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Shuster, Mary F. Hebert and Qingcheng Mao",reviewType:"peer-reviewed",authors:[{id:"41058",title:"Prof.",name:"Qingcheng",middleName:null,surname:"Mao",fullName:"Qingcheng Mao",slug:"qingcheng-mao"},{id:"56512",title:"Ms.",name:"Diana",middleName:null,surname:"Shuster",fullName:"Diana Shuster",slug:"diana-shuster"},{id:"56513",title:"Prof.",name:"Mary",middleName:null,surname:"Hebert",fullName:"Mary Hebert",slug:"mary-hebert"}]},{id:"23191",type:"chapter",title:"Exercise Guidelines for Women with Gestational Diabetes",slug:"exercise-guidelines-for-women-with-gestational-diabetes",totalDownloads:4131,totalCrossrefCites:0,signatures:"Michelle F. Mottola and Stephanie-May Ruchat",reviewType:"peer-reviewed",authors:[{id:"39818",title:"Dr.",name:"Michelle",middleName:null,surname:"Mottola",fullName:"Michelle Mottola",slug:"michelle-mottola"},{id:"57874",title:"Dr.",name:"Stephanie-May",middleName:null,surname:"Ruchat",fullName:"Stephanie-May Ruchat",slug:"stephanie-may-ruchat"}]},{id:"23192",type:"chapter",title:"Gestational Diabetes Mellitus After Delivery",slug:"gestational-diabetes-mellitus-after-delivery",totalDownloads:3394,totalCrossrefCites:0,signatures:"Aleida M. Rivas",reviewType:"peer-reviewed",authors:[{id:"50382",title:"Dr.",name:"Aleida",middleName:"M.",surname:"Rivas",fullName:"Aleida Rivas",slug:"aleida-rivas"}]}]},relatedBooks:[{type:"book",id:"10717",title:"Gestational Diabetes Mellitus",subtitle:"New Developments",isOpenForSubmission:!1,hash:"df4ea168770f9a62d90a92429dc237b7",slug:"gestational-diabetes-mellitus-new-developments",bookSignature:"Miroslav Radenković",coverURL:"https://cdn.intechopen.com/books/images_new/10717.jpg",editedByType:"Edited by",editors:[{id:"45327",title:"Prof.",name:"Miroslav",surname:"Radenkovic",slug:"miroslav-radenkovic",fullName:"Miroslav Radenkovic"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"},chapters:[{id:"79080",title:"Biomarkers in GDM, Role in Early Detection and Prevention",slug:"biomarkers-in-gdm-role-in-early-detection-and-prevention",signatures:"Samar Banerjee",authors:[{id:"418302",title:"Dr.",name:"Samar",middleName:null,surname:"Banerjee",fullName:"Samar Banerjee",slug:"samar-banerjee"}]},{id:"79117",title:"Epigenetic: New Insight in Gestational Diabetes Mellitus",slug:"epigenetic-new-insight-in-gestational-diabetes-mellitus",signatures:"Maria Grazia Dalfrà, Silvia Burlina and Annunziara Lapolla",authors:[{id:"16137",title:"Prof.",name:"Annunziata",middleName:null,surname:"Lapolla",fullName:"Annunziata Lapolla",slug:"annunziata-lapolla"},{id:"362247",title:"Dr.",name:"Maria Grazia",middleName:null,surname:"Dalfrà",fullName:"Maria Grazia Dalfrà",slug:"maria-grazia-dalfra"},{id:"427752",title:"Dr.",name:"Silvia",middleName:null,surname:"Burlina",fullName:"Silvia Burlina",slug:"silvia-burlina"}]},{id:"78115",title:"The Interaction between the Gut Microbiota and Chronic Diseases",slug:"the-interaction-between-the-gut-microbiota-and-chronic-diseases",signatures:"Temitope Sanusi-Olubowale",authors:[{id:"355351",title:"Ph.D. Student",name:"Temitope",middleName:null,surname:"Sanusi-Olubowale",fullName:"Temitope Sanusi-Olubowale",slug:"temitope-sanusi-olubowale"}]},{id:"79090",title:"Improving Gestational Diabetes Management through Patient Education",slug:"improving-gestational-diabetes-management-through-patient-education",signatures:"Radiana Staynova and Vesselina Yanachkova",authors:[{id:"426925",title:"Dr.",name:"Radiana",middleName:null,surname:"Staynova",fullName:"Radiana Staynova",slug:"radiana-staynova"},{id:"426989",title:"Dr.",name:"Vesselina",middleName:null,surname:"Yanachkova",fullName:"Vesselina Yanachkova",slug:"vesselina-yanachkova"}]},{id:"79162",title:"Using Resistance Training in Women with Gestational Diabetes Mellitus to Improve Glucose Regulation",slug:"using-resistance-training-in-women-with-gestational-diabetes-mellitus-to-improve-glucose-regulation",signatures:"Brittany R. 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Accurate diagnosis is crucial for appropriate treatment of esophageal diseases, including surgical intervention. With advancements in the surgical treatment of esophageal diseases, the importance of upper gastrointestinal endoscopy has been increasing. In this chapter, the endoscopic techniques used in the examination of the esophagus are discussed.
During endoscope insertion, the cough or gag reflex is induced and the movement of the esophageal lumen increases, thereby making esophageal examination difficult. Therefore, proper endoscope insertion is essential for accurate examination of the esophagus.
