Endoscopy Center Research Articles

A129 OUTCOMES FOLLOWING ENDOSCOPIC SUBMUCOSAL DISSECTION OF SUPERFICIAL GASTROINTESTINAL TRACT NEOPLASTIC LESIONS FROM A TERTIARY-CARE ACADEMIC CENTRE

Abstract Background Endoscopic submucosal dissection (ESD) is an advanced luminal resection technique for dysplastic and early cancerous gastrointestinal (GI) tract neoplasms. By removing lesions en bloc, this method provides more accurate histopathologic evaluation of resection margins in comparison to endoscopic mucosal resection (EMR). Superior curative resection and lower recurrence rates over EMR have been shown in addition to the benefit of reduced morbidity and mortality compared to surgery. While ESD has become well-established in Asia and Europe, its adoption in North America – and in particular Canada – has been slowed by multiple technical and economic factors including a scarcity of infrastructure, institutional support, and standardized training. Additionally, reproduced Canadian data corroborating its known global efficacy is currently lacking. Aims Our aim was to evaluate clinical and technical outcomes in patients who underwent ESD of superficial GI tract neoplasms at a tertiary-care academic centre. Methods We conducted a retrospective single-centre cohort study at The Centre for Advanced Therapeutic Endoscopy & Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada. Consecutive adults (age ampersand:003E 18) who underwent ESD of any superficial GI tract neoplasm from October 2017 to December 2022 were included in the study. Primary outcomes were rates of en bloc, complete (R0), and curative resections. Secondary outcomes were rates of recurrence and adverse events. Data was collected through electronic chart review. Results ESD was performed in a total of 308 lesions with a mean size of 2.5 cm (range, 1-7 cm). Gastric ESD was the most common (n=130), followed by esophageal (n=91), rectal (n=62), and colonic (n=22). Three patients underwent duodenal ESD. En bloc, R0, and curative resection rates were 89.2%, 84.7%, and 71.8%, respectively. 64.3% of lesions were cancerous on pathology (n=198), of which 48 had at least submucosal invasion. Rates of delayed bleeding and deep mural injury (DMI) requiring surgical intervention were 3.9% and 1.3%, respectively. Overall recurrence at the first surveillance endoscopy (SE1) was 3.6%. Conclusions En bloc, R0, and curative resection rates reported from this largest single-centre Canadian ESD cohort are comparable to existing North American data. Low rates of early recurrence and an adequate safety profile have been demonstrated with this emerging oncologic method of resection. Additional investigation is warranted to optimize lesion selection and determine long-term clinical outcomes to further establish this technique in the management of superficial GI tract neoplasms. Table I. Procedural characteristics, outcomes, and adverse events for patients who underwent ESD of superficial GI tract neoplasms. Funding Agencies None

Distribution and Characteristics of Colonic Diverticula in Northern China.

The prevalence of colonic diverticula is rising in eastern countries, possibly related to aging and the adoption of a western lifestyle. However, limited data exist regarding the distribution and endoscopic features of colonic diverticula in this population. This study aimed to assess the number, size, depth, and location of colonic diverticula in our study cohort. We collected data from patients who underwent colonoscopy at the Endoscopy Center of Tianjin Medical University General Hospital and Bao Di Clinical College of Tianjin Medical University. We thoroughly evaluated and documented any colonic diverticula encountered during the procedures. Logistic regression analysis was employed to explore associations between participant characteristics and the presence of colonic diverticula. Our study included a total of 27,021 eligible patients from our colonoscopy database, among whom 1529 individuals (5.67%) exhibited one or more diverticulosis. Patients with colonic diverticula (mean age: 58.6) were significantly older and exhibited a male predominance compared with those without diverticula. Cases of right-sided, left-sided, and bilateral diverticulosis were recorded in 1161 (76.0%), 170 (11.1%), and 198 patients (12.9%), respectively. Patients with right-sided diverticula (mean age: 55.2), more common in males, were younger than those with left-sided diverticula (mean age: 67.1, P < 0.05), which were more frequent in females (P < 0.001). Individuals aged 60 years or older (odds ratio: 4.32, P < 0.001) and those with bilateral diverticulosis (odds ratio: 21.2, P < 0.001) had a higher likelihood of having a greater burden of diverticula. Colonic diverticula in Northern China predominantly manifests as right-sided, more common in males, and associated with older age. Notably, patients with right-sided diverticulosis tend to be younger than those with left-sided diverticula. In addition, a higher burden of diverticula is more prevalent in individuals aged 60 years or older and those with a bilateral distribution pattern.

