83 results found
Tziortziotis I, Laskaratos F-M, Coda S, 2021, Role of artificial intelligence in video capsule endoscopy, Diagnostics, Vol: 11, Pages: 1-16, ISSN: 2075-4418
Capsule endoscopy (CE) has been increasingly utilised in recent years as a minimally invasive tool to investigate the whole gastrointestinal (GI) tract and a range of capsules are currently available for evaluation of upper GI, small bowel, and lower GI pathology. Although CE is undoubtedly an invaluable test for the investigation of small bowel pathology, it presents considerable challenges and limitations, such as long and laborious reading times, risk of missing lesions, lack of bowel cleansing score and lack of locomotion. Artificial intelligence (AI) seems to be a promising tool that may help improve the performance metrics of CE, and consequently translate to better patient care. In the last decade, significant progress has been made to apply AI in the field of endoscopy, including CE. Although it is certain that AI will find soon its place in day-to-day endoscopy clinical practice, there are still some open questions and barriers limiting its widespread application. In this review, we provide some general information about AI, and outline recent advances in AI and CE, issues around implementation of AI in medical practice and potential future applications of AI-aided CE.
Hayee B, SCOTS II Project group, Bhandari P, et al., 2021, COVID-19 transmission following outpatient endoscopy during pandemic acceleration phase involving SARS-CoV-2 VOC 202012/01 variant in UK., Gut
Bedwani NH, English W, Coda S, et al., 2021, Developing a prioritization model for endoscopy and colorectal cancer 2-week wait referrals during the COVID-19 pandemic-is faecal immunochemical testing the answer?, BRITISH JOURNAL OF SURGERY, Vol: 108, Pages: E18-E19, ISSN: 0007-1323
Hayee B, Thoufeeq M, Rees CJ, et al., 2020, Safely restarting GI endoscopy in the era of COVID-19, GUT, Vol: 69, Pages: 2063-+, ISSN: 0017-5749
Hayee B, Thoufeeq M, Rees CJ, et al., 2020, Safely restarting GI endoscopy in the era of COVID-19, Gut, Vol: 69, Pages: 2063-2070, ISSN: 0017-5749
Puli C, Coda S, Khoo D, 2020, A rare case of reversible bulbar palsy secondary to Boerhaave’ssyndrome, Journal of Gastrointestinal and Digestive System, Vol: 10, Pages: 1-3, ISSN: 2161-069X
Banks M, Graham D, Jansen M, et al., 2019, British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma, GUT, Vol: 68, Pages: 1545-1575, ISSN: 0017-5749
Thayalasekaran S, Alkandari A, Varytimiadis L, et al., 2019, To cap/cuff or ring: do distal attachment devices improve the adenoma detection?, EXPERT REVIEW OF GASTROENTEROLOGY & HEPATOLOGY, Vol: 13, Pages: 119-127, ISSN: 1747-4124
Coda S, 2018, To cap/cuff or ring: do distal attachment devices improve the adenoma detection?, Expert Review of Gastroenterology and Hepatology, ISSN: 1747-4124
Coda S, Siersema P, Stamp G, et al., 2015, Biophotonic endoscopy: a review of clinical research techniques for optical imaging and sensing of early gastrointestinal cancer, Endoscopy International Open, Vol: 3, Pages: E1-E13, ISSN: 2364-3722
Detection, characterization, and staging constitutethe fundamental elements in the endoscopicdiagnosis of gastrointestinal diseases, but histologystill remains the diagnostic gold standard.New developments in endoscopic techniques maychallenge histopathology in the near future. Anideal endoscopic technique should combine awide-field, “red flag” screening technique withan optical contrast or microscopy method forcharacterization and staging, all simultaneouslyavailable during the procedure. In theory, biophotonicadvances have the potential to unite theseelements to allow in vivo “optical biopsy.”These techniques may ultimately offer the potentialto increase the rates of detection of high risklesions and the ability to target biopsies and resections,and so reduce the need for biopsy, costs,and uncertainty for patients. However, their utilityand sensitivity in