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Gastrointestinal cancer is a major public health problem. Gastrointestinal cancer is the third most common cancer in Western countries and Korea. Detection of early neoplastic lesions in gastrointestinal tract is essential for cure, because prognosis and survival are related to the size and stage of malignant lesions.
Endoscopic screening and treatment of pre-malignant lesions prevents approximately 80% of gastrointestinal cancer. However, white-light endoscopy is an imperfect technology, since missed rates of up to 25% have been reported in colonoscopic evaluation. Furthermore, polyps without malignant potential were treated without benefit but with additional costs and risks to the patient. There are several known predictors of an inadequate endoscopic examination. These include patient characteristics or skills of the endoscopists. Therefore, a variety of advanced technologies has been attempted to overcome these issues.
Molecular imaging has emerged as a new discipline in gastrointestinal endoscopy. Molecular imaging is defined as visualization and measurement of biological processes at the cellular and subcellular levels within living systems. Targeted molecular imaging can quantify the target expression, which can be used for diagnosing and managing diseases. The current targeting ligands include peptide, aptamer, protein or antibody. Endoscopic molecular imaging can be defined as the visualization of molecular characteristics with endoscopy. These innovations will allow us not only to locate a tumor or dysplastic lesion but also to visualize its molecular characteristics and the activity of specific molecules and biological processes that affect tumor behavior and/or its response to therapy. Molecular imaging techniques have been developed for a more precise classification of mucosal alterations with selection of patients for invasive therapy or surveillance. Further, molecular and functional imaging techniques could identify novel targets for therapies and new prospects to access response to therapies. The future of endoscopic diagnosis is likely to be impacted by a combination of biomarkers and technology.
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