Endoscopy Specialists Research Articles

TPOAb Indicates neuroendocrine tumor in autoimmune gastritis: A retrospective study of 91 patients

BackgroundThe association between serological indexes and occurrence of complications in patients with autoimmune gastritis (AIG) remains unclear. Methods91 patients with AIG were recruited and their clinical information were collected. The differences between serological indexes and complications of AIG were analyzed. And potential biomarker for early prediction and diagnosis of AIG with complications was explored. ResultsAIG patients in our study was 58.12 ± 11.68 years old, containing 31 males and 60 females. G17 was elevated in 49 of 52; PGI/II decreased in 43/49; GPA positive in 48/61; Anemia presented 28 in 80; Vitamin B12 deficiency occurred 23 in 58. Neuroendocrine tumor (NET) was the most common complication in AIG patients, accounting for 27/91. The second was polyps, making up for 14/91. There is also 9/91 of gastric mucosa neoplasia happened in AIG. No significant difference of G7, PGI, PGII, PGI/II and VB12 in AIG was found in different gastric mucosal lesions (P > 0.05). However, AIG patients with TPOAb positive had a higher risk in the occurrence of NET simultaneously (P = 0.0212). Those AIG with NET patients exhibited a significantly higher TPOAb level (P = 0.0078). ROC curve suggested that TPOAb can predict the existence of NET in AIG (AUC = 0.7410, P < 0.05). ConclusionWe found that TPOAb can serve as a predictive biomarker of NET in AIG. This accessible test is helpful for endoscopy specialists to pay attention to gastric mucosal lesions in TPOAb-positive AIG patients, improving early diagnosis and intervention of comorbidities ability.

P461 Deep learning model for endoscopic differential diagnosis between intestinal lymphoma and Crohn's disease: a multicenter study

Abstract Background Primary and secondary intestinal lymphoma (IL) are a relatively rare cancer, while easily misdiagnosed due to the unclear aetiology and unspecific clinical symptoms. Moreover, the endoscopic features of IL vary depending on pathological types, making it difficult to distinguish from Crohn's disease (CD). This study aims to develop deep learning models based on endoscopic images, facilitating the differential diagnosis of IL and CD. Methods We retrospectively recruited 271 patients with IL and 232 patients with CD from 6 tertiary centres in China. With out-of-focus or poor-bowel-prepared images excluded, we used 1739 IL and 1649 CD images for internal and external validation to build deep learning models. For internal validation, we used five-fold cross-validation with 1517 IL images and 1428 CD images from 5 centres randomly assigned without any patient overlap. 222 IL and 221 CD images from the 6th centre were used for independent external validation to measure the generalization ability of models. Further, we compared the performance of models with that of clinical physicians consisting of 2 junior physicians and 2 endoscopy specialists with more than ten years of clinical experience. We evaluated models using metrics such as accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) and used the kappa statistic to measure the inter-rater reliability between models and clinical physicians. Results We developed multiple convolutional neural network models, including ResNet18, ResNet34, ResNet50, VGG16, VGG19, DenseNet121, Inception v3, and Xception. The top 3 models in the internal validation were Inception v3, Xception, and DenseNet121. Inception v3 showed the best performance (accuracy: 83.1%; AUC: 0.910), while Xception performed better on average (average accuracy: 76.8%; average AUC: 0.834). In the external validation, the top 3 models were Inception v3, DenseNet121, and VGG19. Inception v3 achieved the highest accuracy of 81.9%, while DenseNet121 had the best AUC of 0.903. Compared with clinical physicians, Inception v3 performed better than junior physicians (average accuracy: 67.2%) and showed good agreement with the best endoscopy specialist (kappa: 0.604, p&amp;lt;0.05). Conclusion Convolutional neural network models using endoscopic images were able to differentiate PIL from CD, with better-diagnosing performance than junior physicians, good agreement with specialists, and good generation ability, which were expected to assist clinical physicians lacking experience to differentiate PIL and CD more precisely under endoscope.

