Gastrointestinal Endoscopy Research Articles

Clinical Course: A 72-year-old male with a history of hypertrophic obstructive cardiomyopathy (HOCM), chronic atrial fibrillation, septal myomectomy, and mitral regurgitation presented with dyspnea on exertion, unintentional 80-pound weight loss for one year and two weeks of progressive dysphagia with difficulty tolerating liquids. On presentation, he was hemodynamically stable. Physical examination revealed temporal wasting, III/VI holosystolic cardiac murmur, and bilateral pitting edema. Right heart catheterization revealed an elevated pulmonary capillary wedge pressure (36 mmHg) and low cardiac index (Fick 1.1 L/min/m2). The patient was started on a milrinone infusion and treated with intravenous bumetanide. A nasogastric feeding tube was inserted for tube feeds. The patient was a former smoker, former alcohol consumer, and had no prior colonoscopies. Barium esophagram revealed concave deformities consistent with left atrial (LA) enlargement. CT chest, abdomen and pelvis with contrast revealed severe cardiomegaly, significant LA enlargement and no visible malignancy. Trans-thoracic echocardiogram (TTE) revealed left ventricular ejection fraction 55-60%, abnormal diastolic function, massively dilated LA with a volume index of 298 ml/m2 and severe mitral regurgitation with a diminutive posterior leaflet. Later gastrointestinal endoscopy and colonoscopy showed no evidence of malignancy. Due to the absence of malignancy, the patient’s failure to thrive was thought to be secondary to end stage heart failure and dysphagia due to severely dilated LA causing esophageal compression. The patient underwent percutaneous endoscopic gastrotomy tube placement for nutritional supplementation and was discharged to a rehabilitation facility. Discussion: Cardiac cachexia is often discussed in the context of advanced heart failure due to multi-organ interactions. However, in HOCM, external compression must be considered in patients with dysphagia to reduce morbidity and maintain nutritional status. In addition to TTE, barium esophagram and CT imaging are crucial for excluding malignancy. The patient’s history of HOCM, chronic atrial fibrillation and chronic mitral regurgitation likely contributed to his severe LA dilation. As the patient also suffers chronic heart failure, cardiac cachexia was likely a significant contributor to the patient’s weight loss. Early recognition and intervention are crucial to improving quality of life and survival.

ABSTRACTAlpha‐fetoprotein‐producing gastric cancer (AFPGC) is a rare histological subtype of gastric cancer that is often diagnosed at an advanced stage. In the present case, an elevated lesion was detected in the gastric antrum during upper gastrointestinal endoscopy screening and diagnosed as early gastric cancer of cT1a. The patient underwent endoscopic submucosal dissection (ESD), and pathological examination showed positive staining for AFP, leading to a diagnosis of AFPGC confined to the intramucosa (pT1a). An additional laparoscopic distal gastrectomy with lymphadenectomy was performed, which revealed no residual tumor and no lymph node metastasis. The patient has remained recurrence‐free for 4 years after the additional surgery. Intramucosal gastric cancer with AFP production is extremely rare, and limited data are available regarding the need for additional surgical resection after ESD. Notably, a previous case of metastatic recurrence in AFPGC of cT1a was reported. Therefore, treatment decisions should be made on the basis of a thorough discussion and the patient's full informed consent.

Nasopharyngeal airway relieves upper airway obstruction to alleviate hypoxemia during painless gastrointestinal endoscopy for obese outpatients: a prospective randomized controlled trial.

