Gastrointestinal Endoscopy Research Articles

Treatment of choice for malignant gastric outlet obstruction: More than clearing the road

In this editorial, we comment on the in-press article in the World Journal of Gastrointestinal Endoscopy concerning the treatment of malignant gastric outlet obstruction (mGOO). The original theory of treatment involves bypassing the obstruction or reenabling the patency of the passage. Conventional surgical gastroenterostomy provides long-term relief of symptoms in selected patients, with substantial morbidity and a considerable rate of delayed gastric emptying. Endoscopic stenting was introduced as an alternative minimally invasive procedure with less procedural morbidity and rapid clinical improvement; however, it presented a high rate of long-term recurrence. Therefore, challenges remain in the treatment of mGOO patients to improve clinical outcomes. Endoscopic ultrasound-guided gastroenterostomy has recently emerged as a promising method because of the combined effects of surgery and endoscopy, whereas stomach-partitioning gastrojejunostomy has been reported as a modified surgical procedure to reduce the rate of delayed gastric emptying. In decision-making regarding the treatment of choice, it should be taken into account that mGOO might be accompanied by a variety of pathological conditions, including cancer cachexia, anorexia, malabsorption, and etc. , all of which can also lead to the characteristic symptoms and poor nutritional status of mGOO. The treatment plan should consider comprehensive aspects of patients to achieve practical improvements in prognosis and the quality of life.

Assessment of high-risk gastroesophageal varices in cirrhotic patients using quantitative parameters from dual-source dual-energy CT.

To investigate the clinical value of dual-source dual-energy CT (dsDECT) quantitative parameters in evaluating hemodynamics and predicting high-risk gastroesophageal varices in cirrhotic patients. 98 consecutive patients were collected in this prospectively study and all patients underwent an abdominal triple-phase contrasted-enhanced examination with dsDECT. Iodine concentration (IC) and normalized iodine concentration (NIC) of the liver parenchyma, spleen parenchyma and aorta at different phases were recorded, and arterial iodine fraction (AIF), iodine washout rate (IWR), and extracellular volume (ECV) were calculated. Using upper gastrointestinal endoscopy as the reference standard, patients who met the inclusion and exclusion criteria were divided into groups with varices need treatment (VNT) and non-VNT. The clinical characteristics, traditional CT features and quantitative dsDECT parameters were compared between the VNT group and the non-VNT group using univariate analysis. The binary logistics analysis was used to build a model for diagnosing VNT. The receiver operating characteristic (ROC) curve was used for analysis and the DeLong test was used to compare different ROC curves. Finally, 57 patients were included in this study. Univariate analysis showed statistically significant differences in NIC of the liver at the portal venous phase (NIC-LPVP), IWR of the liver (IWR-L) and spleen volume between the VNT group and the non-VNT group (p < 0.05). The mixed-CT model was built by binary logistics analysis. The ROC curves of NIC-LPVP, IWR-L, spleen volume and the mixed-CT model were statistically significant (p < 0.05) for predicting VNT in cirrhotic patients, among which the area under the ROC curve of the mixed-CT model was the highest. Dual-source dual-energy CT has added clinical value in evaluating hepatic hemodynamics and diagnosing VNT in patients with liver cirrhosis.

Outcome of Pediatric Inflammatory Bowel Disease in Asian Children: A Multinational One-year Follow-up Study.