Expert consensus on endoscopic diagnosis and treatment of the benign pancreaticobiliary junction disease (2023 edition)

The pancreaticobiliary junction (PBJ) stands as a pivotal "hub" where the bile and pancreatic ductsmerge, directing the flow rate and direction of bile and pancreatic juice. Benign pancreaticobiliary junction diseases(BPBJD) can lead to compromised outflow of bile and pancreatic secretions, resulting in elevated pressures within the bile and pancreatic ducts, causing ductal dilation, secretion stasis, and stone formation.Furthermore, BPBJD can shift the direction of bile and pancreatic juice, inducing pancreaticobiliary reflux, bile-pancreatic reflux, or enterobiliary reflux, thereby causing both acute and chronic inflammation and tumors in the biliopancreatic system. Owing to the unique anatomical position of the PBJ and the often intricate and elusive symptoms of benign diseases in this region, clinicians might mainly address standard biliary and pancreatic diseases, overlooking the primary issues associated with the PBJ.Such oversight can yield less-than-optimal clinical outcomes. In response to this, the Gallbladder-Preserving Surgery Committee, Endoscopy Specialist Branch of Chinese Medical Doctor Association and the editorial board of the National Medical Journal of China assembled renowned domestic experts from the fields of hepatobiliary and pancreatic surgery and digestive endoscopy. Drawing upon the latest domestic and international research findings, as well as the clinical expertise of specialists from related fields within China, they have collaboratively developed an expert consensus on the endoscopic diagnosis and treatment of BPBJD. The overarching aim is to propagate and standardize the diagnosis and treatment approaches for BPBJD.

Clean mucosal area detection of gastroenterologists versus artificial intelligence in small bowel capsule endoscopy.

Studies comparing the detection of clean mucosal areas in capsule endoscopy (CE) using human judgment versus artificial intelligence (AI) are rare. This study statistically analyzed gastroenterologist judgments and AI results. Three hundred CE video clips (100 patients) were prepared. Five gastroenterologists classified the video clips into 3 groups (≥75% [high], 50%-75% [middle], and < 50% [low]) according to their subjective judgment of cleanliness. Visualization scores were calculated using an AI algorithm based on the predicted visible area, and the 5 gastroenterologists' judgments and AI results were compared. The 5 gastroenterologists evaluated CE clip video quality as "high" in 10.7% to 36.7% and as "low" in 28.7% to 60.3% and 29.7% of cases, respectively. The AI evaluated CE clip video quality as "high" in 27.7% and as "low" in 29.7% of cases. Repeated-measures analysis of variance (ANOVA) revealed significant differences in the 6 evaluation indicators (5 gastroenterologists and 1 AI) (P < .001). Among the 300 judgments, 90 (30%) were consistent with 5 gastroenterologists' judgments, and 82 (91.1%) agreed with the AI judgments. The "high" and "low" judgments of the gastroenterologists and AI agreed in 95.0% and 94.9% of cases, respectively. Bonferroni's multiple comparison test showed no significant difference between 3 gastroenterologists and AI (P = .0961, P = 1.0000, and P = .0676, respectively) but a significant difference between the other 2 with AI (P < .0001). When evaluating CE images for cleanliness, the judgments of 5 gastroenterologists were relatively diverse. The AI produced a relatively universal judgment that was consistent with the gastroenterologists' judgements.

Implementation of artificial intelligence in upper gastrointestinal endoscopy.

The application of artificial intelligence (AI) using deep learning has significantly expanded in the field of esophagogastric endoscopy. Recent studies have shown promising results in detecting and differentiating early gastric cancer using AI tools built using white light, magnified, or image‐enhanced endoscopic images. Some studies have reported the use of AI tools to predict the depth of early gastric cancer based on endoscopic images. Similarly, studies based on using AI for detecting early esophageal cancer have also been reported, with an accuracy comparable to that of endoscopy specialists. Moreover, an AI system, developed to diagnose pharyngeal cancer, has shown promising performance with high sensitivity. These reports suggest that, if introduced for regular use in clinical settings, AI systems can significantly reduce the burden on physicians. This review summarizes the current status of AI applications in the upper gastrointestinal tract and presents directions for clinical practice implementation and future research.

