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CC BY 4.0 · Journal of Digestive Endoscopy 2023; 14(01): 022-029
DOI: 10.1055/s-0043-1762574
Research Article

Development of a Low-Cost Gastroscope Prototype (GP) for Potential Cost-Effective Gastric Cancer Screening in Prevalent Regions

James Xu
1   Division of Gastroenterology & Hepatology, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Wisconsin, United States
2   Department of Internal Medicine, Kaiser Permanente San Francisco Medical Center, University of California-San Francisco, and University of California-Berkeley, United States
,
Mark E. Benson
1   Division of Gastroenterology & Hepatology, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Wisconsin, United States
,
Liam M. Granlund
3   Morgridge Institute for Research, Madison, Wisconsin, United States
,
Seth Gehrke 
3   Morgridge Institute for Research, Madison, Wisconsin, United States
,
Dylan Stanfield
1   Division of Gastroenterology & Hepatology, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Wisconsin, United States
,
Jennifer Weiss
1   Division of Gastroenterology & Hepatology, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Wisconsin, United States
,
Patrick Pfau
1   Division of Gastroenterology & Hepatology, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Wisconsin, United States
,
Anurag Soni
1   Division of Gastroenterology & Hepatology, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Wisconsin, United States
,
Ben L. Cox
3   Morgridge Institute for Research, Madison, Wisconsin, United States
,
George Petry
3   Morgridge Institute for Research, Madison, Wisconsin, United States
,
Robert A. Swader
3   Morgridge Institute for Research, Madison, Wisconsin, United States
,
Mark Reichelderfer
1   Division of Gastroenterology & Hepatology, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Wisconsin, United States
,
Zhanhai Li
4   Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Wisconsin, United States
,
Tenzin Atrukstang
1   Division of Gastroenterology & Hepatology, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Wisconsin, United States
,
Nyah Banik
1   Division of Gastroenterology & Hepatology, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Wisconsin, United States
,
Kevin W. Eliceiri
3   Morgridge Institute for Research, Madison, Wisconsin, United States
5   Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Wisconsin, United States
,
Deepak V. Gopal
1   Division of Gastroenterology & Hepatology, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Wisconsin, United States
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Abstract

Background Screening for gastric cancer is known to be associated with reduced mortality in populations with high prevalence. However, many countries with high prevalence do not screen, with high costs being a significant reason for this.

Aims To describe, develop, and assess the potential for a low-cost gastroscope for early cancer screening and patient risk stratification.

Methods Our interdisciplinary team used both off-the-shelf and fabricated components to create multiple gastroscope prototypes (GP) in iterative fashion based off clinician feedback. Clinician endoscopists were surveyed using Likert scales regarding device potential, video quality, and handling when testing on a GI training device. Video quality comparison to clinically standard high-definition white light endoscopy (HD-WLE) was done using the absolute categorical ratings (ACR) method.

Results A candidate cost-effective GP with clinical potential was developed. Although initial versions were scored as inferior via ACR on all views tested when compared to HD-WLE (p < 0.001), participants agreed the concept may be beneficial (M = 4.52/5, SD = 0.72). In testing improved versions, participants agreed the device had the ability to identify discrete (M = 4.62/5, SD = 0.51) and subtle lesions (M = 4/5, SD = 0.7) but most felt video quality, although improved, was still less than HD-WLE. Sufficiency of maneuverability of device to visualize gastric views was rated as equivocal (M = 2.69/5, SD = 1.25).

Conclusion The presented low-cost gastroscopic devices have potential for clinical application. With further device development and refinement including the possible addition of technologies in telemedicine and artificial intelligence, we hope the GP can help expand gastric cancer screening for populations in need.

Keywords

endoscopy - gastric cancer - screening

Abstract Presented in part as e-Poster/e-Presentation DDW 2020, ASGE Tu 1568-2020.