Epidemiological data on pediatric inflammatory bowel disease (PIBD) have been reported in Asian countries. However, short-term follow-up data, especially in Southeast Asian countries, are limited. Analyze and compare the baseline and 1-year follow-up (1FU) data for PIBD in Asian children. The multinational network included patients with PIBD (aged <19 years) in five Asian countries (Malaysia, Philippines, Singapore, Sri Lanka, and Thailand). The diagnosis of PIBD requires gastrointestinal endoscopy. The patients' demographics, clinical information, disease-related outcomes, and treatment data at 1FU were collected. In 1995-2021, 368 patients were enrolled (CD, 56.8%; UC, 38%; and IBD-unclassified, 5.2%). At 1FU, symptoms including diarrhea, bloody stools, and nausea/vomiting subsided in <3%, while abdominal pain persisted in 10.5% of patients with CD and 7.1% of patients with UC. Assessment endoscopy was performed at 1FU in 38% of CD and 31% of UC cases, of which 21% and 23% showed mucosal healing, respectively. Oral prednisolone was administered to 55.3% of patients at diagnosis and 26.8% at 1FU, while infliximab was administered to 2.5% and 7.2% of patients at diagnosis and 1FU, respectively. Independent factors of 1-year clinical remission for CD were oral prednisolone (odds ratio [OR], 0.20; 95% confidence interval [CI], 0.06-0.68), antibiotic use (OR, 0.09; 95% CI, 0.01-0.54), and immunomodulator use (OR, 5.26; 95% CI, 1.52-18.22). A history of weight loss at diagnosis was the only independent risk factor of an IBD flare by 1FU (OR, 2.01; 95% CI, 1.12-3.63). The proportion of children with PIBD and abdominal pain at 1FU remained high. The rates of repeat endoscopy and infliximab use were suboptimal with high rates of systemic corticosteroid use. Quality improvement based on the aforementioned predictors may enhance PIBD care in this geographic region or similar settings.

Uncommon Presentation of Gastric Heterotopia Manifesting as a Polypoid Mass

Introduction: Gastric heterotopia (GH) is characterized by the presence of differentiated gastric mucosa tissue outside the stomach, with the most common site being the proximal esophagus, known as the inlet patch. Complications have been reported, but polyps are rarely seen. Despite the low incidence of relevant manifestations described, controversies remain regarding the clinical significance of this condition. Case report: A 53-year-old man with heartburn and regurgitation was referred for management of a sessile polyp (Paris 0-Is) in the proximal esophagus, identified during an esophagogastroduodenoscopy. The patient's medical history includes heavy tobacco consumption. Additionally, he was taking esomeprazole at a dose of 40 mg. We repeated upper gastrointestinal endoscopy and observed two areas of pink mucosa in opposite position in the proximal esophagus, suggestive of gastric heterotopia. One of these areas had a polypoid morphology with congestive and friable mucosa, measuring approximately 12 mm. Narrow Band Imaging evaluation demonstrated a preserved glandular and vascular pattern. Anatomopathological assessment of the lesion revealed fragments of gastric-type mucosa, consisting of occasionally poorly oriented foveolar structures, compatible with ulcerated gastric heterotopia. A multidisciplinary approach led us to decide on an expectant strategy due to its probable benign course. Conclusion: Hyperplastic polyps rarely originate from esophageal inlet patches, and to our knowledge, only a few case reports of gastric heterotopia with polypoid morphology exist in the literature. Further research is needed to determine the most appropriate management for these patients.

OGC SO02 - Analysis of routine upper gastrointestinal endoscopy referrals and outcomes in a single tertiary service

Abstract Background Routine (category 3/4) upper gastrointestinal endoscopies (UGIE) constitute a significant proportion of endoscopy workload in the National Health Service. Referrals are varied and there are opportunities for service improvement to reduce clinician burden and improve patient outcomes. This is of particular relevance to the early detection and prevention of cancer. This work aimed to analyse routine UGIE referrals and subsequent endoscopies in a large tertiary service to identify quality improvement opportunities within the health board. Method Referral indications for all males over 50 years awaiting routine UGIE in the health board on 02/03/2023 were reviewed. Referrals were categorised into 7 groups based on primary presentation and indication for UGIE; “Liver/variceal”, “Gastric”, “Oesophageal”, “Anaemia”, “Dysphagia”, “Tissue transglutaminase (TTG) positive” or “Other”. Data on findings, biopsy, and follow-up were gathered where UGIE was subsequently performed. To analyse routine cases only, patients referred for anaemia or dysphagia were excluded from final analysis. Results 471 records were reviewed and 332 patients included in final analysis; 210 had undergone UGIE at assessment point (3 records unavailable), with 99 waiting and 23 died/did not attend/declined. The most common referral indications were “Gastric” (41.6%), “Liver” (29.2%), and “Oesophageal” (21.4%) (n=207). 84 were excluded due to anaemia/dysphagia. At UGIE, 6.3% identified Barrett's oesophagus/malignancy across all groups with 1 case of new malignancy. 80.2% received medical/conservative management following their scope. Conclusion While pathology was identified at routine UGIE, a large number of procedures were required to identify this and there was no Barrett's oesophagus rich group. We have identified opportunities for improvement in the delivery of routine UGIE service in the health board which may reflect nationally. These include altered vetting practices and potential UGIE-saving procedures including cytosponge.

