Endoscopic Diagnosis Research Articles

Raman fiber-optic probe for rapid diagnosis of gastric and esophageal tumors with machine learning analysis or similarity assessments: a comparative study.

Gastric and esophageal cancers, the predominant forms of upper gastrointestinal malignancies, contribute significantly to global cancer mortality. Routine detection methods, including medical imaging, endoscopic examination, and pathological biopsy, often suffer from drawbacks such as low sensitivity and laborious and complex procedures. Raman spectroscopy is a non-invasive and label-free optical technique that provides highly sensitive biomolecular information to facilitate effective tumor identification. In this work, we report the use of fiber-optic Raman spectroscopy for the accurate and rapid diagnosis of gastric and esophageal cancers. Using a database of 14,000 spectra from 140 ex vivo tissue pieces of both tumor and normal tissue samples, we compare the random forest (RF) and our established Euclidean distance Raman spectroscopy (EDRS) model. The RF analysis achieves a sensitivity of 85.23% and an accuracy of 83.05% in diagnosing gastric tumors. The EDRS algorithm with improved diagnostic transparency further increases the sensitivity to 92.86% and accuracy to 89.29%. When these diagnostic protocols are extended to esophageal tumors, the RF and EDRS models achieve accuracies of 71.27% and 93.18%, respectively. Finally, we demonstrate that fewer than 20 spectra are sufficient to achieve good Raman diagnostic accuracy for both tumor tissues. This optimizes the balance between acquisition time and diagnostic performance. Our work, although conducted on ex vivo tissue models, offers valuable insights for in vivo in situ endoscopic Raman diagnosis of gastric and esophageal cancer lesions in the future. Our study provides a robust, rapid, and convenient method as a new paradigm in in vivo endoscopic medical diagnostics that integrates spectroscopic techniques and aRaman probe for detecting upper gastrointestinal malignancies.

VIII season of the UralEndo forum Tobolsk plenary session, April 26-27, 2024

The article is dedicated to the plenum of the leaders of the UralEndo forum, held on April 26-27, 2024 in Tobolsk - the city that is rightfully the spiritual heart of the Urals and western Siberia, the cultural and historical center of Russia, where the current state tasks of primary health care development are closely intertwined with the tasks of preserving the best traditions of domestic medicine for the benefit of patients and our native country! In brief overview of the plenum events, the main topics are briefly presented, the achievements and problems of endoscopy in the huge Ural region are summarized, the main working tasks of the forum for the near future are formulated with reference to modern promising methods of endoscopic diagnosis and treatment based on advanced Russian and international experience of their introduction into broad clinical practice at all levels of medical care, starting from the primary level.

Endoscopic diagnosis of larynx pathology

Despite the large number of publications devoted to the diagnosis of laryngeal pathology, the issues of timely and early diagnosis of malignant neoplasms of this localization still remain very relevant. In 2022, the proportion of patients with laryngeal cancer in stages I-II was 40.3%, stage III - 30.3%, stage IV - 28.4%, while 13.1% were actively detected. Accordingly, stage III-IV cancer of the larynx accounts for 58.7%.

Evaluating the discrepancies between evidence-based and community standard practices in the endoscopic diagnosis of esophageal squamous cell carcinoma: a survey study.

