Gastrointestinal Endoscopic Biopsy Research Articles

Artificial Intelligence-Assisted Daily Quality Control System for the Histologic Diagnosis of Gastrointestinal Endoscopic Biopsies: A 1-Year Experience.

Seegene Medical Foundation, one of the major clinical laboratories in South Korea, developed SeeDP, an artificial intelligence (AI)-based postanalytic daily quality control (QC) system that reassesses all gastrointestinal (GI) endoscopic biopsy (EB) slides for incorrect diagnoses. To review the operational records and clinical impact of SeeDP since its launch in March 2022. Operational records of SeeDP were retrieved for the period of March 1, 2022, to February 28, 2023. Among cases scanned during 40 working days (March 10, 2022, to May 4, 2022), all discordant cases encountered by 2 pathologists were reviewed. Cases of SeeDP-assisted revised diagnoses were collected and compared with cases recognized using conventional methods. Occasional scanner failures and various types of aberrant errors compromised QC coverage, resulting in the scanning of only 67.7% (572 254 of 844 906) of all EB slides submitted and 0.8% of the scanned slides being further excluded from the AI analysis. The AI predictions differed from the pathologists' diagnoses in 42 760 of the 557 672 gastrointestinal EB slides (7.7%) successfully assessed by the AI models; however, a detailed review of discordant slides revealed that true misdiagnosis accounted for only 5.5% (25 of 454) of the disagreements. Compared with conventional error recognition methods, SeeDP detected more misdiagnoses (7 versus 14) within a significantly shorter time (average, 3.6 versus 38.7 days; P < .001), including 1 signet ring cell carcinoma initially diagnosed as gastritis. AI-based daily QC systems are plausible solutions to guarantee high-quality pathologic diagnosis by enabling rapid detection and correction of misdiagnosis.

Histopathological Spectrum of the Upper Gastrointestinal Tract Endoscopic Biopsies at a Tertiary Hospital: A Descriptive Cross-sectional Study.

Upper gastrointestinal tract disorders are prevalent worldwide, encompassing neoplastic and non-neoplastic lesions like infections and inflammation. Endoscopic biopsies play a crucial role in diagnosis, treatment monitoring, and complication detection. Despite their routine use, comprehensive data on their histopathological spectrum is sparse. This study aimed to delineate this spectrum and assess the prevalence of non-neoplastic and neoplastic lesions in upper gastrointestinal tract endoscopic biopsies. This descriptive cross-sectional study at a tertiary care center analyzed upper gastrointestinal endoscopic biopsies from August 1, 2019, to July 31, 2021. After obtaining ethical clearance (reference number: 039-078/079), we collected all upper gastrointestinal endoscopic biopsies received during the two-year study period, excluding inadequate biopsies, resection specimens, therapeutic cases, and specific lesions.Histopathological examination was conducted using H&E, Giemsa, and Periodic acid-Schiff stains. Diagnoses were categorized into non-neoplastic and neoplastic lesions following WHO guidelines. Data were analyzed using SPSS 16.0 to determine the frequency of neoplastic and non-neoplastic cases. Among 155 upper gastrointestinal biopsies, 124 (80%) were non-neoplastic (95% CI: 73.71-86.29%) and 31 (20%) were neoplastic (95% CI: 13.71-26.29%). Non-neoplastic lesions were predominantly chronic gastritis, with chronic active gastritis being the most frequent 34 (27.41%). Neoplastic lesions were mainly adenocarcinomas in the stomach 20 (64.51%) and squamous cell carcinomas in the esophagus 7 (22.58%). The prevalence of neoplastic lesions were found to lower compared to the published literature and showed predominance of adenocarcinoma in upper gastrointestinal neoplastic lesions.

A Hospital-Based Cross-Sectional Study on the Histopathology of Upper Gastrointestinal Tract Endoscopic Biopsy in Dyspeptic Patients.

