Impact of real-time artificial intelligence integration on detection of gastric lesions: an exploratory single-center before-and-after study using low-definition routine endoscopy.

Adequate gastric mucosal visibility (GMV) is essential for high quality upper gastrointestinal (GI) endoscopy. Simethicone and N-acetylcysteine (NAC) are commonly used to improve mucosal visibility, but the optimal timing of administration remains uncertain. This double-blinded randomized controlled trial (RCT) evaluated the optimal interval between premedication (simethicone + NAC) and endoscopy for achieving adequate GMV. In this RCT, adults undergoing elective upper GI endoscopy were randomized to four groups: placebo (Group 1), premedication to endoscopy interval of 10-20 (Group 2), 21-30 (Group 3), or > 30 min (Group 4). GMV was scored in four gastric regions (antrum, distal body, proximal body, fundus) on a 4-point scale (range 4-16). The primary outcome was adequate GMV (total score < 7). Secondary outcomes included median total GMV score, region-wise mucosal visibility scores, lesion detection rate, and predictors of adequate GMV. A total of 1200 adults were randomized to four groups. Adequate GMV was significantly more frequent in Groups 3 (64.7%) and 4 (66.7%) than in placebo (2.7%) or Group 2 (25.0%). Subgroup analysis within Group 4 demonstrated a declining trend after 50 min. ROC analysis suggested an optimal cut-off of 25 min in predicting adequate GMV with area under the curve of 0.80. In region-wise analysis, mean visibility scores were lowest in antrum and distal body. There was no significant difference in the detection of gastric lesions across study groups (p = 0.913). No serious adverse events related to premedication were observed. Premedication with simethicone and NAC significantly improves GMV. The improvement becomes optimal at 20-30 min after ingestion and is consistently maintained up to 50 min. ClinicalTrials.gov identifier: NCT06581783.

Gastric lesions may be incidentally detected during pancreatobiliary endoscopic ultrasonography (PB-EUS). We aimed to clarify the detection rate of gastric lesions and the impact of awareness on the detection of gastric lesions during PB-EUS. We retrospectively analyzed consecutive patients who underwent PB-EUS (1932 procedures, 1220 patients). We compared the detection rate of incidental gastric lesions and documentation of gastric findings between the groups without and with gastric screening during PB-EUS: former group (2009-2014: 505 procedures, 409 patients) and latter group (2015-2020: 1427 procedures, 918 patients), respectively. Thirteen gastric lesions were incidentally detected during PB-EUS, all in the latter group, including gastric cancer (n = 1), malignant lymphoma (n = 1), gastric adenoma (n = 1), gastric submucosal tumor (n = 2), and gastric ulcer (n = 8). The detection rate of gastric lesions was significantly higher in the latter group than in the former group per procedure (0.91% vs. 0%, P = 0.027) and per patient (1.41% vs. 0%, P = 0.015), and gastric findings were significantly more commonly described in patients' medical records (39.8% vs. 2.97%, P < 0.001). Gastric lesions may be encountered during PB-EUS. A quick screening during PB-EUS improved the detection rate of gastric lesions, presumably due to increased awareness of gastric lesions during the procedure.

BackgroundCurrent studies have shown that longer observation time can improve neoplastic detection rate. This study aimed to clarify whether endoscopists with longer observation times can detect more focal lesions.MethodsBased on the mean examination time for Esophagogastroduodenoscopy (EGD) without biopsy, endoscopists were divided into fast and slow groups, and the detection rate of focal lesions was compared between the two groups. Univariate analysis, multivariate analysis and restricted cubic spline were used to explore the factors of focal lesion detection rate.ResultsMean examination time of EGD without biopsy was 4.5 min. The cut-off times used were 5 min. 17 endoscopists were classified into the fast (4.7 ± 3.6 min), and 16 into the slow (7.11 ± 4.6 min) groups. Compared with fast endoscopists, slow endoscopists had a higher detection rate of focal lesions (47.2% vs. 51.4%, P < 0.001), especially in the detection of gastric lesions (29.7% vs. 35.9%, P < 0.001). In univariate and multivariate analyses, observation time, patient age and gender, expert, biopsy rate, and number of images were factors in FDR. There is a nonlinear relationship between observation time and FDR.ConclusionLonger examination time improves the detection rate of focal lesions. Observation time is an important quality indicator of the EGD examination.