Relationship between Child-Pough score and late complications in hospital patients with liver cirrhosis

This study aimed to determine the frequency of available complications in patients with liver cirrhosis and any dependence according to the Child-Pough score. A retrospective study of cases with newly diagnosed liver cirrhosis was conducted in the Gastroenterology Clinic of UMBAL Pleven from 2017 to 2021. Of them, 258 (71.5%) were men and 103 (28.5%) were women. The mean age of the studied population was 57.8 years &amp;plusmn; 11.4 years. The leading aetiology was alcohol in 244 (67.6%) of them. All cases were classified according to Child-Pough score system into three groups: Child A 98(27%), Child B 141(39%), and Child C 122(34%). Ours findings show that the occurrence of ascites is most common in the studied population at 232 (64.5%). Esophageal varices were found in 164 (62.4%) patients out of 264 who underwent upper gastrointestinal endoscopy. Portal encephalopathy was found in 170 (47.09%), with a predominance of the minimal in 116 (68.23%) of them. Jaundice was found in 124 (34.34%), and more of them were in Child C. In 65 (18%), renal dysfunction was found, such as acute renal dysfunction in 12.4%. In conclusion, the high frequency of available complications is closely related to late diagnosis.

The competency of the novel through-the-scope suture device for gastric mucosal defects: In vivo study in a porcine model (with video).

Endoscopic closures of mucosal defects following endoscopic resection can be challenging and time-consuming. The novel through-the-scope suture device has demonstrated acceptable closure times, but its learning curve is still unknown. This study aims to evaluate the number of cases required to achieve competency in this device. Two endoscopists participated; a novice with less than 400 experiences in upper gastrointestinal endoscopy and an expert with over 500 experiences in endoscopic submucosal dissection. Neither endoscopist had previous exposure to the device. In four porcine models, 24 gastric mucosal defects, each 2-4 cm in diameter, were created by endoscopic mucosal resection with ligation. Each endoscopist performed endoscopic closure for 12 mucosal defects with a single through-the-scope suture device per lesion. The primary endpoint was the number of cases needed to reach competency, defined as achieving a procedure time below the average closure time reported in the literature. Secondary endpoints included procedure time, complete closure success rates, and incidence of adverse events. The mean defect size was 2.9 (±0.2) cm. Competency was achieved after six cases in the expert and seven cases in the novice. The median closure time was 9.0 (interquartile range [IQR]: 6.0-11.0) min for the expert and 8.0 (IQR: 6.2-9.7) min for the novice (p = 0.862). Complete closure success rates were 75.0% (n = 9) for the expert and 83.3% (n = 10) for the novice. No adverse events were reported. A small number of cases were required for both expert and novice endoscopists to reach competency in the novel through-the-scope suture device.

Abstract 4120573: Abrupt cardiac rupture of the patient with ATTR amyloidosis

A Japanese male in his 80s was admitted to our emergency department with chest pain. His prior history was syncope and ventricular tachycardia. Transthoracic echocardiography (TTE) revealed thickening of the basal part of the antero-septal wall and thinning of the basal part of the inferior wall. Coronary angiography (CAG), cardiac MRI and blood test revealed no specific abnormalities. The day before his emergency admission, he visited the cardiology outpatient department for a periodic examination of cardiac hypertrophy. ECG, chest X-ray, and TTE were unchanged from his prior examination. However, that night, he experienced chest pain and was transferred to our hospital. On arrival, his vital signs were critical, with a blood pressure of 70/59 mmHg. ECG indicated ST elevation in antero-lateral leads. TTE detected pericardial effusion, and contrast-enhanced CT identified two focal areas of non-enhancement in the myocardium and pericardial effusion without signs of aortic dissection. CAG revealed no significant stenosis or obstructive lesion. During coronary angiography, the patient deteriorated to asystole. Cardiopulmonary resuscitation and percutaneous pericardial drainage were initiated. Hemorrhagic pericardial effusion was aspirated. Immediate surgical hemostasis was undergone, revealing about 2 cm lacerations and hematoma in the anterior and inferior wall. After surgery, he complained of abdominal discomfort. Esophageal gastrointestinal endoscopy was undergone to investigate the abdominal discomfort, and he was diagnosed with early gastric cancer. Endoscopic submucosal dissection (ESD) was undergone, and histopathological examination revealed adenocarcinoma and eosinophilic amorphous materials deposited in the submucosal vessels. Congo red staining of the submucosal vessels revealed orange-red areas. A technetium-99m pyrophosphatase scintigraphy showed Grade 2 uptake in the heart. Transthyretin (TTR) staining was positive in the specimen from ESD, leading to a diagnosis of TTR amyloidosis. Genetic test for TTR was negative, which led to a diagnosis of wild-type TTR amyloidosis and tafamidis was started. In cases of acute pericardial effusion and/or cardiac rupture, it is imperative to consider cardiac amyloidosis as a potential etiology, in addition to myocardial infarction and aortic dissection, especially in patients with left ventricular wall thickening, neuropathy, or abnormal ECG, also known as “red flag”.