The first obstacle encountered during endoscope insertion is the uvula. Access to the pyriform sinus can be gained without difficulty if the endoscope is carefully inserted to the right or left of the uvula, taking care not to make contact with the centrally placed uvula. The second and most difficult part of endoscope insertion is the insertion of the endoscope into the pyriform sinus. This part is sometimes problematic for beginners, as well as for board-certified endoscopists. Upon reaching the left pyriform sinus, a slight clockwise rotation of the scope with gentle pressure is recommended for insertion in the left pyriform sinus [1]. This technique is successful in most cases; however, in some patients with anatomical variations, endoscopists experience severe resistance that may lead to bleeding or even perforation. Two types of pyriform sinus are shown in Figure 1. In Figure 1a, there is no central ridge; thus, the clockwise rotation technique can be used. In contrast, in Figure 1b, a central ridge is present in the left pyriform sinus, and the true lumen is more medial than normal, but its path runs upward (i.e., medially). After traversing the pyriform sinus, the path goes downward (i.e., laterally). Thus, performing the clockwise rotation technique without checking for the central ridge can result in severe pyriform sinus injury. Further, air insufflation is needed to determine the presence of a central ridge.
Two types of pyriform sinus. (a) Left pyriform sinus without central ridge. (b) Left pyriform sinus with central ridge.
Chromoendoscopy entails the application of a chemical substance to the mucosal surface of the gastrointestinal tract to facilitate visualization and detection of dysplastic and malignant lesions [2]. Since the recent introduction and adoption of virtual chromoendoscopy methods such as narrow-band imaging (NBI), the importance of dye-based chromoendoscopy in day-to-day clinical practice has been decreasing [3]. Nevertheless, chromoendoscopy remains important in many clinical conditions. In this chapter, some chromoendoscopy methods still used in esophageal endoscopy will be discussed.
Acetic acid is a weak acid that breaks up the disulfide bridges of glycoproteins of the mucus layer, resulting in protein denaturation and surface pattern enhancement [2]. BE is a known risk factor of high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). Current nondysplastic BE surveillance guidelines recommend that random four-quadrant biopsy specimens be taken every 1–2 cm to check for dysplasia [4]. Due to the time-consuming and labor-intensive nature of the procedure, the American Society for Gastrointestinal Endoscopy Technology Committee released the Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) criteria for nondysplastic BE surveillance. These criteria help determine which advanced imaging technique with targeted biopsy can replace the current surveillance guidelines for the detection of HGD and EAC. The performance thresholds in the PIVI criteria are per-patient sensitivity ≥90%, negative predictive value ≥98%, and specificity ≥80% [1]. Based on these criteria, only acetic acid chromoendoscopy, NBI, and confocal laser endomicroscopy can replace the current guidelines [4]. However, the use of acetic acid chromoendoscopy is on the decline due to the long procedural time, uneven distribution of dye over the mucosa, and high interobserver variability due to lack of classification [5].
Lugol solution is an iodine-based solution used in the detection of dysplasia and cancer in squamous epithelia. Since iodine binds to glycogen, which is abundant in nonkeratinized squamous epithelium, and neoplastic tissues have low glycogen levels, they are not stained by Lugol solution [2]. Lugol staining has long been regarded as the gold standard for the detection and delineation of squamous cell carcinoma (SCC) and squamous dysplasia [6]. However, Lugol solution can cause thyrotoxicosis in patients with thyroid disease, iodine hypersensitivity, and retrosternal discomfort [2]. Regarding the avoidance of these side effects, several studies have compared Lugol’s iodine chromoendoscopy and NBI. A recent meta-analysis revealed no significant difference in diagnostic sensitivity between the two methods (88% versus 92%); it also revealed that NBI has a significantly higher specificity than Lugol’s iodine chromoendoscopy (88% versus 82%) [7]. Furthermore, several observational studies reported no significant difference in complete resection rate between the two methods [8, 9].
Electronic chromoendoscopy involves endoscopic imaging technologies that provide detailed contrast enhancement of the mucosal surface and blood vessels in the form of electronic signals that can be analyzed using various image-processing techniques [10, 11]. There are various types of electronic chromoendoscopy, and they include NBI, i-SCAN, and flexible spectral imaging color enhancement (FICE).
NBI is an endoscopic optical image enhancement technology based on the penetration properties of light. An NBI filter in front of a xenon arc lamp produces two narrow bands of light with wavelengths of 415 nm and 540 nm [10]. Capillaries in the superficial mucosa are highlighted by the 415-nm-wavelength light band and appear brown. The longer 540-nm-wavelength light band makes deeper-lying veins appear blue-green [11]. Due to an abundance of blood vessels in the submucosal layer, a normal esophagus appears pale green on NBI [12]. Thus, lesions can be observed in great detail as a result of the color contrast effect at the mucosa of the gastroesophageal junction (GEJ) and in cases of early esophageal SCC (ESCC) [11].
i-SCAN (Pentax, Tokyo, Japan) is another postprocessing digital contrast technology that consists of three enhancement features: surface enhancement, which sharpens the image; contrast enhancement, where darker (depressed) areas look bluer; and tone enhancement, a form of digital narrowed-spectrum imaging [13]. It was reported in several studies that i-SCAN is superior to white-light endoscopy (WLE) in the detection of reflux esophagitis and dysplasia in BE [14, 15]. However, i-SCAN is a relatively recent technology compared with NBI, and further research is still needed.
The FICE system takes an ordinary endoscopic image of different parts of the gastrointestinal mucosa from the video processor and arithmetically processes and estimates it to produce an image of a given dedicated wavelength between 400 and 700 nm. Single-wavelength images are randomly selected and assigned the colors red, green, and blue to build and display virtually enhanced color images [16]. A previous study compared WLE and the FICE system for the diagnosis of BE, but additional research is needed [17].