The practice of endoscopic diagnosis of esophageal squamous cell carcinoma (ESCC) often diverges from evidence-based standards due to various factors, including inadequate dissemination of evidence or a mismatch between evidence and real-world contexts. This survey aimed to identify discrepancies between evidence-based standard practices and community standard practices for ESCC among endoscopists. An online survey targeting endoscopists who perform upper gastrointestinal endoscopy at least weekly was conducted to collect data on clinical practices related to ESCC diagnosis. The survey, comprising 20 questions, was disseminated through multiple professional networks. Descriptive statistical analysis and logistic regression were performed to analyze the data. Data from 819 endoscopists were included in the analyses. Notably, a significant proportion employed narrow-band imaging/blue-laser imaging over iodine staining, and preferences varied based on risk assessment for ESCC. In total, 64.0% of endoscopists primarily used iodine solution at a concentration of 1% or less, while 96.5% of endoscopists performed an observation of the oral cavity and the pharynx when conducting upper gastrointestinal endoscopies on individuals at high risk of ESCC. The surveillance interval for metachronous multiple ESCCs was most commonly every 6months, followed by every 12months. In addition, most physicians conducted surveillance of metastatic recurrence at 6-month intervals. This survey highlights significant gaps between evidence-based and community standard practices in the endoscopic diagnosis of ESCC. These findings underscore the need for enhanced dissemination of evidence-based guidelines and consideration of real-world clinical contexts to bridge these gaps and optimize patient care.

Correlation of gastrointestinal symptom rating scale and frequency scale for the symptoms of gastroesophageal reflux disease with endoscopic findings

Background Gastroesophageal Reflux Disease (GERD) is caused by the reflux of gastric contents into the esophagus and has a 13% global prevalence that is increasing. GERD symptoms negatively impact physical, social, and emotional quality of life. The Frequency Scale for the Symptoms of GERD (FSSG) and the Gastrointestinal Symptom Rating Scale (GSRS) determine the efficacy of treatment but may not correlate with endoscopically estimated esophageal mucosal injury severity. We aimed to probe the correlation between FSSG, GSRS, and esophageal injury severity to evaluate whether these scores can predict GERD severity. Methods A total of 2962 patients who underwent physical examinations, including upper gastrointestinal endoscopy, at the Kyoto Kuramaguchi Medical Center, Japan, were enrolled in this study. Upper gastrointestinal endoscopy was used to diagnose fundic mucosal atrophy, reflux esophagitis based on the Los Angeles (LA) classification, gastroesophageal flap value function (GEFV) based on Hill’s classification, and Barrett’s esophagus. Endoscopic diagnoses were examined for correlations with FSSG and GSRS scores. Results In reflux esophagitis, FSSG and GSRS scores correlated with LA-B and LA-C endoscopic diagnosis but not with LA-M and LA-A endoscopic findings. Multiple regression analysis results were similar. FSSG scores reflected advanced fundic gland mucosal atrophy, while GSRS scores associated with high grade of GEFV. Conclusions This is the first report to examine the correlation between FSSG and GSRS scores and endoscopic findings in a relatively large patient population. Our findings suggest that these scores can diagnose the severity of reflux esophagitis.

Endoscopic diagnosis of melanoma

Background. Although skin melanoma is a tumour which can be localised visually, its current diagnosis remains unsatisfactory. Skin melanoma exhibits an extremely diverse clinical presentation and a highly variable progression of the neoplastic process.Aim. To analyze our experience in diagnosing metastatic melanoma of the gastrointestinal tract.Materials and methods. The paper presents data from endoscopic and morphological studies of 29 patients who were diagnosed with metastatic melanoma with lesions of the gastrointestinal tract at the Department of Endoscopy the N. Blokhin National Medical Research Centre of Oncology.Results. Among the patients there were 12 (41.3 %) men and 17 (58.6 %) women, whose average age was 50 and 53 years, respectively, the majority of metastatic lesions of the gastrointestinal tract were asymptomatic, only 4 (13.8 %) patients had the disease accompanied by complaints such as difficulty passing food, in 2 cases (6.9 %) episodes of gastrointestinal bleeding were detected. In 7 (24.1 %) cases, the source of metastasis was not identified. The features of the manifestation of metastatic melanomas include the frequently combined lesions of the oesophagus, stomach and duodenum. In rare cases, there is a combination of pigmented and pigmented forms of melanoma.Conclusion. Given the high potential for regional metastasis, the ability of melanoma to disseminate through the skin, the occurrence of multiple metastases even in the absence of local growth, and its often asymptomatic progression in gastrointestinal organs, the diagnostic protocol should encompass the full spectrum of endoscopic techniques. This includes esophagogastroduodenoscopy and colonoscopy, utilizing advanced methods such as narrow-band imaging, magnification, or a combination of both. Biopsy samples should be taken for morphological, cytological, and immunological analysis. Additionally, comprehensive diagnostic methods such as immunoscopy should be employed.

