Diagnostic Challenges in Endoscopy Open Access

We are honoured to serve as guest editors for this special volume of “Diagnostic Challenges in Endoscopy” for Digestive Diseases. In this issue, we have collated a series of five articles to discuss the use of artificial intelligence (AI) in endoscopy, the role of video capsule endoscopy in diagnosis of gastrointestinal (GI) bleeding, and a novel method for differentiating gallbladder polyps.

AI has been increasingly applied to various fields of diagnostic endoscopy, such as adenoma detection and differentiation of benign from malignant GI polyps. An article by Richter et al. [1] highlighted a potential additional benefit of using AI for adenoma detection – AI can help maintain adenoma detection rate throughout the day, potentially negating the effect of fatigue, resulting in decrease in adenoma detection rates towards the end of the day.

GI bleeding is a common presentation at the emergency department. If not managed promptly, it can be potentially life-threatening. Choi et al. [2] demonstrated that although there exist a multitude of scoring systems to aid physicians in risk stratification for GI bleeding, it is important that these scoring systems are first validated in the local population. For patients presenting with overt or obscure GI bleeding, capsule endoscope is often used for investigation. However, it requires physicians to analyse and interpret results at the end of the test, potentially delaying the time taken for diagnosis. Ravi et al. [3] described a pilot point-of-care study where trained nurses provided real-time analysis and interpretation of capsule endoscopy results at a standard comparable to physicians. In bariatric patients presenting with iron deficiency anaemia, there is insufficient data to suggest whether video capsule endoscopy is safe for use. Peleg et al. [4] demonstrated that video capsule endoscopy can potentially be used in patients post-sleeve gastrectomy with minimal adverse effects.

Currently, imaging is used to differentiate between benign and possibly malignant gallbladder polyps. If imaging suggests possibility of malignancy in the gallbladder polyp, radical surgery is performed. Biopsy is not routinely performed for suspicious gallbladder polyps. Tang et al. [5] described a novel probe-based confocal laser endomicroscopy that can be used to differentiate benign and malignant gallbladder polyps. We hope that readers of Digestive Diseases will find this volume an interesting and useful addition to the existing literature on diagnostic challenges in endoscopy.