In this section, understanding of the concepts of AI, machine learning (ML), deep learning (DL), and convolutional neural network (CNN) is essential. AI is the broadest term used in the description of machines that mimic human intelligence [18]. ML is a subfield of AI, and DL is a subfield of ML. ML is divided into supervised learning and unsupervised learning. In supervised learning, labeled datasets are used to train algorithms to classify data or predict outcomes accurately. In contrast, in unsupervised learning, unlabeled datasets are used to train algorithms [19]. In DL, unsupervised learning and neural networks are used. CNN is a type of artificial neural network used in image recognition and processing that is specifically designed to process pixel data [20]. AI is extensively used or studied with regard to the esophagus and will be considered at the end of the discussion of each disease.
Esophagitis refers to inflammation or injury to the esophageal mucosa [21]. The types of esophagitis based on etiology include reflux esophagitis, infectious esophagitis, exfoliative esophagitis, eosinophilic esophagitis (EoE), and pill-induced esophagitis.
Gastroesophageal reflux disease (GERD) is a condition in which stomach contents reflux into the esophagus or beyond (e.g., into the oral cavity, larynx, or lungs) causing troublesome symptoms and complications [22]. The extent of mucosal breaks due to erosion or ulceration is the sole determinant of severity grade [23]. Grade A refers to one or more mucosal breaks no longer than 5 mm that do not extend beyond two mucosal folds. Grade B refers to one or more mucosal breaks more than 5 mm long that do not extend beyond two mucosal folds. Grade C refers to one or more mucosal breaks that extend beyond two or more mucosal folds but involve less than 75% of the esophageal circumference. Grade D refers to one or more mucosal breaks that involve at least 75% of the esophageal circumference. Currently, due to lack of interobserver agreement, minimal changes are not included in the GERD Los Angeles (LA) classification [23]. Recently, a DL model that uses CNNs for automatic classification and interpretation of routine GERD LA grades was proposed [24]. However, given that the available data are limited, more studies are needed.
Esophageal candidiasis is the most common type of infectious esophagitis [25]. Immunocompromised patients are most at risk, and the most common symptoms are odynophagia, dysphagia, and retrosternal pain. Endoscopic examination is the best approach to diagnosing esophageal candidiasis, and multiple white plaques adherent to the mucosa are considered definitively diagnostic of the disease (Figure 2). The most common treatment is systemic and oral administration of fluconazole, an antifungal agent [25].
Esophageal candidiasis.
The two most common causes of viral esophagitis are herpes simplex virus (HSV) and cytomegalovirus (CMV). HSV esophagitis ulcers are circumscribed ulcers with raised edges that are described as volcano-like ulcers [26]. CMV esophagitis ulcers are well-demarcated vertical or horizontal linear shallow ulcers that occur in the middle and distal portions of the esophagus [27]. It is sometimes difficult to differentiate between HSV esophagitis and CMV esophagitis because their endoscopic characteristics often overlap [28]. Recently, an ML model for differentiating CMV esophagitis from HSV esophagitis was developed. It was developed based on the analysis of 87 patients with HSV esophagitis and 63 patients with CMV esophagitis using 666 endoscopic images of HSV esophagitis and 416 endoscopic images of CMV esophagitis. The sensitivity and specificity of the model were 100% [28].
Sloughing esophagitis is characterized by superficial necrotic squamous epithelium and endoscopic plaques or membranes (Figure 3) [29]. The symptoms include dysphagia, odynophagia, nausea, vomiting, abdominal pain, heartburn, chest pain, hematemesis, and obstructive symptoms secondary to the accumulation of casts in the esophageal lumen [30]. The pathogenesis is thought to involve exposure to drugs that cause esophageal damage or autoimmune conditions accompanied by esophageal damage. Such drugs include dabigatran, nonsteroidal anti-inflammatory drugs, bisphosphonates, and iron. The autoimmune conditions include celiac disease, pemphigus vulgaris, bullous pemphigoid, and lupus [30]. Prognosis is usually favorable, and long-term complications are rare. Treatment includes discontinuation of the offending agent and administration of proton-pump inhibitors (PPIs). Steroids may be helpful when a patient has an autoimmune condition [30].
Sloughing esophagitis.
EoE is a chronic immune-mediated inflammatory condition of the esophagus. Its symptoms are mainly related to esophageal dysfunction and include vomiting, dysphagia, and feeding difficulties. Diagnosis of EoE requires endoscopy with biopsy. The endoscopic findings include furrows (i.e., vertical lines in the mucosa), concentric rings, white plaques, edema, and stricture (Figure 4). The American College of Gastroenterology (ACG) recommends a minimum of six biopsies. A finding of 15 or more eosinophils per high-power field in the maximally affected area is required for diagnosis [31]. The treatment options are PPIs, topical corticosteroids, and allergy testing–directed elimination diet. A previous study presented a graphical representation of a suggested management algorithm [32].
Eosinophilic esophagitis.
Pill-induced esophagitis may present as erosions, kissing ulcers, and multiple small areas of ulceration with bleeding mainly in the middle third of the esophagus [33]. Treatment of pill-induced esophagitis consists of discontinuation of the offending drug and use of PPIs or sucralfate to hasten esophageal mucosal healing [34].