A296 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND PRIMARY SCLEROSING CHOLANGITIS: A RETROSPECTIVE STUDY OF A HIGH-VOLUME PROGRAMME

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is a crucial component of care in primary sclerosing cholangitis (PSC). Aims In this retrospective study, we sought to characterize the clinical and procedural characteristics of PSC patients undergoing ERCP in a high-volume therapeutic endoscopy centre. Methods Using procedural codes and chart review from April 2011 to July 2021, PSC patients who underwent ERCP at St. Michael’s Hospital (SMH) were identified. Chart review of documentation was done to collect clinical attributes, procedural characteristics, pathology, and post-ERCP complications within 90 days. Descriptive statistics and regression analyses were conducted. Results There were 167 PSC patients included (69% male, 66% concurrent inflammatory bowel disease). Of 464 ERCPs performed, 64% were patients’ 2nd or more ERCP at SMH. When evaluating patient characteristics per ERCP procedure, median age was 45 yrs. (IQR 31-59), median duration of PSC diagnosis was 6.7 yrs (IQR 2.2-11.0), with cirrhosis diagnosed in 42%. Symptoms at ERCP were jaundice (56%), abdominal pain (43%), subjective fevers (30%) and pruritus (25%). Bloods pre-ERCP demonstrated median ALP 362 U/L (IQR 231-552) and median total bilirubin 76 µmol/L (IQR 29-141). Procedural indications were biliary obstruction (82%), cholangitis (31%) and concern for malignancy (22%). Procedural details are summarized in Figure 1. Stent insertion was associated with concern for malignancy (OR 2.87, 95%CI 1.81-4.55), previous stent insertion (OR 1.73, 95%CI 1.16-2.62) and elevated bilirubin (per unit increase in log[bilirubin] OR 1.53, 95%CI 1.23-1.92). Neoplastic pathology was noted in 20% of satisfactory cytology samples and 27% of biliary/bile duct biopsies, while 86% and 76% had reactive/inflammatory/atypical cells respectively. Post-ERCP complications within 90 days (ascertained in 423 ERCPs) was reported in one-third (127, 31%). The most common complications were biliary blockage (23%), post-ERCP cholangitis (15%), and stent failure (9.3%). Stent insertion was significantly associated with 90-day post-ERCP complications on multivariable analyses accounting for per patient clustering, sex, age, relevant stricture presence, stone removal, target location, symptoms, and pre-ERCP bilirubin level. Conclusions Patients with PSC who undergo ERCP have high disease burden. Stent insertion is associated with a sicker PSC phenotype with more obstruction (i.e., higher bilirubin, concern for malignancy); this may explain its association with higher 90-day post-ERCP complications. As this study is limited in its single centre retrospective nature, large-scale administrative data studies are needed to characterize and define optimal use of ERCP in the management of PSC. Figure 1. Procedural characteristics of 464 endoscopic retrograde cholangiopancreatographies in 167 patients with primary sclerosing cholangitis. Funding Agencies None

Patients' values and preferences regarding endoscopic therapy for Barrett's esophagus: A cross-sectional survey study.

Endoscopic eradication therapy (EET) has evolved as a minimally invasive and efficacious option to treat patients with dysplastic Barret's esophagus. We aimed to conduct a cross-sectional study to assess patient values and preferences on EET. All consecutive patients at our clinic and endoscopy center were enrolled between November 2020 and April 2022. The primary outcome was their willingness to undergo EET measured using a validated survey tool. Predictors of this outcome included patient demographics, disease characteristics, procedure types, and physician characteristics. We used a multivariable logistic regression model to assess the association between the primary outcome and its predictors. A total of 101 consecutive Barret's esophaguspatients were surveyed. The median age was 67 years, and 71.3% were males. About 48% (n = 48) of the patients had dysplasia, 19% had no dysplasia and others were unsure about the presence or absence of dysplasia. About one-third (30%, n = 30) of patients placed equal values on preventing cancer and avoiding adverse events, and 68% said they were somewhat or definitely willing to undergo EET (ablation and resection). On multivariable logistic regression analysis, the patient value of high emphasis on cancer prevention (odds ratio [OR] 2.9 [1.1-7.6], p = 0.0344) and positive relationship with a gastroenterologist (OR 4.7 [1.3-17], p = 0.02) were strongly associated with increased willingness to undergo EET. In this single-center prospective study of Barret's esophaguspatients, the willingness to undergo EET was strongly associated with two predictors: high emphasis on cancer prevention and a positive relationship with the gastroenterologist.

