GI Lesions Research Articles

S1637 Stereomicroscopic On-Site Evaluation in Endoscopic Ultrasound-Guided Tissue Acquisition of Upper GI and Pancreatic Lesions: A Systematic Review and Meta-Analysis

S1637 Stereomicroscopic On-Site Evaluation in Endoscopic Ultrasound-Guided Tissue Acquisition of Upper GI and Pancreatic Lesions: A Systematic Review and Meta-Analysis

Prospective, multicenter, self-controlled clinical trial on the effectiveness and safety of a cable-transmission magnetically controlled capsule endoscopy system for the examination of upper GI diseases

Many GI disorders and precancerous conditions often present asymptomatically, leading to delayed patient diagnoses and treatment interventions. In this study, we developed a novel cable-transmission magnetically controlled capsule endoscopy (CT-MCCE) system for detecting GI diseases and assessed its safety and feasibility through clinical trials. This prospective, multicenter trial compared CT-MCCE with conventional gastroscopy in patients aged 18 to 75 years with upper GI tract diseases between October 2022 and July 2023. The primary endpoints were the evaluation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in the detection of focal lesions within the esophagus, stomach, and duodenal bulb using CT-MCCE. One hundred eighty individuals (mean age, 43.1 years; 52.22% women) were recruited from 3 hospitals in China. CT-MCCE detected lesions in the esophagus with a sensitivity of 97.22%, specificity of 100%, PPV of 100%, NPV of 98.18%, and accuracy of 98.89%; detected gastric focal lesions in the entire stomach with a sensitivity of 96.81%, specificity of 98.84%, PPV of 98.91%, NPV of 96.59%, and accuracy of 97.78%; and detected lesions in the duodenal bulb with a sensitivity of 100%, specificity of 100%, PPV of 100%, NPV of 100%, and accuracy of 100%. There were no significant differences between CT-MCCE and EGD regarding the cleanliness of the upper GI tract and visibility of the upper GI mucosa. However, CT-MCCE was associated with a lower incidence of discomfort than EGD (P< .001). The diagnostic performance of CT-MCCE is comparable with that of EGD in the completion of upper GI tract examinations and lesion detection. Furthermore, the improved tolerance of CT-MCCE in detecting upper GI diseases was noted without any observed adverse events. (Clinical trial registration number: ChiCTR2200063630.).

A multicenter, retrospective study of a through-the-needle injection–capable electrosurgical knife for endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is a technically challenging resection technique for en bloc removal of dysplastic and early cancerous GI lesions. We conducted a single-arm retrospective study evaluating the safety and efficacy of a new through-the-needle injection-capable electrosurgical knife used in upper and lower ESD procedures performed at 6 U.S. academic centers. Data were retrospectively collected on consecutive cases in which the new ESD knife was used. The primary efficacy endpoint was successful ESD (en bloc resection with negative margins). Secondary efficacy endpoints included en bloc resection rate, curative resection rate, median ESD time, and median dissection speed. The safety endpoint was device- or procedure-related serious adverse events. ESD procedures of 581 lesions in 579 patients were reviewed, including 187 (32.2%) upper GI and 394 (67.8%) lower GI lesions. Prior treatment was reported in 283 (48.9%) patients. Successful ESD was achieved in 477 (82.1% of 581) lesions-lower for patients with versus without submucosal fibrosis (73.6% vs 87.0%, respectively; P< .001) but similar for those with versus without previous treatment (81.7% vs 82.3%, respectively; P= .848). A total of 443 (76.2% of 581) lesions met criteria for curative resection. Median ESD time was 1.0 (range, 0.1-4.5) hour. Median dissection speed was 17.1 (interquartile range, 5.3-29.8) cm2/h. Related serious adverse events were reported in 15 (2.6%) patients, including delayed hemorrhage (1.9%), perforation (0.5%), or postpolypectomy syndrome (0.2%). A newly developed through-the-needle injection-capable ESD knife showed a good success rate and excellent safety at U.S. (Clinical trial registration number: NCT04580940.).