BE is a condition characterized by metaplasia of normal esophageal squamous epithelium to specialized columnar epithelium with goblet cells [35]. The ACG guidelines recommend considering BE when the length of the columnar mucosa is at least 1 cm. When BE is suspected, at least eight random biopsy samples should be taken if the BE segment length is <2 cm, and in patients with suspected long-segment BE, four biopsy samples should be taken for every 2 cm of BE segment [36]. Based on the length of salmon-colored mucosa proximal to the GEJ, BE is classified into two groups: short-segment BE and long-segment BE (Figure 5). Long-segment BE is defined as BE with segment length ≥ 3 cm, and short-segment BE is defined as BE with segment length < 3 cm [36]. Screening endoscopy is recommended for patients with chronic GERD symptoms and three or more additional risk factors of BE (e.g., male gender, age > 50 years, white race, tobacco smoking, obesity, and history of BE or EAC in a first-degree relative) [35]. If screening endoscopy does not reveal dysplasia, surveillance endoscopy should be repeated in 3–5 years. Further, a histological grade of “indefinite for dysplasia” should be confirmed by a second pathologist with gastrointestinal expertise, PPI therapy should be initiated, and endoscopic biopsy should be repeated within 6 months [35]. When the histological grade is low-grade dysplasia (LGD), endoscopic mucosal resection or endoscopic submucosal dissection of all visible lesions should be performed, followed by ablation of the remaining BE segment (i.e., endoscopic eradication therapy [EET]) with the goal of complete eradication of intestinal metaplasia (CEIM). Alternatively, surveillance can be performed every 6 months for the first year and annually thereafter [36]. When the histological grade is HGD or intramucosal carcinoma (T1a), EET with the goal of CEIM should be performed. It is recommended to enroll patients with LGD or HGD for surveillance and reflux control after CEIM is achieved [35]. Surveillance at 1 year after CEIM and every 2 years thereafter is recommended for patients with LGD. Surveillance at 3, 6, and 12 months after CEIM and annually thereafter is recommended for patients with HGD or intramucosal carcinoma [35]. Esophagectomy is typically recommended for patients with EAC and submucosal invasion (T1b). Alternatively, EET can be considered for patients with superficial submucosal invasion (sm1, to a depth < 500 μm) and low-risk features such as negative deep margin, well-moderate differentiation, and absence of lymphovascular invasion [35]. Regarding neoplasia detection, the sensitivity and specificity of AI are >90% and > 80%, respectively. Further, regarding neoplasia characterization, the sensitivity and specificity of AI are 90% and 88%, respectively [37].
Barrett’s esophagus. (a) WLE. (b) NBI.
ESCC is the most common type of esophageal cancer worldwide; it is especially common in Asia and Africa (Figure 6) [38]. The risk factors for ESCC include long-standing exposure to tobacco and alcohol, achalasia, head and neck squamous cell cancer, tylosis, history of lye ingestion, celiac sprue, and hot liquid ingestion [39]. In addition, the etiological role of human papilloma virus infection is under study [39]. Endoscopic screening should be considered in the presence of risk factors. Infiltration depth prediction is important since it is primarily associated with lymph node metastasis [40]. The Japan Esophageal Society uses a simplified classification of vessel irregularities known as intrapapillary capillary loops (IPCLs) to predict infiltration depth. Type A vessel refers to a normal or abnormal microvessel without severe irregularity, that is, a microvessel with normal epithelium or inflammation and low-grade intraepithelial neoplasia [41]. Abnormal microvessels with severe irregularity or highly dilated abnormal vessels are classified as type B1, B2, or B3. Type B1 vessels have loop-like formations and a predicted invasion depth of epithelium (EP) or lamina propria mucosae (LMP). Type B2 vessels do not have loop-like formations, and their predicted invasion depth is muscularis mucosae or submucosa (SM1). Type B3 vessels have highly dilated vessels and a predicted invasion depth of the submucosa (SM2) or deeper [41]. ESD is recommended for lesions with invasion depth of T1a-EP/T1a-LMP, noncircumferential lesions, and circumferential lesions with lengths ≤5 cm. Furthermore, ESD can be used to remove noncircumferential lesions with invasion depth of T1a-MM/T1b-SM1. Surgery or chemoradiation should be considered when the invasion depth is T1a-EP/T1a-LMP and lateral extension is circumferential with length > 5 cm. It should also be considered when the invasion depth is T1a-MM/T1b-SM1 and lateral extension is circumferential [39]. In a recent study by Everson et al., it was reported that the sensitivity and specificity of AI using CNN for the classification of abnormal IPCL patterns were 89.3% and 98%, respectively [42].
Esophageal squamous cell carcinoma. (a) WLE, (b) tone enhancement mode with i-scan.
Esophageal diverticula are a rare condition that causes dysphagia, regurgitation, and chest pain [43]. They are classified into two: pulsion diverticula and traction diverticula. Pulsion diverticula are associated with increased intraluminal pressure, which causes herniation. Zenker’s diverticulum, which is a pulsion-type pharyngoesophageal pseudodiverticulum, is the most common type of esophageal diverticulum (Figure 7) [44]. Surgery can be considered for the management of Zenker’s diverticulum. However, the current first-line treatment involves cutting the entire septum and creating a common cavity between the esophagus and the diverticulum [45]. There are two methods of endoscopic septum division. The first is conventional flexible endoscopic septum division, which entails full-thickness incision of the mucosa, submucosa, and the muscular fibers to create a common cavity between the esophagus and the diverticulum. The second is Zenker’s diverticulum per-oral endoscopic myotomy, which entails minimal mucosal incision to advance the endoscope into the submucosal space of the septum. Complete septotomy is then performed, and the mucosal incision site is securely closed with several endoclips [45].
