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IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-06-01 DOI: 10.1016/S1521-6918(25)00061-7
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引用次数: 0
Screening for and surveillance of premalignant conditions of the stomach 胃癌前病变的筛查和监测
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.bpg.2025.101978
Irina Luzko , Leticia Moreira , Jan Bornschein
Strategies for population-based screening are thus far only implemented in high incidence countries such as South Korea or Japan with data showing a positive impact on gastric cancer mortality. Screening in most Western countries is deemed not cost-effective as these are mainly classified as low or intermediate risk regions. This is in part due to high costs for endoscopy as the diagnostic gold-standard. Blood testing for serum pepsinogens is implemented as a pre-screening tool in some Asian countries but can better highlight mucosal atrophy than the cancer itself. Endoscopic surveillance of patients with advanced preneoplastic conditions allows detection of early neoplastic lesions that can be treated endoscopically, resulting in better outcome, and is hence now also recommended by several European countries. However, there is no uniform approach, so screening and surveillance strategies need to take regional characteristics into account including gastric cancer incidence and cost for endoscopy among others.
迄今为止,基于人群的筛查策略仅在韩国或日本等高发病率国家实施,数据显示对胃癌死亡率有积极影响。大多数西方国家的筛查被认为不具有成本效益,因为这些国家主要被归类为低风险或中等风险地区。这在一定程度上是由于内窥镜检查作为诊断的黄金标准成本高昂。在一些亚洲国家,血清胃蛋白酶原的血液检测是一种预先筛查工具,但它比癌症本身更能突出粘膜萎缩。对晚期肿瘤前病变患者进行内窥镜监测可以发现早期肿瘤病变,这些病变可以通过内窥镜治疗,从而获得更好的结果,因此现在也被一些欧洲国家推荐。然而,没有统一的方法,因此筛查和监测策略需要考虑区域特征,包括胃癌发病率和内镜检查费用等。
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引用次数: 0
Cost effectiveness analysis of Barrett's esophagus screening: A systematic review Barrett食管筛查的成本-效果分析:一项系统综述
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.bpg.2025.101980
Caroline L. Matchett , Mert Sahinkoc , Jagpreet Chhatwal , John B. Kisiel , Prasad G. Iyer
Barrett's esophagus screening is critical for early detection of esophageal adenocarcinoma, but optimal strategies remain debated. This systematic review analyzed thirteen studies evaluating screening cost-effectiveness through September 2024. Both traditional endoscopic and emerging non-endoscopic methods were cost-effective compared to no screening, with incremental cost-effectiveness ratios below standard willingness-to-pay thresholds. Non-endoscopic approaches, particularly swallowed cell collection devices with biomarkers, demonstrated superior cost-effectiveness versus standard endoscopy. Cost-effectiveness improved in populations with higher disease prevalence. Current evidence supports implementing screening programs, especially using non-endoscopic methods in high-risk populations. Future research should focus on validating risk stratification tools to further optimize screening approaches.
Barrett食管筛查对于早期发现食管腺癌至关重要,但最佳策略仍存在争议。本系统综述分析了截至2024年9月评估筛查成本效益的13项研究。与不进行筛查相比,传统的内镜和新兴的非内镜方法都具有成本效益,增量成本-效果比低于标准的支付意愿阈值。与标准内窥镜相比,非内窥镜方法,特别是带有生物标志物的吞下细胞收集装置,显示出更高的成本效益。在疾病流行率较高的人群中,成本效益得到改善。目前的证据支持实施筛查方案,特别是在高危人群中使用非内窥镜方法。未来的研究应侧重于验证风险分层工具,以进一步优化筛查方法。
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引用次数: 0
Novel devices and biomarkers in screening for esophageal squamous cell cancer 用于食管鳞状细胞癌筛查的新设备和生物标志物
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.bpg.2025.102005
Wladyslaw Januszewicz , Karol Nowicki-Osuch
Esophageal squamous cell carcinoma (ESCC) remains a significant global health challenge, with high mortality rates primarily due to late-stage diagnosis. Detecting ESCC at an early stage, when still amenable to endoscopic resection, could potentially improve survival outcomes and help reduce the overall disease burden. However, despite being the gold standard for ESCC diagnosis, conventional endoscopy has several limitations that hinder its widespread implementation for screening purposes. These include high-costs, invasiveness, suboptimal sensitivity in identifying precancerous lesions, and prerequisite specialized personnel and facilities. In this review, we aim to discuss the current ESCC screening practices and explore emerging screening methods incorporating novel diagnostic devices and biomarkers.