위내시경 영상에서 위암 분류에 최적화된 데이터 증대방법 연구

Gastric cancer is the most common cancer in Korea and an effective way to treat gastric cancer is early treatment. Gastroscopy is being performed for early detection of gastric cancer, and this paper proposes Computer-aided Diagnostics(CADx) system that can help gastroscopy. As a model for classifying gastric cancer, we use Xception, which reduces computation and improves performance. Due to the nature of medical images, data augmentation was used to solve the lack of data and overfitting could occur. The data augmentation methods used were AutoAugment and Variational AutoEncoder(VAE). AutoAugment is a data augmentation method using color changes, shear, rotation, etc., and VAE learns to standardize the probability distribution of the data, helping to generate data similar to the original data to capture features. The data augmentation method with the best performance is the augmentation method through VAE, and the recall showed 94.84% of the performance. The data augmentation method optimized for the gastroscopy data set is the augmentation method through VAE. It can help the endoscopy specialist diagnose and increase the gastric cancer complete cure rate.

Colonoscopy image classification using self-supervised visual feature learning

Colonoscopy image classification is an image classification task that predicts whether colonoscopy images contain polyps or not. It is an important task input for an automatic polyp detection system. Recently, deep neural networks have been widely used for colonoscopy image classification due to the automatic feature extraction with high accuracy. However, training these networks requires a large amount of manually annotated data, which is expensive to acquire and limited by the available resources of endoscopy specialists. We propose a novel method for training colonoscopy image classification networks by using self-supervised visual feature learning to overcome this challenge. We adapt image denoising as a pretext task for self-supervised visual feature learning from unlabeled colonoscopy image dataset, where noise is added to the image for input, and the original image serves as the label. We use an unlabeled colonoscopy image dataset containing 8,500 images collected from the PACS system of Hospital 103 to train the pretext network. The feature exactor of the pretext network trained in a self-supervised way is used for colonoscopy image classification. A small labeled dataset from the public colonoscopy image dataset Kvasir is used to fine-tune the classifier. Our experiments demonstrate that the proposed self-supervised learning method can achieve a high colonoscopy image classification accuracy better than the classifier trained from scratch, especially at a small training dataset. When a dataset with only annotated 200 images is used for training classifiers, the proposed method improves accuracy from 72,16% to 93,15% compared to the baseline classifier.

Nursing Difficulties and Issues in Endoscopic Sedation: Qualitative Research in Japan.

Gastrointestinal endoscopic treatments have increased in Japan. Respiratory depression is as an unexpected development during sedation. This study aimed to clarify the sedation-related difficulties encountered by nurses involved in endoscopic treatment. Participants were five nurses who had worked for more than a year in the endoscopy department of a gastrointestinal endoscopy specialist guidance facility in Sapporo. Semistructured interviews were conducted. The number of recording units obtained was 129, which were divided into 12 categories and subdivided into 42 subcategories. The nursing practice difficulties related to sedation in endoscopic treatment were classified into two major categories: “difficulties in nursing practice” and “system difficulties.” All of the “difficulty in nursing practice” items were role-fulfilling difficulties involved in protecting patient safety and reducing anxiety and discomfort. Four of these items reflected difficulties related particularly to the role of the nurse in charge of the sedated patient in the endoscopy room. To reduce the difficulties encountered by nurses, a treatment environment system must be devised to ensure patient safety and improve the education support system for nurses with regard to sedation.

Effect of disease duration on the association between serum albumin and mucosal healing in patients with ulcerative colitis

ObjectiveSerum albumin is used as a marker of acute inflammation. Several studies have addressed the association between serum albumin and clinical outcome in patients with ulcerative colitis (UC). While mucosal...

Analysis of factors that could affect symptomatic outcome in patients having laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres

ObjectiveInvestigate factors that influence quality of life after laparoscopic excision of deep rectovaginal endometriosis. Study designA multicentre prospective cohort study involving 63 hospitals accredited as British Society for Gynaecological Endoscopy specialist endometriosis centres was conducted. The study population comprised of 8368 women who had undergone laparoscopic surgical excision of deep rectovaginal endometriosis requiring dissection of the pararectal space. The main outcome assessed was mean quality of life measured using the EuroQol 100 mm visual analogue score at 6 and 24 months after surgery according to potential prognostic factors. These factors included patient characteristics (age, smoking status, BMI), previous treatments for endometriosis, concomitant bowel surgery and surgical complications. ResultsQuality of life improved from a mean pre-operative score of 55/100 to 72/100 (p < 0.01), at 6 months following surgery and this elevated score was sustained at 24 months (mean VAS = 71/100; p < 0.01). Smoking and previous surgery for endometriosis were associated with significantly reduced quality of life at both 6 months (mean difference −7.7 (standard error (SE) 1.0); P < 0.01 and -2.8 (SE 0.7); P < 0.01 respectively) and 24 months after surgery (mean difference −6.8 (SE 1.8); P < 0.01 and −4.5 (SE 1.2); P < 0.01 respectively). Age over 45 years was predictive of greater clinical improvement at 6 and 24 months (mean difference 5.5 (SE 1.2); P < 0.01 and 9.7 (SE 2.2); P < 0.01) as was the use of gonadotrophin analogues (GnRHa) (mean difference 7.6 (SE 1.2); P < 0.01 and 8.9 (SE 2.0); P < 0.01). Conclusion(s)Laparoscopic excision of deep endometriosis in specialist centres improves quality of life. Women should be advised to stop smoking and consider pre-operative ovarian suppression. Surgery should be avoided prior to referral to a specialist centre in women diagnosed with deep rectovaginal endometriosis to achieve a better quality of life outcome.