Prevalence of Helicobacter Pylori Infection Among Dyspepsia Patients in a Tertiary Care Hospital of Puducherry

Background: Dyspepsia is a relatively common clinical condition characterized by chronic / recurrent upper abdominal pain or discomfort. Dyspeptic individuals were found to be infected with H-pylori than asymptomatic individuals. Though most individuals are asymptomatic, H. pylori plays a key role in the etiology of many upper gastrointestinal disorder. Materials and Methods: This cross-sectional prospective analytical study was done in Department of General surgery, IGMCRI Pondicherry from February 2022 to June 2022. Both male and female patients attending surgery OPD of age 20 to 60 years with upper gastrointestinal symptoms like dyspepsia and epigastric pain were subjected to upper gastrointestinal endoscopy and scopy findings noted and a Rapid urease test done for them. Results: The prevalence of H-Pylori was found to be 53%. Gender wise distribution shows more prevalence among females (61%) compared to males (44%). Of the total patients, 72% presented with abdominal pain, 34% presented with associated nausea, vomiting and 50% presented with regurgitation, 47% presented with bloating sensation. 11% present with other associated symptoms like malena and dysphagia. 9 patients with dyspepsia had ulcers in the antral wall and duodenum with 33% RUT positivity. 11 of them presented with pangastritis with 72% RUT positivity, 47 of them had antral gastritis with 66% RUT positivity, and 15 of them were found to have normal endoscopic findings with 33% RUT positivity.47% of the patients with esophageal varices and 20% of the patients with ulceroproliferative growth showed RUT positivity. Conclusion: This study validates that more than half the patients with dyspepsia in our population are H-pylori positive. Early referral for Upper GI endoscopy can help diagnose the same and associated clinical condition and initiate an early anti-H. Pylori regimen to achieve quicker symptom relief in these patients.

Treatment outcomes of non-curative endoscopic submucosal dissection for superficial gastric neoplasia: A retrospective study at a tertiary care center in the United States.

Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer; additional treatment may be recommended for patients in whom resection is not curative per the American Society for Gastrointestinal Endoscopy guidelines. The aim of this study was to assess treatment outcomes of ESD for gastric neoplasia, with a focus on cases of non-curative resection. This was a retrospective study of all individuals undergoing ESD for the treatment of gastric adenocarcinoma or dysplasia in a high-volume tertiary care center in the United States. Data on patient demographic characteristics, clinical history, lesion characteristics, and procedural and clinical outcomes were collected from the electronic medical record. Among 82 cases undergoing ESD for the management of gastric neoplasia, 32 cases resulted in non-curative resection. 20 of these non-curative cases did not get additional treatment, among which recurrence occurred in two cases with positive horizontal margins only. These patients did not show lymph node metastasis and underwent further endoscopic or surgical resection. There was no recurrence in 11 cases with undifferentiated carcinomas of ≤2 cm in size. Although this study was limited by its retrospective design, small sample size, and follow-up duration, our findings suggest that a risk-adapted strategy could be employed for certain patients undergoing non-curative ESD per American Society for Gastrointestinal Endoscopyguidelines, with close follow-up instead of routine surgery in select cases with favorable features. Further studies are needed to refine the criteria for additional treatment after non-curative ESD in Western populations.