We first present advancements in endoscopic imaging techniques aimed at improving diagnostic accuracy and reducing operator dependency. These include artificial intelligence (AI)-assisted endoscopy, which enhances lesion detection, and confocal laser endomicroscopy, which enables real-time cellular-level assessment. Next, we explore the available non-endoscopic screening modalities such as swallowable cytology-based sampling devices. These minimally invasive tools, when combined with AI-assisted cytological analysis and molecular biomarkers, offer a viable alternative to conventional biopsy for early ESCC detection. We then provide an overview of circulating biomarkers, including circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), microRNAs, and protein-based markers, summarizing the current state of research on liquid biopsies and their potential role in ESCC screening. Additionally, we discuss breath and salivary diagnostics as emerging cost-effective, non-invasive approaches. Finally, we present the latest insights into tissue biomarkers, highlighting their relevance in identifying precancerous lesions and stratifying risk in ESCC screening.
食管鳞状细胞癌(ESCC)仍然是一个重大的全球健康挑战,其高死亡率主要是由于晚期诊断。在早期阶段检测ESCC,当仍然适合内镜切除时,可能会改善生存结果,并有助于减轻总体疾病负担。然而,尽管作为ESCC诊断的金标准,常规内窥镜检查有几个限制,阻碍了其在筛查目的中的广泛实施。这些因素包括高成本、侵入性、识别癌前病变的灵敏度不够理想,以及必要的专业人员和设施。在这篇综述中,我们旨在讨论当前ESCC的筛查实践,并探索结合新型诊断设备和生物标志物的新兴筛查方法。我们首先介绍了内窥镜成像技术的进展,旨在提高诊断准确性和减少对操作者的依赖。其中包括人工智能(AI)辅助内窥镜检查,增强病变检测,共聚焦激光内窥镜检查,实现实时细胞水平评估。接下来,我们探讨可用的非内窥镜筛查方式,如可吞咽细胞学为基础的取样装置。这些微创工具与人工智能辅助细胞学分析和分子生物标志物相结合,为早期ESCC检测提供了一种可行的替代方法。然后,我们概述了循环生物标志物,包括循环肿瘤DNA (ctDNA)、循环肿瘤细胞(CTCs)、microrna和基于蛋白质的标志物,总结了液体活检的研究现状及其在ESCC筛查中的潜在作用。此外,我们讨论呼吸和唾液诊断作为新兴的成本效益,非侵入性的方法。最后,我们介绍了组织生物标志物的最新见解,强调了它们在ESCC筛查中识别癌前病变和分层风险方面的相关性。
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引用次数: 0
Artificial intelligence in early screening for esophageal squamous cell carcinoma 人工智能在食管鳞状细胞癌早期筛查中的应用
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.bpg.2025.102004
Si-yan Yan , Xin-yu Fu , Yan Yang , Liu-yi Jia , Jia-wei Liang , Ying-hui Li , Ling-ling Yan , Ying Zhou , Xian-bin Zhou , Shao-wei Li , Xin-li Mao
Esophageal squamous cell carcinoma (ESCC) remains a significant global health burden with high incidence and mortality rates, particularly in developing regions. Early detection is crucial for improving patient survival, yet conventional screening methods such as endoscopy and non-endoscopic techniques face limitations in accuracy, cost, and dependency on clinician expertise. This review explores the transformative role of artificial intelligence (AI) in ESCC screening. AI technologies, including machine learning, deep learning, and transfer learning, demonstrate remarkable potential for early ESCC screening by targeting high-risk populations, optimizing screening modalities, refining screening intervals, and enhancing cost-effectiveness. AI-driven systems improve lesion detection, vascular pattern recognition, and risk prediction by integrating imaging, genomic, and clinical data. Additionally, AI applications in liquid biopsy analysis enable non-invasive detection of circulating tumor cells and DNA, further advancing early diagnosis. Despite these advancements, challenges such as dataset variability, model generalizability, algorithm transparency, and ethical and legal concerns require resolution to fully harness AI's capabilities. This paper highlights the current applications, persistent challenges, and future directions for AI in revolutionizing ESCC screening.