Background Dyspepsia is one of the most common GI complaints encountered in clinical practice. Histopathological assessment of endoscopic gastric mucosa biopsy is crucial to delineate the exact cause of dyspepsia to guide patients' management. Objectives The aim of this study was to determine the histopathological spectrum of upper gastrointestinal (GI) tract endoscopic biopsies and to study the age and sex distribution of the predominant upper GI lesions. Methods A cross-sectional study was conducted in the Department of Pathology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India, from January 2022 to December 2023. All endoscopic mucosal biopsies of the esophagus, stomach, and duodenum (first and second parts) lesions were examined under a microscope for histopathological findings. Results Out of 250 endoscopic biopsies studied, there were 76 cases of esophageal biopsies, 149 cases of gastric biopsies, and 25 cases of duodenal biopsies. The male-to-female ratio was 1.2:1. Non-neoplastic lesions were more common than neoplastic lesions. The most common lesions encountered were esophagitis in the esophagus, gastritis in the stomach, and duodenitis in the duodenum. Conclusion The main organic cause of dyspepsia in our setting was chronic gastritis. We conclude that endoscopy of the upper GI tract and histopathological examination help in the earlier detection of both benign and malignant lesions. This aids in better timely management of the patients and improves the overall treatment provided resulting in a better prognosis.

Iron-Associated Mucosal Changes: A Potentially Under Recognized Entity in Upper Gastrointestinal Endoscopic Biopsies.

Iron-Associated Mucosal Changes: A Potentially Under Recognized Entity in Upper Gastrointestinal Endoscopic Biopsies.

Imprint Cytology of Gastrointestinal Endoscopic Tissue Biopsies at Kenyatta National Hospital, East Africa, Kenya

Imprint Cytology of Gastrointestinal Endoscopic Tissue Biopsies at Kenyatta National Hospital, East Africa, Kenya

Helicobacter pylori-Associated Immune Thrombocytopenia: Diagnostic and Therapeutic Approach.

The relationship between immune thrombocytopenia (ITP) and Helicobacterpylori infection has largely been an unexplored entity. This review article aims at focusing on the role of H. pylori in secondary ITP. We also elucidated the importance of diagnostic workup and treatment of H. pylori in this article. The mechanisms of H. pylori-associated ITP have been covered in this article. The factors determining platelet response to H. pylori eradication therapy have been mentioned. It is extremely crucial to be aware that H. pylori is a major causative pathogen for new-onset ITP as well as chronic ITP. Upper gastrointestinal endoscopic biopsy is the best invasive method for the diagnosis of the same. Further studies need to be conducted across larger, more diverse groups to validate our observation that eradication of H. pylori could aid platelet recovery in ITP.

Gastric Tuberculosis Accompanied by Cutaneous Fistula: A Case Report

Gastric Tuberculosis (TB) is a rare presentation. Posterior gastric perforation with tuberculosis complications is extremely unusual. The authors herewith present a case of a 32-year-old male, with complaints of fever for two months and discharge from the left-side of the back for 15 days, through which ingested food particles were drained. The patient was a known case of Type 2 Diabetes Mellitus (T2DM) and was recently diagnosed with pulmonary TB. He was evaluated with an upper Gastrointestinal (GI) endoscopic biopsy, Contrast-enhanced Computed Tomography (CECT), and Gastrografin (GGF) studies to confirm the diagnosis. He presumably developed gastric ulceration with posterior perforation, tracking through the retroperitoneum and presenting as a subcostal abscess that was inadvertently incised and converted into a fistula. He was treated both medically and surgically. He recovered completely and discharged with full course of Antitubercular Treatment (ATT) drugs and didactic medications. The presence of a cutaneous fistula in association with gastric TB underscores the diverse clinical presentations of this infectious disease, emphasising the importance of early detection and tailored management approaches.