Dysphagia is a strong predictor of revision supraglottoplasty in pediatric laryngomalacia

BackgroundThere is growing research on the association between swallowing dysfunction and laryngomalacia. Supraglottoplasty is the surgical intervention used to treat laryngomalacia, however a portion of patients who undergo this procedure will require a revision surgery. Predictive risk factors for revision supraglottoplasty in patients with laryngomalacia are not well understood, and previous studies failed to evaluate swallowing systematically. HypothesisWe predict a significant association between swallowing dysfunction and revision supraglottoplasty for patients with laryngomalacia. MethodsThis was a retrospective cohort study of consecutive patients between 2013 and 2023 at a tertiary pediatric care centre (Stollery Children's Hospital). All patients had an endoscopic diagnosis of laryngomalacia by a staff otolaryngologist and at minimum a systematic clinical swallowing assessment by a speech language pathologist, with an instrumental assessment as needed. Patients with genetic or neurological comorbidities, lack of follow up information, or age of >3 years were excluded. Clinical and instrumental swallow data, demographic information, surgical outcomes and revision surgeries were documented and collected. Univariate analysis was done to determine associations between variables and revision supraglottoplasty. Binary logistic regression was done to determine independent predictors of revision supraglottoplasty. Results214 patients met the inclusion criteria and were analyzed in the study. 24 patients (11 %) required revision supraglottoplasty. 118 out of the 214 patients (55 %) had an instrumental assessment completed (FEES or VFSS). Of those, 92 (78 %) had abnormal findings on instrumental assessments. Univariate analysis showed Type 2 laryngomalacia (P = 0.017), presence of aspiration (P=<0.001), presence of cyanosis (P = 0.002) and abnormal findings on an instrumental assessment (P = 0.013) to be significantly associated with the need for revision supraglottoplasty. Binary regression analysis showed aspiration (OR = 5.6 {2.087–14.889}, P=<0.001) and cyanosis (OR = 5.3 {1.852–15.181}, P = 0.002) to be the only independent predictors of revision supraglottoplasty. ConclusionPresence of aspiration is a strong predictive factor for revision supraglottoplasty in patients with laryngomalacia, when swallowing is evaluated systematically. More prospective research is needed to understand the relationship between swallowing dysfunction, laryngomalacia and surgery.

Correlation of Endoscopic and Histopathological Diagnoses in Upper Gastrointestinal Tract Lesions: A Cross-Sectional Study.

Introduction Gastrointestinal tract (GIT) endoscopy with biopsy is essential for diagnosing and managing various GIT diseases, including malignancies and inflammatory conditions. This study aimed to analyze the spectrum of histopathological lesions in the GIT and their correlation with the endoscopic findings. Methodology This retrospective observational study was conducted at a tertiary medical college involving 114 patients who underwent GIT endoscopy between June 2023 and June 2024. This study focused on lesion types across different GIT sites (esophagus, stomach, and duodenum) and the agreement between endoscopic and histological diagnoses. Results Lesions were most prevalent in the stomach (52.6% of cases, n=60), followed by the duodenum (35.1%, n=40) and esophagus (12.3%, n=14). Significant correlations were found between endoscopic and histological diagnoses in the esophagus (concordance for esophagitis was 100%) and stomach (concordance for gastritis was 95%). In the duodenum, the concordance was high for duodenitis (100%) but lower for other lesions such as neuroendocrine tumors (71.43%). However, Cohen's kappa values indicated poor overall agreement across all sites (κ=0.49), reflecting variability in diagnostic accuracy. Conclusion This study highlights the reliability of endoscopic procedures for diagnosing upper GIT lesions, particularly in the esophagus and stomach, while emphasizing the challenges in diagnosing duodenal lesions. These findings support the need for targeted screening and further research to enhance diagnostic accuracy and patient outcomes in GIT diseases.