Development and Assessment of a Gastroscopy Electronic Learning System for Primary Learners: Randomized Controlled Trial.

BackgroundEndoscopic examination is a popular and routine procedure for the diagnosis and treatment of gastrointestinal (GI) diseases. Skilled endoscopists are in great demand in clinical practice, but the training process for beginners to become endoscopy specialists is fairly long. Convenience and a self-paced, learner-centered approach make electronic learning (e-learning) an excellent instructional prospect.ObjectiveThis study aimed to develop and apply an e-learning system in gastroscopy teaching and learning and to evaluate its effectiveness and user satisfaction.MethodsThe e-learning software Gastroscope Roaming System was developed for primary learners. The system simulates the real structure of the upper gastrointestinal (UGI) tract to teach the main characteristics of gastroscopy under both normal conditions and conditions of common UGI tract diseases. A randomized controlled trial was conducted. Participants were randomly allocated to an e-learning group (EG)or a non–e-learning control group after a pretest. On completing the training, participants undertook a posttest and gastroscopy examination. In addition, the EG completed a satisfaction questionnaire.ResultsOf the 44 volunteers, 41 (93%) completed the gastroscopy learning and testing components. No significant pretest differences were found between the intervention and control groups (mean 50.86, SD 6.12 vs mean 50.76, SD 6.88; P=.96). After 1 month of learning, the EG’s posttest scores were higher (mean 83.70, SD 5.99 vs mean 78.76, SD 7.58; P=.03) and improved more (P=.01) than those of the control group, with better performance in the gastroscopy examination (mean 91.05, SD 4.58 vs mean 84.38, SD 5.19; P<.001). Overall, 85% (17/20) of the participants were satisfied with the e-learning system, and 95% (19/20) of the participants considered it successful.ConclusionsE-learning is an effective educational strategy for primary learners to acquire skills in gastroscopy examination and endoscopic imaging of the GI tract.Trial RegistrationChinese Clinical Trial Registry ChiCTR-IOR-17013091; http://www.chictr.org.cn/showproj.aspx?proj=22142

Analysis of microRNA expression in brush cytology specimens improves the diagnosis of pancreatobiliary cancer

Background/ObjectivesMalignant pancreatobiliary strictures are in many cases clinically indistinguishable and present a major problem to endoscopy specialists. Intraductal sampling procedures such as brush cytology are commonly used for diagnosis with a sensitivity that is low for a diagnostic test used in daily clinical practice. MicroRNA (miR) alterations detected in many cancers are disease-specific, which can be utilized in clinical applications. The aim of the present study was to analyze whether determination of miR expression levels in intraductal brush cytology specimens is a feasible approach to improve the diagnosis of pancreatobiliary cancer. MethodsBrush cytology specimens have been collected during endoscopic retrograde cholangio-pancreatography (ERCP) and analyzed by routine cytology and ancillary miR assays. Total RNA was extracted using the miRNeasy Mini Kit and the expression of miRs frequently dysregulated in pancreatobiliary cancer (miR-16, miR-21, miR-196a, miR-221) were analyzed by quantitative real-time PCR using RNU6B as internal control. ResultsRoutine cytology resulted in no false positive diagnoses, however, the combined sensitivity remained at 53.8%. Expression (ΔCt values) of miR-16 (p = 0.0039), miR-196a (p = 0.0003) and miR-221 (p = 0.0049) showed a clear statistical significance between malignant and benign pancreatobiliary specimens (n = 35). Malignancy could be detected combining routine cytology and the miR-196a single marker expression levels with a sensitivity of 84.6% (92.9% in biliary strictures) with no false positives. ConclusionsThe results offer the first direct demonstration that microRNAs are readily detectable in brush cytology specimens obtained during ERCP, and have the potential to help the cytological diagnosis of pancreatobiliary malignancy.