Histopathological Study of Upper Gastrointestinal Tract Endoscopic Biopsies in a Teaching Hospital

Background: When a patient has an upper gastrointestinal disorder-which frequently manifests as dyspepsia-upper gastrointestinal endoscopy is considered the preferred diagnostic procedure. Without a biopsy, endoscopy cannot be considered complete, and the most reliable method for diagnosing lesions seen during endoscopy is histopathology. Methodology: This retrospective study was conducted in the Department of Pathology at A.C.S Medical College and Hospital for one year duration from July 2022 to July 2023. A total of fifty-five endoscopic biopsy specimens were obtained; they were preserved in 10% formalin and regularly stained with hematoxylin and eosin. Results: The majority was found to be 45.4% (25/40) of those aged 61-70, 36.3% (20/55) of those aged 51-60, and 18.1% (10/55) of those aged 40-50.Thirty patients (18.7%) had duodenal lesions, 80 cases (50%) had stomach lesions, and 50 cases (31.2%) had oesophageal lesions. Most upper gastrointestinal tract endoscopic biopsies came from the stomach. Conclusion: Endoscopy is insufficient without biopsy, and the gold standard for diagnosing lesions seen during an endoscopy is histopathology. The particular location of mucosal lesions can be seen with the use of upper gastrointestinal tract endoscopy. Therefore, we may draw the conclusion that using these two approaches together offers a potent diagnostic tool for improved patient care.

A study of histopathological features of upper gastrointestinal tract endoscopic biopsies in a tertiary care centre

Upper gastrointestinal tract (UGIT) comprises of esophagus, stomach and duodenum till the second part. Diseases affecting this region include inflammatory lesions, dysplasias, benign neoplasms and malignancies. Endoscopic biopsy and histopathological examination is considered as gold standard for gastrointestinal disorders. Endoscopic biopsy aids in early diagnosis of malignancy and better patient management. Present study was conducted with an aim of studying various histopathological features of endoscopic biopsies obtained from the UGIT.This study was a retrospective study of all UGIT endoscopic biopsies that were received from January 2015 to April 2020. Archived hematoxylin and eosin stained slides were retrieved and reviewed for various morphological abnormalities.During the study period 70 endoscopic biopsies from the UGIT were received. The incidence of malignancy was 74% and non-neoplastic lesions amounted to 26% of the biopsies. Biopsies from the esophagus (63%) constituted the major portion, followed by stomach (34%) and duodenum (3%).In our study incidence of malignancy outnumbered the non-neoplastic conditions. Esophagus was the most commonly biopsied site and squamous cell carcinoma of middle part of the esophagus was the most common malignancy. Inflammatory conditions constituted major part of the non-neoplastic lesions.

Fecal S100A12 concentrations in cats with chronic enteropathies.

The aim of this study was to compare fecal S100A12 concentrations in cats diagnosed with chronic enteropathy (CE) with healthy control cats. This was a prospective, cross-sectional study. Forty-nine cats that had gastrointestinal signs for >3 weeks and a complete diagnostic work-up, including bloodwork, abdominal ultrasound and upper and/or lower gastrointestinal endoscopic biopsies, were enrolled into the CE group. Nineteen cats from the CE group were diagnosed with inflammatory bowel disease (IBD) or chronic inflammatory enteropathy (CIE) and 30 with alimentary lymphoma (LSA), based on histopathology results and additional testing with immunohistochemistry or molecular clonality testing with PCR if indicated. Nineteen apparently healthy control cats were included in the study. One fecal sample was collected from each cat and S100A12 concentrations were quantified by an analytically validated in-house ELISA. Fecal S100A12 concentrations differed between cats with LSA (median 110 ng/g; interquartile range [IQR] 18-548) and control cats (median 4 ng/g; IQR 2-25 [P <0.001]) and between cats with IBD (median 34 ng/g; IQR 15-973) and control cats (P <0.003). S100A12 concentrations in CE cats (median 94 ng/g; IQR 16-548) were statistically significantly higher compared with control cats (P <0.001). The area under the receiver operating characteristic curve (AUROC) to separate healthy cats from CE cats was 0.81 (95% confidence interval [CI] 0.70-0.92) and was statistically significant (P <0.001). The AUROC to separate cats with IBD from cats with LSA was 0.51 (95% CI 0.34-0.68) and was not statistically significant (P = 0.9). Fecal S100A12 concentrations at the time of diagnostic investigation were higher in cats with CIE and LSA than in healthy controls but did not differ between cats with LSA and those with CIE/IBD. This study is an initial step toward evaluating a novel non-invasive marker of feline CIE. Further studies are needed to determine the diagnostic utility of fecal S100A12 concentrations in cats with CE, including comparing cats with IBD/CIE and LSA, and to compare them with cats with extra-gastrointestinal disease.