clinical practice must be evaluatedagainst those of conventional histopathology.This review describes some of the most recent applicationsof biophotonics in endoscopic opticalimaging and metrology, along with their fundamentalprinciples and the clinical experiencethat has been acquired in their deployment astools for the endoscopist. Particular emphasishas been placed on translational label-free opticaltechniques, such as fluorescence spectroscopy,fluorescence lifetime imaging microscopy (FLIM),two-photon and multi-photon microscopy, secondharmonic generation (SHG) and third harmonicgeneration (THG) imaging, optical coherencetomography (OCT), diffuse reflectance, Ramanspectroscopy, and molecular imaging
Coda S, Thillainayagam AV, 2015, Symptoms and signs of lower gastrointestinal disease, Medicine, Vol: 43, Pages: 146-152, ISSN: 0304-5412
Symptoms of lower gastrointestinal (GI) disease are common and frequently trigger consultation in primary and secondary care. Diarrhoea, abdominal pain and constipation are presentations of a wide range of different underlying pathologies, from chronic, benign, functional conditions to acutely life-threatening emergencies. Lower GI bleeding is often due to serious pathology and requires rational investigation based on a systematic clinical assessment. Extra-intestinal manifestations of lower GI disease can often give a clue to the underlying diagnosis. In this contribution, we review the aetiology, clinical features, investigations and management for a range of lower GI symptoms, namely diarrhoea, constipation, lower GI bleeding, bloating and abdominal pain.
Zakeri N, Coda S, Webster S, et al., 2014, Risk factors for endoscopic sedation reversal events: a five-year retrospective study, Frontline Gastroenterology
, 2014, Oncology applications: Intraoperative diagnosis of head and neck carcinoma, Fluorescence Lifetime Spectroscopy and Imaging, Publisher: CRC Press, Pages: 404-415
Coda S, Thillainayagam A, 2014, State of the art in advanced endoscopic imaging for the detection and evaluation of dysplasia and early cancer of the gastrointestinal tract, Clinical and Experimental Gastroenterology, Pages: 133-150
Coda S, Thompson AJ, Roche KL, et al., 2014, Ex vivo and in vivo measurements of endoscopic time-resolved autofluorescence spectroscopy of gastrointestinal disease, Optics in Clinical Practice II
INTRODUCTIONFluorescence lifetime spectroscopy (FLS) can resolve the emission spectrum and the decay rate of tissue autofluorescence to provide intrinsic information without the need for exogenous probes. A single point fibre-probe FLS system has been developed for regular ex vivo/in vivo research use in endoscopy.AIMS & METHODSSixty samples were collected from 23 patients and 42 measurements were acquired in vivo from 17 patients undergoing endoscopy. Tissues were excited at 375 and 435 nm and emission detected in 16 channels over the range 400-600 nm. Each diseased sample was compared to a normal sample near the lesion, fitting the mean lifetime to a double-exponential decay model. Colonic polyps and inflammatory bowel disease (IBD) were the diseases predominantly investigated.RESULTSEx vivo: the fluorescence lifetime (FL) of normal colon did not vary based on the region of colon from which the tissue was excised. A decrease in 435 nm mean FL for neoplastic polyps was found significant (p = 0.021). With 375 nm, the FLs of 4 IBD samples were longer than those of the nearby normal colon.In vivo: significant differences were obtained between different regions of normal colon obtained from patients diagnosed with a polyp for 375-nm-excitation. The greatest difference was between right and left colon (p = 0.001). A negative shift in the FL for neoplastic polyps with 435 nm was observed, in agreement with the result seen ex vivo.CONCLUSIONOur results suggest that the 435-nm-excited FL measurements might help physicians discriminate between neoplastic polyps and normal surrounding colon during endoscopy.