Current management status of cleaning and disinfection for gastrointestinal endoscopy: a meta-analysis

Objective This study aimed to evaluate the current status of cleaning and disinfection management for digestive endoscopy, provide data for standardization processing techniques, and improve the quality of cleaning and disinfection. Methods Two reviewers independently and comprehensively searched the PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Wanfang, and CBM databases on February 1, 2023. The inclusion and exclusion criteria were strictly followed during the literature survey and data extraction. All observational studies detailing the current cleaning and disinfection management status for digestive endoscopy in hospitals were included. Meta-analysis was performed using STATA 16.0 software. Results After removing different articles, the meta-analysis finally included 54 articles associated with multiple countries. The authors favor auditing staffers to confirm compliance with guidelines. The meta-analysis results indicated a configuration rate of 76% (95% CI: 68–83%) for separate rooms designated for reprocessing; 79% (95% CI: 72–84%) for reprocessing rooms with adequate ventilation; 30% (95% CI: 24–36%) for automated endoscope washer-disinfectors; 68% (95% CI: 55–81%) for complete protective equipment usage; 90% (95% CI: 83–95%) for the configuration rate of endoscope and accessory storage cabinets; 50% (95% CI: 38–61%) for changing enzymatic-type detergents after each use; 51% (95% CI: 30–71%) for the use of purified or sterilized water for final rinsing; 80% (95% CI: 70–88%) for monitoring disinfectant concentration; 87% (95% CI: 80–93%) for microbial monitoring; and 44% (95% CI: 26–62%) for the usage of protective equipment. Conclusion The configuration of the automated endoscope washer-disinfector, non-standard cleaning and disinfection procedures, and a lack of occupational protection awareness among personnel responsible for cleaning and disinfecting digestive endoscopy were all apparent issues. It was suggested that all departments enhance their levels of management and supervision, standardize reprocessing procedures and quality control details, upgrade hardware facilities and spatial layouts, reinforce personnel training, and increase staff awareness of nosocomial infection risks.

Effect of remimazolam on oxygen reserve compared with propofol during upper gastrointestinal endoscopy: Randomized controlled study.

Propofol is commonly used for endoscopic sedation. However, it can induce adverse hemodynamic effects. Remimazolam is known to have a fast onset and short duration comparable to that of propofol, but with fewer effects on hemodynamics. We assessed the Oxygen Reserve Index to verify whether a sedative dose of remimazolam would better preserve oxygenation in the mild hyperoxic range than propofol in sedated patients undergoing diagnostic upper gastrointestinal endoscopy. Patients scheduled for diagnostic upper gastrointestinal endoscopy were enrolled. Patients were randomly assigned to either the remimazolam or propofol groups and received 0.1 mg/kg remimazolam or 0.5 mg/kg propofol, respectively. Bolus injections of either 0.05 mg/kg remimazolam or 0.25 mg/kg propofol were added if required. The primary outcome was the prevalence of oxygen reserve depletion, defined as the Oxygen Reserve Index decreasing to 0.00, and hypoxia defined as peripheral oxygen saturation falling to <94%. Among 69 patients, the incidence of oxygen reserve depletion was significantly higher in the propofol group (65.7% vs. 38.2%, P = 0.022). Hypoxia was frequently observed in the propofol group, whereas none was observed in the remimazolam group (11.4% vs. 0%, P = 0.042). Additional sedative injections were frequently required to complete endoscopy in the propofol group. None of the patients in the remimazolam group required airway interventions. Nausea was frequent in the propofol group in the recovery room. Our results indicate that remimazolam is a safe and useful sedative for upper gastrointestinal endoscopy.

Relationship of different metabolic obesity phenotypes with reflux esophagitis: a propensity score matching analysis