BackgroundDescriptive data on gastric cancer (GC) from African countries are limited. We describe the prevalence, clinicopathological features, short-term outcomes and factors associated with gastric cancer at Muhimbili National Hospital (MNH), which is a tertiary-level facility in Tanzania.MethodsThis cross-sectional study enrolled consenting patients aged ≥ 18 years who underwent diagnostic upper endoscopy at MNH from September 2023 to February 2024. The participants were followed up for 90 days to determine whether they died or developed gastrointestinal bleeding or gastric outlet obstruction. Sociodemographic and clinicopathological data were collected through a questionnaire and analysed via SPSS software. The prevalence of gastric cancer and short-term outcomes are expressed as proportions. Logistic regression analysis was used to test the significance of the associations between predictor variables and gastric cancer. A p value of < 0.05 was considered significant.ResultsA total of 870 patients were included, 459 (52.8%) of whom were male. The mean (± SD) age of the participants was 53.3 (± 17.4) years. GC was observed in 77 (8.9%) patients, with a male to female ratio of 0.83:1 and a mean age of 59.4 (± 10.6) years. The symptoms associated with GC were upper abdominal pain in 71(92.2%), weight loss 39(50.6%), abdominal fullness 24(31.2%), and vomiting 23(29.9%). H. pylori antibody testing was positive in 63 (81.8%) GC patients. The antrum was the most common location for GC in 51 (66.2%) patients, with ulcerative morphology in 47 (61.0%) patients. Histologically, 72 patients (96.1%) had adenocarcinomas. H. pylori infection (aOR 4.711; 2.493–8.902; P < 0.001), and cigarette smoking (aOR 2.477; 1.453–4.221; P = 0.001) were independently associated with GC. The 90-day mortality rate was 45.5% (35/77). Within the 90-day follow-up period, 88.3% (68/77) of the patients received palliative care, and 9.1% (7/77) were eligible for curative treatment.ConclusionsThe prevalence of gastric cancer among patients undergoing upper gastrointestinal endoscopy at Muhimbili National Hospital is high. Most patients have advanced disease at presentation, and the 90-day mortality rate is high. Cigarette smoking and H. pylori infection were independently associated with GC in this population.

Introduction Brunner gland adenoma is a rare benign tumor originating from the excessive proliferation of Brunner glands in the duodenum. It accounts for approximately 1% of all duodenal tumors and is often asymptomatic. However, in some cases, it may cause gastrointestinal bleeding, obstruction, or dyspeptic symptoms. Case Presentation: We present the case of a 58-year-old female who was admitted to the emergency department with fatigue, nausea, vomiting, and melena. She had a history of coronary artery disease and was on daily acetylsalicylic acid therapy. Upper gastrointestinal endoscopy revealed a pedunculated polyp measuring 1.8 × 1.6 × 1 cm in the duodenal bulb, with an irregular clotted surface causing partial luminal obstruction. Endoscopic polypectomy was successfully performed, and histopathological examination confirmed the diagnosis of Brunner gland adenoma. No malignancy or dysplasia was detected. Discussion: Brunner gland adenomas should be considered in the differential diagnosis of duodenal polyps detected during endoscopic evaluation. Although typically benign, these lesions can lead to significant clinical symptoms and may mimic malignancy. Endoscopic polypectomy is the preferred treatment for small and pedunculated lesions, while surgical excision may be required for larger or broad-based lesions. Careful follow-up is essential to monitor for recurrence or complications.

Upper gastrointestinal (GI) endoscopy is a common diagnostic and therapeutic procedure, typically performed under conscious sedation to improve patient comfort and cooperation. However, the choice of sedative remains a topic of ongoing debate. This study aimed to compare the safety and efficacy of midazolam and propofol for sedation during upper GI endoscopy. A total of 80 patients scheduled for elective upper GI endoscopy at the Endoscopy Unit of our hospital between February 2023 and October 2023 were recruited for this prospective, randomized controlled trial. Patients were randomly assigned to two equal groups: one group received propofol, while the other received midazolam. The anesthesiologist was aware of the sedative agent being administered, but the patients were blinded to the treatment. Both sedatives were administered via intravenous bolus, with dosages adjusted as needed to maintain an appropriate level of sedation. The recovery time was significantly shorter in the propofol group compared to the midazolam group. While the propofol group exhibited a decrease in systolic blood pressure, this was transient and did not result in significant adverse effects. In contrast, the midazolam group experienced a notable reduction in oxygen saturation, with a higher incidence of hypoxia compared to the propofol group. No major adverse events, such as cardiac arrhythmias or respiratory depression, were observed in either group during the procedure. The sedation quality, as assessed by the Observer's Assessment of Alertness and Sedation (OAA/S) scale, was stable throughout the procedure in the propofol group, while some variability was noted in the midazolam group. The results of this study suggest that propofol is a more effective and safer sedative agent than midazolam for upper GI endoscopy. Propofol offers faster recovery times and more stable sedation, with fewer complications related to oxygen saturation. It is therefore recommended as the sedative of choice for upper GI endoscopy, although careful monitoring of blood pressure is essential

