The American Society for Gastrointestinal Endoscopy’s GIE Editorial Board’s top 10 advances in GI endoscopy in 2019 list showcases numerous ways that technological growth is moving the field forward.

That includes the emergence of artificial intelligence in GI endoscopy, improving adenoma detection rates (ADR), innovative endoscope designs, enhanced imaging, and evolving techniques for polypectomy.

“As acknowledged in updated guidelines from the European Society of Gastrointestinal Endoscopy, it now seems inevitable that AI will continue to revolutionize endoscopy in the very near future,” the list’s authors write. “In 2019, reports continued to support a role for AI in diagnosing esophageal and gastric cancers and for endoscopic robots that can assist in efficient, effective and safe removal.”

A retrospective analysis from Japan of more than 8,000 images of esophageal cancer found that convolutional neural networks could improve detection rates. Investigators in China developed a GI artificial intelligence diagnostic system (called GRAIDS) that collected more than a million images of upper GI lesions with histologic proven malignancy. GRAIDS provided “both real-time intraprocedural assistance in community settings and what could essentially be considered easy access to a ‘virtual reality second option.’”

Narrow-band imaging (NBI), blue laser imaging (BLI), and linked-color imaging (LCI) are variations of image-enhanced endoscopy. Studies published in 2019 “suggest that NBI, BLI, and LCI may have a role in improving colon polyp detection and that BLI has similar utility as NBI in characterizing colon polyps,” the authors write.

Improving ADRs ranked fourth on the GIE Editorial Board list, with image enhancing and AI cited as potential factors.

Evolving techniques for polypectomy included underwater polypectomy and a new video-based cold snare polypectomy assessment tool. Endoscopic training, meanwhile, leapt forward in 2019 as “increasing use of simulators and other interactive technology have attracted more interest.”

Topping the GIE Editorial Board’s list was endoscope disinfection. Duodenoscopes are especially hard to clean because of their elevator mechanism and multiple moving parts. The FDA believes the best way to reduce the risk of cross-contamination is by transitioning to scopes with innovative designs that make “reprocessing easier, more effective, or unnecessary.”

The authors cite an “autopsy” of two duodenoscopes at an institution that experienced an outbreak of multidrug-resistant Klebsiella pneumonia. Miscommunication, undetected damaged parts, inadequate repair of damaged duodenoscopes, and duodenoscope design abnormalities all played a role, they write.

“As an alternative to reusable endoscopes, various disposable options have been described ranging from disposable tips to completely disposable single-use endoscopes,” they add.

Click here to access the entire list and read the editorial board's breakdown of each advancement.