Evaluation of Rockall and Blatchford Scores and Forrest Staging in Upper Gastrointestinal Bleeding

Objective: The study aimed to investigate the predictive value of Rockall and Blatchford scores and endoscopic Forrest staging in the need for transfusion and intensive care in upper gastrointestinal bleeding. Materials and Methods: This retrospective study was conducted on 294 patients with gastrointestinal bleeding who presented to the emergency department between January 1 and June 1, 2013. Results: The mean age of 294 patients was 58.73±21.30 years. The endoscopic diagnoses of the patients included peptic ulcer (43.5%, n=128), erosive gastritis (17.3%, n=51), and erosive bulbitis (12.6%, n=37). There was no statistically significant relationship between Forrest staging and Rockall and Blatchford scores (p=0.944, p=0.757). The need for blood transfusion was significantly more frequent in patients with a Rockall score of 5 and above and those with a high Blatchford score (p=0.004, p=0.001). Patients with a Rockall score of 5 and above were significantly more common among those referred to the intensive care unit (p=0.003). Conclusion: Pre-endoscopic Rockall and Blatchford scores and endoscopic Forrest staging can be used safely in predicting transfusion requirement, intensive care requirement, mortality risk, treatment and follow-up of patients with gastrointestinal bleeding, and thus may help to reduce health expenditures.

WP3.16 - Comparing Outcomes in Acute Upper Gastrointestinal Bleeding: Initial Presentation versus In-hospital Incidence - A Single-Centre Investigation

Abstract Aims Acute upper gastrointestinal bleeding (AUGIB) is a gastrointestinal emergency with varied patient outcomes. We aimed to compare the outcomes of patients whose primary admission presentation was AUGIB versus inpatients who subsequently developed AUGIB as a complication. Methods This was a retrospective study of all adult patients receiving endoscopy for AUGIB in a single surgical unit from September 2021 to September 2022. Patient demographics, laboratory results, medical history and clinical progress, 30 and 90-day mortality were compared. Results 145 patients were identified, 75 (51.7%) were male and median age was 65 years (IQR 53-75). 117 presented to hospital with AUGIB (group 1) and 28 developed AUGIB as an inpatient (group 2). Median length-of-stay was 3.3 vs 10 days, respectively (p=0.014). Group 2 were more likely to present with symptomatic anaemia (p=0.001), higher National Early Warning System scores (p&amp;lt;0.001), shock (p&amp;lt;0.001), higher Glasgow-Blatchford score (p&amp;lt;0.001) and require blood transfusions (p&amp;lt;0.001). Group 2 had higher ASA Scores (p&amp;lt;0.001) and higher 30-day and 90-day all-cause mortality. No statistical correlations were noted regarding the distribution of endoscopic diagnoses obtained between both groups.Group 1(n=117)Group 2(n=28)P-Value30-Day all-cause Mortality4 (3.4%)4 (14.3%)0.02490-Day all-cause Mortality9 (7.7%)8 (28.6)0.002 Conclusion Our results echo previous studies that patients who develop AUGIB whilst an inpatient have significantly poorer outcomes. Causation is likely multifactorial and warrants further study. It remains important to closely apply the AUGIB care bundle and early critical care input to optimize outcome.