A deep learning model based on magnifying endoscopy with narrow-band imaging to evaluate intestinal metaplasia grading and OLGIM staging: A multicenter study

Background and PurposePatients with stage III or IV of operative link for gastric intestinal metaplasia assessment (OLGIM) are at a higher risk of gastric cancer (GC). We aimed to construct a deep learning (DL) model based on magnifying endoscopy with narrow-band imaging (ME-NBI) to evaluate OLGIM staging. MethodsThis study included 4473 ME-NBI images obtained from 803 patients at three endoscopy centres. The endoscopic expert marked intestinal metaplasia (IM) regions on endoscopic images of the target biopsy sites. Faster Region-Convolutional Neural Network model was used to grade IM lesions and predict OLGIM staging. ResultsThe diagnostic performance of the model for IM grading in internal and external validation sets, as measured by the area under the curve (AUC), was 0.872 and 0.803, respectively. The accuracy of this model in predicting the high-risk stage of OLGIM was 84.0%, which was not statistically different from that of three junior (71.3%, p = 0.148) and three senior endoscopists (75.3%, p = 0.317) specially trained in endoscopic images corresponding to pathological IM grade, but higher than that of three untrained junior endoscopists (64.0%, p = 0.023). ConclusionThis DL model can assist endoscopists in predicting OLGIM staging using ME-NBI without biopsy, thereby facilitating screening high-risk patients for GC.

Histomolecular profile of Helicobacter pylori strains circulating in Brazzaville (Congo).

Helicobacter pylori (Hp) infection is a real public health problem in the Congo. We aimed study the histomolecular profile of Hp strains circulating in Brazzaville, Congo, in order to contribute to the improvement of Hp-infected patients in the country. This was an analytical-transversal study carried out from January to November 2020 (i.e. a study period of 11 months) in the endoscopy centers of Brazzaville as well as the molecular biology and anatomopathology laboratories of Pointe-Noire and Oyo. It involved 100 symptomatic patients over the age of 18 referred for upper GI endoscopy. These patients underwent gastric biopsies for histopathological analysis according to the Sydney classification and molecular analysis using the real-time polymerase chain reaction (PCR) technique. The frequency of Hp infection was determined using real-time PCR. PCR was also used to identify the Hp strains and assess their tropism in the gastric mucosa. Digestive symptoms, endoscopic lesions, and histopathological lesions associated with HP infection were studied. The incidence of Hp infection was 91%, with a female predominance of 52.75% and an average age of 46.32 years. Endoscopy revealed normal mucosa (56.14%), ulcerated lesions (12.28%), and gastritis (22.81%) in infected patients. Histopathologically, the lesions were chronic atrophic gastritis (91%), with inflammatory activity (16.46%), intestinal metaplasia (16.46%), and adenocarcinoma (3.3%). Cag A strains were present in 85.71% of cases and had no preferential tropism in the gastric mucosa. Strains carrying the Cag A gene were present in severe and serious endoscopic and histopathological lesions. The prevalence of Hp infection is 91% in the Brazzaville population. Cag A strains circulate in high proportions and are implicated in the occurrence of severe lesions of the gastric mucosa.

Curative Effect Analysis of Endoscopic Submucosal Dissection in Giant Laterally Spreading Rectal Tumors.

The objective of this study was to investigate the clinical efficacy of endoscopic submucosal dissection (ESD) in the treatment of giant lateral developing rectal-type tumors (laterally spreading tumors, LSTs). There are no specialized studies on the efficacy of ESD in the treatment of LSTs measuring >5cm in diameter, surgery was often used in the past, but it has the disadvantages of large trauma, many complications, and high cost. The data of 185 patients with rectal LSTs who had undergone ESD in the digestive endoscopy center of our hospital from January 2012 to June 2020 were retrospectively analyzed. Based on the size of the lesions, the patients were divided into 2 groups: diameter ≤5cm (110 cases) and diameter >5cm (75 cases), and we summarized and analyzed the en bloc resection rate, curative resection rate, procedure time, muscle injury, bleeding, perforation, postoperative stricture, and recurrence. There was no difference in the en bloc resection rate and R0 resection rate between the 2 groups ( P =0.531). Moreover, there was no difference in the incidence of delayed perforation, postoperative stenosis, and recurrence, but the incidence of delayed bleeding was significantly higher in the giant LST group than the small LST group ( P =0.001). Moreover, for giant rectal LSTs, the growth pattern of the lesion, JNET classification, and the extent of postoperative mucosal defect do not significantly affect the efficacy of ESD. It is worth mentioning that the operation time was longer in the group with a diameter >5cm, in which perforation was more frequent and the muscle layer was more likely to be injured during ESD ( P <0.001). The muscle injury during ESD was mainly related to the diameter of the lesion, the crossing the rectal pouch, and the operation time. The use of ESD to treat giant rectal LSTs (>5cm) is relatively difficult and can easily lead to intraoperative muscle injury, perforation, and late postoperative bleeding. However, if active intervention is performed, patients can still achieve good efficacy and prognosis, which can be applied in hospitals with certain conditions.