Coda S, Thompson AJ, Kennedy GT, et al., 2014, Fluorescence lifetime spectroscopy of tissue autofluorescence in normal and diseased colon measured ex vivo using a fiber-optic probe, Biomedical Optics Express, Vol: 5, Pages: 515-538, ISSN: 2156-7085
We present an ex vivo study of temporally and spectrally resolved autofluorescence in a total of 47 endoscopic excision biopsy/resection specimens from colon, using pulsed excitation laser sources operating at wavelengths of 375 nm and 435 nm. A paired analysis of normal and neoplastic (adenomatous polyp) tissue specimens obtained from the same patient yielded a significant difference in the mean spectrally averaged autofluorescence lifetime −570 ± 740 ps (p = 0.021, n = 12). We also investigated the fluorescence signature of non-neoplastic polyps (n = 6) and inflammatory bowel disease (n = 4) compared to normal tissue in a small number of specimens.
Coda S, 2014, An Investigation of the Diagnostic Potential of Autofluorescence Lifetime Spectroscopy and Imaging for Label-Free Contrast of Disease
The work presented in this thesis aimed to study the application of fluorescence lifetime spectroscopy (FLS) and fluorescence lifetime imaging microscopy (FLIM) to investigate their potential for diagnostic contrast of diseased tissue with a particular emphasis on autofluorescence (AF) measurements of gastrointestinal (GI) disease.Initially, an ex vivo study utilising confocal FLIM was undertaken with 420-nm-excitation to characterise the fluorescence lifetime (FL) images obtained from 71 GI samples from 35 patients. A significant decrease in FL was observed between normal colon and polyps (p = 0.024), and normal colon and inflammatory bowel disease (IBD) (p = 0.015). Confocal FLIM was also performed on 23 bladder samples. A longer, although not significant, FL for cancer was observed, in paired specimens (n = 5) instilled with a photosensitizer.The first in vivo study was a clinical investigation of skin cancer using a fibre-optic FL spectrofluorometer and involved the interrogation of 27 lesions from 25 patients. A significant decrease in the FL of basal cell carcinomas compared to healthy tissue was observed (p = 0.002) with 445-nm-excitation.A novel clinically viable FLS fibre-optic probe was then applied ex vivo to measure 60 samples collected from 23 patients. In a paired analysis of neoplastic polyps and normal colon obtained from the same region of the colon in the same patient (n = 12), a significant decrease in FL was observed (p = 0.021) with 435-nm-excitation. In contrast, with 375-nm-excitation, the mean FL of IBD specimens (n = 4) was found to be longer than that of normal tissue, although not statistically significant. Finally, the FLS system was applied in vivo in 17 patients, with initial data indicating that 435-nm-excitation results in AF lifetimes that are broadly consistent with ex vivo studies, although no diagnostically significant differences were observed in the signals obtained in vivo.
Elson DS, Marcu L, French PMW, 2014, Overview of fluorescence lifetime imaging and metrology, ISBN: 9781439861677
This chapter aims to present an overview of fluorescence lifetime imaging (FLIM) and metrology in the context of their biomedical applications, introducing the main approaches that are discussed in detail in subsequent chapters of this book. Before discussing fluorescence lifetime measurements, however, it is important to understand the phenomenon of fluorescence, of which a brief discussion is provided here, and the reader is directed to the classic textbook by Lakowicz (1999) for further details.
Coda S, French PMW, Dunsby C, 2014, Oncology applications: Gastrointestinal cancer, Fluorescence Lifetime Spectroscopy and Imaging: Principles and Applications in Biomedical Diagnostics, Pages: 379-386, ISBN: 9781439861677
Cancers of esophagus, stomach, and colon are among the most common cancers worldwide, accounting for a total of 2.2 million new cases each year (Boyle and Levin 2008). Prevention of these conditions is currently based on early detection of early-stage cancers or premalignant conditions during conventional white-light endoscopy (WLE). Today, there is a range of more sophisticated biophotonics techniques under development that aim to enhance the contrast of areas of concern beyond what is possible with conventional WLE. Commercially available techniques include high-definition endoscopy (HDE; Adler et al. 2009; Buchner 2010; Rex and Helbig 2007), narrow band imaging (NBI; Gono et al. 2004), magnifying chromoendoscopy (MCE; Kudo et al. 1996), autofluorescence (AF) imaging (AFI; Nakaniwa et al. 2005), and confocal laser endomicroscopy (CLE; Kiesslich et al. 2004; Wang et al. 2007).