276. AI NAVIGATION SURGERY FOR ESOPHAGEAL CANCER

Abstract With recent technological innovations, artificial intelligence (AI) has begun to be used not only in endoscopic diagnosis and pathology diagnosis but also in the field of surgery. AI enables objective and consistent recognition and evaluation, making it suitable for surgical assistance in surgical operations as well as for the evaluation of surgical techniques and learning curves. First, an AI-assisted surgical procedure recognition system for robotic esophagectomy was developed. By focusing on surgical procedures, the system automatically recognizes surgical procedures with 84% accuracy using AI. In particular, more than 90% of accuracy was obtained in the phase for Left RLN lymph node dissection and Post-dissection to completion of surgery. In addition, as intraoperative navigation, a system for automatic recognition of critical organs such as the recurrent laryngeal nerve, trachea, and subclavian artery was developed, and its recognition accuracy is gradually improving, enabling organ recognition in real time. Currently, with data from more than 100 cases, the system is able to predict Intersection over Union (IoU) with an accuracy of 0.3-0.4. Similar developments are underway in other areas, such as automatic recognition of the surgical process in robotic distal gastrectomy, and a surgical difficulty prediction system is being built using this technology. This system is expected to make it possible to automatically determine the degree of difficulty of surgery during the operation, leading to the decision to change the surgical team during the operation and the prediction of the operation completion time. These technologies can be useful not only for intraoperative navigation, but also surgical education and postoperative care. Using them, young surgeons have the opportunity to dive into authentic scenarios and acquire practical experience safely, bypassing the dangers inherent in real-life surgeries. Through the use of AI-powered interactive simulations, they can deeply grasp surgical methods, establishing the groundwork of crucial practical abilities needed for performing successful operations. In the future, we intend to verify the external validity of these systems using data from multiple facilities, and further work on the development of a surgical support system that transcends fields, with the aim of obtaining regulatory approval as a medical device. In addition to the potential clinical applications of the systems under development, we would like to discuss the current status and future of AI-based surgical support systems in the surgical field.

White spots around colorectal tumors are cancer-related findings and may aid endoscopic diagnosis: a prospective study in Japan.

During endoscopy, white spots (WS) are sometimes observed around benign or malignant colorectal tumors; however, few reports have investigated WS, and their significance remains unknown. Therefore, we investigated the significance of WS from clinical and pathological viewpoints and evaluated its usefulness in endoscopic diagnosis. Clinical data of patients with lesions diagnosed as epithelial tumors from January 1, 2019, to December 31, 2020, were analyzed (n=3,869). We also performed a clinicopathological analysis of adenomas or carcinomas treated with endoscopic resection (n=759). Subsequently, detailed pathological observations of the WS were performed. The positivity rates for WS were 9.3% (3,869 lesions including advanced cancer and non-adenoma/carcinoma) and 25% (759 lesions limited to adenoma and early carcinoma). Analysis of 759 lesions showed that the WS-positive lesion group had a higher proportion of cancer cases and larger tumor diameters than the WS-negative group. Multiple logistic analysis revealed the following three statistically significant risk factors for carcinogenesis: positive WS, flat lesions, and tumor diameter ≥5 mm. Pathological analysis revealed that WS were macrophages that phagocytosed fat and mucus and were white primarily because of fat. WS are cancer-related findings and can become a new criterion for endoscopic resection in the future.

Exploring vision transformers for classifying early Barrett's dysplasia in endoscopic images: A pilot study on white-light and narrow-band imaging.

Various deep learning models, based on convolutional neural network (CNN), have been shown to improve the detection of early esophageal neoplasia in Barrett's esophagus. Vision transformer (ViT), derived from natural language processing, has emerged as the new state-of-the-art for image recognition, outperforming predecessors such as CNN. This pilot study explores the use of ViT to classify the presence or absence of early esophageal neoplasia in endoscopic images of Barrett's esophagus. A BO dataset of 1918 images of Barrett's esophagus from 267 unique patients was used. The images were classified as dysplastic (D-BO) or non-dysplastic (ND-BO). A pretrained vision transformer model, ViTBase16, was used to develop our classifier models. Three ViT models were developed for comparison based on imaging modality: white-light imaging (WLI), narrow-band imaging (NBI), and combined modalities. Performance of each model was evaluated based on accuracy, sensitivity, specificity, confusion matrices, and receiver operating characteristic curves. The ViT models demonstrated the following performance: WLI-ViT (Accuracy: 92%, Sensitivity: 82%, Specificity: 95%), NBI-ViT (Accuracy: 99%, Sensitivity: 97%, Specificity: 99%), and combined modalities-ViT (Accuracy: 93%, Sensitivity: 87%, Specificity: 95%). Combined modalities-ViT showed greater accuracy (94% vs 90%) and sensitivity (80% vs 70%) compared with WLI-ViT when classifying WLI images on a subgroup testing set. ViT exhibited high accuracy in classifying the presence or absence of EON in endoscopic images of Barrett's esophagus. ViT has the potential to be widely applicable to other endoscopic diagnoses of gastrointestinal diseases.

