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Endoscopy: Challenges and Opportunities  \nGiuseppe Dell’Anna 1,2,†, Francesco Mandarino 1,3,†, Lucia Centanni 1,3, Ilaria Lodola 1,3, Jacopo Fanizza 1,3, Ernesto Fasulo 1,3, Sarah Bencardino 1,3, Lorenzo Fuccio 4, Antonio Facciorusso 5, Gianfranco Donatelli 6,7, Tommaso Lorenzo Parigi 1,3, Federica Furfaro 1,3, Ferdinando D’Amico 1,3, Sara Massironi 1,3, Alberto Malesci 1,3, Federica Ungaro 1,3, Silvio Danese 1,3 and Vito Annese 2,3, *  \nAcademic Editor: Alain Couvineau  \nReceived: 19 March 2025  \nRevised: 9 May 2025  \nAccepted: 15 May 2025  \nPublished: 18 May 2025  \nCitation: Dell’Anna, G.; Mandarino, F.; Centanni, L.; Lodola, I.; Fanizza, J.; Fasulo, E.; Bencardino, S.; Fuccio, L.; Facciorusso, A.; Donatelli, G.; et al. Transforming Gastrointestinal Diagnosis with Molecular Endoscopy:  \nChallenges and Opportunities. Int. J. Mol. Sci. 2025, 26, 4834 . [https://doi.org/10.3390/ijms26104834](https://doi.org/10.3390/ijms26104834)  \n[Copyright:](Copyright:) © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://creativecommons.org/](https://creativecommons.org/)[ ](https://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/)) .  \n1 Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60,  \n20132 Milan, Italy; [dellanna.giuseppe@hsr.it](dellanna.giuseppe@hsr.it) (G.D.); [mandarino.francesco@hsr.it](mandarino.francesco@hsr.it) (F.M.);  \n[centanni.lucia@hsr.it](centanni.lucia@hsr.it) (L.C.); [lodola.ilaria@hsr.it](lodola.ilaria@hsr.it) (I.L.); [fanizza.jacopo@hsr.it](fanizza.jacopo@hsr.it) (J.F.); [fasulo.ernesto@hsr.it](fasulo.ernesto@hsr.it) (E.F.);  \n[bencardino.sarah@hsr.it](bencardino.sarah@hsr.it) (S.B.); [parigi.tommaso@hsr.it](parigi.tommaso@hsr.it) (T.L.P.); [furfaro.federica@hsr.it](furfaro.federica@hsr.it) (F.F.);  \n[damico.ferdinando@hsr.it](damico.ferdinando@hsr.it) (F.D.); [massironi.sara1@hsr.it](massironi.sara1@hsr.it) (S.M.); [malesci.alberto@hsr.it](malesci.alberto@hsr.it) (A.M.);  \n[ungaro.federica@hsr.it](ungaro.federica@hsr.it) (F.U.); [sdanese@hotmail.com](sdanese@hotmail.com) (S.D.)  \n2 Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy  \n3 Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy  \n4 Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, via Massarenti 9, 40138 Bologna, Italy; [lorenzofuccio@gmail.com](lorenzofuccio@gmail.com)  \n5 Faculty of Medicine and Surgery, University of Salento, Piazza Tancredi 7, 73100 Lecce, Italy; [antonio.facciorusso@virgilio.it](antonio.facciorusso@virgilio.it)  \n6 Unité d’Endoscopie Interventionnelle, Hopital Privé des Peupliers, Ramsay Générale de Santé,  \n75013 Paris, France; [donatelligianfranco@gmail.com](donatelligianfranco@gmail.com)  \n7 Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy  \n* Correspondence: vito.annese@grupposandonato.it † These authors contributed equally to this work.  \nAbstract: Molecular endoscopy represents a transformative advance in the detection, diagnosis, and management of gastrointestinal diseases, addressing the critical limitations of conventional techniques. Current diagnostic standards, such as white light endoscopy (WLE), often fail to detect early-stage lesions, particularly in high-risk populations like Barrett’s esophagus or inflammatory bowel disease patients. To overcome these challenges, molecular endoscopy, using fluorescent molecular probes, may offer ultimate precision by targeting disease-specific biomarkers. Technologies like Confocal Laser Endomicroscopy (CLE) and Immunoendoscopy are re","cbCaibyAGuNC4Pud","https://ap.wps.com/l/cbCaibyAGuNC4Pud","pdf",479990,17,"English","# Abstract\n# Keywords\n# 1. Introduction","[{\"question\":\"Why does conventional white light endoscopy often miss early gastrointestinal lesions?\",\"answer\":\"It frequently fails to detect early-stage lesions, particularly in high-risk populations such as Barrett’s esophagus and inflammatory bowel disease patients.\"},{\"question\":\"How does molecular endoscopy improve diagnostic precision?\",\"answer\":\"It uses fluorescent molecular probes to target disease-specific biomarkers, enabling visualization of molecular and microarchitectural changes in vivo.\"},{\"question\":\"What challenges remain before molecular endoscopy can be used routinely?\",\"answer\":\"Key barriers include high costs, lack of standardization, and the need for specialized training, despite ongoing innovations like standardization efforts and AI integration.\"}]","Transforming Gastrointestinal Diagnosis with Molecular Endoscopy - Challenges and Opportunities | PDF",1790217185,43]