Esophagogastroduodenoscopy (EGD) is the pivotal procedure for diagnosis of upper gastrointestinal (UGI) lesions. However, significant variation in EGD performance among endoscopists impacts detection rates of UGI cancers and precursor lesions. We developed a novel EGD quality monitoring system and evaluated its effectiveness in a randomized controlled study. The endoscopy quality control assistant (EQCA) was developed using deep convolutional neural networks and long short-term memory. Patients (≥18 years) undergoing EGD in seven hospitals were consecutively enrolled and randomly assigned to the EQCA-assisted group or control group. The primary outcome was the detection rate for cancer-related lesions (low and high grade intraepithelial neoplasia and cancer) and cancer (early and advanced cancer) in the UGI tract. After randomization and exclusions, 16 005 patients in the control group and 16 012 in the EQCA group were analyzed. Detection rates for UGI cancer-related lesions and cancer were significantly higher in the EQCA group than in the control group (8.00% vs. 5.55%; 1.93% vs. 1.21%; both P < 0.001). The EQCA group had a higher operation score, reflecting examination quality, and longer inspection time than the control group. The detection rate for UGI cancer-related lesions was positively correlated with operation score (r = 0.9217, P < 0.001) and inspection time (r = 0.8943, P < 0.001) for each hospital. The use of EQCA during EGD was associated with increased detection of UGI cancer and precancerous lesions. Our novel EQCA system can be an effective tool for monitoring real-time EGD quality.

Gastrointestinal cancers account for 26% of cancer incidence and 35% of cancer-related deaths globally. Early detection is crucial but often limited by white light endoscopy (WLE), which misses subtle lesions. Texture and color enhancement imaging (TXI), introduced in 2020, enhances texture, brightness, and color, addressing WLE's limitations. This meta-analysis evaluates TXI's effectiveness compared to WLE in gastrointestinal lesion lesion detection. A systematic review and meta-analysis were conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of CENTRAL, PubMed, Embase, and Web of Science identified randomized controlled trials and observational studies comparing TXI with WLE. Outcomes included lesion detection rates, color differentiation, and visibility scores. The risk of bias was assessed using the Cochrane ROB 2.0 tool and Newcastle-Ottawa tools, and evidence certainty was evaluated using Grading of Recommendations Assessment, Development, and Evaluation. Seventeen studies with 16,634 participants were included. TXI significantly improved color differentiation (mean difference: 3.31, 95% confidence interval [CI]: 2.49-4.13), visibility scores (mean difference: 0.50, 95% CI: 0.36-0.64), and lesion detection rates (odds ratio [OR]: 1.84, 95% CI: 1.52-2.22) compared to WLE. Subgroup analyses confirmed TXI's advantages across pharyngeal, esophageal, gastric, and colorectal lesions. TXI also enhanced adenoma detection rates (OR: 1.66, 95% CI: 1.31-2.12) and mean adenoma detection per procedure (mean difference: 0.48, 95% CI: 0.25-0.70). TXI improves gastriontestinal lesion lesion detection by enhancing visualization and color differentiation, addressing key limitations of WLE. These findings support its integration into routine endoscopy, with further research needed to compare TXI with other modalities and explore its potential in real-time lesion detection.

