News Release 

Enhanced-image endoscopy more effective than conventional imaging for detecting upper GI cancers

Embargoed News from Annals of Internal Medicine

American College of Physicians

Research News

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.

1. Enhanced-image endoscopy more effective than conventional imaging for detecting upper GI cancers

Abstract: https://www.acpjournals.org/doi/10.7326/M19-2561

URL goes live when the embargo lifts

Linked color imaging (LCI), a new image-enhanced endoscopy technique that allows users to recognize slight differences in mucosal color, is more effective than conventional white light imaging (WLI) for detecting tumors in the upper gastrointestinal tract. Findings from a randomized controlled trial are published in Annals of Internal Medicine.

The primary goal of upper GI endoscopic examination is to detect neoplastic lesions in the pharynx, esophagus, and stomach. However, early-stage lesions may be overlooked by conventional white light endoscopy.

Researchers from National Hospital Organization Hakodate National Hospital, Hakodate, Hokkaido, Japan identified 1,502 patients with known previous or current cancer of the GI tract to compare the performance of LCI with WLI in detecting neoplastic lesions in the upper GI tract. The patients were randomly assigned to WLI followed by LCI examination (WLI group) or LCI followed by WLI examination (LCI group), with the patients just about evenly divided into each group. The researchers found that the doctors using LCI diagnosed 1.67 more neoplastic lesions in the first examination than they did with WLI. The proportion of patients with overlooked neoplasms was also lower in the LCI group than in the WLI group. The authors conclude that LCI is more effective than WLI for detecting neoplastic lesions in the pharynx, esophagus, and stomach. Their results suggest that many neoplastic lesions are being overlooked by conventional white light endoscopy performed in routine clinical practice. They say to reduce the rate of overlooking neoplasms, LCI should ideally be applied in clinical practice.

Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. The corresponding author, Mototsugu Kato, MD, PhD, can be reached directly at mkato1957@gmail.com.

2. Expert commentary: Effective contact tracing requires public trust and community engagement - two elements that are currently lacking in the U.S. COVID-19 response

Abstract: https://www.acpjournals.org/doi/10.7326/M20-5834

URL goes live when the embargo lifts

Manual or digital contract tracing is an important measure for mitigating the COVID-19 pandemic, yet there are concerns about how, in practice, this measure may impede individual liberties. To be effective, contact tracing requires public trust and community engagement, two things that are lacking in the current political and social climate. Researchers from the University of California, San Francisco present a framework for assessing the effectiveness of contact tracing. Their commentary is published in Annals of Internal Medicine.

The COVID-19 pandemic has challenged the traditional public health balance between benefiting the good of the community through contract tracing and restricting individual liberty. State laws authorize contact tracing by public health officials, with safeguards. For example, it is routinely carried out for tuberculosis cases and during measles outbreaks. With COVID-19, contact tracing aims to notify all persons who were within 6 feet of an infected person for at least 10 minutes during the 14 days before diagnosis. Although public health laws allow "mandatory" contact tracing, in effect contact tracing is voluntary because people who do not want to cooperate can decline to talk or say they do not recall contacts or locations. Apps and other digital means of contact tracing cannot account for mask-wearing, social distancing, or the presence of other safety measures.

According to the authors, current efforts at contact tracing have failed because of a lack of trust and engagement among U.S. citizens, in addition to the fact that both manual and digital efforts have been flawed. For contact tracing to work, broad community support is needed. The authors provide a framework by which public health officials and those with large public platforms can work together to disseminate messages to the community and garner acceptance. A special focus should be directed at communities of color, where the authors say there is more mistrust of contact tracing. According to the authors, even if apps used for contact tracing have acceptable risks to privacy, complex cultural, political, and ideological problems and tradeoffs need to be resolved for broad support for all mitigation efforts to be effective.

Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. The corresponding author, Bernard Lo, MD, can be reached directly at bernardlo@greenwall.org.

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Also in this issue:

Health Care Organizations Should Be as Generous as Their Workers
Leonard L. Berry, PhD, MBA, and Rana Lee Adawi Awdish, MD
Ideas and Opinions
Abstract: https://www.acpjournals.org/doi/10.7326/M20-5172

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