A new artificial intelligence system for both stomach and small-bowel capsule endoscopy

Despite the benefits of artificial intelligence in small-bowel (SB) capsule endoscopy (CE) image reading, information on its application in the stomach and SB CE is lacking. In this multicenter, retrospective diagnostic study, gastric imaging data were added to the deep learning-based SmartScan (SS), which has been described previously. A total of 1069 magnetically controlled GI CE examinations (comprising 2,672,542 gastric images) were used in the training phase for recognizing gastric pathologies, producing a new artificial intelligence algorithm named SS Plus. A total of 342 fully automated, magnetically controlled CE examinations were included in the validation phase. The performance of both senior and junior endoscopists with both the SS Plus-assisted reading (SSP-AR) and conventional reading (CR) modes was assessed. SS Plus was designed to recognize 5 types of gastric lesions and 17 types of SB lesions. SS Plus reduced the number of CE images required for review to 873.90 (median, 1000; interquartile range [IQR], 814.50-1000) versus 44,322.73 (median, 42,393; IQR, 31,722.75-54,971.25) for CR. Furthermore, with SSP-AR, endoscopists took 9.54 minutes (median, 8.51; IQR, 6.05-13.13) to complete the CE video reading. In the 342 CE videos, SS Plus identified 411 gastric and 422 SB lesions, whereas 400 gastric and 368 intestinal lesions were detected with CR. Moreover, junior endoscopists remarkably improved their CE image reading ability with SSP-AR. Our study shows that the newly upgraded deep learning-based algorithm SS Plus can detect GI lesions and help improve the diagnostic performance of junior endoscopists in interpreting CE videos.

Sprayable Hydrogel Sealant for Gastrointestinal Wound Shielding.

Naturally occurring internal bleeding, such as in stomach ulcers, and complications following interventions, such as polyp resection post-colonoscopy, may result in delayed (5-7 days) post-operative adverse events-such as bleeding, intestinal wall perforation, and leakage. Current solutions for controlling intra- and post-procedural complications are limited in effectiveness. Hemostatic powders only provide a temporary solution due to their short-term adhesion to GI mucosal tissues (less than 48 h). In this study, a sprayable adhesive hydrogel for facile application and sustained adhesion to GI lesions is developed using clinically available endoscopes. Upon spraying, the biomaterial (based on polyethyleneimine-modified Pluronic micelles precursor and oxidized dextran) instantly gels upon contact with the tissue, forming an adhesive shield. In vitro and in vivo studies in guinea pigs, rabbits, and pig models confirm the safety and efficacy of this biomaterial in colonic and acidic stomach lesions. The authors' findings highlight that this family of hydrogels ensures prolonged tissue protection (3-7 days), facilitates wound healing, and minimizes the risk of delayed complications. Overall, this technology offers a readily adoptable approach for gastrointestinal wound management.

Chronic Kidney Disease and Its Impact on The Gastrointestinal Tract: A Prospective Observational Study

Chronic kidney disease (CKD) is a pervasive and progressive condition that wreaks havoc on renal function, but its far-reaching impact extends beyond the kidneys. In this article, we explore the intricate relationship between CKD and the Gastrointestinal Tract (GIT), shedding light on the underreported and multifaceted digestive pathologies that afflict CKD patients. We conducted a study involving 80 CKD patients admitted between June 2022 and June 2023, revealing that 85% of these patients experienced various GI symptoms, with nausea, vomiting, and anorexia being the most common. These symptoms may stem from urea and metabolic waste accumulation or dialysis-related effects. Endoscopic examinations unveiled abnormalities in 86% of the cases, primarily localized in the stomach, with gastritis being the predominant lesion. Gastric and duodenal ulcers were relatively rare, aligning with previous studies. Gastrointestinal bleeding occurred in 8% of cases, often linked. to erosive gastritis or angiodysplasia. Interestingly, hiatus hernia prevalence was higher in conservative management patients rather than those undergoing haemodialysis. Most patients were in Stage V CKD, with 80% receiving conservative treatment. Our findings suggest a correlation between the severity of renal impairment and the likelihood of upper GI lesions. In conclusion, CKD profoundly affects the GI tract, causing a spectrum of symptoms and potential complications, including underreported upper GI lesions. Early recognition through upper GI endoscopy and prompt management is crucial to reduce morbidity and mortality in CKD patients. This study highlights the need for increased awareness and vigilance in managing the intricate interplay between CKD and the GIT, benefitting both patients and healthcare professionals in their battle against this multifarious condition.