Patterns and Grading of Gastrointestinal Graft-Versus-Host Disease: A Clinicopathologic Correlation Study.

The present study investigated gastrointestinal involvement patterns of acute graft-versus-host disease and assessed the correlation of pathologic severity with clinical grading. Pathology reports of gastrointestinal (GI) endoscopic biopsies taken from 164 post-hematopoietic stem cell transplant patients with at least 1 endoscopic gastrointestinal biopsy diagnosed as "consistent with acute graft-versus-host disease" between 2005 and 2019 were retrieved from the automated hospital database. Endoscopic, pathologic and clinical gradings were performed using Freiburg criteria, Lerner and modified Seattle-Glucksberg grading systems, respectively. The majority of the patients (n = 140, 85.4%) were investigated with more than one biopsy from various gastrointestinal sites with a total of 479 biopsies: 44 (9.2%) esophagus, 90 (18.8%) stomach, 91 (19.0%) duodenum, 20 (4.2%) terminal ileum, 32 (6.7%) right colon, 87 (18.2%) left colon and, 115 (23.9%) rectum. Overall, lower gastrointestinal (n = 118/126, 93.6%) and upper gastrointestinal (n = 91/97, 93.8%) involvements were similar (P = .3). While the most severely affected site was duodenum (P = .021) in upper gastrointestinal, pathologic grades were similar in lower gastrointestinal sites, though more severe than upper gastrointestinal (P = .003). Pathologic grading had a low positive correlation with both clinical (r = 0.308, P = .001) and endoscopic grading (coefficient: 0.261, P = .003). Considering the similar graft-versus-host disease frequency of upper and lower gastrointestinal tract, distal colon evaluation with rectosigmoidoscopy seems to be a practical approach in patients with suspected gastrointestinal graft-versus-host disease. As it was positively correlated with both endoscopic and clinical grade, pathologic grading should be performed in these patients to assess gastrointestinal involvement patterns.

Comparison of bleeding following gastrointestinal endoscopic biopsy in patients treated with and without direct oral anticoagulants.

Background and study aims Despite the widespread use of direct oral anticoagulants (DOACs), the association between DOAC use and complications (e. g., bleeding) following gastrointestinal endoscopic biopsy remains unclear. This study aimed to evaluate complications after biopsy in patients treated with DOACs in Japan, where biopsies would be generally performed without DOAC withdrawal based on guideline recommendations. Patients and methods Using a Japanese nationwide database, we identified patients taking DOACs who underwent gastrointestinal endoscopic biopsy (n = 2,769, DOAC group) and those not taking DOACs (n = 129,357, control group) from April 2015 to November 2020. We conducted 1:4 propensity score (PS) matching and overlap PS-weighting analyses with adjustment for background characteristics to compare occurrence of post-procedure hemorrhage and stroke within 1 week after biopsy, and thrombin use on the day of biopsy without a diagnosis of hemorrhage. Results In total, 578 patients (0.44 %) developed post-procedure hemorrhage, and 13 patients (0.01 %) developed stroke. The DOAC group had more comorbidities than the control group. The PS matching analysis revealed no significant differences in post-procedure hemorrhage (odds ratio, 1.52 [95 % confidential interval, 0.96-2.41]) or stroke (1.00 [0.21-4.71]), whereas the DOAC group received thrombin more often than the control group (1.60 [1.30-1.95]). The results were equivalent in the overlap PS-weighting analysis. Conclusions The PS analyses showed no significant differences in complications following gastrointestinal endoscopic biopsy between DOAC users and non-users. These results suggest the safety of endoscopic biopsy without DOAC withdrawal although the need for careful hemostasis remains.

Erratum: Comparison of bleeding following gastrointestinal endoscopic biopsy in patients treated with and without direct oral anticoagulants

[This corrects the article DOI: 10.1055/a-1981-2946.].

Improving quality control in the routine practice for histopathological interpretation of gastrointestinal endoscopic biopsies using artificial intelligence.

