a resect and discard strategy to minimize cost, time, and risk [1]. On the other end of the spectrum, advanced imaging with endocytoscopy may provide information to determine which lesions are amenable to endoscopic resection by providing a real-time method to diagnose invasive cancer [2].