Clinical and pathogenetic features of diarrheal syndrome in COVID-19 in children

SARS-CoV-2 is known to be able to infect the gastrointestinal tract, causing a variety of symptoms. Practice shows that the clinical presentation of diarrheal syndrome with COVID-19 does not fit into the classic manifestations of osmotic diarrhea. Cases of lesions of the lower intestine are often reported. Purpose. The study aims at evaluation of the features of clinical manifestations and laboratory parameters of diarrheal syndrome to determine the possible mechanism of gastrointestinal damage in children with COVID-19. Material and methods. 80 subjects were examined on the basis of the Kazan Regional Clinical Hospital. 40 patients were selected for the main group with diarrhea and a confirmed diagnosis of COVID-19, 40 for the control group with rota- or norovirus infection. The examination included a daily examination, laboratory tests to assess the clinical features of the course, etiological decoding, study of the pathogenetic mechanisms of diarrhea in COVID-19. Results. COVID-19 differs from classical viral diarrhea in more pronounced catarrhal respiratory syndrome (p&lt;0.001), pyretic fever (p=0.001). Vomiting is more typical for rota- and norovirus infections (p&lt;0.001). SARS-CoV-2 is statistically significantly more likely to cause clinical scenario of distal colitis (p=0.034). Patients with increased levels of carbohydrates in the feces were observed more often in the viral diarrhea group, and calprotectin — in the COVID-19 group (p&lt;0.05). A significant qualitative and quantitative imbalance of the intestinal microflora is more typical for patients infected with SARS-CoV-2. Conclusion. The conducted study suggests a complex genesis of gastrointestinal lesions in children with COVID-19, which includes signs of both osmotic and exudative (invasive) mechanisms of diarrhea formation. Clearly, GI lesion in COVID-19 is a multifactorial process.

Diagnostic utility of CT angiography compared with endoscopy in patients with acute GI hemorrhage

Because it is minimally invasive, CT angiography (CTA) has emerged as an attractive diagnostic tool for investigation of acute GI hemorrhage. This study examined patients with acute GI bleeding who underwent CTA. CTA was the initial diagnostic examination in 177 patients, identifying upper and lower GI bleeding lesions in 16 and 27 patients, respectively. In 103 patients with an initial negative CTA, 78 had endoscopy (32 EGD and 46 colonoscopy/flexible sigmoidoscopy), of whom 52 (67%) had a bleeding lesion identified, including 23 with a high-risk bleeding lesion requiring therapy. Peptic ulcer disease and diverticular bleeding were the most commonly identified bleeding lesions. With endoscopy as a criterion standard, the sensitivity of CTA for the detection of a source of GI bleeding was 20%. CTA has very poor sensitivity for identification of a GI bleeding source or lesion, suggesting that CTA should not be used as an initial diagnostic test.

Phenotype and outcomes of very early onset and early onset inflammatory bowel diseases in a Montreal pediatric cohort.

The incidence of very-early-onset inflammatory bowel disease (VEO-IBD) and early-onset IBD (EO-IBD) is increasing. Here, we report their phenotype and outcomes in a Montreal pediatric cohort. We analyzed data from patients diagnosed with IBD between January 2014 and December 2018 from the CHU Sainte-Justine. The primary endpoint was to compare the phenotypes of VEO-IBD and EO-IBD. The secondary endpoints involved comparing outcomes and rates of steroid-free clinical remission (SFCR) at 12 (±2) months (m) post-diagnosis and at last follow-up. 28 (14 males) and 67 (34 males) patients were diagnosed with VEO-IBD and EO-IBD, respectively. Crohn's disease (CD) was more prevalent in EO-IBD (64.2% vs. 39.3%), whereas unclassified colitis (IBD-U) was diagnosed in 28.6% of VEO-IBD vs. 10.4% of EO-IBD (p < 0.03). Ulcerative colitis (UC) and IBD-U predominantly presented as pancolitis in both groups (VEO-IBD: 76.5% vs. EO-IBD: 70.8%). Combining all disease subtypes, histological upper GI lesions were found in 57.2% of VEO-IBD vs. 83.6% of EO-IBD (p < 0.009). In each subtype, no differential histological signature (activity, eosinophils, apoptotic bodies, granulomas) was observed between both groups. At 12 m post-diagnosis, 60.8% of VEO-IBD and 62.7% of EO-IBD patients were in SFCR. At a median follow-up of 56 m, SFCR was observed in 85.7% of VEO-IBD vs. 85.0% of EO-IBD patients. The rate of patients in SFCR at 1-year post-diagnosis and at the end of follow-up did not significantly differ between both groups.