Publication History

Article published online:
01 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Li S, Chung DC, Mullen JT. Screening high-risk populations for esophageal and gastric cancer. J Surg Oncol 2019; 120 (05) 831-846
    CrossrefPubMedGoogle Scholar
  • 2 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
    Google Scholar
  • 3 Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomarkers Prev 2014; 23 (05) 700-713
    CrossrefPubMedGoogle Scholar
  • 4 Li ZX, Kaminishi M. A comparison of gastric cancer between Japan and China. Gastric Cancer 2009; 12 (01) 52-53
    CrossrefPubMedGoogle Scholar
  • 5 Axon A. Symptoms and diagnosis of gastric cancer at early curable stage. Best Pract Res Clin Gastroenterol 2006; 20 (04) 697-708
    CrossrefPubMedGoogle Scholar
  • 6 Liu D, Zhang B, Matsunaga T. et al. A comparison of gastric cancer surgery between Japan and China. Yonago Acta Med 2019; 62 (04) 268-272
    CrossrefPubMedGoogle Scholar
  • 7 Dan YY, So JB, Yeoh KG. Endoscopic screening for gastric cancer. Clin Gastroenterol Hepatol 2006; 4 (06) 709-716
    CrossrefPubMedGoogle Scholar
  • 8 Hayashi Y, Yamamoto Y, Suganuma T. et al. Comparison of the diagnostic utility of the ultrathin endoscope and the conventional endoscope in early gastric cancer screening. Dig Endosc 2009; 21 (02) 116-121
    CrossrefPubMedGoogle Scholar
  • 9 Shaker R, Saeian K. Unsedated transnasal laryngo-esophagogastroduodenoscopy: an alternative to conventional endoscopy. Am J Med 2001; 111 (8, Suppl 8A) 153S-156S
    CrossrefPubMedGoogle Scholar
  • 10 Chen W, Zheng R, Baade PD. et al. Cancer statistics in China, 2015. CA Cancer J Clin 2016; 66 (02) 115-132
    CrossrefPubMedGoogle Scholar
  • 11 Zong L, Abe M, Seto Y, Ji J. The challenge of screening for early gastric cancer in China. Lancet 2016; 388 (10060): 2606
    CrossrefPubMedGoogle Scholar
  • 12 Gao Q-Y, Fang J-Y. Early esophageal cancer screening in China. Best Pract Res Clin Gastroenterol 2015; 29 (06) 885-893
    CrossrefPubMedGoogle Scholar
  • 13 Liu Q, Zeng X, Wang W. et al. Awareness of risk factors and warning symptoms and attitude towards gastric cancer screening among the general public in China: a cross-sectional study. BMJ Open 2019; 9 (07) e029638
    CrossrefPubMedGoogle Scholar
  • 14 Liu H, Akiki S, Barrowman NJ, Bromwich M. Mobile endoscopy vs video tower: a prospective comparison of video quality and diagnostic accuracy. Otolaryngol Head Neck Surg 2016; 155 (04) 575-580
    CrossrefPubMedGoogle Scholar
  • 15 Chikkerur S, Sundaram V, Reisslein M, Karam L. Objective video quality assessment methods: A classification, review, and performance comparison. IEEE Trans Broadcast 2011; 57 (02) 165-182
    CrossrefGoogle Scholar
  • 16 Takahashi A, Schmidmer C, Lee C. et al. VQEG report on the validation of video quality models for high definition video content. Multimedia Tools Appl 2010; 2: 1-93
    Google Scholar
  • 17 Sugano K. Screening of gastric cancer in Asia. Best Pract Res Clin Gastroenterol 2015; 29 (06) 895-905
    CrossrefPubMedGoogle Scholar
  • 18 Mizoue T, Yoshimura T, Tokui N. et al; Japan Collaborative Cohort Study Group. Prospective study of screening for stomach cancer in Japan. Int J Cancer 2003; 106 (01) 103-107
    CrossrefPubMedGoogle Scholar
  • 19 Lee KJ, Inoue M, Otani T, Iwasaki M, Sasazuki S, Tsugane S. JPHC Study Group. Gastric cancer screening and subsequent risk of gastric cancer: a large-scale population-based cohort study, with a 13-year follow-up in Japan. Int J Cancer 2006; 118 (09) 2315-2321
    CrossrefPubMedGoogle Scholar
  • 20 Hamashima C. Systematic Review Group and Guideline Development Group for Gastric Cancer Screening Guidelines. Update version of the Japanese guidelines for gastric cancer screening. Jpn J Clin Oncol 2018; 48 (07) 673-683
    CrossrefPubMedGoogle Scholar
  • 21 Jun JK, Choi KS, Lee HY. et al. Effectiveness of the Korean National Cancer Screening Program in reducing gastric cancer mortality. Gastroenterology 2017; 152 (06) 1319-1328.e7
    CrossrefPubMedGoogle Scholar
  • 22 Shluzas LA. et al. “The iterative nature of medical device design.” DS 58–1: Proceedings of ICED 09, the 17th International Conference on Engineering Design, Vol. 1, Design Processes, Palo Alto, CA, USA, August 24—27,2009
  • 23 Ciocîrlan M. Low-cost disposable endoscope: pros and cons. Endosc Int Open 2019; 7 (09) E1184-E1186
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Di L, Wu H, Zhu R. et al. Multi-disciplinary team for early gastric cancer diagnosis improves the detection rate of early gastric cancer. BMC Gastroenterol 2017; 17 (01) 147
    CrossrefPubMedGoogle Scholar
  • 25 Menon S, Trudgill N. How commonly is upper gastrointestinal cancer missed at endoscopy? A meta-analysis. Endosc Int Open 2014; 2 (02) E46-E50
    Google Scholar
  • 26 Yalamarthi S, Witherspoon P, McCole D, Auld CD. Missed diagnoses in patients with upper gastrointestinal cancers. Endoscopy 2004; 36 (10) 874-879
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Wu L, Zhou W, Wan X. et al. A deep neural network improves endoscopic detection of early gastric cancer without blind spots. Endoscopy 2019; 51 (06) 522-531
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Koziarski M, Cyganek B. Impact of low resolution on image recognition with deep neural networks: an experimental study. Int J Appl Math Comput Sci 2018; 28 (04) 735-744
    CrossrefGoogle Scholar
  • 29 Shen L, Zhou C, Liu L. et al. Application of oral contrast trans-abdominal ultrasonography for initial screening of gastric cancer in rural areas of China. Dig Liver Dis 2017; 49 (08) 918-923
    CrossrefPubMedGoogle Scholar
  • 30 Tan MC, Graham DY. Screening for gastric cancer: focus on the ants instead of the ant hill. Clin Gastroenterol Hepatol 2021; 19 (09) 1990-1991
    CrossrefPubMedGoogle Scholar