Prevalence of Helicobacter pylori among medical workers in Moscow and Kazan according to ¹³С-urease breath test

Rationale: The relevance of the problem is related to the lack of data on Helicobacter pylori (HP) prevalence in Russia, which is associated with the risk of peptic ulcer and gastric cancer, and also, on the other hand, to the non-adherence of the doctors to the existing expert guidelines on diagnosis of this infection and HP eradication therapy. Aim: To assess the prevalence of HP among medical workers and their willingness to undergo eradication therapy. Materials and methods: A total of 315 medical workers (61 men and 254 women) aged 18 to 76 years were examined, among them 221 in Moscow and 94 in Kazan. To assess the HP contamination rate, all participants performed a ¹³С-urease breath test with the “HELICARB” test kit according to the “four-point” technique. All participants were asked to complete the questionnaires to access the impact of social and occupational factors on the prevalence of HP. Results: HP was identified in 54.9% of the examined subjects, including 45.9% of men and 57.1% of women. The prevalence of HP in Moscow was substantially lower (49.8%) than in Kazan (67%). The proportion of HP-positive subjects increased with age from 41.8% in those below 25 years of age to 76.9% in those above their 60s. 60.2% of married participants and 49% of the singles were HP-positive. Among doctors, HP prevalence rate was the largest in the endoscopy specialists (61.5%) and internists (60.9%). Only 61.4% of HP-positive medical workers expressed their willingness to undergo eradication therapy. Conclusion: The study showed a high prevalence of HР in medical workers increasing with age. It is presumably related to hygiene habits and conditions during childhood of each generation; however, one cannot exclude their potential contamination during their occupational activities.

Investigation and analysis of professional training situation and demands for digestive endoscopy nurses

Objective To investigate the training situation and demands for professional training of digestive endoscopy nurses, and provide feasibal basis to establish professional digestive endoscopy nurse training system. Methods Using the self-designed digestive endoscopy nurses professional training demand questionnaire, 97 students were surveyed, who participated in the digestive endoscopy nurses professional training in July 2015 in Jilin province. Results 100% of digestive endoscopy nurses showed the will to participate in the digestive endoscopy specialist knowledge and skills training, and 98.97% showed the demand to accept training of new knowledge and progress in endoscopic specialized subject. Respectively 70.1% and 91.8% of nurses before or after entering the department received digestive endoscopy specialist knowledge training. The demand score for professional training in digestive endoscopy nurses was (4.47±0.63) points, which was in the need level; thereinto, the nursing cooperation about digestive endoscope surgery was what they need most in training content(4.56±0.61). 91.8% of nurses would choose the head nurses in Endoscopic Department as the training staff and 78.4% would choose experienced nurses. Conclusions Digestive endoscopy nurses for professional training in Jilin province is in urgent need. Based on the present nursing situation of digestive endoscopy, we should set up and improve the digestive endoscopy training scheme and training content, strengthen the digestive endoscopy professional training system and nursing teachers team construction. Key words: Digestive endoscopy nurse; Professional training; Demand; Investigation and analysis

Implementation challenges and successes of a population-based colorectal cancer screening program: a qualitative study of stakeholder perspectives.

BackgroundFew studies describe system-level challenges or facilitators to implementing population-based colorectal cancer (CRC) screening outreach programs. Our qualitative study explored viewpoints of multilevel stakeholders before, during, and after implementation of a centralized outreach program. Program implementation was part of a broader quality-improvement initiative.MethodsDuring 2008–2010, we conducted semi-structured, open-ended individual interviews and focus groups at Kaiser Permanente Northwest (KPNW), a not-for-profit group model health maintenance organization using the practical robust implementation and sustainability model to explore external and internal barriers to CRC screening. We interviewed 55 stakeholders: 8 health plan leaders, 20 primary care providers, 4 program managers, and 23 endoscopy specialists (15 gastroenterologists, 8 general surgeons), and analyzed interview transcripts to identify common as well as divergent opinions expressed by stakeholders.ResultsThe majority of stakeholders at various levels consistently reported that an automated telephone-reminder system to contact patients and coordinate mailing fecal tests alleviated organizational constraints on staff’s time and resources. Changing to a single-sample fecal immunochemical test (FIT) lessened patient and provider concerns about feasibility and accuracy of fecal testing. The centralized telephonic outreach program did, however, result in some screening duplication and overuse. Higher rates of FIT completion and a higher proportion of positive results with FIT required more colonoscopies.ConclusionsAddressing barriers at multiple levels of a health system by changing the delivery system design to add a centralized outreach program, switching to a more accurate and easier-to-use fecal test, and providing educational and electronic support had both benefits and problematic consequences. Other health care organizations can use our results to understand the complexities of implementing centralized screening programs.