A rare case of primary gastrointestinal stromal tumour of the stomach presenting as perforation peritonitis

Presentation of gastrointestinal stromal tumours (GISTs) as perforation peritonitis is a rare entity with only few cases reported in literature. Here we present a case of a 50-year-old male with acute abdomen and signs of peritonitis. Abdominal radiography revealed dilated small bowel loops in the absence of any free intraperitoneal air. Exploratory laparotomy revealed a growth arising from the stomach wall at the distal part of the body along the greater curvature. Wide excision of the lesion was done with rent closure. Histopathological examination further confirmed the diagnosis of a GIST of the stomach. Post operatively patient received Imatinib therapy and is doing well on follow up. Although rare, GISTs should be considered in the differential diagnosis of perforated GI lesions.

Comparison of Endoscopic Ultrasound-Guided Fine-Needle Aspiration with Fine-Needle Biopsy for Solid Gastrointestinal Lesions: A Randomized Crossover Single-Center study

Abstract Background/Aims The purpose of this study was to compare the results of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) and fine-needle biopsy (FNB) performed at the same site in a single session in the same patient. Methods Consecutive patients with solid gastrointestinal lesions referred for EUS evaluation underwent EUS-FNA and FNB using 22G needles with three and two passes, respectively, in the same session. Patients were randomized to one group having EUS-FNA first followed by EUS-FNB, while other group had EUS-FNB first followed by EUS-FNA. Results Total 50 patients (31 male) of mean age 56.58 ± 14.2 years and mean lesion size of 2.6 (±2) cm were included. The Kappa agreement for final diagnosis for FNA and FNB was 0.841 and 0.61, respectively. The sensitivity and specificity of FNA versus FNB were 85.19 versus 62.96% and 100 versus 100%, respectively, in comparison with final diagnosis. Conclusion Both EUS-FNA and FNB are equally safe when compared between the two techniques simultaneously in same lesion. EUS-FNA is better than FNB in terms of sensitivity, diagnostic accuracy, and tissue yield for solid GI lesion. However, the specificity and positive predictive value were equally good for both the modalities.

Patterns of Histomorphology of Upper GI Lesions Diagnosed on Endoscopic biopsies: a Retrospective Analysis

Patterns of Histomorphology of Upper GI Lesions Diagnosed on Endoscopic biopsies: a Retrospective Analysis

Study of carcinoembryonic antigen tumor marker in gastrointestinal pathology

Background: Cancer mortality and morbidity has been increased in recent years, with gastrointestinal cancers comprising the majority of overall malignant conditions. All Indian cancer registries identify the digestive system as the most common cancer site in males. In women, breast cancer exhibits the highest occurrence, followed by cancers of the genital organs and the digestive system. Tumor markers are usually proteins or glycoproteins produced by the body in response to cancerous growth or by the cancer tissue that are possible to detect in serum, urine, or tissue samples. CEA assay is an inexpensive and easy to perform test; however, repeated measurements to monitor disease, follow up and the response to therapy contribute to higher costs and increase laboratory workload. Materials and Methods: The present study was carried out on 100 patients. Type of sample includes blood sample in plain vacutte received in tumor marker section of the pathology department. Objective: To make a comparative analysis of CEA in various gastrointestinal lesions.  Pre and post operative study of Serum CEA in known case of gastrointestinal carcinoma.  To study the factors affecting serum CEA concentrations. Results: The present study was conducted from June 2018 to December2020 in the Department of Pathology, at tertiary care hospital, 100 cases were studied. Preoperative and postoperative mean CEA value, Mean CEA value in inflammatory, Benign and Malignant lesions as well as in well, moderately and poorly differentiated carcinoma were measured.Conclusion: In general, this study showed that serum CEA levels are increased in people with habit of cigarette smoking and in benign and inflammatory lesions of GIT along with Malignant GI lesions. Carcinoembryonic antigen (CEA) usually normalizes after surgery. After curative resection of primary CRC (colorectal carcinoma), a large number of patients' CEA levels declined to normal values within 4-6 weeks. Amongst many contradictory results, the measurement of CEA is a useful method for screening, diagnosis, follow-up and treatment of CRC but Physiological influences that need to be considered in interpreting the results include effects of aging and smoking. Serum CEA values fails to decline in patients with distant metastasis and advanced disease even after complete surgical removal of the tumour. Serum concentrations of CEA tend to be higher in patients with well-differentiated tumors compared with those with poorly differentiated tumors.

