Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2020; 12(10): 388-400
Published online Oct 16, 2020. doi: 10.4253/wjge.v12.i10.388
Fluorescence guided intraluminal endoscopy in the gastrointestinal tract: A systematic review
Olivia Engholt Mortensen, Nikolaj Nerup, Morten Thorsteinsson, Morten Bo Søndergaard Svendsen, Hironari Shiwaku, Michael Patrick Achiam
Olivia Engholt Mortensen, Nikolaj Nerup, Morten Thorsteinsson, Michael Patrick Achiam, Department of Surgical Gastroenterology, Copenhagen University Hospital, Copenhagen 2100, Denmark
Morten Bo Søndergaard Svendsen, Copenhagen Academy for Medical Education and Simulation, Copenhagen University Hospital, Copenhagen 2100, Denmark
Hironari Shiwaku, Department of Surgical Gastroenterology, Fukuoka University Faculty of Medicine, Fukuoka 814-0133, Japan
Author contributions: Mortensen OE, Achiam MP, Nerup N, Shiwaku H, and Svendsen MBS contributed to the idea, conceptualized, and designed the review; Mortensen OE, Achiam MP, and Thorsteinsson M carried out the screening process and data extraction; Mortensen OE drafted the initial manuscript; all authors reviewed and approved the final manuscript as submitted.
Conflict-of-interest statement: All authors state that they have no conflict of interest.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 statement have been adopted.
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:
Corresponding author: Olivia Engholt Mortensen, BSc, Research Fellow, Department of Surgical Gastroenterology, Copenhagen University Hospital, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark.
Received: May 13, 2020
Peer-review started: May 13, 2020
First decision: June 15, 2020
Revised: June 29, 2020
Accepted: September 8, 2020
Article in press: September 8, 2020
Published online: October 16, 2020
Research background

Different studies have investigated the use of fluorescence based endoscopy systems where the white light has been supplemented by infrared light and the use of relevant fluorophores. Fluorescence endoscopy is among the recent advances within the field of fluorescence-guided surgery and cancer-specific imaging.

Research motivation

The aim of this systematic review was to evaluate both the diagnostic and therapeutic value of fluorescence-guided flexible intraluminal endoscopy. Angiogenesis and neovascularization are important factors in tumor invasion, and as mucosal and submucosal vessels are not visible to the naked eye, but after intravenous injection of a fluorophore and illumination by infrared light, profound structures can be visualized.

Research objectives

Fluorescence endoscopy can be used within the detection the early development of neoplasms and tumors, adenomas, assessment of tumor invasion within the gastrointestinal tract. Those qualities are a part of the recent advances within the field of fluorescence-guided surgery and cancer-specific imaging.

Research methods

The research method was a data analysis. We followed the PRISMA guidelines for this systematic review. The research covered five databases; PubMed, Scopus, Web of Science, Embase, and the Cochrane Collection. Authors screened title and abstract for inclusion, subsequently full-text for inclusion according to eligibility criteria listed in the protocol. The risk of bias was assessed for all studies according to the Newcastle-Ottawa Scale. The authors extracted the data and reported the results in both text and tables.

Research results

We included seven studies in the systematic review after screening a total of 2769 papers. Four studies evaluated the usefulness of fluorescence endoscopy in assessing tumor invasion. Three of the four studies reported an exceptional diagnostic accuracy in assessing tumor invasion, thus representing better visualization and more correct diagnosis by fluorescence endoscopy compared with the conventional endoscopy. The relationship between the endoscopic findings, tumor invasion, and tumor vascularity was evaluated in two studies showing a significant correlation. The use of fluorescence endoscopy is a promising method.

Research conclusions

This systematic review explored the diagnostic and therapeutic value of fluorescence endoscopy. This study proposes fluorescence endoscopy as a method, which can increase those values, in the context of what is already known. This systematic review reflects a high clinical applicability, and fluorescence endoscopy is a method, that builds on the approach of tumor vascularity. This is the hypothesis of this systematic review and how this cooperate with the diagnostic and therapeutic value.

Research perspectives

More studies are needed to utilize the feasibility of fluorescence endoscopy compared with other endoscopic methods exploring the diagnostic and therapeutic value in different clinical issues.