Clinical application of intensified nursing intervention in electronic coloscopy preparation.

Electronic coloscopy is an invasive procedure and achieving an ideal result can be challenging, leading to low intestinal cleanliness scores and a poor intestinal polyp positive rate. (1) To demonstrate the impact of intensified nursing intervention on electronic colonoscopy. (2) To improve patients' satisfaction with medical services related to intestinal cleanliness during preparation, the accuracy of the intestinal polyp-positive rate, and nursing. Our study included 120 patients who underwent electronic coloscopy. These patients were randomly assigned to either the observation group or the control group, with 60 cases in each group. Patients in the control group received conventional nursing intervention, which included face-to-face oral and written instructions. In addition to the conventional intervention, patients in the observation group received intensified guidance interventions, which included instructions via phone, as well as WeChat messages and pictures. The patients in the observation group who received intensified guidance interventions demonstrated better intestinal cleanliness during preparation compared to the control group (P< 0.05). Besides, the accuracy of the intestinal polyp positive rate was higher in the observation group than in the control group (P< 0.05). Finally, regarding patient satisfaction with the nursing service provided by the endoscopy center, the observation group had a higher level of satisfaction than the control group (P< 0.05). The intensified guidance interventions provided to patients undergoing electronic colonoscopy resulted in a significant improvement in intestinal cleanliness during preparation, as well as an increase in the accuracy of the intestinal polyp-positive rate and patient satisfaction with our nursing service. Therefore, we believe that these interventions are highly beneficial and should be promoted and applied in clinical settings.

Medical therapy has similar hemostatic efficacy with endoscopic treatment for PUB patients with adherent clot (FIIb ulcers).

Currently, there is no clear consensus on whether medical treatment or endoscopic treatment should be used for peptic ulcer bleeding patients with adherent clot. The aim of this study is to investigate the hemostatic effects of medical treatment, single endoscopic treatment, and combination endoscopic treatment for peptic ulcer bleeding (PUB) patients with adherent clot. We retrospectively analyzed PUB patients with adherent clot who underwent endoscopic examination or treatment in our center from March 2014 to January 2023 and received intravenous administration of proton pump inhibitors. Patients were divided into medical treatment (MT) group, single endoscopic treatment (ST) group, and combined endoscopic treatment (CT) group. Subsequently, inverse probability of treatment weighting (IPTW) was performed to calculate the rebleeding rate. A total of 605 eligible patients were included in this study. After IPTW, the rebleeding rate in the MT group on days 3, 7, 14, and 30 were 13.3 (7.3), 14.2 (7.8), 14.5 (7.9), and 14.5 (7.9), respectively; the rebleeding rates in the ST group were 17.4 (5.1), 20.8 (6.1), 20.8 (6.1), and 20.8 (6.1), respectively; the rebleeding rates in the CT group were 0.4 (0.9), 1.7 (3.3), 2.3 (4.5), and 2.3 (4.5), respectively. Although the rebleeding rate in the medical treatment group was higher, there was no significant difference among the three groups on days 3, 7, 14, and 30 (P = 0.132, 0.442, 0.552, and 0.552). Medical therapy has similar hemostatic efficacy with endoscopic treatment for PUB patients with adherent clot (FIIb ulcers). However, for patients with more risk factors and access to well-equipped endoscopy centers, endoscopic treatment may be considered. The choice of treatment approach should be based on the individual conditions of the patient, as well as other factors such as medical resources available.

Assessment of the diagnostic significance of endoscopic ultrasonography in the differential diagnosis of formations of the hepatopancreatoduodenal zone

Purpose of the work. To study the structure of the hepatopancreaticoduodenal zone (HPD) masses according to the endosonographic picture and to estimate the diagnostic informativeness of endoscopic ultrasonography (EUS) in diagnostics of these masses in comparison with ultrasound examination of HPD (ultrasound of HPD) and computer tomography of abdominal cavity organs (CT of OBP) with contrasting. Materials and Methods. A retrospective analysis of medical records of 71 patients with GDZ masses who underwent inpatient treatment in the department of abdominal surgery and applied for diagnostic purposes to the endoscopic centre of Karaganda Multidisciplinary Hospital No.3 for EUS for the period from January 2021 to December 2022 was carried out. Results and discussion. Sensitivity of EUS in differential diagnostics of PG tumours, hepaticocholedochal dilatation, vascular invasion and metastasis to regional lymph nodes was 85%, 94,12%, 64,71% and 100% respectively, specificity - 95,93%, 100%, 80% and 92% respectively. Conclusion. Correct assessment of all manifestations of a tumour influences the choice of treatment tactics and consequently its immediate and long-term results. EUS is an effective method of differential diagnostics of pseudocysts and cystic tumours of PG, tumours of large duodenal papilla (LDP), as well as biliary tract neoplasms.