Comparison of PuraStat self-assembling peptide hydrogel versus mineral-based Hemospray for endoscopic hemostasis of upper and lower gastrointestinal lesions in pigs

ObjectiveTo compare a RADA16-based self-assembling peptide hydrogel versus an inorganic powder-based spray device for controlling postoperative bleeding in upper and lower GI mucosal lesions in pigs.MethodsMultiple mucosal lesions were endoscopically-created in the stomachs and lower colons of six Yorkshire swine on Day 0. Three animals’ wounds were treated with 2.5% RADA16 solution (PuraStat®), two animals were treated with an aerosolized mineral powder (Hemospray®), and one animal was an untreated control. Primary outcomes were test article applications required to control initial bleeding, time-to-hemostasis, and rebleeding incidence. Secondary outcomes included animal recovery, and clinical pathology at weekly endoscopic evaluations and the 4-week study terminus.ResultsNumber of material administrations required and time-to-hemostasis was comparable between PuraStat and Hemospray groups. Rebleeding rates were comparable between treatments. Two of 12 (17%) Hemospray and none of 18 (0%) PuraStat stomach sites experienced rebleeding during the final 4 min of the 10-min observation period. No delayed bleeding was observed during weekly endoscopic follow-ups. Hematology and serology values remained normal in all animals. Histology showed expected healing responses at all PuraStat- and Hemospray-treated defects, with less inflammation than untreated sites. Histomorphological observations were comparable between different groups for both the stomach and colon for test and control materials, with lower inflammation scores than untreated sites. Performance and usability responses were generally good with both systems, although the Ability to Treat Intended Site score was significantly better with PuraStat in upper GI lesions.ConclusionsPuraStat and Hemospray were effective topical hemostats for mild-to-moderate bleeding in upper and lower GI wounds. Rebleeding was observed in two of 12 Hemospray-treated sites and none of 18 PuraStat-treated sites. PuraStat and Hemospray were associated with better wound healing than untreated controls. The ability to treat upper GI lesions was easier with the PuraStat versus Hemospray system.

Gastrointestinal Lesions and Its Associated Factors in Adult Males With Iron Deficiency Anaemia: A Cross-Sectional Study From Tertiary Care Centre of North India.

BackgroundAround 30% of the world's population suffers from iron deficiency anaemia (IDA). The standard evaluation for IDA involves upper and lower endoscopy, which allows for the confirmation of pathology of the gastrointestinal tract (GIT) induced due to IDA through iron malabsorption mechanism or loss of blood. Assessing the prevalence of lesions of GIT of significant nature among males having IDA, was the goal of our study.MethodsOur cross-sectional study was conducted for two years and involved 152 males (adults) with confirmed cases of IDA from the Outpatient (OPD) and In-patient (IPD) in the present hospital. Following collecting consent (both informed and written in nature), patient-specific data was collected in a standardized form, and a blood sample was taken for laboratory testing. The analyses were done at a 5% level of significance; an association was considered significant if the p-value < 0.05.ResultsThe average age of the study participants was 59.6 years. The commonest lesions reported were antral gastritis (9.9%) and H. pylori gastritis (7.2%) in upper GI; and haemorrhoid (9.2%) and anal fissure (3.9%) in lower GI. The overall prevalence of any GI lesions was 65.1%. The GI lesions were significantly associated higher among men with age > 50 years (73.7%). The presence of occult blood in stools (p < 0.0001) and parasites in stools (p=0.0001) were significantly related to the presence of GI lesions.ConclusionGI lesions are frequently detected in males with IDA. Whether it is symptomatic male or asymptomatic male with anaemia refractory to iron treatment, GIT should be evaluated in them.

Is There Decreasing Prevalence of Helicobacter Pylori Infection in Patients with Dyspepsia?

