Advances in endoscopic techniques for early detection and treatment of gastrointestinal cancers: A systematic review

The early detection and treatment of gastrointestinal cancers are critical for improving patient outcomes. These techniques include white light endoscopy (WLE), chromoendoscopy, i-scan, flexible spectral imaging color enhancement (FICE), Narrow-Band Imaging (NBI), confocal laser endomicroscopy (CLE), and others. While these modalities offer promising diagnostic accuracy, their effectiveness varies based on the clinical setting and specific type of lesion. This systematic review aims to assess the diagnostic accuracy and clinical utility of these advanced endoscopic techniques in the early detection of gastrointestinal cancers.

A comprehensive systematic review was conducted to evaluate studies published between January 2020 and December 2024. The inclusion criteria involved randomized controlled trials, prospective studies, and retrospective studies that compared advanced endoscopic techniques such as WLE, chromoendoscopy, i-scan, FICE, NBI, and CLE in the diagnosis of gastrointestinal cancers. Data on diagnostic accuracy, sensitivity, specificity, and clinical outcomes were extracted and analyzed. Studies were assessed for quality, and a comparison table was created to summarize key findings.

A total of 23 studies met the inclusion criteria, involving a diverse range of gastrointestinal cancers including colorectal, gastric, and esophageal cancers. The results showed that advanced endoscopic techniques, particularly NBI, FICE, and CLE, had significantly higher diagnostic accuracy compared to traditional WLE. For instance, NBI demonstrated superior accuracy in diagnosing colorectal and gastric lesions, while FICE was particularly effective in detecting gastric lesions. CLE showed high sensitivity and accuracy for detecting submucosal lesions. The diagnostic performance of i-scan and chromoendoscopy was also found to be promising, with several studies reporting improved detection rates in colorectal and gastric cancers.

Advanced endoscopic techniques offer substantial improvements in the early detection and diagnosis of gastrointestinal cancers. NBI, FICE, CLE, and i-scan are among the most effective modalities, with superior diagnostic accuracy compared to traditional methods like WLE. However, challenges such as high costs, the need for specialized training, and the lack of large-scale clinical trials hinder their widespread adoption. Future research should focus on the integration of artificial intelligence, the development of cost-effective devices, and the standardization of protocols to enhance the utility of these technologies in clinical practice.