Pancreatic biopsy evaluation with nsCanary: A “smart ROSE” device for feedback on sample adequacy and cancer presence in endoscopic biopsies—Initial human clinical trial results.

618 Background: Pancreatic cancer (PC) accounts for 0.5 million new cases and 4.7% of the world's cancer-related deaths in 2020. Endoscopic ultrasound (EUS) guided fine needle biopsies (FNB) are the current standard of care for confirming suspicious lesions, however the diagnostic accuracy is reported below 70%. Rapid on-site evaluation (ROSE) improves the diagnostic performances of biopsies to reduce the number of needle passes, complication rates, and the need for additional procedures. However, availability of an on-site pathologist is often not feasible. NovaScan has pioneered the use of an impedance spectroscopy biomarker for cancer detection in different tissues based on the Cole Relaxation Frequency (CRF). NovaScan has developed the nsCanary, a ”smart ROSE” device that assesses PC presence in FNBs obtained during endoscopic procedures ex vivo, in real-time and on-site, without altering the tissue sample or affecting the workflow. Methods: Data were collected in a double-blind, IRB approved study from a cohort of 53 patients (28 males, 25 females) undergoing EUS procedures for suspected pancreatic lesions at the Texas International Endoscopy Center. FNBs were performed with a 22 gauge biopsy from a transduodenal approach. Each biopsy sample was transferred onto a disposable strainer allowing for any excess fluid to drain. An electrode for scanning was placed onto the core samples for data collection with the nsCanary a low cost, portable device used in the operating room. CRF is measured in the 1 kHz - 10 MHz frequency range via custom-designed hardware and assessment of the sample is completed in a few seconds. Subsequently, the sample is flushed into a pathology jar to undergo the standard workflow for cytology. The algorithm for extracting the CRF from the measurement was developed based on our previous preclinical study with transgenic KPC mice Samples with a CRF below 1 MHz were considered noncancerous, while CRF values above 1MHz or the absence of a CRF reading were considered cancerous. Results: PC assessment provided by nsCanary was validated against pathology outcomes for each biopsy sample. Findings showing a sensitivity of 86.7% and a specificity of 84.2% are reported in the table. Conclusions: We believe the nsCanary device will provide immediate feedback to the endoscopist on cancer presence and on the adequacy of the sample. This device is intended to support the decision-making process, by enabling clinicians to overcome the challenge of proving cancer presence during the first biopsy procedure, ultimately avoiding revisits and unnecessary trauma.[Table: see text]

Spatio-Temporal Feature Transformation Based Polyp Recognition for Automatic Detection: Higher Accuracy than Novice Endoscopists in Colorectal Polyp Detection and Diagnosis.

Artificial intelligence represents an emerging area with promising potential for improving colonoscopy quality. To develop a colon polyp detection model using STFT and evaluate its performance through a randomized sample experiment. Colonoscopy videos from the Digestive Endoscopy Center of the First Affiliated Hospital of Anhui Medical University, recorded between January 2018 and November 2022, were selected and divided into two datasets. To verify the model's practical application in clinical settings, 1500 colonoscopy images and 1200 polyp images of various sizes were randomly selected from the test set and compared with the STFT model's and endoscopists' recognition results with different years of experience. In the randomized sample trial involving 1500 colonoscopy images, the STFT model demonstrated significantly higher accuracy and specificity compared to endoscopists with low years of experience (0.902 vs. 0.809, 0.898 vs. 0.826, respectively). Moreover, the model's sensitivity was 0.904, which was higher than that of endoscopists with low, medium, or high years of experience (0.80, 0.896, 0.895, respectively), with statistical significance (P < 0.05). In the randomized sample experiment of 1200 polyp images of different sizes, the accuracy of the STFT model was significantly higher than that of endoscopists with low years of experience when the polyp size was ≤ 0.5cm and 0.6-1.0cm (0.902 vs. 0.70, 0.953 vs. 0.865, respectively). The STFT-based colon polyp detection model exhibits high accuracy in detecting polyps in colonoscopy videos, with a particular efficiency in detecting small polyps (≤ 0.5cm)(0.902 vs. 0.70, P < 0.001).