BackgroundObesity is associated with an increased risk of reflux esophagitis (RE). Metabolic abnormalities have been implicated in the pathogenesis of RE. However, the role of metabolic status in the risk of RE among individuals with varying degrees of obesity remains unclear. Therefore, our study aimed to assess the association between metabolic obesity phenotypes and the risk of RE.MethodsThis study included a cohort of 24,368 participants aged 18 years and older who underwent upper gastrointestinal endoscopy at the First Affiliated Hospital of Dalian Medical University during health checkups between January 1, 2008, and December 31, 2021. Among these participants, a total of 9,947 individuals were classified into four groups based on their obesity phenotype: metabolically healthy normal weight (MHNW), metabolically healthy obesity (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy obesity (MUO). To account for potential confounding factors, multivariate logistic regression analysis was applied to examine the association between metabolic obesity phenotypes and the risk of RE, with stratification by sex and age.ResultsAmong all participants, the MUNW, MHO, and MUO groups demonstrated a higher risk of RE when compared to the MHNW group. After controlling for all confounding factors, the MUO group exhibited the highest risk, with an odds ratio (OR) of 3.723 (95% CI: 2.751–5.040) in males and 5.482 (95% CI: 4.080–7.367) in females. The prevalence of RE increased in proportion to the number of metabolic risk factors. Subgroup analyses, which accounted for all confounders, revealed that the MHO, MUNW, and MUO phenotypes were associated with an elevated risk of RE in individuals under 60 years old as well as those over 60 years old. Interestingly, a more comprehensive analysis indicated that obesity may have a greater effect on the risk of RE than metabolic disorders.ConclusionsBoth metabolic disorders and obesity were associated with an increased risk of RE. The effect of obesity on RE prevalence may be stronger than that of metabolic disorders, emphasizing the significance of obesity regardless of metabolic health status. Clinical interventions should address not only obesity but also metabolic disorders in order to reduce the risk of RE.

Variability in non-tumor areas of colorectal cancer patients as revealed by endoscopic intestinal step biopsies

A comprehensive endoscopic small and large intestinal untargeted step biopsy procedure was conducted to compare gene expression between the normal intestinal mucosa of healthy individuals and that of patients with colorectal tumors. From 78 participants (healthy individuals [n = 17], patients with colorectal conventional adenomas [n = 6], patients with Tis–T1 colorectal cancer [n = 41], patients with T2–4 colorectal cancer [n = 14]), biopsies of normal mucosa of the terminal ileum, right-sided colon (cecum and ascending colon), and left-sided colorectum (descending colon, sigmoid colon, and rectum) were obtained using a lower gastrointestinal endoscope. RNA was extracted from all samples, and total transcriptome sequencing was performed. Transcriptome data from 388 samples was analyzed. DNA was also extracted from tumor biopsy tissues and analyzed for whole-exome sequencing. In healthy individuals, gene expression differed significantly among the terminal ileum, right-sided colon, and left-sided colorectum, presumably linked to embryological factors. There were differences in gene expression in the normal mucosa in colorectal cancer patients, compared to healthy controls. Patients with tumors, especially T2–4 colorectal cancer, showed considerable variation in gene expression in non-tumor tissues, even in the terminal ileum distant from the tumor site. Based on endoscopic biopsies, the results imply cancer-predisposing conditions in seemingly normal tissues. The present study points to the importance of small intestine and cancer-predisposing conditions in the colon of colorectal cancer patients, with possible implications for developing novel immunotherapy and other therapeutic modalities.

Application of large language model combined with retrieval enhanced generation technology in digestive endoscopic nursing

BackgroundAlthough large language models (LLMs) have demonstrated powerful capabilities in general domains, they may output information in the medical field that could be incorrect, incomplete, or fabricated. They are also unable to answer personalized questions related to departments or individual patient health. Retrieval-augmented generation technology (RAG) can introduce external knowledge bases and utilize the retrieved information to generate answers or text, thereby enhancing prediction accuracy.MethodWe introduced internal departmental data and 17 commonly used gastroenterology guidelines as a knowledge base. Based on RAG, we developed the Endo-chat medical chat application, which can answer patient questions related to gastrointestinal endoscopy. We then included 200 patients undergoing gastrointestinal endoscopy, randomly divided into two groups of 100 each, for a questionnaire survey. A comparative evaluation was conducted between the traditional manual methods and Endo-chat.ResultsCompared to ChatGPT, Endo-chat can accurately and professionally answer relevant questions after matching the knowledge base. In terms of response efficiency, completeness, and patient satisfaction, Endo-chat outperformed manual methods significantly. There was no statistical difference in response accuracy between the two. Patients showed a preference for AI services and expressed support for the introduction of AI. All participating nurses in the survey believed that introducing AI could reduce nursing workload.ConclusionIn clinical practice, Endo-chat can be used as a highly effective auxiliary tool for digestive endoscopic care.