Colorectal and gastric cancer are major causes of cancer-related deaths. In Korea, gastrointestinal (GI) endoscopic biopsy specimens account for a high percentage of histopathologic examinations. Lack of a sufficient pathologist workforce can cause an increase in human errors, threatening patient safety. Therefore, we developed a digital pathology total solution combining artificial intelligence (AI) classifier models and pathology laboratory information system for GI endoscopic biopsy specimens to establish a post-analytic daily fast quality control (QC) system, which was applied in clinical practice for a 3-month trial run by four pathologists. Our whole slide image (WSI) classification framework comprised patch-generator, patch-level classifier, and WSI-level classifier. The classifiers were both based on DenseNet (Dense Convolutional Network). In laboratory tests, the WSI classifier achieved accuracy rates of 95.8% and 96.0% in classifying histopathological WSIs of colorectal and gastric endoscopic biopsy specimens, respectively, into three classes (Negative for dysplasia, Dysplasia, and Malignant). Classification by pathologic diagnosis and AI prediction were compared and daily reviews were conducted, focusing on discordant cases for early detection of potential human errors by the pathologists, allowing immediate correction, before the pathology report error is conveyed to the patients. During the 3-month AI-assisted daily QC trial run period, approximately 7-10 times the number of slides compared to that in the conventional monthly QC (33 months) were reviewed by pathologists; nearly 100% of GI endoscopy biopsy slides were double-checked by the AI models. Further, approximately 17-30 times the number of potential human errors were detected within an average of 1.2 days. The AI-assisted daily QC system that we developed and established demonstrated notable improvements in QC, in quantitative, qualitative, and time utility aspects. Ultimately, we developed an independent AI-assisted post-analytic daily fast QC system that was clinically applicable and influential, which could enhance patient safety.

Esophageal Salvage Cytology: An Underused Complementary Procedure Employed During Upper Gastrointestinal Endoscopic Biopsy

Esophageal Salvage Cytology: An Underused Complementary Procedure Employed During Upper Gastrointestinal Endoscopic Biopsy

Association of Helicobacter Pylori in Carcinoma Stomach at Maharaja Krishna Chandra Gajapat Medical College: A Prospective Study.

Introduction Gastric cancer is the fourth most common type of cancer and the second leading cause of cancer-related death in the world. The etiology of gastric cancer includes Helicobacter pylori infection, diet, lifestyle, tobacco, alcohol, and genetic susceptibility. Upper gastrointestinal endoscopy (UGIE) is the most effective method for examining the upper gastrointestinal tract as compared to the other examination tools. Objective To study the histopathological finding of upper gastrointestinal endoscopic biopsies and its association with H. pylori in cases of carcinoma stomach. Materials and methods This was a hospital-based observational study carried out in the Department of Surgery, at Maharaja Krushna Chandra Gajapati Medical College, Berhampur, a tertiary care hospital in Eastern India. Study population consisted of 106 patients for a period of 2 years from July 2019 to June 2021, after due consideration of the inclusion and exclusion criteria. Endoscopic location and pathological types of the gastric lesion were noted, and all biopsy specimens were investigated to see the presence of H. pylori by rapid urease test (RUT) and histological examination in the form of Giemsa and H&E stain. Results In the present study of 106 cases, 62 cases (58.49%) were found to be positive for H. Pylori by RUT and 72 cases (67.92%) were positive for H. pylori by smear staining. In histopathological study, 72 cases (67.92%) were of intestinal type of carcinoma and 34 cases (32.07%) were of diffuse type of carcinoma. Smear for H . pylori was positive in 56 cases (77.78%) among the 72 cases of intestinal type of carcinoma stomach. Whereas only 16 cases (47.05%) were found to be smear-positive for H. pylori among the 34 cases of diffuse type of lesion. Irrespective of histological type, H. pylori was positive in 67.92% of patients with carcinoma stomach. This association was statistically significant (p<0.001) and indicates its role in intestinal type of gastric carcinoma. Conclusion There is a high frequency of H. pylori infection in cases of stomach cancer. This study confirmed the higher association of H. pylori infection with gastric cancer. Its association with the intestinal histological variety of stomach cancer is more common than diffuse type. The prevalence of H. pylori infection in distal stomach carcinoma is higher than proximal.

