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World J Gastroenterol. Mar 21, 2022; 28(11): 1113-1122
Published online Mar 21, 2022. doi: 10.3748/wjg.v28.i11.1113
Advanced imaging and artificial intelligence for Barrett's esophagus: What we should and soon will do
Marco Spadaccini, Edoardo Vespa, Viveksandeep Thoguluva Chandrasekar, Madhav Desai, Harsh K Patel, Roberta Maselli, Alessandro Fugazza, Silvia Carrara, Andrea Anderloni, Gianluca Franchellucci, Alessandro De Marco, Cesare Hassan, Pradeep Bhandari, Prateek Sharma, Alessandro Repici
Marco Spadaccini, Edoardo Vespa, Roberta Maselli, Alessandro Fugazza, Silvia Carrara, Andrea Anderloni, Gianluca Franchellucci, Alessandro De Marco, Alessandro Repici, Department of Endoscopy, Humanitas Research Hospital, IRCCS, Rozzano 20089, Italy
Marco Spadaccini, Edoardo Vespa, Roberta Maselli, Gianluca Franchellucci, Alessandro De Marco, Alessandro Repici, Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
Viveksandeep Thoguluva Chandrasekar, Department of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ 85054, United States
Madhav Desai, Prateek Sharma, Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO 66045, United States
Harsh K Patel, Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA 70124, United States
Cesare Hassan, Endoscopy Unit, Nuovo Regina Margherita Hospital, Roma 00153, Italy
Pradeep Bhandari, Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, United Kingdom
Pradeep Bhandari, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO6 3LY, United Kingdom
Author contributions: Spadaccini M and Vespa E equally contributed to this work; All authors substantially contributed to the conception and design of the study, acquisition of data, or analysis and interpretation of data, and final approval of the version of the article to be published; Spadaccini M and Vespa E drafted the article; Vespa E, Chandrasekar VT, Desai M, Patel HK, Maselli R, Fugazza A, Carrara S, Anderloni A, Franchellucci G, De Marco A, Hassan C, Bhandari P, Sharma P, and Repici A critically revised the important intellectual content of the manuscript.
Conflict-of-interest statement: Maselli R reports consulting fees for Fuji; Anderloni A reports consulting fees for Olympus and Medtronic; Carrara S reports consulting fees for Olympus and Medtronic; Fugazza A reports consulting fees for Olympus; Hassan C reports consulting fees for Fuji and Medtronic; Repici A reports consulting fees for Fuji, Olympus, and Medtronic; All other authors declare no competing interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco Spadaccini, MD, Doctor, Department of Endoscopy, Humanitas Research Hospital, IRCCS, Via Manzoni 56, Rozzano 20089, Italy. marco.spadaccini@humanitas.it
Received: July 19, 2021
Peer-review started: July 19, 2021
First decision: August 6, 2021
Revised: August 12, 2021
Accepted: February 12, 2022
Article in press: February 12, 2022
Published online: March 21, 2022
Abstract

Barrett’s esophagus (BE) is a well-established risk factor for esophageal adenocarcinoma. It is recommended that patients have regular endoscopic surveillance, with the ultimate goal of detecting early-stage neoplastic lesions before they can progress to invasive carcinoma. Detection of both dysplasia or early adenocarcinoma permits curative endoscopic treatments, and with this aim, thorough endoscopic assessment is crucial and improves outcomes. The burden of missed neoplasia in BE is still far from being negligible, likely due to inappropriate endoscopic surveillance. Over the last two decades, advanced imaging techniques, moving from traditional dye-spray chromoendoscopy to more practical virtual chromoendoscopy technologies, have been introduced with the aim to enhance neoplasia detection in BE. As witnessed in other fields, artificial intelligence (AI) has revolutionized the field of diagnostic endoscopy and is set to cover a pivotal role in BE as well. The aim of this commentary is to comprehensively summarize present evidence, recent research advances, and future perspectives regarding advanced imaging technology and AI in BE; the combination of computer-aided diagnosis to a widespread adoption of advanced imaging technologies is eagerly awaited. It will also provide a useful step-by-step approach for performing high-quality endoscopy in BE, in order to increase the diagnostic yield of endoscopy in clinical practice.

Keywords: Barrett’s esophagus, Endoscopy, Artificial intelligence, Surveillance, Advanced imaging, Neoplasia

Core Tip: It is recommended that patients with Barrett’s esophagus (BE) have regular endoscopic surveillance, with the ultimate goal of detecting early-stage neoplastic lesions, before they could progress to invasive carcinoma. Over the last two decades advanced imaging techniques, from traditional dye-spray chromoendoscopy to more practical virtual chromoendoscopy technologies, have been introduced with the aim to enhance neoplasia detection in BE. As witnessed in other fields, artificial intelligence (AI) has revolutionized the field of diagnostic endoscopy and is set to cover a pivotal role in BE as well. In this commentary, we summarize recent research advances and provide future perspectives regarding advanced imaging technology and AI in BE. It also provides a useful step-by-step approach for performing high-quality endoscopy in BE, in order to increase the diagnostic yield of endoscopy in clinical practice.