Background: Word-wide there is decreasing prevalence of Helicobacter pylori (H. Pylori) infection. As we are lacking in consistent data regarding H. Pylori infection in our polpulation, we aimed to find out prevalence of H.pylori infection in patients with dyspepsia in Nort-East part of Bangladesh. &#x0D; Material and methods: Clinical variables, stool antigen test result and endoscopic findings of consecutive patients with dyspepsia were recorded in a semi-structured questionnaire. Statistical analysis was done with SPSS programme 17.0(). Significance level was set at 0.05 or less.&#x0D; Results: A toal of 790 patients (male 549, female 241) were included in the study with higher mean age among female patients (41.46 VS. 39.19, p.008) than male patients. Three most common dyspetic symptoms were abdominel pain (n=365, 46.2%), bloating (n=280, 35.4%) and vomiting (n=163, 20.6%). A total of 217(39.5%) male and 87(36.0%) female were positive for stool antigen test (n=308, 38.5%) for H. pylori. No significant association was found between Helicobacter pylori infection and presence of individual dyspeptic symptom, number of dyspeptic symptoms (OR 1.385, p .103), age (OR .998, p .668), sex (OR 1.157, p .362), rural/urban residence (OR 1.126, p .503) or socioeconomic condition (OR .965, p .09). Around 81% (293/360) subjects had upper GI lesion (Gastritis/gastric ulcer, duoudenitis/duodenalulcer, oesophagitis/ulcer) in endoscopy and stool antigent positivity in paietnts with duodenal and gastric lesions (37% VS. 36.6%) were comparable.&#x0D; Conclusion: H. pylori infection rate among patients with dyspepsia is is in favour of declining prevalence of H.pylori infection in comparison to previous sudies. Majority of patients with dyspepsia had upperGI lesion in endoscopy. No sigficant differece was noted in H. pyori prevalence rate anong gastric or duodenal lesion or among PPI takers or non-takers.&#x0D; JCMCTA 2022 ; 33 (1) : 97-102

Histopathological study of neoplastic lesions of upper gastrointestinal tract endoscopic biopsies

Upper gastrointestinal tract disorders are one of the most commonly encountered problems in clinical practice and are a leading cause of morbidity and mortality. A wide spectrum of disorders can affect the upper gastrointestinal tract, with inflammatory and neoplastic lesions being the most common. Endoscopy, in combination with biopsy plays an important role in timely diagnosis and early management.To study the spectrum of neoplastic lesions of upper gastrointestinal tract and its correlation with socio-demographic details.This is a cross-sectional study conducted at department of pathology, MMCRI from January 2019 to June 2020.A total of 87 upper GI endoscopic biopsies were received and were routine processed and histopathological assessment was done. Thereafter, 50 biopsies diagnosed as neoplastic lesions were included in the present study. Age of the patients varied from 41-80 years with male : female ratio of 2.3 :1. Out of 50 endoscopic biopsies, 34 cases( 68%) were from esophagus and 16 (32%) from stomach. All cases were malignant. Squamous cell carcinoma was the commonest malignancy in the esophagus while adenocarcinoma was the commonest malignancy of stomach.Endoscopy guided biopsy of upper GIT is simple, safe, cost effective, day care procedure with less complication rates and gives direct visualization of pathological site. Most of the patients with GIT malignancy have vague symptoms or no symptoms in early stage and are often diagnosed only in advanced stage. Hence, endoscopy in combination with biopsy acts as a useful diagnostic tool for upper GI lesions and has revolutionized the management of patients.

Endoscopic submucosal dissection and tunneling procedures using novel image-enhanced technique.

Background and AimsRecent innovations in image-enhanced endoscopy allow early detection and management of GI lesions. In this study, we aim to analyze the utility of texture and color enhancement imaging (TXI) and red dichromatic imaging (RDI) during endoscopic submucosal dissection (ESD) and submucosal tunneling procedures.MethodsPatients who underwent ESD, submucosal tunneling endoscopic resection, and peroral endoscopic myotomy (POEM) using the novel imaging technique including TXI and RDI were included in the study.ResultsTwenty-five patients (13 male; age 43 ± 15.69 years) underwent POEM for achalasia (n = 20), submucosal tunneling endoscopic resection for esophageal subepithelial lesions (n = 3), and ESD for gastric neuroendocrine tumors (n = 2). All of the procedures were successfully performed. Mean procedure duration was 55.52 ± 21.61 minutes. TXI mode was used in all the cases, whereas RDI mode was used on 15 occasions. While using RDI mode, hemostasis was achieved in 1 attempt on 12 (80%) occasions. The site of mucosal incision was revised in 3 cases during POEM based on TXI and RDI modes.ConclusionsSubmucosal tunneling and endoscopic dissection procedures can be conveniently performed using a new image-enhanced technique. RDI is useful in localizing the site of bleeding during endoscopic dissection.