Artificial intelligence (AI) is reshaping gastrointestinal endoscopy, yet its role in training remains unexplored. This narrative review summarizes current evidence on AI-assisted endoscopy training, addresses potential drawbacks, and envisions future directions. This narrative review was performed via a systematic MEDLINE search (including articles from inception to January 2025), with search terms covering 'AI', 'endoscopy,' and 'training.' Studies were excluded if they were reviews, letters, editorials or comments; focused solely on model development; lacked a training component; or were limited to simple comparisons between the performance of endoscopists and AI systems. After screening 1443 records, 27 articles were included in this review. AI demonstrates potential in enhancing the training of various types of endoscopy (including luminal, hepatobiliary, capsule, and therapeutic endoscopy) by improving quality metrics, enhancing lesion detection, and guiding anatomical landmark recognition, yet the current applications are mainly task-based. Future AI must evolve to provide comprehensive training and personalized performance tracking to endoscopists of different levels of experience. Further studies are needed to assess objective educational outcomes and cost-effectiveness. Key concerns for AI adoption, including deskilling, over-reliance, ethical considerations, and practicality, should be addressed through structured implementation, quality assurance, and regulatory framework. In conclusion, AI can augment endoscopy training by improving skill acquisition and procedural quality, yet significant gaps remain. More research is needed to support its widespread integration.

Aims: The COVID-19 pandemic disrupted diagnostic services worldwide, particularly gastrointestinal (GI) endoscopy, raising concerns about delayed diagnoses and stage migration in gastric cancer. Helicobacter pylori (H. pylori), a key factor in gastric carcinogenesis, may also influence mucosal susceptibility to SARS-CoV-2. However, data on how these disruptions affected gastric cancer profiles remain limited. To compare clinical, endoscopic, and pathological features of patients undergoing upper GI endoscopy during and after the COVID-19 pandemic, and to evaluate the association between nutritional status and tumor burden in gastric cancer patients. Methods: This retrospective cohort study included 478 patients who underwent diagnostic upper GI endoscopy due to dyspeptic or alarm symptoms at a tertiary care center in Turkiye. Patients were divided into two groups: pandemic (June 2021 to June 2022; n=216) and post-pandemic (May to October 2023; n=262). Demographics, symptoms, endoscopic and histopathological findings, and body-mass index (BMI) were analyzed. Statistical methods included t-tests, Chi-square tests, logistic regression, and Spearman correlation. Results: Patients evaluated during the pandemic more frequently reported alarm symptoms and had significantly lower weight and BMI. H. pylori positivity (41.7% vs. 28.2%; p=0.03), peptic ulcer (16.7% vs. 8.4%; p=0.04), and gastric cancer (7.4% vs. 2.3%; p=0.02) were all more prevalent in the pandemic group. Among 22 patients with gastric cancer, those diagnosed during the pandemic exhibited more advanced disease (T3-T4: 75.0% vs. 33.3%; p=0.02), more frequent nodal involvement (62.5% vs. 16.7%; p=0.01), and BMI. Pandemic-period endoscopy remained an independent predictor of advanced-stage gastric cancer in multivariable analysis (OR=3.41; 95% CI: 1.31-8.88; p=0.008). Strong inverse correlations were found between BMI and tumor depth (p=-0.73), and between BMI and nodal involvement (p=-0.87). Conclusion: The COVID-19 pandemic was associated with diagnostic delays and increased frequency of advanced-stage gastric cancer. BMI showed a strong inverse relationship with tumor aggressiveness and has potential to serve as a practical indicator of disease burden. These findings underscore the importance of preserving access to endoscopic diagnostics and highlight the prognostic value of nutritional parameters during public health emergencies.

