Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2020; 26(4): 433-447
Published online Jan 28, 2020. doi: 10.3748/wjg.v26.i4.433
Recent advances in diagnostic upper endoscopy
Jun-Liang Teh, Asim Shabbir, Soon Yuen, Jimmy Bok-Yan So
Jun-Liang Teh, Asim Shabbir, Soon Yuen, Jimmy Bok-Yan So, Department of Surgery, National University Hospital System, Singapore 119228, Singapore
Jun-Liang Teh, Soon Yuen, Department of Surgery, Jurong Health Campus, National University Health System, Singapore 609606, Singapore
Jimmy Bok-Yan So, Department of Surgery, National University of Singapore, Singapore 119074, Singapore
Author contributions: Teh JL designed the research, performed the article search and drafted the manuscript; Shabbir A and Yuen S designed the research and proof-read the article; So JBY designed the research, performed the article search, drafted and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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 Non Commercial (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: Jimmy Bok-Yan So, MbChB, MPH, FAMS, Professor of Surgery, Department of Surgery, National University Hospital, Level 8 Towerblock, Singapore 119228, Singapore. jimmy_so@nuhs.edu.sg
Received: October 13, 2019
Peer-review started: October 13, 2019
First decision: December 5, 2019
Revised: January 10, 2020
Accepted: January 15, 2020
Article in press: January 14, 2020
Published online: January 28, 2020
Abstract
BACKGROUND

Esophageo-gastro-duodenoscopy (EGD) is an important procedure used for detection and diagnosis of esophago-gastric lesions. There exists no consensus on the technique of examination.

AIM

To identify recent advances in diagnostic EGDs to improve diagnostic yield.

METHODS

We queried the PubMed database for relevant articles published between January 2001 and August 2019 as well as hand searched references from recently published endoscopy guidelines. Keywords used included free text and MeSH terms addressing quality indicators and technological innovations in EGDs. Factors affecting diagnostic yield and EGD quality were identified and divided into the follow segments: Pre endoscopy preparation, sedation, examination schema, examination time, routine biopsy, image enhanced endoscopy and future developments.

RESULTS

We identified 120 relevant abstracts of which we utilized 67 of these studies in our review. Adequate pre-endoscopy preparation with simethicone and pronase increases gastric visibility. Proper sedation, especially with propofol, increases patient satisfaction after procedure and may improve detection of superficial gastrointestinal lesions. There is a movement towards mandatory picture documentation during EGD as well as dedicating sufficient time for examination improves diagnostic yield. The use of image enhanced endoscopy and magnifying endoscopy improves detection of squamous cell carcinoma and gastric neoplasm. The magnifying endoscopy simple diagnostic algorithm is useful for diagnosis of early gastric cancer.

CONCLUSION

There is a steady momentum in the past decade towards improving diagnostic yield, quality and reporting in EGDs. Other interesting innovations, such as Raman spectroscopy, endocytoscopy and artificial intelligence may have widespread endoscopic applications in the near future.

Keywords: Upper endoscopy, Gastroscopy, Quality indicators, Gastric cancer

Core tip: In this article, we aim to provide a comprehensive review to identify factors affecting diagnostic yield and esophageo-gastro-duodenoscopy quality. These are divided into pre endoscopy preparation, sedation, examination schema, examination time, routine biopsy, image enhanced endoscopy and future developments. There is a steady momentum in the past decade towards improving diagnostic yield, quality and reporting in esophageo-gastro-duodenoscopys. Other interesting innovations, such as Raman spectroscopy, endocytoscopy and artificial intelligence will also be discussed.