Consensus guidelines on the diagnosis and treatment of pancreatic pseudocyst and walled-off necrosis from a Chinese multiple disciplinary team expert panel.

To prepare a set of practice guidelines to standardize the entire process, from diagnosis to treatment and follow-up, for pancreatic pseudocysts and walled-off necrosis. Thirty-six experts in the fields of digestive endoscopy, pancreatic surgery, interventional radiology, and others presented their opinions via discussions in online conferences by referring to the patient, intervention, comparison, and outcomes principles and then reviewed the evidence and statements using the Delphi method to reach a consensus. The consensus of >80% was finally achieved for the items. The experts discussed and reached a consensus on 29 statements including 10 categories: (1) definition and classification, (2) imaging and endoscopic diagnosis, (3) therapeutic implications, (4) surgical therapy, (5) percutaneous catheter drainage, (6) endoscopic retrograde cholangiopancreatography, (7) EUS-guided drainage, (8) stent selection for EUS-guided drainage, (9) complication related to stents for cyst drainage, and (10) drug treatment and follow-up. This consensus based on the clinical experience of experts in various fields and international evidence-based medicine further standardizes the multidisciplinary diagnosis and treatment processes for pancreatic pseudocysts and walled-off necrosis.

Impact of SPY Fluorescence Angiography on Incidence of Ureteroenteric Stricture After Urinary Diversion.

Ureteroenteric strictures (UESs) are a common and morbid complication of radical cystectomy and urinary diversions. UES occurs in 4% to 25% of all patients undergoing urinary diversion, and anastomotic ischemia is implicated in stricture formation. SPY fluorescence angiography is a technology that can be employed during open surgery that allows for evaluation of ureteral perfusion. We performed a prospective single-institution study of intraoperative use of SPY for ureteral assessment with a primary outcome of UES incidence compared with a cohort of historic controls prior to the use of SPY during urinary diversion at our institution. Chart abstraction was conducted to determine the presence of confirmed stricture in these patients, defined as endoscopic diagnosis or definitive imaging findings. Statistical analysis was performed using χ2 test for UES incidence. Demographic characteristics were analyzed with Wilcoxon rank sum test and χ2 test. A total of 332 patients underwent urinary diversion during the study period. UES occurred in 31 of 277 patients (11.1%) in the control group compared with 1 of 55 patients (1.8%) enrolled in the SPY arm (P = .03). The per-ureter UES rate was 6.7% (33/582) in the control group compared with 0.9% (1/107) in the SPY group. Median follow-up in the SPY group was 17.5 months and 58.6 months in the control group. Median Charlson Comorbidity Index was 5 in the SPY group and 4 in the control group. There were no other significant demographic differences between the study groups. SPY fluorescent angiography can be used during open urinary diversion to ensure perfusion to ureteroenteric anastomosis. Our single-institution study demonstrates a decreased incidence of UES when ureteral perfusion assessment is performed. NCT05022199.