食管鳞状细胞癌(ESCC)仍然是全球重大的健康负担,发病率和死亡率高,特别是在发展中地区。早期发现对于提高患者生存率至关重要,然而传统的筛查方法,如内窥镜和非内窥镜技术,在准确性、成本和对临床医生专业知识的依赖方面存在局限性。本文综述了人工智能(AI)在ESCC筛查中的变革作用。人工智能技术,包括机器学习、深度学习和迁移学习,通过针对高危人群、优化筛查方式、优化筛查间隔和提高成本效益,在早期ESCC筛查中显示出巨大的潜力。人工智能驱动的系统通过整合成像、基因组和临床数据,改善了病变检测、血管模式识别和风险预测。此外,人工智能在液体活检分析中的应用可以实现循环肿瘤细胞和DNA的无创检测,进一步推进早期诊断。尽管取得了这些进步,但数据集可变性、模型泛化性、算法透明度以及道德和法律问题等挑战需要解决,以充分利用人工智能的能力。本文重点介绍了人工智能在革命性的ESCC筛选中的当前应用、持续挑战和未来方向。
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引用次数: 0
Early diagnosis of gastric cancer: Endoscopy and artificial intelligence 胃癌早期诊断:内镜与人工智能
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.bpg.2025.101979
N. Gonçalves , J. Chaves , I. Marques- Sá , M. Dinis-Ribeiro , D. Libânio
Early diagnosis of gastric cancer enables effective, minimally invasive and organ-sparing treatment throughout endoscopic resection. This technique offers low rates of adverse events, improved quality of life compared to surgery, and excellent disease-free survival when curative criteria are met.
Upper gastrointestinal endoscopy with biopsies is the gold standard for diagnosing either pre-malignant conditions or gastric cancer but high-quality endoscopy is paramount to avoid missing lesions. Also, adequate endoscopic assessment of a gastric lesion is crucial to select patients for endoscopic resection and remains the best predictor for curative resection. However, curative resection rates have been stable at around 80–85 % in recent years, so there is room for improvement in patient/lesion selection for endoscopic resection.
This review intends to address strategies that can be pursued to optimize upper gastrointestinal endoscopy quality, improve gastric lesion detection and characterization, and unveil how Artificial Intelligence can contribute to this process in the near future.
胃癌的早期诊断可以在整个内镜切除过程中实现有效、微创和保留器官的治疗。与手术相比,该技术的不良事件发生率低,生活质量提高,当满足治疗标准时,无病生存期很好。上消化道内窥镜活检是诊断癌前病变或胃癌的金标准,但高质量的内窥镜检查对于避免遗漏病变至关重要。此外,对胃病变进行充分的内镜评估对于选择内镜切除的患者至关重要,并且仍然是治疗性切除的最佳预测指标。然而,近年来治愈率稳定在80 - 85%左右,因此内镜下切除的患者/病变选择仍有提高的空间。本文旨在探讨优化上消化道内窥镜检查质量、提高胃病变检测和表征的策略,并揭示人工智能在不久的将来如何在这一过程中发挥作用。
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引用次数: 0
Preface to special edition: Screening and Early diagnosis of upper gastrointestinal neoplastic lesions 特刊前言:上消化道肿瘤病变的筛查与早期诊断
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.bpg.2025.101983
J. Honing , M. Dinis-Ribeiro
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引用次数: 0
Barrett's esophagus screening: Current modalities, risk-based approaches, and future perspectives 巴雷特食管筛查:当前模式,基于风险的方法,和未来的前景
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.bpg.2025.101989
Nanda Provoost , Rebecca C. Fitzgerald , Judith Honing
Barrett's Esophagus (BE) is a precursor lesion of esophageal adenocarcinoma (EAC). To enable early detection of neoplasia, BE patients undergo regular endoscopic surveillance. However, more than 90 % of EAC patients were not previously diagnosed with the precursor BE, indicating that detection practices are inadequate. Screening for BE could be a strategy to detect BE in the general population, bridging the gap in early diagnosis. Given the limitations of affordable and accessible endoscopy methods for widespread use, efforts should prioritize targeted screening of at-risk individuals using less invasive approaches. For instance, the use of cell collection devices coupled with biomarker assays in patients with GERD could offer a more cost-effective solution to identify undiagnosed cases. In this review, we provide a comprehensive overview of the at-risk population for BE, current screening modalities, and future perspectives to pave the way for effective and practical BE screening.