Coda S, French PMW, Dunsby C, 2014, Part IV. Tissue autofluorescence lifetime spectroscopy and imaging: applications. Chapter 17. Oncology applications: Gastrointestinal cancer, Fluorescence Lifetime Spectroscopy and Imaging - Principles and Applications in Biomedical Diagnostics, Editors: Marcu, French, Elson, Publisher: Taylor & Francis, Pages: 379-384
Coda S, Thompson AJ, Roche KL, et al., 2013, Clinical fluorescence lifetime metrology for GI cancer, Multidimensional fluorescence imaging and metrology
Zakeri N, Webster S, Coda S, et al., 2013, Safe sedation in endoscopy: time for a new approach?, International Association of Risk Management in Medicine (IARMM) 2nd World Congress of Clinical Safety - “Risk in Clinical Care”
Zakeri N, Webster S, Coda S, et al., 2013, Safe Sedation in Endoscopy: Time for a New Approach?, British Society of Gastroenterology Annual Meeting (BSG 2013)
Introduction Despite increasing awareness of the potential hazards of endoscopic sedation, complications from sedation remain a major concern. Serious harm or death resulting from sedation overdose is now a Department of Health ‘never event’1. Previous work by our group (2000–2005) demonstrated a steady sedation reversal incidence of 0.27%. Trust guidelines, in line with the current British Society of Gastroenterology safe sedation guidelines (2003)2, were developed in 2005 (revised 2011). We present the results of a retrospective survey, evaluating whether the incidence and risk factors for sedation reversal events have changed.Methods Our Trust is a large tertiary referral endoscopic centre across 3 sites. A retrospective analysis of all endoscopy (n = 73,989) was performed, including all sedated endoscopic procedures carried out between 2007 and 2012 (n = 52,553). Flumazenil or naloxone administration was used as a marker of sedation overdose requiring reversal. The results were compared to the previous single-site audit of 2000 to 2005 (n = 20,569). Reversal episodes were analysed for associations with total sedation dose given, patient ASA grade, age and procedure undertaken. Statistical analysis was carried out using chi squared test and the linear regression model (Origin®).Results In total 149 sedation reversals were recorded, representing 0.28% of all sedated endoscopic procedures, with no significant difference from the reversal rate (0.27%) recorded between 2000 and 2005 (p = 0.79). Mean dose of midazolam used in reversal events was 3.1mg (range 0.5–14mg). Mean dose of opioid (as pethidine equivalent) was 47.9mg (range 12.5–150mg). Higher than recommended doses of midazolam (5mg) or opioid (pethidine equivalent 50mg) were administered in 7.4% and 6.7% of reversal events, respectively. Endoscopic Retrograde Cholangiopancreatography (ERCP) was most associated with sedation reversal (1%). Mean dose of midazolam varied by pro
Coda S, Kelly DJ, Lagarto JL, et al., 2013, Autofluorescence lifetime imaging and metrology for medical research and clinical diagnosis, Optical Molecular Probes, Imaging and Drug Delivery (OMP)
Fluorescence lifetime imaging (FLIM) and single-point lifetime measurements of tissue autofluorescence can provide label-free contrast of diseased tissue as we have previously shown for ex vivo samples presenting cancer in breast , skin [2,3,4], GI tract , bladder , pancreas  and liver , presenting heart disease  and cartilage degeneration . We are now working to translate FLIM to in vivo applications. The complexity of autofluorescence decay profiles resulting from the mixtures of tissue matrix components and metabolites typically encountered in biological tissue, however, present challenges for lifetime analysis since the large numbers of detected photons required to adequately fit such decay profiles require data acquisition times that are often incompatible with practical (e.g. clinical) constraints. To realise FLIM with modest numbers of detected photons per pixel, one