The impact of relaxing the requirements for dyspeptic Symptom Onset frequency or duration in Rome IV Criteria on the Symptom Pattern and diagnosis of functional dyspepsia

BackgroundThe Rome IV criteria for functional dyspepsia (FD) has strict requirements for symptom frequency and onset duration, making it difficult for patients to meet these criteria in clinical practice. This study aimed to investigate the impact of relaxing the Rome IV criteria on the diagnosis and symptom pattern of FD.MethodsA cross-sectional, multi-center study was conducted involving 2935 consecutive broadly defined FD patients without positive findings on upper gastrointestinal endoscopy or routine examinations. Questionnaires were used to collect demographic and upper gastrointestinal symptom data. Symptom pattern was compared between Rome IV criteria defined FD patients and those defined by relaxed Rome IV criteria.ResultsOnly 22.2% of broadly defined FD patients rigorously fulfilled Rome IV criteria. No significant difference was found for proportion of patients with dyspeptic symptoms, dysmotility-like symptoms, reflux-like symptoms, as well as severity and onset frequency of dyspeptic symptoms (all P > 0.05), between patients who didn’t fulfill Rome IV criteria for FD solely due to a duration of 3–6 months and Rome IV criteria defined FD patients. Patients with broadly defined postprandial distress syndrome (PDS) who didn’t fulfill Rome IV criteria solely due to a symptom frequency of 1–2 days per week had significantly lower symptom severity (P < 0.001), but similar postprandial symptom characteristics compared to those defined by the Rome IV criteria.ConclusionsA symptom duration criterion of 3 months may be sufficient for diagnosing FD. Reducing the symptom onset frequency to no less than 1 day per week in the Rome IV criteria for PDS does not affect its postprandial symptom characteristics.

Microbiological surveillance result of endoscopes after INTERCEPT Foam Spray: a quasi-experimental pilot study in Singapore.

This study aimed to assess the impact of INTERCEPT Foam Spray (IFS) application on delayed endoscope reprocessing through microbiological surveillance culture (MSC). A quasi-experimental, matched-comparison pilot study was conducted using gastrointestinal endoscopy. IFS was applied to the endoscopes after precleaning and before reprocessing the next day. An equal number of endoscopes, matched by endoscope type, were subjected to routine reprocessing. The MSC were subjected to high-level disinfection to detect any contamination. Data were analyzed using the chi-square test or Fisher exact test (categorical data) and Student t-test (continuous data). In total, 150 MSCs were collected from 42 endoscopes. Positive MSCs were observed in 4.0% (4/75) of the sprayed group and 1.3% (1/75) of the control group (95% confidence interval [CI], 30.34-0.31; p>0.05), all of which were contributed by colonoscopes. Colonoscope were more prone to positive MSC (mean difference in percentage, p<0.05). Mean spraying hours were not associated with detected growth (11.7% vs. 13.6; 95% CI, 1.43 to -5.27; p>0.05), with environmental and skin flora being the primary contaminants. IFS may be applied when delayed endoscope processing is necessary, but with caution when applied to colonoscopes. However, further research is warranted to verify the result.

Sedation practices in Gastrointestinal Endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) survey.

Sedation practices in Gastrointestinal Endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) survey.

Third generation sequencing analysis detects significant differences in duodenal microbiome composition between functional dyspepsia patients and control subjects.