巴雷特食管(BE)是食管腺癌(EAC)的前兆病变。为了早期发现肿瘤,BE患者定期接受内镜检查。然而,超过90%的EAC患者以前没有被诊断出患有前体BE,这表明检测实践是不充分的。BE筛查可能是在普通人群中发现BE的一种策略,弥补了早期诊断的差距。鉴于广泛使用的可负担和可获得的内窥镜检查方法的局限性,应优先考虑使用侵入性较小的方法对高危人群进行有针对性的筛查。例如,在胃食管反流患者中使用细胞收集装置和生物标志物检测可以提供一种更具成本效益的解决方案,以识别未确诊的病例。在这篇综述中,我们全面概述了BE的高危人群,目前的筛查方式,以及未来的前景,为有效和实用的BE筛查铺平道路。
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引用次数: 0
Screening and surveillance of hereditary upper GI cancers 遗传性上消化道肿瘤的筛查和监测
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.bpg.2025.102018
Lianlian Wu , Massimiliano di Pietro
Upper GI cancer has poor prognosis. Of all upper GI malignancies, 1–3 % have a well-defined germline genetic cause. Hereditary upper GI cancers include squamous cell carcinoma as part of Tylosis, signet ring cell carcinoma of the stomach occurring in the context of hereditary diffuse gastric cancer syndrome, gastric adenocarcinoma affecting individuals with familial adenomatous polyposis syndrome (FAP), Gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS), Lynch, Juvenile Polyposis and Peutz-Jeghers Syndromes, and duodenal adenocarcinoma, for which individuals with FAP and Lynch syndromes are at increased risk. This review will discuss the management of people with suspected or confirmed hereditary syndromes related to increased risk of upper GI cancers, with particular reference to indication for genetic testing, age of start of endoscopic screening, best practice in relation to endoscopic surveillance and indication for surgery.
上消化道肿瘤预后较差。在所有上消化道恶性肿瘤中,1 - 3%有明确的生殖系遗传病因。遗传性上消化道癌症包括作为Tylosis一部分的鳞状细胞癌,发生在遗传性弥漫性胃癌综合征背景下的胃印戒细胞癌,发生在家族性腺瘤性息肉病综合征(FAP)个体的胃腺癌,胃腺癌和近端胃息肉病(GAPPS), Lynch,青少年息肉病和Peutz-Jeghers综合征,以及十二指肠腺癌。患有FAP和Lynch综合征的人患病风险更高。本综述将讨论与上消化道癌症风险增加相关的疑似或确诊遗传综合征患者的管理,特别涉及基因检测的适应症、开始内镜筛查的年龄、与内镜监测有关的最佳实践和手术适应症。
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引用次数: 0
Advances towards gastric cancer screening: Novel devices and biomarkers 胃癌筛查的新进展:新设备和生物标志物
IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-03-01 DOI: 10.1016/j.bpg.2025.102009
Catarina Lopes , Carina Pereira
Gastric cancer is a pressing global health issue that ranks fifth as the most commonly diagnosed malignancy and leading cause of cancer-related deaths. Early detection is critical for improving patient outcomes, with five-year survival rates exceeding 90 % when diagnosed at initial stages. Current screening modalities, primarily reliant on upper gastrointestinal endoscopy, are highly accurate, but not without limitations, such as invasiveness, high cost, low adherence and accessibility.
Hence, this review aligns with the ongoing efforts to answer the pressing need for innovative approaches, emphasising novel devices and biomarker advancements over the last decade. We highlight non-endoscopic methods such as magnetically controlled capsule endoscopy and point-of-care testing. Additionally, we will provide an overview into the field of liquid biopsies and emerging biomarkers in GC detection, towards accurate, less invasive and costly screening tools that hold the promise for greater accessibility and citizen involvement.
胃癌是一个紧迫的全球健康问题,排名第五,是最常见的恶性肿瘤,也是癌症相关死亡的主要原因。早期发现对于改善患者预后至关重要,在初始阶段得到诊断的5年生存率超过90%。目前的筛查方式,主要依赖于上消化道内窥镜,是高度准确的,但并非没有限制,如侵入性,高成本,低依从性和可及性。因此,这篇综述与正在进行的努力相一致,以回答对创新方法的迫切需求,强调在过去十年中新设备和生物标志物的进步。我们强调非内窥镜方法,如磁控胶囊内窥镜和即时检测。此外,我们将概述气相色谱检测中的液体活检和新兴生物标志物领域,以实现准确,侵入性低,成本高的筛选工具,这些工具有望提高可及性和公民参与度。
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引用次数: 0
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Best Practice & Research Clinical Gastroenterology
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