Comparison of Sequential, Hybrid, and Quadruple Therapy Protocols in Helicobacter pylori Eradication: A Single-Center Study.

Many treatment protocols are used in Helicobacter pylori eradication treatment within the framework of factors such as antibiotic resistance, drug side effects, patient compliance, and regional differences. H. pylori was diagnosed with upper gastrointestinal system endoscopic biopsy in the Internal Diseases Gastroenterology Endoscopy Unit of Atatürk University Medical Faculty Hospital; a total of 229 patients over the age of 18 were evaluated prospectively by dividing them into 3 groups and applying 3 different H. pylori eradication treatment protocols. A total of 229 patients who completed the treatment were included in the study. H. pylori eradication was achieved in 186 patients and not achieved in 43 patients. The H. pylori eradication success of our study was found to be 81.2%. Among the 84 patients in group 1, while H. pylori eradication was achieved in 67 of them, it was not achieved in 17 patients. The eradication success of quadruple treatment with bismuth was 79.8%. Also, among the 68 patients in group 2, while H. pylori eradication was achieved in 55 patients, it was not achieved in 13. The eradication success of the 14-day hybrid treatment was 80.9%. Among the 77 patients in group 3, while H. pylori eradication was achieved in 64 patients, it was not achieved in 13. The eradication success of the 10-day sequential treatment was 83.1%. It is necessary to conduct studies to find the most successful eradication regimen in primary care treatment of H. pylori in our country, to determine the regional antibiotic resistance rates, to individualize the proton pump inhibitor treatment due to metabolism and resistance differences, to examine the factors that stop from achieving the desired eradication success, and especially to avoid unnecessary antibiotic use.

Feasibility of combined upper and lower gastrointestinal endoscopic biopsy in the common marmoset (Callithrix jacchus) to evaluate gastrointestinal diseases.

Chronic gastroenteropathies, including gluten sensitivity and marmoset wasting syndrome, frequently occur in captive colonies of common marmosets (Callithrix jacchus). Early identification and diagnosis of affected animals are desirable. Endoscopic examination of the colon in marmosets is described, but the small intestine can harbor significant mucosal lesions not representing those in the colon. Evaluating the small intestine currently requires invasive surgical biopsies due to the small patient size, carrying a risk of severe complications. Endoscopic intubation and multisite biopsy of the duodenum/proximal jejunum are demonstrated in 10 marmosets under general anesthesia. Esophagogastroduodenoscopy with colonoscopy efficiently aid in examining the gastrointestinal tract and obtaining an antemortem histologic diagnosis in marmosets with chronic gastrointestinal signs. This minimally invasive technique is feasible in marmosets. Future investigations into the pathogenesis of chronic gastroenteropathies will benefit from these data, leading to improved animal welfare and better individual and colony health management.

Metastatic Gastric Carcinoma with Gastric Outlet Obstruction Extirpated by Palliative Gastrojejunostomy

Gastric cancer, third most common cause of death due to cancer and the fifth most common cancer across the world, present with symp-toms like early satiety, nausea, vomiting, abdominal pain and loss of weight. The common age of presentation lies between 50 to 70 years. Here, we discuss about a case of a 50years old patient presented with chief complaints of pain in the epigastric region, insidious in onset, gradually progressive, burning in nature and associated with early satiety and bloodstained vomiting. Upper Gastrointestinal Endoscopy (UGIE), Endoscopic biopsy and Contrast Enhanced Computed Tomography (CECT) were in favor of Metastatic Gastric Adenocarcinoma obstructing Gastric Outlet. Considering Gastric outlet obstruction, the patient underwent Palliative Gastrojejunostomy and Postoperative Radio chemotherapy. This case emphasizes the significance about considering palliative surgical care in improving the patient compliance and quality of life.

Histopathological spectrum with clinical correlation of lower gastrointestinal tract endoscopic biopsies

Histopathological spectrum with clinical correlation of lower gastrointestinal tract endoscopic biopsies