Correlation of the detection rate of upper GI cancer with artificial intelligence score: results from a multicenter trial (with video)

The quality of EGD is a prerequisite for a high detection rate of upper GI lesions, especially early gastric cancer. Our previous study showed that an artificial intelligence system, named intelligent detection endoscopic assistant (IDEA), could help to monitor blind spots and provide an operation score during EGD. Here, we verified the effectiveness of IDEA to help evaluate the quality of EGD in a large-scale multicenter trial. Patients undergoing EGD in 12 hospitals were consecutively enrolled. All hospitals were equipped with IDEA developed using deep convolutional neural networks and long short-term memory. Patients were examined by EGD, and the results were recorded by IDEA. The primary outcome was the detection rate of upper GI cancer. Secondary outcomes were part scores, total scores, and endoscopic procedure time, which were analyzed by IDEA. A total of 17,787 patients were recruited. The total detection rate of cancer-positive cases was 1.50%, rangingfrom .60% to 3.94% in each hospital. The total detection rate of early cancer-positive cases was .36%, ranging from .00% to 1.58% in each hospital. The average total score analyzed by IDEA ranged from 64.87 ± 16.87 to 83.50 ±9.57 in each hospital. The cancer detection rate in each hospital was positively correlated with total score (r= .775, P= .003). Similarly, the early cancer detection rate was positively correlated with total score (r= .756, P= .004). This multicenter trial confirmed that the quality of the EGD result is positively correlated with the detection rate of cancer, which can be monitored by IDEA. (Clinical trial registration number: ChiCTR2000029001.).

Histopathological study of gastrointestinal endoscopic biopsies in pediatric patients

Abstract Background Non neoplastic GI lesions in pediatrics are variable and differ in types and prevalence among each pediatric age group. Helicobacter pylori is an important pathogen that can cause gastritis and peptic ulcers in adults as well as in children. Celiac disease is a gluten-dependent autoimmune disorder which affects individuals having genetic susceptibility. Eosinophilic gastrointestinal diseases are disorders that primarily affect the gastrointestinal tract with eosinophil-rich inflammation in the absence of known causes for eosinophilia. Inflammatory bowel disease (IBD) is a chronic inflammatory disorder, mainly affecting the gastrointestinal tract with extraintestinal manifestations and associated immune disorders. It seems that it is one of the most common gastrointestinal diseases affecting children in the developed countries. Aim of the work To study different types of paediatric non neoplastic gastrointestinal lesions from gastrointestinal endoscopic biopsies received at the Pathology Department in Ain Shams University hospital during a period of 2 years (2017-2018), and to correlate them with the clinicopathological presentations and endoscopic findings. Patients and Methods A cross sectional study was conducted on all pediatric gastrointestinal biopsies received at Pathology Department in Ain Shams University Hospital during the period of two years (2017- 2018). Only cases with information for all the covariates (n = 580) were selected and the results were statistically analyzed. Results Total 580 pediatric cases were enrolled according to inclusion criteria. Nonspecific gastrointestinal inflammation represented (47.1%), Helicobacter pylori associated gastrointestinal inflammation represented (43.5%), Eosinophilic gastrointestinal disease represented (3.8%), Inflammatory bowel disease (IBD) represented (3.7%), Celiac disease represented (1.9%). Conclusion This is the first study conducted in Ain Shams University Hospitals to assess the different types of pediatric non neoplastic gastrointestinal lesions received with clinicopathological and endoscopic correlation. The most common pediatric non neoplastic GI lesion is Helicobacter pylori infection. The diagnosis of pediatric non neoplastic GI disorder necessitates interdepartmental teamwork between GI pediatricians and pathologists.