Background: Narrow Band Imaging (NBI) cystoscopy is an optical enhancement technique developed to improve mucosal and vascular visualization, allowing early and precise detection of bladder neoplasms. By filtering white light into narrow spectral bands, NBI enhances the contrast of vascular structures associated with malignancy. Despite its proven advantages in gastrointestinal endoscopy, its diagnostic value in bladder tumor detection compared with conventional White Light Cystoscopy (WLC) remains underexplored, especially in local clinical settings. Objective: This study aimed to assess the diagnostic accuracy of NBI cystoscopy in detecting bladder tumors and to evaluate its effectiveness in reducing unnecessary biopsies compared with WLC. Methods: A prospective observational study was conducted among 40 patients aged 18 years or older who presented with hematuria or symptoms suggestive of bladder malignancy. All patients underwent both WLC and NBI cystoscopy sequentially in the same session. Lesions were independently evaluated by two experienced urologists blinded to each other’s findings. Biopsies were performed on lesions identified as suspicious by either modality, and histopathology served as the gold standard. Diagnostic parameters, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated using SPSS version 25. Results: NBI detected 30 suspicious lesions compared with 25 detected by WLC. Histopathology confirmed 22 lesions as malignant. NBI demonstrated superior sensitivity (93.3%) and specificity (88.9%) compared with WLC (73.3% and 66.7%, respectively). The PPV and NPV of NBI were 86.7% and 94.4%, respectively. Importantly, NBI reduced unnecessary biopsies by 87.5%, as seven of eight deferred lesions were confirmed benign upon follow-up, highlighting its role in minimizing invasive procedures. Conclusion: NBI cystoscopy offers significantly improved diagnostic accuracy over WLC, enhancing bladder tumor detection and reducing unwarranted biopsies. These findings advocate for incorporating NBI into clinical protocols for managing non-muscle invasive bladder cancer. Future large-scale, multicenter studies are recommended to validate these results and optimize its clinical integration.

BackgroundGastro-oesophageal reflux disease (GORD) presents with either oesophageal or extra-oesophageal symptoms, or both. The association between symptom subtypes and upper gastrointestinal endoscopy (UGIE) findings has been rarely studied in Nigeria. Our study aimed to determine the pattern of symptom subtypes and UGIE abnormalities, as well as their association in patients with GORD symptoms in Nigeria.MethodsA retrospective, cross-sectional study of UGIE findings in patients with GORD from two endoscopy suites in southwest Nigeria, conducted from January 2022 to December 2023. Symptoms were categorised as oesophageal-only (OO), extra-oesophageal only (EO), or oesophageal plus extra-oesophageal (O + E). Demographic and UGIE data were compared using ANOVA, Pearson’s chi-square, or Fisher’s exact tests using R software. Analyses were two-tailed, and statistical significance was set at p < 0.017.ResultsThere were 411 patients, 180 (43.8%) of whom were male, with a mean age of 45.3 years. The most frequent symptoms were chest pain (131, 31.9%) and heartburn (97, 23.6%). Overall, 280 (68.1%) of them presented with EO, 99 (24.1%) with OO, and 32 (7.8%) with O + E symptoms. Patients with O + E were younger (mean age 37.7 years) than those with OO (44.6 years) or EO (46.4 years), p = 0.008. On UGIE, gastroduodenal erosions were seen in 250 (60.8%), GORD-associated oesophageal injury in 183 (44.5%), peptic ulcer in 43 (10.5%), candidal oesophagitis in 38 (9.3%), tumour in 6 (1.5%), and normal findings in 34 (8.3%). Only gastroduodenal erosions were associated with symptom subtype.ConclusionMost patients with GORD presented with extra-oesophageal symptoms. While fewer than half had reflux-associated oesophageal injury, non-oesophageal lesions were present in the majority of patients, highlighting the importance of endoscopic evaluation in patients with GORD symptoms.

To investigate the level of worry in patients undergoing painless gastrointestinal endoscopy and to identify the factors and pathways that influence this worry. This cross-sectional study collected data between March and April 2024. A convenience sampling method was employed to select 477 patients scheduled for painless gastrointestinal endoscopy from a tertiary general hospital in Xiamen, China. The survey employed a self-administered general information questionnaire, along with validated scales measuring worry levels (WLs), psychological resilience (PR), and social support (SS). A multiple logistic regression analysis was used to investigate the factors influencing the level of worry. Model 4 of the PROCESS macro (v3.3) was used to analyze the mediating effects of PR on the relationship between SS and WLs. Worry scores were moderate (median score: 36, IQR: 25–47, on a 0–75 scale). Multivariate analysis revealed distinct predictors for different WLs. Rural residence was significantly associated with all three worry levels. Patients undergoing endoscopy for rechecking showed higher odds of mild worry, while those with fecal abnormalities and those enrolled in Urban Employee Basic Medical Insurance had increased odds of moderate worry. Lower monthly income (<¥ 4000) was associated with moderate worry. Younger age (<40 years) was the strongest predictor for severe worry. History of unsedated endoscopy, abdominal discomfort, and Urban Employee Basic Medical Insurance were also significant predictors for severe worry. Furthermore, PR mediated the relationship between SS and worry. Individualized communication and support plans should be developed based on different symptoms, medical histories, and specific patient characteristics. Particular attention should be paid to rural residents, younger patients (<40 years), those with lower incomes, patients experiencing abdominal discomfort or fecal abnormalities, and those with previous unsedated endoscopy experience. The type of medical insurance (Urban Employee Basic Medical Insurance) should also be considered as it was associated with both moderate and severe WLs.