Abstract B001: Impedance based biomarker for “smart ROSE” pancreatic cancer detection: Initial results from an ongoing clinical trial with nsCanary

Abstract Pancreatic cancer (PC) accounts for half a million new cases and 4.7% of cancer-related deaths globally in 2020. Endoscopic ultrasound (EUS) guided fine needle biopsies (FNB) are the current standard for confirming suspicious lesions, although their diagnostic accuracy remains below 70% with a non-diagnostic rate of the first procedure as high as 40%. Rapid on-site evaluation (ROSE) was introduced to improve diagnostic accuracy via on-site pathology assessment. However, ROSE availability is often limited due to resource constraints. NovaScan has developed the nsCanary, a ”smart ROSE” device, which uses a bioimpedance spectroscopy biomarker based on the Cole Relaxation Frequency (CRF) to detect cancer in biopsy samples in real-time and on-site. The aim of this study is to present initial results from a clinical trial that validates the nsCanary’s ability to detect PC in biopsy samples. Data were collected with the nsCanary device in an IRB approved double-blind study including a cohort of 44 patients (20 males, 24 females; average age of 63 years; 66% White, 22% African American, 12% Hispanic) undergoing EUS procedures with FNB sampling for suspected PC at the Texas International Endoscopy Center in Houston, TX. The nsCanary is a small desktop instrument that performs spectral bioimpedance analysis to extract the CRF based biomarker in less than 30 seconds without altering the biopsied tissue. A touch panel user interface allows for the user to input information and start the measurement. Obtained biopsy samples were flushed in a disposable strainer in order to drain any excess fluid. A circular disposable electrode, consisting of an interdigitated array with alternating polarities was placed in contact with the sample to perform measurements of complex bioimpedance in the 1 kHz - 10 MHz frequency range. The design of the electrode allows it to sense the signal from samples as small as FNB cores. Samples with CRF value below 1 MHz for every scan were considered noncancerous. Samples with at least one CRF value above 1MHz or absence of CRF reading (i.e., CRF out of range) were considered cancerous. PC assessment provided by nsCanary was validated against histopathology outcomes for each biopsy sample. Pathology results indicated that out of the cancerous lesions observed, there were 7 cases of pancreatic adenocarcinoma, 2 cases of invasive adenocarcinoma, 1 case of ductal adenocarcinoma, and 1 case of metastatic renal cell carcinoma. Findings showed a sensitivity of 81.8%, specificity of 84.8%, PPV of 64.3% and NPV of 93.3% for a total of n=44 patients. The device is low cost, portable, and can be used in the surgical suite without interfering with the standard workflow or affecting the sample for following pathological assessment. The implementation of the nsCanary device into the clinic will adjunctively support the decision-making process by providing immediate feedback on cancer detection and sample adequacy. This will enable endoscopists to diagnose PC on the first biopsy procedure, ultimately facilitating prompt treatment of patients. Citation Format: Federica Dibennardo, Martina Guidetti, Onur Fidaner, Daniel S. Gehrke, Donato Ceres, Margaret C. John, Constantine H. Bovalis, Isaac Raijman, Les Bogdanowicz. Impedance based biomarker for “smart ROSE” pancreatic cancer detection: Initial results from an ongoing clinical trial with nsCanary [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr B001.

The Diagnostic Yield of Endoscopic Ultrasound in Asymptomatic Patients with Unexplained Dilated Common Bile Duct, or Double Duct Sign with Normal Transaminase a Retrospective Study from a Single Urban-based University Endoscopy Center.

Common bile duct dilatation alone or double duct sign (both CBD and dilated pancreatic duct dilatation) and abnormal liver enzymes are highly predictive of biliary disease. This can be identified on ultrasound (US), CT scan, and/or magnetic resonance cholangiopancreatography (MRCP). Unexplained dilatation on imaging might warrant endoscopic ultrasound (EUS) to identify any occult causes. Supporting literature about the importance of using EUS in these conditions is evolving with no clear evidence-based approach to evaluate asymptomatic dilated ducts.We aim to investigate the diagnostic yield of EUS in unexplained CBD dilatation or double duct sign with normal liver enzymes. A retrospective data analysis was conducted from January 2015 to October 2021 on asymptomatic patients with a dilatated CBD of 7 mm or more and 9 mm if the patient had a cholecystectomy history or double duct sign with normal liver enzymes. 32 EUS procedures were indicated for unexplained dilated CBD or double duct sign on imaging with normal liver enzymes. 23 had CBD dilatation alone (72 %), and 9 had a double duct sign (28 %). 20 of the included patients were females (63 %), and 12 were males (37 %), with a mean age of 63.8 ± 17 and 68.2 ± 14 years old, respectively (p = 0.424). The diagnosis after EUS in CBD dilatation alone showed a yield of 56 % as follow; no pathology in 10 (44 %), sludge in 9 patients (39 %), CBD stone in 3 (13 %), malignant stricture in 1 (4 %) (Fig. 1). On the other hand, EUS in those with double duct signs showed a diagnostic yield of 55 %; no pathology in 4 (45 %), pancreatic head adenocarcinoma in 3 patients (33 %), Biliary stone in one patient, and malignant CBD stricture in one patient (11 % each) (Fig. 2). Unexplained CBD dilatation or Double duct sign on imagining in patients with normal liver enzymes should warrant further investigation with EUS to avoid missing serious pathological conditions such as stones, sludge, stricture, or a mass.