Zenker’s diverticulum.
Esophageal inlet patches (IPs) are well-circumscribed areas of mucosa that are salmon-pink in color, variable in size, and oval-round or even geographically shaped (Figure 8) [46]. Most IPs are located just below the upper esophageal sphincter or in the postcricoid region of the esophagus [46]. Since most IPs present with no symptoms and are located in the upper esophagus, where endoscopists tend to pass the endoscope quickly, it is difficult to identify and observe IPs in detail. However, since adenocarcinomas sometimes arise in IPs, careful observation is necessary [47]. It is recommended that WLE be used first when inserting the endoscope and NBI be used to observe the esophagus up to the pyriform sinus when retracting the endoscope.
Esophageal inlet patch. (a) WLE. (b) NBI.
Esophageal stricture is an abnormal narrowing of the esophageal lumen (Figure 9). It can be benign or malignant. The etiology of benign esophageal stricture includes corrosive substance ingestion, EoE, radiation injury, and drug-induced esophagitis. Treatment includes mechanical or balloon dilation, esophageal stents, or surgical management [48].
Esophageal stricture: (a) with a bean stuck in the stricture; (b) after bean removal.
Hiatal hernia is a condition in which the upper part of the stomach bulges through an aperture in the diaphragm (Figure 10). There are four anatomical classifications of hiatal hernia: types 1, 2, 3, and 4. Type 1 or sliding hernias are associated with symmetrical ascent of the stomach through the diaphragmatic crus. A patient with type 1 hernia who has reflux symptoms can first undergo PPI therapy with lifestyle modification. In contrast, a patient with symptomatic paraesophageal hernia (types 2, 3, and 4) is at high risk for obstruction, and surgery should be considered for such a patient [49].
Esophageal hiatal hernia: (a) sliding-type hiatal hernia; (b) paraesophageal hernia (mixed type).
Esophageal squamous papilloma is a wart-like exophytic mass located in the middle to distal esophagus (Figure 11). Most papillomas are benign, small, and can be easily removed during forceps biopsy. However, owing to the few reported cases of carcinomatous transformation of these lesions, definite removal is necessary if a papilloma bleeds, is unusually large, elicits foreign-body sensation, or shows atypical changes on histological examination [50].
Esophageal squamous papilloma.
Esophageal sentinel polyps (or sentinel folds) are inflammatory polyps at the GEJ associated with recurrent GERD (Figure 12) [51]. Although sentinel polyps are benign, biopsy is indicated if a lesion is discovered for the first time or if it changes in size or shape.
Sentinel polyp.
Hyperplastic polyps are uncommon lesions that most commonly occur at the GEJ (Figure 13) [52]. There are no reported cases of malignant transformation of esophageal hyperplastic polyps [52]. However, when the polyp size is larger than 10 mm, it is difficult to determine if the polyp originated from the GEJ or from the gastric cardia; in such cases, complete removal of the polyp should be considered [53].
Hyperplastic polyp at the GEJ.
Subepithelial lesions (SELs) of the gastrointestinal tract are tumors that originate from the muscularis mucosa, submucosa, or muscularis propria [54]. The most common (70–80%) benign esophageal SEL is leiomyoma [55]. However, carcinoid tumors, lymphomas, glomus tumors, and gastrointestinal stromal tumors (GISTs) are malignant or have malignant potential and must be considered [56]. The 2022 European Society of Gastrointestinal Endoscopy (ESGE) guidelines do not recommend WLE or advanced imaging techniques for the characterization of SEL subtypes. Furthermore, the guidelines recommend endoscopic ultrasonography (EUS) as the best tool for the characterization of features of SEL (e.g., size, location, originating layer, echogenicity, shape), but EUS alone cannot distinguish between the types of SEL. Tissue diagnosis is required for SELs with features suggestive of GIST, size >20 mm, high-risk stigmata, or requirement of surgical resection or oncological treatment. The ESGE suggests esophagogastroduodenoscopy (EGD) surveillance at 3–6 months if asymptomatic SELs are found on EGD. EGD is recommended at intervals of 2–3 years for lesions <10 mm and at intervals of 1–2 years for lesions 10–20 mm in size. For asymptomatic unresected SELs >20 mm in size, the ESGE recommends surveillance with EGD plus EUS at 6 months, and then at intervals of 6–12 months [54].
Esophageal varices are dilated submucosal veins of the distal esophagus that connect the portal and systemic circulations (Figure 14) [57]. General rules for describing endoscopic findings of esophageal varix were proposed by the Japan Society for Portal Hypertension [58]. The rules define six main categories: location (L), form (F), color (C), red color (RC) signs, bleeding signs, and mucosal findings. Regarding location, Ls, Lm, and Li stand for Locus superior, Locus medialis, and Locus inferior, respectively. Regarding form, F0 denotes no varicose appearance, F1 denotes straight small-caliber varices, F2 denotes moderately enlarged and beady varices, and F3 denotes markedly enlarged, nodular, or tumor-shaped varices. Regarding color, Cw denotes white varices, Cb denotes blue varices, CwTh denotes thrombosed white varices, and Cb-Th denotes thrombosed blue varices. Regarding RC signs, RWM denotes red wale markings, CRS denotes cherry red spots, HCS denotes hematocystic spots, and Te denotes telangiectasia. Nonselective beta-blockers (e.g., nadolol, propranolol, carvedilol) should be considered if small (≤5 mm) varices with RWM or medium/large (>5 mm) varices are found on screening endoscopy [59].