We report the case of a 38-year-old woman who visited our hospital because of persistent bloody stool one month after starting treatment with dupilumab, an anti-interleukin-4 receptor subunit α (IL-4Rɑ) monoclonal antibody, for bronchial asthma. Based on the lower gastrointestinal endoscopy findings, the patient was diagnosed with ulcerative colitis. Despite medication, the patient's bloody stool was not well controlled; however, the situation improved after discontinuation of dupilumab. Based on the patient's clinical course, drug-induced ulcerative colitis due to dupilumab was diagnosed. Careful monitoring of the symptoms associated with the development of enteritis is necessary after dupilumab administration.

BackgroundDeficiency in ELF4, X-linked (DEX) is a recently recognized monogenic autoinflammatory disorder and a novel type of congenital immunodeficiency. Due to the limited number of reported cases, understanding of DEX remains incomplete. In clinical settings, children with this condition are often misdiagnosed as having diseases such as Behçet’s disease or inflammatory bowel disease, due to overlapping clinical features.MethodsGenomic DNA was isolated from peripheral blood samples for genetic analysis, and genomic DNA was extracted from the peripheral blood samples of the proband’s mother for x chromosome inactivation (XCI) analysis.ResultsA retrospective analysis was conducted on the clinical and genetic characteristics of a 3-year-old male patient with DEX in China. This study offers a detailed exploration of the child’s specific clinical symptoms and treatment approach, in addition to a comprehensive review of the primary clinical manifestations and genotypic traits of individuals with DEX.ConclusionThis study aims to increase clinicians’ understanding of DEX. In cases where young male patients present with recurrent fever, oral or mucosal ulcers, or repeated infections, DEX should be strongly considered. Early implementation of gastrointestinal endoscopy and genetic testing is recommended to enable a more precise and timely diagnosis, laying a solid foundation for informed treatment decisions.

We aimed to quantify the per-procedure costs of acquiring, maintaining/repairing and reprocessing reusable gastrointestinal endoscopes by observing practices in a large National Health Service (NHS) hospital. We conducted a bottom-up micro-costing analysis to capture the costs of reusable gastrointestinal endoscopes using a detailed resource-use data sheet and observations at the University Hospital Coventry and Warwickshire (UHCW). The data sheet drew on the published literature and NHS decontamination guidance. Cost categories included (1) measuring personnel time for reprocessing endoscopes, (2) reprocessing materials and (3) acquisition and maintenance/repair of endoscopy and reprocessing equipment. Data were obtained through observation and interviews with staff. Costs were calculated using the data collected at UHCW and cross-checked with data from two other NHS Trusts, manufacturers and the literature. Staff time for reprocessing averaged 35 min per procedure (£23.57: 22% of the total cost). The reprocessing materials' cost per procedure was £16.41 (15% of the total cost). Total capital acquisition cost per procedure was £46.9 (44% of the total cost), including endoscopy capital (£37.4) and reprocessing capital (£9.5). Total maintenance/repair cost per procedure was £20.46 (19% of the total cost). These led to a total cost of £107.34 per endoscopy procedure. Some observed values were slightly lower than but generally comparable to similar studies. We identified the key drivers of costs, led by capital costs. The results of our study could be used in economic evaluations involving reusable gastrointestinal endoscopes. The methodology can inform the cost evaluation of medical devices that require intensive reprocessing.