Segundo consenso mexicano para la Enseñanza de la endoscopia gastrointestinal

Gastrointestinal endoscopy has shown an overwhelming consolidation in the field of both national and international medicine. Its development, evolution and scope have gone beyond borders with a future bringing huge challenges including gastrointestinal endoscopy teaching. Thus, AMEG developed a second Mexican consensus in Gastrointestinal endoscopy teaching, which gave birth to a unique, complete, visionary and updated academic program. This program will be used in all teaching facilities -all of which progressively homogeneus- with the commitment of qualified professors and with defined teacher-student-facility profiles, so that our country receives a top-level GI endoscopy specialist.

Multimodal and multimedia image analysis and collaborative networking for digestive endoscopy

ObjectiveThe ultimate goal of the Syseo project is to create a chain of collaborative processes to allow the hepato-gastroenterology endoscopy specialist to manage images easily. MethodsA field study has been done to better understand and formalize practices and contexts of use. Based on these results, we have designed tools for gastroenterology, tackling several domains of computer science and reusing well-known format or concepts especially DICOM files, semantic retrieval and infocus-breakpoint. ResultsSyseo consists in four main components: (1) a data management system relying on the well-known standard DICOM format; (2) a polyp ontology and description logics to manage gastroenterological images; (3) software to estimate the size of a neoplasia from colonoscopic images and (4) pearly user interfaces to enhance collaboration. DiscussionPreliminary results of Syseo are quite promising since the proposed solutions enable to efficiently store, annotate, retrieve medical data, while providing relatively accurate measuring tools for physicians and medical staff.

Focused open necrosectomy in necrotizing pancreatitis

BackgroundThe control of sepsis is the primary goal of surgical intervention in patients with infected necrosis. Simple surgical approaches that are easy to reproduce may improve outcomes when specialists in endoscopy are not available. The aim of the present study was to describe the experience with a focused open necrosectomy (FON) in patients with infected necrosis. MethodA prospective pilot study conducted to compare a semi‐open/closed drainage laparotomy and FON with the assistance of peri‐operative ultrasound. The incidence of sepsis, dynamics of C‐reactive protein (CRP), intensive care unit (ICU)/hospital stay, complication rate and mortality were compared and analysed. ResultsFrom a total of 58 patients, 36 patients underwent a conventional open necrosectomy and 22 patients underwent FON. The latter method resulted in a faster resolution of sepsis and a significant decrease in mean CRP on Day 3 after FON, P = 0.001. Post‐operative bleeding was in 1 versus 7 patients and the incidence of intestinal and pancreatic fistula was 2 versus 8 patients when comparing FON to the conventional approach. The median ICU stay was 11.6 versus 23 days and the hospital stay was significantly shorter, 57 versus 72 days, P = 0.024 when comparing FON versus the conventional group. One patient died in the FON group and seven patients died in the laparotomy group, P = 0.139. DiscussionFON can be an alternative method to conventional open necrosectomy in patients with infected necrosis and unresolved sepsis.

PTH-064 Narrow Band Imaging Facilitates Detection of Inlet Patches in the Cervical Oesophagus

IntroductionEctopic gastric mucosa in the cervical oesophagus (inlet patch) is easily missed on endoscopic examination because of its localization, usually just below the upper oesophageal sphincter. In some individuals, an...

PMO-026 Re-audit of action on positive H pylori (HP) serology: significantly better … not yet perfect

IntroductionWe identified a patient with duodenal ulcer re-bleed whose earlier Hp seropositive result was overlooked, hence not acted on. This triggered an audit1 of action taken on hospital–initiated Hp seropositive...