can approximate the autofluorescence profiles to a monoexponential decay model to enable pixelwise fitting. To extract more information from complex autofluorescence signals from such FLIM data, one can use prior knowledge and apply global fitting to more complex models  or apply phasor analysis . Alternatively, one can forego imaging and bin all detected autofluorescence photons to a single point measurement that can then be fitted to complex decay models – including with respect to different spectral channels where there are sufficient detected photons. Having demonstrated the diagnostic efficacy (AUC up to 0.82) of global fitting with a multiphoton multispectral FLIM instrument based on the DermaInspect instrument (JenLab GmbH) with 25 s in vivo acquisition times , we are now working to develop tools for rapid internal autofluorescence lifetime measurements.Following our ex vivo studies of skin cancer using single-point spectrally resolved lifetime measurements, we have developed compact trolley-based clinical fibre-optic-probe based autofluorescence fluorom
Coda S, Thompson AJ, Lenz MO, et al., 2013, Fluorescence lifetime imaging and spectroscopy for label-free contrast of gastrointestinal diseases, Regional Annual British Society of Gastroenterology Meeting
Coda S, Kelly DJ, Lagarto JL, et al., 2013, Autofluorescence lifetime imaging and metrology for medical research and clinical diagnosis
We report the development of instrumentation to utilise autofluorescence lifetime for the study and diagnosis of disease including cancer and osteoarthritis. ©2013 The Optical Society (OSA).
Trentino P, Baldi F, Coda S, 2013, A rare cause of gastrointestinal bleeding: a paraprosthetic aortojejunal fistula., Atlas of Ileoscopy, Editors: Trecca, Publisher: Springer
Coda S, Antonellis F, Tsagkaropulos S, et al., 2012, Complete Endoscopic Closure (Clipping) of a Large Esophageal Perforation After Pneumatic Dilation in a Patient with Achalasia, JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES, Vol: 22, Pages: 815-818, ISSN: 1092-6429
Coda S, Antonellis F, Tsagkaropulos S, et al., 2012, Complete endoscopic closure (clipping) of a large esophageal perforation after pneumatic dilation in a patient with achalasia, Journal of Laparoendoscopic & Advanced Surgical Techniques, Vol: 22, Pages: 1-4, ISSN: 1092-6429
The risk of esophageal perforation following endoscopic balloon dilation for achalasia is in the range of 1 and 5% with a mortality rate of 1-20%. Perforations need to be recognized early and, if reasonable, an immediate endoscopic repair should be pursued quickly. Herein, we report a case of successful endoscopic closure by clipping of a large iatrogenic perforation in a patient with achalasia.An 80-year-old woman with achalasia was admitted to our institution to undergo pneumatic dilation. A 40-mm balloon dilator with inflation pressure of 20 PSI was used for 2 minutes as usual. During the procedure, the patient had a transient bradycardia. Endoscopic control showed a 2-cm rupture of the distal esophagus. Prompt endoscopic repair of the perforation by endoclips (n=6) was then attempted, followed by conservative management by total parenteral nutrition and intravenous antibiotics.Endoscopic clipping closed completely the esophageal perforation. The patient was given oral nutrition 10 days later without any complications. Six months after the discharge, the patient was healthy and free of dysphagia. Endoscopy showed complete healing of the esophageal mucosa without luminal stenosis.This report highlights that prompt endoscopic clipping is a useful means to close a large esophageal perforation caused by pneumatic dilation.
Thillainayagam AV, Coda S, 2012, Real-time endoscopic fluorescence lifetime imaging and spectroscopy for label-free contrast of gastrointestinal diseases, 3rd International Congress on Biophotonics
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