BackgroundChronopharmacology is an important but underexplored aspect of propofol administration. Despite the implementation of propofol administration models, none have yet incorporated temporal variables. This study aims to investigate the impact of temporal variations on propofol administration during sedated gastrointestinal (GI) endoscopy. Moreover, we aim to develop regression models to predict manually-controlled propofol administration that integrate temporal variables.MethodsThis prospective single-center cohort study enrolled patients undergoing sedated GI endoscopy. For analysis, patients were categorized into 4 groups based on the anesthesia start time: Group 1 (8:00–10:00), Group 2 (10:00–12:00), Group 3 (13:00–15:00), and Group 4 (15:00–17:00). Perioperative characteristics and propofol doses were compared across groups. Correlation analysis was conducted to evaluate the relationship between propofol dose and the anesthesia start time. Subsequently, linear regression models were developed for manually-controlled propofol administration.ResultsA total of 146 cases were included in the statistical analysis. Significant differences were found for all parameters related to propofol dose across the 4 different groups, including induction dose, maintenance dose, total dose and these doses per kilogram per hour. Furthermore, there were positive correlations between the anesthesia start time and all parameters. In the linear regression models, the induction dose equation incorporated the anesthesia start time, age and weight as variables. The model of the maintenance dose per kilogram per hour included the anesthesia start time, duration and weight as variables.ConclusionThe results suggest that propofol dose increases with later anesthesia start times. Therefore, further clinical administration of propofol should incorporate a heightened consideration of temporal factors.Trial registrationThis prospective study has been registered in the Chinese Clinical Trial Registry (Registration date: December 3, registry number ChiCTR2400093328).

Background and objectiveMost troubling of painless gastrointestinal endoscopy is hypoxia and hypotension. Esketamine has sympathomimetic and respiratory protection, which combined with midazolam and propofol may reduce these troubles. So, this study aims to explore the efficacy and safety of this regimen.MethodsIn total, 318 patients who received painless gastrointestinal endoscopy from November 2022 to April 2023 were included and randomly divided into two groups at 1:1: 0.1 µg/kg sufentanil (Suf) or 0.15 mg/kg esketamine (Esk) group. Except for analgesics, all patients were given midazolam and propofol. The incidence of hypotension and hypoxia (SPO2 < 93%) during the examination was observed.ResultsCompared with the Suf, the Esk group reduced the incidence of hypotension (12.8% vs 36.2%, 95% confidence interval (CI) 13.20—33.09, P < 0.001), respiratory depression (apnea > 30 s) (2.1% vs 15.4%, 6.47—20.52, P < 0.001), and hypoxia (7.1% vs 16.1%, 1.07—16.92, P = 0.018), but may increase the incidence of coughing (P < 0.001) and increased secretions (P = 0.032). There was no significant difference in the examination and recovery time (P > 0.05).ConclusionEsketamine, midazolam, and propofol for painless gastrointestinal endoscopy can achieve opioid-free sedation and reduce the occurrence of hypotension and hypoxia. However, the dosages of this regimen need to be further explored to avoid coughing and increased secretions.Trial registrationThis study has been registered in the Chinese Clinical Trial Center (https://www.chictr.org.cn/index.html, Date: November 3, 2022, No: ChiCTR2200065379).Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-09073-5.

Cancer is a major cause of morbidity and mortality globally, leading to significant healthcare and socioeconomic burdens. Medical education is crucial in preparing future healthcare professionals to manage cancer care effectively. To compare the expectations of first-year medical students about oncology training with the actual knowledge and experiences of more advanced students. A cross-sectional, quantitative study was conducted with 373 medical students (152 first-year, 121 fourth-year, and 100 sixth-year) using structured questionnaires. Data was analyzed using SPSS version 25.0, with a 5% significance level. Most students considered oncology knowledge and training highly relevant, particularly in diagnostic methods, clinical examination, and palliative care (≥ 93%). However, significant differences emerged across years. Fourth-year students reported greater uncertainty about the relevance of diagnostic tools such as colonoscopy (p = 0.025), upper gastrointestinal endoscopy (p = 0.005), and mammography (p = 0.025), as well as hereditary syndromes (p = 0.016). Sixth-year students showed reduced endorsement of molecular testing, with 21.3% reporting neutrality. A striking gap was observed between the importance attributed to oncology internships by first-year students (≥ 84%) and the limited opportunities reported by advanced students, particularly in pathology, genetics, and radiotherapy (≤ 10% completion). Among those who completed internships, nearly all acknowledged their significant contribution to learning, especially in palliative care and clinical oncology. Despite strong recognition of oncology's importance, gaps remain between students' expectations and their actual educational experiences, particularly in genetics, molecular testing, and access to internships. Expanding structured, longitudinal, and practice-oriented oncology training is essential to prepare future physicians to meet the demands of cancer care and precision medicine.