BACKGROUND Small bowel obscured its lesions as secrets which were difficult to diagnose before video capsule endoscopy as a new modality for investigation. Aim of the study Evaluation of video capsule endoscopy in comparison to radiological examination in detection of small bowel lesions. Patients and methods Fifty patients were recruited from Kafrawy Video Capsule Endoscopy Unit of Internal Medicine Department and endoscopy unit of Ain Shams University Hospital. The study included patients with occult or overt GIT bleeding, patients with unexplained microcytic iron deficiency anemia, patients with chronic diarrhea and abdominal pain, with normal upper GI endoscopy and colonoscopy. Exclusion of any patient younger than 18 years old, has intestinal stricture, achalasia, or dysphagia. All patients were studied biochemically with CBC and radiological by CT pelvis and abdomen with IV and oral positive contrast some of them were radiologically examined with CTE or CT mesenteric angiography. All patients were endoscopically examined by OGD, colonoscopy, VCE, and some of them were examined also with enteroscope. Results The study revealed that the detection rate of SB lesions with VCE was 84%. In the current study, (44%) of cases had AVMs, (72.73) % of them were above the age of forty five, and (27.27) % were below the age of forty five. All patients who were investigated with CT mesenteric angiography revealed negative results. In this study (20) % of patients had SB masses and polyps, (70) % of them were at age of forty five or more and only (30) % of them were below the age of forty five. All patients underwent CT pelvis and abdomen with IV and oral positive contrast, and we found that all patients had a negative results regarding the SB lesions. In comparison between CTE and VCE in detection of SB vascular lesions CTE did not detect SB vacular lesions. On the other hand, VCE detected the AVMs in the cases with negative CTE results. In this study one patient (2)% was diagnosed with hookworm infection. All patient underwent for OGD. We found that (20)% of patients had a significant gastric or duodenal lesions (proximal to the papilla) by VCE but missed by upper GI endoscopy. In our study the concomitant of VCE and enteroscope increase the detection of SB vascular lesions than isolated use of VCE only. Conclusion VCE has a high detection rate of SB lesions (84)%. CTE has a low significance in detection of SB vascular lesions and CT mesenteric angiography sensitivity relatively low. AVMs more common with increasing the age. PHE and SB ectopic varicies, were found to be common causes of GIT bleeding in CLD patient. There is a significant rate of missed gastric and duodenal (proximal to the papilla) lesions that the cause of GIT bleeding and unexplained iron deficiency anemia in OGD examination that were detected by VCE.

Accuracy of artificial intelligence–assisted detection of upper GI lesions: a systematic review and meta-analysis

Topical anesthesia: To use or not to use—that is the question

IntroductionThere are no established quality indicators for upper gastrointestinal (UGI) endoscopy. We conducted a systematic review of potential quality indicators for UGI endoscopy that are associated with the diagnosis of...

The introduction of magnetically controlled capsule endoscopy overcame the restriction of passive capsule endoscopy movement, thus allowing an improved visualization of the gastrointestinal lumen, where other imaging studies seem to be unhelpful. The aim of this study is to systematically review the performance of magnetically controlled capsule endoscopy and evaluate its potential as a less invasive diagnostic method in the detection of gastric lesions. A systematic search was performed in PubMed (Medline), EMBASE, Google Scholar, Scopus, Who Global Health Library (GHL), Virtual Health Library (VHL), Clinicaltrials.gov, Cochrane Library, and ISI Web of Science databases. Proportion meta-analyses were performed to estimate the pooled sensitivity of magnetically controlled capsuled endoscopy in the detection of gastrointestinal lesions. Among the 3026 studies that were initially assessed, 7 studies were finally included, with a total of 916 patients and 745 gastric lesions. The mean capsule endoscopy examination time was 21.92±8.87 minutes. The pooled overall sensitivity of magnetically controlled capsule endoscopy was 87% [95% confidence interval (CI), 84%-89%]. Subgroup analysis showed that the sensitivity of identifying gastric ulcers was 82% (95% CI: 71%-89%), gastric polyps was 82% (95% CI: 76%-87%), and gastric erosions was 95% (95% CI: 86%-98%). In general, magnetically controlled capsule endoscopy was well tolerated by the participants with minimal adverse events. The magnetically controlled capsule endoscopy demonstrated an acceptable sensitivity of identifying gastric lesions. Further prospective comparative studies are needed to identify the risks and benefits of this new technique, as well as to determine its role as a replacement for conventional gastroscopy.