Comparison of the recovery time of remimazolam besylate and propofol for gastrointestinal endoscopy sedation in elderly patients.

Background: Recovery time is a crucial factor in ensuring the safety and effectiveness of both patients and endoscopy centers. Propofol is often preferred due to its fast onset and minimal side effects. Remimazolam is a new intravenous sedative agent, characterized by its rapid onset of action, quick recovery and organ-independent metabolism. Importantly, its effect can be specifically antagonized by flumazenil. The primary goal of this study is to compare the recovery time of remimazolam besylate and propofol anesthesia during endoscopic procedures in elderly patients. Methods: 60 patients aged 65-95 years who underwent gastrointestinal endoscopy were randomly and equally assigned to two groups: the remimazolam group (Group R) and the propofol group (Group P). The primary measure was the recovery time, defined as the time from discontinuing remimazolam or propofol until reaching an Observer's Assessment of Alertness and Sedation scale (OAA/S) score of 5 (responds readily to name spoken in normal tone). The time required to achieve an OAA/S score of 3 (responds after name spoken loudly or repeatedly along with glazed marked ptosis) was also recorded and compared. Results: The recovery time for Group R (2.6 ± 1.6 min) was significantly shorter than that for Group P (10.8 ± 3.0 min), with a 95% confidence interval (CI): 6.949-9.431 min, p <0.001. Similarly, the time to attain an OAA/S score of 3 was significantly less in Group R (1.6 ± 0.9 min) compared to Group P (9.6 ± 2.6 min), with a 95% CI: 6.930-8.957 min, p <0.001. Conclusion: Our study demonstrated that remimazolam anesthesia combined with flumazenil antagonism causes a shorter recovery time for elderly patients undergoing gastrointestinal endoscopy compared to propofol. Remimazolam followed by flumazenil antagonism provides a promising alternative to propofol for geriatric patients, particularly during gastrointestinal endoscopy.

Endoscopic sleeve gastroplasty safety profile - retrospective, single-center analysis of 222 consecutive patients including the learning curve period.

The global obesity epidemic affects over 1.9 billion adults, with an additional 650 million classified as obese. Endoscopic sleeve gastroplasty (ESG) is a type of minimally invasive endobariatric procedure. It is a less invasive alternative to laparoscopic sleeve gastrectomy (LSG). Although the effectiveness of ESG is lower, it might have a better safety profile. To assess the safety profile of ESG and describe complications classified as grade II or higher, using the Clavien-Dindo classification, with an overview of the learning curve. We included 222 patients who underwent ESG at the Endoscopic and Bariatric Surgery Center of the hospital in Brzeziny from January 2021 to October 2023. The severity of complications was evaluated based on the Clavien-Dindo classification, considering complications of grade II or higher. Among the studied group of patients, a total of 4 (1.8%) cases of perioperative bleeding into the gastrointestinal tract were recorded. One (0.5%) patient had the most severe grade IVb complication that required treatment in the Intensive Care Unit. All patients with serious adverse events (SAE) fully recovered. We did not observe an association between the learning curve, procedure duration, and the frequency or severity of postoperative complications. The presented results confirm the high safety of ESG in the treatment of obesity.

Utility of rapid on-site evaluation during bronchoscopy in the diagnosis of pulmonary tuberculosis.