Helicobacter pylori infection represents a well-established risk factor for the development of gastric carcinogenesis, yet reliable clinical or endoscopic predictors of infection remain poorly defined. Identifying non-invasive or endoscopic markers of this infection could improve early detection, which is crucial for effective prevention and clinical management. This single-center study included 737 patients who underwent upper gastrointestinal endoscopy. We compared clinical, laboratory, and endoscopic features between H. pylori-positive and H. pylori-negative individuals. A total of 263 with H. pylori-positive gastric biopsies and 474 with H. pylori-negative biopsies were enrolled in our study. Cerebrovascular disease (9.51% vs. 5.51%, p = 0.04, OR = 1.80), type 2 diabetes mellitus (T2DM—22.05% vs. 15.86%, p = 0.04, OR 1.5), and alcohol consumption (18.96% vs. 9.3%, p = 0.00, OR = 2.28) were significantly more prevalent among H. pylori-positive patients. Heartburn was more commonly reported in H. pylori-negative individuals (23.77% vs. 15.38%, p = 0.01, OR = 0.58). Laboratory parameters showed no significant differences between groups. Regarding endoscopic findings, corporal erythema (26.92% vs. 16.17%, p = 0.00, OR = 1.91), corporal erosions (11.54% vs. 5.32%, p = 0.00, OR = 2.32), and submucosal hemorrhages (20.91% vs. 11.6%, p = 0.00, OR = 2.01) were associated with H. pylori infection. In the multivariate logistic regression models, alcohol consumption and corporal lesions remained independent predictors of H. pylori-associated gastritis, even after adjusting for age, sex, and PPI use. This study identifies alcohol consumption and specific corporal mucosal changes as novel, independent predictors of H. pylori infection. Heartburn was negatively associated with active H. pylori infection, while the rest of the symptoms did not predict infection or mucosal lesions. The laboratory parameters did not differ significantly between groups. These findings underscore the potential of targeted endoscopic evaluation and risk-based screening (particularly among T2DM and alcohol-consuming populations) to enhance early detection and management of H. pylori-associated disease.

Endoscope-associated infections remain a persistent concern despite adherence to reprocessing guidelines. Microbial surveillance is essential for quality control, but its effectiveness may depend on sampling timing and technique. This prospective multicenter study was conducted across three gastrointestinal endoscopy units across multiple campuses of a tertiary general hospital in Wuhan, China. Sampling was performed either immediately after high-level disinfection (HLD) or following overnight storage in a dry cabinet, using one of two techniques: the conventional flushing sampling method (CFSM) or the flush-brush-flush sampling method (FBFSM). The overall pass rate for disinfected digestive endoscopes was 83.4% (212/254). Compared to CFSM, FBFSM exhibited a significantly lower overall pass rate (X2 = 5.895, P = 0.015), indicating enhanced microbial recovery. Endoscopes sampled after overnight drying showed significantly higher pass rates (87.7% vs. 79.3%) and reduced detection rate of high-concern organisms (HCOs), particularly Pseudomonas spp. and Gram-positive cocci, compared with samples collected immediately post-HLD. The drying phase of endoscope reprocessing plays a critical role in reducing residual microbial contamination. Additionally, FBFSM demonstrated superior sensitivity in post- reprocessing surveillance, highlighting its value as a more effective sampling method compared to CFSM.

BackgroundGastric cancer (GC) is a prevalent gastrointestinal malignancy. In recent years, the application of artificial intelligence (AI) in GC has become increasingly widespread. This study aims to employ bibliometric analysis to offer valuable insights for researchers.MethodsPublications concerning the application of AI in GC between 2005 and 2024 were retrieved from the Web of Science Core Collection. Subsequently, VOSviewer, CiteSpace, and Scimago Graphica were employed to conduct the bibliometric analysis of the selected literature.ResultsA total of 903 publications were included in this study. In the past two decades, the application of AI in GC has become more widely used, and the number of papers published has shown a rapid growth trend. China, Japan, and South Korea are the most prolific countries in this field. Yonsei University, the Chinese Academy of Sciences, and Shanghai Jiao Tong University are the three institutions with the most publications. Surgical Endoscopy and Other Interventional Techniques is the most published journal and also the most cited journal. Woo Jin Hyung from Yonsei University is both the most prolific author and the author with the highest H-index. Gastric cancer, surgery, and artificial intelligence are the three keywords most used. The keywords “upper gastrointestinal endoscopy” and “artificial intelligence” have been prominent until now.ConclusionThis study offers a comprehensive visual overview of the application of AI in GC over the past two decades. AI-assisted screening, diagnosis, and prognosis prediction in GC are anticipated to represent focal points of future research in this domain.