The staining results of early gastric cancer by indigo carmine chromoendoscopy associated with histological structure: a retrospective study

BackgroundAt present, conventional endoscopy and chromoendoscopy using indigo carmine (IC) is a very useful method to determine the demarcation line (DL) of early gastric cancer lesions, but it is not suitable for all lesions.AimsThis study aimed to determine the applicable conditions for IC chromoendoscopy.MethodsWe retrospectively evaluated 187 lesions in 181 patients who had an endoscopic diagnosis of EGC and were treated with endoscopic submucosal dissection (ESD). According to the existence of the DL between the lesion mucosa and normal mucosa with IC chromoendoscopy, the lesions were divided into two groups: clear group and unclear group. Clinicopathological characteristics were evaluated in each group. From January 2022 to March 2023, the postoperative pathological sections of 19 lesions (81 slices) in the clear group and 19 lesions (80 slices) in unclear group were scanned with high definition, and the crypt structure between the two groups was evaluated.ResultsThere was no significant difference in clinical factors between the clear group and unclear group. There were significant differences in crypt area, crypt length, and crypt opening diameter between the two groups. In the clear group, there were significant differences in crypt area, crypt length, and crypt opening diameter between the normal area and cancer area, but there was no significant difference in the unclear group.ConclusionsThe margins of lesions with fused or absent crypt structures, a small crypt area, a short crypt length, and a short crypt opening diameter can be easily determined with IC chromoendoscopy.

Endoscopic detection and diagnosis of gastric cancer using image-enhanced endoscopy: A systematic review and meta-analysis.

We aimed to conduct a systematic review and meta-analysis to assess the value of image-enhanced endoscopy including blue laser imaging (BLI), linked color imaging, narrow-band imaging (NBI), and texture and color enhancement imaging to detect and diagnose gastric cancer (GC) compared to that of white-light imaging (WLI). Studies meeting the inclusion criteria were identified through PubMed, Cochrane Library, and Japan Medical Abstracts Society databases searches. The pooled risk ratio for dichotomous variables was calculated using the random-effects model to assess the GC detection between WLI and image-enhanced endoscopy. A random-effects model was used to calculate the overall diagnostic performance of WLI and magnifying image-enhanced endoscopy for GC. Sixteen studies met the inclusion criteria. The detection rate of GC was significantly improved in linked color imaging compared with that in WLI (risk ratio, 2.20; 95% confidence interval [CI], 1.39-3.25; p < 0.01) with mild heterogeneity. Magnifying endoscopy with NBI (ME-NBI) obtained a pooled sensitivity, specificity, and area under the summary receiver operating curve of 0.84 (95 % CI, 0.80-0.88), 0.96 (95 % CI, 0.94-0.97), and 0.92, respectively. Similarly, ME-BLI showed a pooled sensitivity, specificity, and area under the curve of 0.81 (95 % CI, 0.77-0.85), 0.85 (95 % CI, 0.82-0.88), and 0.95, respectively. The diagnostic efficacy of ME-NBI/BLI for GC was evidently high compared to that of WLI, However, significant heterogeneity among the NBI studies still existed. Our meta-analysis showed a high detection rate for linked color imagingand a high diagnostic performance of ME-NBI/BLI for GC compared to that with WLI.

The prevalence of pouch fistulas in ulcerative colitis following restorative proctocolectomy: a systematic review and meta-analysis.

One complication of restorative proctocolectomy with ileo-anal pouch anastomosis is fistula formation in the pouch. Fistulas can be associated with significant morbidity and pouch failure. We conducted a systematic review with meta- analysis to try and understand the prevalence of pouch fistulas in patients with ulcerative colitis following restorative proctocolectomy. The Embase, Embase Classic, and PubMed databases were searched between January 1979 and April 2022. Studies were included if there were cross-sectional, case-controlled, population-based or cohort studies reporting on prevalence of pouch fistulas in ulcerative colitis. Studies had to report the number of patients with pouch fistulas using either clinical, endoscopic, or radiological diagnosis in an adult population. Thirty-three studies screened met the inclusion criteria. The pooled prevalence of developing at least 1 fistula was 0.05 (95% confidence interval [CI], 0.04-0.07). The pooled prevalence of pouch failure in patients with pouch fistula was found to be 0.24 (95% CI, 0.19-0.30). The pooled prevalence of developing a pouch fistula at 3 years, 5 years and more than 5 years was 0.04 (95% CI, 0.02-0.07), 0.05 (95% CI, 0.02-0.07), and 0.05 (95% CI, 0.02-0.10), respectively. This is the first systematic review and meta-analysis to report the prevalence of pouch fistula. It also provides a pooled prevalence of pouch failure in these patients. These results can help to shape future guidelines, power future studies, and help counsel patients.