Esophageal varix.
The authors declare no conflict of interest.
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All published Book Chapters are licensed under a Creative Commons Attribution 3.0 Unported License. Monographs are licensed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) license granted to all others. Our Copyright Policy aims to guarantee that original material is published while at the same time giving significant freedom to our Authors. IntechOpen upholds a flexible Copyright Policy meaning that there is no copyright transfer to the publisher and Authors hold exclusive copyright to their work.
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\n\n\n\nIntechOpen is committed to disseminating high-quality scientific research in a manner that exemplifies the best practice in scholarly publishing. IntechOpen is an official member of the Committee on Publication Ethics (COPE), which advocates the maintenance of the highest ethical standards for all parties involved in the act of publishing, including Authors, Academic Editors of the book, Peer Reviewers, the publisher and Societies, where applicable.
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\n\nAll scientific works are subject to Peer Review prior to publishing. IntechOpen is a member of the Committee on Publication Ethics (COPE) and all participating referees and Academic Editors are expected to review submitted scientific works in line with the COPE Ethical Guidelines for Peer Reviewers where applicable.
\n\n\n\nThe Internet has changed the dynamics of scholarly communication and publishing which is why we find it necessary to clearly indicate our stance on what we consider to be a published scientific work. A significant number of working papers, early drafts, and similar works in progress are shared openly online between members of the scientific community. It has become common practice for researchers to announce their work on a personal website or a blog in order to gather comments and suggestions from other researchers. Such works and online postings are ‘published’ in the sense that they are made publicly available, but this does not mean that if submitted for publication by IntechOpen they are not original works. We differentiate between reviewed and non-reviewed works when determining whether a work is original and has been published in a scholarly sense or not.
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On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. 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Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. 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He has both an MS and Ph.D. in Biomedical Engineering. He was previously a research scientist at the University of California Los Angeles (UCLA) and visiting professor and researcher at the University of North Dakota. He is currently working in artificial intelligence and its applications in medical signal processing. In addition, he is using digital signal processing in medical imaging and speech processing. Dr. Asadpour has developed brain-computer interfacing algorithms and has published books, book chapters, and several journal and conference papers in this field and other areas of intelligent signal processing. He has also designed medical devices, including a laser Doppler monitoring system.",institutionString:"Kaiser Permanente Southern California",institution:null},{id:"169608",title:"Prof.",name:"Marian",middleName:null,surname:"Găiceanu",slug:"marian-gaiceanu",fullName:"Marian Găiceanu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/169608/images/system/169608.png",biography:"Prof. Dr. Marian Gaiceanu graduated from the Naval and Electrical Engineering Faculty, Dunarea de Jos University of Galati, Romania, in 1997. He received a Ph.D. (Magna Cum Laude) in Electrical Engineering in 2002. Since 2017, Dr. Gaiceanu has been a Ph.D. supervisor for students in Electrical Engineering. He has been employed at Dunarea de Jos University of Galati since 1996, where he is currently a professor. Dr. Gaiceanu is a member of the National Council for Attesting Titles, Diplomas and Certificates, an expert of the Executive Agency for Higher Education, Research Funding, and a member of the Senate of the Dunarea de Jos University of Galati. He has been the head of the Integrated Energy Conversion Systems and Advanced Control of Complex Processes Research Center, Romania, since 2016. He has conducted several projects in power converter systems for electrical drives, power quality, PEM and SOFC fuel cell power converters for utilities, electric vehicles, and marine applications with the Department of Regulation and Control, SIEI S.pA. (2002–2004) and the Polytechnic University of Turin, Italy (2002–2004, 2006–2007). He is a member of the Institute of Electrical and Electronics Engineers (IEEE) and cofounder-member of the IEEE Power Electronics Romanian Chapter. He is a guest editor at Energies and an academic book editor for IntechOpen. He is also a member of the editorial boards of the Journal of Electrical Engineering, Electronics, Control and Computer Science and Sustainability. Dr. Gaiceanu has been General Chairman of the IEEE International Symposium on Electrical and Electronics Engineering in the last six editions.",institutionString:'"Dunarea de Jos" University of Galati',institution:{name:'"Dunarea de Jos" University of Galati',country:{name:"Romania"}}},{id:"4519",title:"Prof.",name:"Jaydip",middleName:null,surname:"Sen",slug:"jaydip-sen",fullName:"Jaydip Sen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/4519/images/system/4519.jpeg",biography:"Jaydip Sen is associated with Praxis Business School, Kolkata, India, as a professor in the Department of Data Science. His research areas include security and privacy issues in computing and communication, intrusion detection systems, machine learning, deep learning, and artificial intelligence in the financial domain. He has more than 200 publications in reputed international journals, refereed conference proceedings, and 20 book chapters in books published by internationally renowned publishing houses, such as Springer, CRC press, IGI Global, etc. Currently, he is serving on the editorial board of the prestigious journal Frontiers