Introduction：The diagnostic value of rapid on-site evaluation (ROSE) in bronchoscopy for lung tumors has been widely researched. However, the diagnostic efficacy of ROSE for pulmonary tuberculosis has not been extensively assessed yet. This study aimed to examine the value of ROSE in diagnosing pulmonary tuberculosis during bronchoscopy, and the relationship between ROSE cytology patterns and acid-fast bacilli (AFB) smears and mycobacterial cultures. Methods：A retrospective study was conducted at a single respiratory endoscopy centre, including 418 patients under clinical or radiological suspicion of having pulmonary tuberculosis who underwent bronchoscopy. In addition to the use of ROSE and definitive cytology, material obtained by aspiration/lavage or brushing was sent for AFB smear and mycobacterial culture. If histopathological examination was required, endobronchial biopsy (EBB), transbronchial lung biopsy (TBLB) and transbronchial needle aspiration (TBNA) were performed at the discretion of the clinician. A composite reference standard (CRS) was used as the diagnostic gold standard for this study. The diagnosis obtained by ROSE was compared with the final diagnosis. Results：Of the 418 patients studied, 282 (67.5%) were diagnosed on the basis of bronchoscopic findings, as follows: pulmonary tuberculosis, in 238 (84.4%); Non-tuberculosis (Non-TB) ，in 44 (15.6%). In 238 pulmonary tuberculosis patients, ROSE cytology showed granulomas without necrosis were observed in 107 cases, granulomas and necrosis in 51 cases, caseous necrosis only in 25 cases, and non-specific inflammation in 55 cases. For the diagnosis of tuberculosis according to CRS, ROSE showed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was 76.9%, 68.2%, 92.9% and 35.3%, respectively. The positivity rate for bacterial detection by acid-fast staining and culture at bronchoscopy was 51.7%. The cytological pattern showed a higher detection rate for bacteria in cases of necrosis. Discussion：The application of rapid on-site evaluation (ROSE) during bronchoscopy is a straightforward procedure that delivers an immediate and precise assessment regarding the adequacy of collected samples, enabling a preliminary diagnosis of pulmonary tuberculosis. ROSE has exhibited a higher sensitivity in detecting pulmonary tuberculosis compared to microbiological examinations. In addition, the cytological presentation of ROSE tends to show a higher positivity rate for microbiological testing in caseous necrosis. Therefore, samples with these characteristics should be prioritised for microbiological examination after on-site evaluation.

Effect of Betty Neuman's systemic model on the anxiety of patients undergoing endoscopy: A randomized control trial

The present study aims to determine the effect of Betty Neuman's systemic model on the anxiety of patients undergoing endoscopy. This randomized control trial investigation involved 44 participants recruited from the endoscopy center of Golestan Province Hospital in the 2022, specifically those prescribed for endoscopic procedures. The data collection instruments employed in this research encompassed a demographic characteristics questionnaire focusing on age, gender, education, and occupation, as well as Spielberger's state-trait anxiety questionnaire (form Y) (STAI-Y). The pre-intervention anxiety levels were 111.41 (SD=17.61) in the intervention group and 109.27 (SD=6.64) in the control group. The Mann-Whitney U test indicated no statistically significant difference in the anxiety levels between the two groups before the intervention (P=0.29). Following the intervention, the anxiety levels were 116.56 (SD=12.25) in the intervention group and 111.95 (SD=4.70) in the control group. The independent t-test revealed a significant difference between the two groups (P&lt;0.01). Furthermore, the Wilcoxon test demonstrated no significant difference in anxiety levels within the control group before and after the intervention (P=0.36), whereas a significant difference was observed in the intervention group before and after the intervention (P&lt;0.01). Moreover, the ANCOVA revealed a statistically significant difference between the two groups after accounting for the pre-test effects (Eta=0.58, P&lt;0.01). This indicates that 58% of the variance in post-test changes can be attributed to the training provided based on the Betty Neuman's systemic model. In conclusion, the implementation of Betty Neuman's systemic model has proven to be effective in reducing anxiety levels among patients undergoing endoscopy. The demonstrated efficacy of Betty Neuman's model suggests that nursing models can serve as a cost-efficient, impactful, and secure treatment approach in patient care.

Upper Gastrointestinal Endoscopy Quality in Italy: A Nationwide Study.

International guidelines advise improving esophagogastroduodenoscopy (EGD) quality in Western countries, where gastric cancer is still diagnosed in advanced stages. This nationwide study investigated some indicators for the quality of EGD performed in endoscopic centers in Italy. Clinical, endoscopic, and procedural data of consecutive EGDs performed in one month in the participating centers were reviewed and collected in a specific database. Some quality indicators before and during endoscopic procedures were evaluated. A total of 3,219 EGDs performed by 172 endoscopists in 28 centers were reviewed. Data found that some relevant information (family history for GI cancer, smoking habit, use of proton pump inhibitors) were not collected before endoscopy in 58.5-80.7% of patients. Pre-endoscopic preparation for gastric cleaning was routinely performed in only 2 (7.1%) centers. Regarding the procedure, sedation was not performed in 17.6% of patients, and virtual chromoendoscopy was frequently (>75%) used in only one (3.6%) center. An adequate sampling of the gastric mucosa (i.e., antral and gastric body specimens) was heterogeneously performed, and it was routinely performed only by 23% of endoscopists, and in 14.3% centers. Our analysis showed that the quality of EGD performed in clinical practice in Italy deserves to be urgently improved in different aspects.

Endoscopic retrograde cholangiopancreatography utilisation and outcomes in the first advanced endoscopy centre in Palestine at Al-Ahli Hospital: a retrospective cohort study

ObjectiveTo evaluate the utilisation and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures, success rates, incidence and risk factors for procedural-related complications in a single centre-based study.Study designRetrospective cohort study.SettingFirst advanced...