Functional dyspepsia (FD) is a multifactorial disorder as its development may be based on several different pathophysiological mechanisms. Interaction of gut microbiome with the host has been proposed as a potential mechanism involved in the disease's pathogenesis. We aimed to characterize microbiome profiling on duodenal luminal content (DLC) of FD patients and compare it to that of controls (CG) and patients with irritable bowel syndrome (IBS). Outpatients fulfilling Rome IV criteria for FD, IBS, and control group (CG) underwent upper gastrointestinal endoscopy and 2 cc of duodenal aspirate (3rd - 4th part) was aspirated in sterile traps. Duodenal microbiome was assessed after DNA extraction and 16S gene-based sequencing on Oxford Nanopore MinION followed by EPI2ME analysis (ONT/Metrich-ore Ltd). Bioanalysis of the microbiome (alpha-, beta-diversity, comparisons of relative abundances for all taxonomic ranks) was implemented in Python. Multiple group means comparisons were performed with one-way Analysis of Variance (ANOVA) and Kruskal-Wallis test with Tuckey's and Dunn's post hoc tests respectively, in case of significance (P-value <0.05). 20 subjects with FD (8 females; age 49.9 ± 13.5 yrs.), 20 with IBS (14 females; age 57.6 ± 14.8 yrs.) and 10 CG (6 females; age 49.2 ± 13.8 yrs.) had their DLC analyzed. The α-diversity index of subjects with FD was significantly lower compared to controls (Shannon's index, p = 0.0218) and similar to that of patients with IBS. Principal Coordinate Analysis (PCoA) generated from species relative abundances (beta-diversity) showed no difference in the DLC profile of subjects with FD and IBS when compared to controls (p = 0.513). Compared to controls, the relative abundance (RA) of Chloroflexota phylum was lower in subjects with FD (p = 0.017) and IBS (p = 0.026), respectively. Additionally, the RA of the Rhodothermota and Thermotogota phyla was lower in FD (p = 0.017 and p = 0.018, respectively) but not in IBS patients (p = 0.15 and p = 0.06, respectively) compared to controls. Interestingly, the RA of specific taxa from Chloroflexota, Rhodothermota and Thermotogota phyla were consistently lower in subjects with FD when compared to CG but similar to IBS, during analysis of all the subsequent major ranks of taxonomy. At the class level, there were significant differences in Syntrophobacteria, Acidithiobacillia, Cytophagia and Flavobacteriia between the FD and CG groups (p < 0.05), but no such difference between FD and IBS was found. Finally, multiple significant differences at the order, family, genus and species level between the FD and CG groups were also detected. A positive relationship between the RA of Streptococcus and those from genus Granulicatella was observed both in FD (p = 0.014) and IBS (p = 0.014) patients. The microbiome profiling from duodenal luminal content of FD patients is significantly different to that of controls, including lower microflora diversity, different microflora structure/composition and specific taxa. Similar differences in the DLC between FD and IBS patients were not evident.

Intussusception in children with celiac disease

ABSTRACT Celiac disease (CD) is a chronic illness. Blood testing for tissue transglutaminase antibodies is the initial screening test for the diagnosis of CD, and upper gastrointestinal endoscopy and duodenal/jejunal biopsy are used to confirm CD. Intussusception (IS) is the process in which a proximal segment of the bowel invaginates through the lumen of a distal segment. The association between pediatric IS and CD has been described but is still not widely recognized. Herein, we report a case of IS as the first manifestation of CD in a child. A 3-year-old girl presented to the emergency department with a 1-week history of marked abdominal distention and lethargy, but there was no history of fever, bleeding per rectum, or jaundice. A second-degree relative had a family history of CD. Clinical examination: The patient was a lethargic child with pale conjunctiva and bilateral lower limb edema. She was a febrile and had a normal hemodynamic status. The adipose tissue was diminished throughout the patient’s body; her weight was 8 kg (&lt;5% weight percentile for girls), and her height was 81 cm (&lt;5% height percentile for girls). Laboratory results included the following: Hb of 9 g/dL, serum ferritin of 10 ng/mL (30–400 ng/mL), normal liver function test results except for hypoalbuminemia at 21 g/L (35–52 g/L), and low blood cholesterol of 0.94 g/L (1.54–2.01 g/L). The patient’s blood sugar level was 98 mg/dL, and her renal function test results were normal, with negative septic screening. Abdominal radiography revealed several air–fluid levels, suggestive of an obstruction in the small bowel. Abdominal ultrasonography revealed typical features confirming the diagnosis of IS. Abdominal computed tomography demonstrated an enteroenteric IS with no other signs of organic causes, such as lymphoma or other tumors. Based on the high index of suspicion of CD, a workup confirmed the diagnosis. A gluten-free diet [A1] was started during the hospital course, and the patient improved dramatically regarding her symptoms and was discharged home. In conclusion, this case highlights the association between IS and CD. Intussusception is an emergency condition and usually idiopathic. However, in atypical or recurrent typical presentations underlying causes, we should do proper investigations to initiate appropriate management. [A1]Abbreviations are generally avoided for terms that are not repeated in the text. In this case, this abbreviation is not used elsewhere in the Abstract. Hence, I have deleted the abbreviation. Categories: Pediatrics, Gastroenterology.