in Communications and Networks and in the technical program committees of a number of high-ranked international conferences organized by the IEEE, USA, and the ACM, USA. He has been listed among the top 2% of scientists in the world for the last three consecutive years, 2019 to 2021 as per studies conducted by the Stanford University, USA.",institutionString:"Praxis Business School",institution:null},{id:"320071",title:"Dr.",name:"Sidra",middleName:null,surname:"Mehtab",slug:"sidra-mehtab",fullName:"Sidra Mehtab",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002v6KHoQAM/Profile_Picture_1584512086360",biography:"Sidra Mehtab has completed her BS with honors in Physics from Calcutta University, India in 2018. She has done MS in Data Science and Analytics from Maulana Abul Kalam Azad University of Technology (MAKAUT), Kolkata, India in 2020. Her research areas include Econometrics, Time Series Analysis, Machine Learning, Deep Learning, Artificial Intelligence, and Computer and Network Security with a particular focus on Cyber Security Analytics. Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:null},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"310576",title:"Prof.",name:"Erick Giovani",middleName:null,surname:"Sperandio Nascimento",slug:"erick-giovani-sperandio-nascimento",fullName:"Erick Giovani Sperandio Nascimento",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y00002pDKxDQAW/ProfilePicture%202022-06-20%2019%3A57%3A24.788",biography:"Prof. Erick Sperandio is the Lead Researcher and professor of Artificial Intelligence (AI) at SENAI CIMATEC, Bahia, Brazil, also working with Computational Modeling (CM) and HPC. He holds a PhD in Environmental Engineering in the area of Atmospheric Computational Modeling, a Master in Informatics in the field of Computational Intelligence and Graduated in Computer Science from UFES. He currently coordinates, leads and participates in R&D projects in the areas of AI, computational modeling and supercomputing applied to different areas such as Oil and Gas, Health, Advanced Manufacturing, Renewable Energies and Atmospheric Sciences, advising undergraduate, master's and doctoral students. He is the Lead Researcher at SENAI CIMATEC's Reference Center on Artificial Intelligence. In addition, he is a Certified Instructor and University Ambassador of the NVIDIA Deep Learning Institute (DLI) in the areas of Deep Learning, Computer Vision, Natural Language Processing and Recommender Systems, and Principal Investigator of the NVIDIA/CIMATEC AI Joint Lab, the first in Latin America within the NVIDIA AI Technology Center (NVAITC) worldwide program. He also works as a researcher at the Supercomputing Center for Industrial Innovation (CS2i) and at the SENAI Institute of Innovation for Automation (ISI Automação), both from SENAI CIMATEC. He is a member and vice-coordinator of the Basic Board of Scientific-Technological Advice and Evaluation, in the area of Innovation, of the Foundation for Research Support of the State of Bahia (FAPESB). He serves as Technology Transfer Coordinator and one of the Principal Investigators at the National Applied Research Center in Artificial Intelligence (CPA-IA) of SENAI CIMATEC, focusing on Industry, being one of the six CPA-IA in Brazil approved by MCTI / FAPESP / CGI.br. He also participates as one of the representatives of Brazil in the BRICS Innovation Collaboration Working Group on HPC, ICT and AI. He is the coordinator of the Work Group of the Axis 5 - Workforce and Training - of the Brazilian Strategy for Artificial Intelligence (EBIA), and member of the MCTI/EMBRAPII AI Innovation Network Training Committee. He is the coordinator, by SENAI CIMATEC, of the Artificial Intelligence Reference Network of the State of Bahia (REDE BAH.IA). He leads the working group of experts representing Brazil in the Global Partnership on Artificial Intelligence (GPAI), on the theme \"AI and the Pandemic Response\".",institutionString:"Manufacturing and Technology Integrated Campus – SENAI CIMATEC",institution:null},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:"Polytechnic University of Timişoara",institution:{name:"Polytechnic University of Timişoara",country:{name:"Romania"}}},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:null},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"414880",title:"Dr.",name:"Maryam",middleName:null,surname:"Vatankhah",slug:"maryam-vatankhah",fullName:"Maryam Vatankhah",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Borough of Manhattan Community College",country:{name:"United States of America"}}},{id:"414879",title:"Prof.",name:"Mohammad-Reza",middleName:null,surname:"Akbarzadeh-Totonchi",slug:"mohammad-reza-akbarzadeh-totonchi",fullName:"Mohammad-Reza Akbarzadeh-Totonchi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Ferdowsi University of Mashhad",country:{name:"Iran"}}},{id:"414878",title:"Prof.",name:"Reza",middleName:null,surname:"Fazel-Rezai",slug:"reza-fazel-rezai",fullName:"Reza Fazel-Rezai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"American Public University System",country:{name:"United States of America"}}},{id:"302698",title:"Dr.",name:"Yao",middleName:null,surname:"Shan",slug:"yao-shan",fullName:"Yao Shan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Dalian University of Technology",country:{name:"China"}}},{id:"125911",title:"Prof.",name:"Jia-Ching",middleName:null,surname:"Wang",slug:"jia-ching-wang",fullName:"Jia-Ching Wang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Central University",country:{name:"Taiwan"}}},{id:"357085",title:"Mr.",name:"P. Mohan",middleName:null,surname:"Anand",slug:"p.-mohan-anand",fullName:"P. Mohan Anand",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356696",title:"Ph.D. Student",name:"P.V.",middleName:null,surname:"Sai Charan",slug:"p.v.-sai-charan",fullName:"P.V. Sai Charan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"357086",title:"Prof.",name:"Sandeep K.",middleName:null,surname:"Shukla",slug:"sandeep-k.