Mo1579 Duration of Endoscopic Examination Significantly Impacts Detection Rates of Neoplastic Lesions During Diagnostic Upper Endoscopy

Adenoma and Serrated Lesion Detection by Colonoscopy Indication: The ADR-ESS (ADR Extended to all Screening/Surveillance) Score

IntroductionThe universal use of upper gastrointestinal (UGI) endoscopy in patients with portal hypertension in combination with increasing number of patients with liver disease has resulted in the detection of indeterminate...

To investigate the efficiency and impact factors of anatomical intelligence for breast (AI-Breast) and hand-held ultrasound (HHUS) in lesion detection. A total of 172 outpatient women were randomly selected, underwent AI-Breast ultrasound (Group AI) once and HHUS twice. HHUS was performed by breast imaging radiologists (Group A) and general radiologists (Group B). For the AI-Breast examination, a trained technician performed the whole-breast scan and data acquisition, while other general radiologists performed image interpretation. The examination time and lesion detection rate were recorded. The impact factors for breast lesion detection, including breast cup size, number of lesions, and benign or malignant lesions were analyzed. The detection rates of Group AI, A, and B were 92.8 ± 17.0%, 95.0 ± 13.6%, and 85.0 ± 22.9%, respectively. Comparable lesion detection rates were observed in Group AI and Group A (P > 0.05), but a significantly lower lesion detection rate was observed in Group B compared to the other two (both P < 0.05). Regarding missed diagnosis rates of malignant lesions, comparable performance was observed in Group AI, Group A, and Group B (8% vs. 4% vs. 14%, all P > 0.05). Scan times of Groups AI, A, and B were 262.15 ± 40.4 s, 237.5 ± 110.3 s, 281.2 ± 86.1 s, respectively. The scan time of Group AI was significantly higher than Group A (P < 0.01), but was slightly lower than Group B (P > 0.05). We found a strong linear correlation between scan time and cup size in Group AI (r = 0.745). No impacts of cup size and number of lesions were found on the lesion detection rate in Group AI (P > 0.05). With the assist of AI-Breast system, the lesion detection rate of AI-Breast ultrasound was comparable to that of a breast imaging radiologist and superior to that of the general radiologist. AI-Breast ultrasound may be used as a potential approach for breast lesions surveillance.

In some patients, there is not any symptomatic relief after cholecystectomy due to the overlap of the symptoms of biliary and gastroduodenal pathologies known as postcholecystectomy syndrome. The aim of this study was to assess the effectiveness of upper gastrointestinal (UGI) endoscopy in reducing the possibility of postcholecystectomy syndrome. This retrospective study was conducted in 194 cases. In patients sampled for histopathologic examination, screening for Helicobacter pylori and intestinal metaplasia was carried out with Giemsa stain and PAS–Alcian stain. Patients who did not undergo UGI endoscopy before operation were designated as Group A (n = 100) and those who underwent routine UGI endoscopy before operation were called Group B (n = 94). Symptomatic relief after cholecystectomy and endoscopic findings were evaluated. Thirty-one of the 39 patients diagnosed with H. pylori, underwent eradication treatment. Seven of the 31 patients undergoing H. pylori eradication during the preoperative period had ongoing symptoms at the postoperative period. On the other hand, only 2 of 8 patients who did not undergo H. pylori eradication during the preoperative period had unremitting symptoms during the postoperative period. Only three of 100 patients who did not receive a UGI endoscopy during the preoperative period had unremitting symptoms during the postoperative period. The main outcome of the study is to evaluate the necessity of performing routine UGI endoscopy before cholecystectomy. Our results show that it is not necessary, because if you take biliary colic as the one and only symptom of indication for cholecystectomy, the ratio of postcholecystectomy syndrome is 3% to 5% and the reason is 50% organic.