Endoscopic Diagnosis and Treatment of Benign Small Bowel Stricture

Benign small bowel strictures can occur in association with various conditions, including small bowel Crohn’s disease, nonsteroidal anti-inflammatory drug-induced enteritis, ischemic enteritis, intestinal tuberculosis, radiation enteritis, postoperative adhesions, and anastomotic strictures. Benign small bowel strictures are classified into two categories, low-grade and high-grade. Low-grade small bowel strictures involve a partial reduction of the internal diameter of the small intestine, causing slight obstruction of the passage of food and digestive fluids without significant bowel obstruction symptoms. By contrast, high-grade small bowel strictures involve a severe narrowing of the intestinal lumen, leading to marked obstruction of the passage of food and digestive fluids and pronounced bowel obstruction symptoms. Small bowel strictures can be diagnosed using various methods, including abdominal plain radiography, abdominal computed tomography, computed tomography enterography, magnetic resonance enterography, balloon-assisted enteroscopy, and abdominal ultrasound. Each diagnostic method has unique advantages and disadvantages as well as differences in diagnostic specificity and sensitivity. Therefore, even if small bowel strictures are not observed using a single imaging technique, their presence cannot be completely excluded. A comprehensive diagnosis that combines clinical information from multiple diagnostic modalities is necessary. Therapeutic approaches for managing small bowel strictures include medical therapy, endoscopic balloon dilation using balloon-assisted enteroscopy, and surgical methods such as strictureplasty and segmental resection. Endoscopic balloon dilation, in particular, can help reduce complications associated with repeated surgeries for strictures.

Diagnostic Accuracy of Artificial Intelligence in Endoscopy: Umbrella Review.

Some research has already reported the diagnostic value of artificial intelligence (AI) in different endoscopy outcomes. However, the evidence is confusing and of varying quality. This review aimed to comprehensively evaluate the credibility of the evidence of AI's diagnostic accuracy in endoscopy. Before the study began, the protocol was registered on PROSPERO (CRD42023483073). First, 2 researchers searched PubMed, Web of Science, Embase, and Cochrane Library using comprehensive search terms. Then, researchers screened the articles and extracted information. We used A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2) to evaluate the quality of the articles. When there were multiple studies aiming at the same result, we chose the study with higher-quality evaluations for further analysis. To ensure the reliability of the conclusions, we recalculated each outcome. Finally, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to evaluate the credibility of the outcomes. A total of 21 studies were included for analysis. Through AMSTAR2, it was found that 8 research methodologies were of moderate quality, while other studies were regarded as having low or critically low quality. The sensitivity and specificity of 17 different outcomes were analyzed. There were 4 studies on esophagus, 4 studies on stomach, and 4 studies on colorectal regions. Two studies were associated with capsule endoscopy, two were related to laryngoscopy, and one was related to ultrasonic endoscopy. In terms of sensitivity, gastroesophageal reflux disease had the highest accuracy rate, reaching 97%, while the invasion depth of colon neoplasia, with 71%, had the lowest accuracy rate. On the other hand, the specificity of colorectal cancer was the highest, reaching 98%, while the gastrointestinal stromal tumor, with only 80%, had the lowest specificity. The GRADE evaluation suggested that the reliability of most outcomes was low or very low. AI proved valuabe in endoscopic diagnoses, especially in esophageal and colorectal diseases. These findings provide a theoretical basis for developing and evaluating AI-assisted systems, which are aimed at assisting endoscopists in carrying out examinations, leading to improved patient health outcomes. However, further high-quality research is needed in the future to fully validate AI's effectiveness.