-shukla",fullName:"Sandeep K. Shukla",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356823",title:"MSc.",name:"Seonghee",middleName:null,surname:"Min",slug:"seonghee-min",fullName:"Seonghee Min",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Daegu University",country:{name:"Korea, South"}}},{id:"353307",title:"Prof.",name:"Yoosoo",middleName:null,surname:"Oh",slug:"yoosoo-oh",fullName:"Yoosoo Oh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"Yoosoo Oh received his Bachelor's degree in the Department of Electronics and Engineering from Kyungpook National University in 2002. He obtained his Master’s degree in the Department of Information and Communications from Gwangju Institute of Science and Technology (GIST) in 2003. In 2010, he received his Ph.D. degree in the School of Information and Mechatronics from GIST. In the meantime, he was an executed team leader at Culture Technology Institute, GIST, 2010-2012. In 2011, he worked at Lancaster University, the UK as a visiting scholar. In September 2012, he joined Daegu University, where he is currently an associate professor in the School of ICT Conver, Daegu University. Also, he served as the Board of Directors of KSIIS since 2019, and HCI Korea since 2016. From 2017~2019, he worked as a center director of the Mixed Reality Convergence Research Center at Daegu University. From 2015-2017, He worked as a director in the Enterprise Supporting Office of LINC Project Group, Daegu University. His research interests include Activity Fusion & Reasoning, Machine Learning, Context-aware Middleware, Human-Computer Interaction, etc.",institutionString:null,institution:{name:"Daegu Gyeongbuk Institute of Science and Technology",country:{name:"Korea, South"}}},{id:"262719",title:"Dr.",name:"Esma",middleName:null,surname:"Ergüner Özkoç",slug:"esma-erguner-ozkoc",fullName:"Esma Ergüner Özkoç",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Başkent University",country:{name:"Turkey"}}},{id:"346530",title:"Dr.",name:"Ibrahim",middleName:null,surname:"Kaya",slug:"ibrahim-kaya",fullName:"Ibrahim Kaya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"419199",title:"Dr.",name:"Qun",middleName:null,surname:"Yang",slug:"qun-yang",fullName:"Qun Yang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Auckland",country:{name:"New Zealand"}}}]}},subseries:{item:{id:"25",type:"subseries",title:"Evolutionary Computation",keywords:"Genetic Algorithms, Genetic Programming, Evolutionary Programming, Evolution Strategies, Hybrid Algorithms, Bioinspired Metaheuristics, Ant Colony Optimization, Evolutionary Learning, Hyperparameter Optimization",scope:"Evolutionary computing is a paradigm that has grown dramatically in recent years. This group of bio-inspired metaheuristics solves multiple optimization problems by applying the metaphor of natural selection. It so far has solved problems such as resource allocation, routing, schedule planning, and engineering design. Moreover, in the field of machine learning, evolutionary computation has carved out a significant niche both in the generation of learning models and in the automatic design and optimization of hyperparameters in deep learning models. This collection aims to include quality volumes on various topics related to evolutionary algorithms and, alternatively, other metaheuristics of interest inspired by nature. For example, some of the issues of interest could be the following: Advances in evolutionary computation (Genetic algorithms, Genetic programming, Bio-inspired metaheuristics, Hybrid metaheuristics, Parallel ECs); Applications of evolutionary algorithms (Machine learning and Data Mining with EAs, Search-Based Software Engineering, Scheduling, and Planning Applications, Smart Transport Applications, Applications to Games, Image Analysis, Signal Processing and Pattern Recognition, Applications to Sustainability).",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",hasOnlineFirst:!1,hasPublishedBooks:!0,annualVolume:11421,editor:{id:"136112",title:"Dr.",name:"Sebastian",middleName:null,surname:"Ventura Soto",slug:"sebastian-ventura-soto",fullName:"Sebastian Ventura Soto",profilePictureURL:"https://mts.intechopen.com/storage/users/136112/images/system/136112.png",biography:"Sebastian Ventura is a Spanish researcher, a full professor with the Department of Computer Science and Numerical Analysis, University of Córdoba. Dr Ventura also holds the positions of Affiliated Professor at Virginia Commonwealth University (Richmond, USA) and Distinguished Adjunct Professor at King Abdulaziz University (Jeddah, Saudi Arabia). Additionally, he is deputy director of the Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI) and heads the Knowledge Discovery and Intelligent Systems Research Laboratory. He has published more than ten books and over 300 articles in journals and scientific conferences. Currently, his work has received over 18,000 citations according to Google Scholar, including more than 2200 citations in 2020. In the last five years, he has published more than 60 papers in international journals indexed in the JCR (around 70% of them belonging to first quartile journals) and he has edited some Springer books “Supervised Descriptive Pattern Mining” (2018), “Multiple Instance Learning - Foundations and Algorithms” (2016), and “Pattern Mining with Evolutionary Algorithms” (2016). He has also been involved in more than 20 research projects supported by the Spanish and Andalusian governments and the European Union. He currently belongs to the editorial board of PeerJ Computer Science, Information Fusion and Engineering Applications of Artificial Intelligence journals, being also associate editor of Applied Computational Intelligence and Soft Computing and IEEE Transactions on Cybernetics. Finally, he is editor-in-chief of Progress in Artificial Intelligence. He is a Senior Member of the IEEE Computer, the IEEE Computational Intelligence, and the IEEE Systems, Man, and Cybernetics Societies, and the Association of Computing Machinery (ACM). Finally, his main research interests include data science, computational intelligence, and their applications.",institutionString:null,institution:{name:"University of Córdoba",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,series:{id:"14",title:"Artificial Intelligence",doi:"10.5772/intechopen.79920",issn:"2633-1403"},editorialBoard:[{id:"111683",title:"Prof.",name:"Elmer P.",middleName:"P.",surname:"Dadios",slug:"elmer-p.-dadios",fullName:"Elmer P. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. 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