Normal Gastrointestinal Endoscopy Research Articles

Public Imaging Datasets of Gastrointestinal Endoscopy for Artificial Intelligence: a Review.

With the advances in endoscopic technologies and artificial intelligence, a large number of endoscopic imaging datasets have been made public to researchers around the world. This study aims to review and introduce these datasets. An extensive literature search was conducted to identify appropriate datasets in PubMed, and other targeted searches were conducted in GitHub, Kaggle, and Simula to identify datasets directly. We provided a brief introduction to each dataset and evaluated the characteristics of the datasets included. Moreover, two national datasets in progress were discussed. A total of 40 datasets of endoscopic images were included, of which 34 were accessible for use. Basic and detailed information on each dataset was reported. Of all the datasets, 16 focus on polyps, and 6 focus on small bowel lesions. Most datasets (n = 16) were constructed by colonoscopy only, followed by normal gastrointestinal endoscopy and capsule endoscopy (n = 9). This review may facilitate the usage of public dataset resources in endoscopic research.

Hepatic Artery Aneurysm: An Unusual Cause of Upper Gastrointestinal Bleed in 49 Years Old Patient

Hepatic artery aneurysm (HAA) is a rare disease. HAA is generally asymptomatic disease when symptomatic, they usually present with abdominal pain, upper gastrointestinal (GI) bleeding and/or jaundice, hypovolaemia secondary to rupture or GI bleeding with normal GI endoscopy. Surgical repair and endovascular treatment are the two therapeutic options available at present. Case report: A 49-year-old male presented at the emergency department with high gastrointestinal bleeding, abdominal pain and jaundice. Gastroscopy showed an ulcer with flat pigmented haematin on ulcer base (Forrest IIc) that was controlled by medical treatment. CT angiography was done and showed aneurysm of the proper hepatic artery almost totally thrombosed measuring 100 × 59 mm associated with signs of contained rupture. Emergency surgery was indicated. The laparotomy objectified a rupture of the aneurysm in the biliary tree in per operative excision of aneurysm and ligation of the hepatic pedicle was carried out. After surgery, the evolution was favorable with a follow-up of 8 months. Conclusion: HAA rupture is a rare cause of upper GI bleeding. The mortality rate after rupture is relatively high. CT angiography or MRI can diagnose a ruptured of HAA. Urgent surgery should be the first choice in patients with a ruptured HAA with active hemorrhage causing hemorrhagic shock.

PTU-032 Iron Deficiency Anaemia (IDA) and Normal Upper and Lower Gastrointestinal Endoscopies: Long Term Outcomes for Patients Investigated According to British Society of Gastroenterology (BSG) Guidelines

Introduction Limited outcome data exists for patients with iron deficiency anaemia (IDA) investigated in accordance with the British Society of Gastroenterology (BSG) guidelines following normal gastrointestinal endoscopy.1 The importance of missed diagnoses in such patients is a key quality indicator for endoscopy services.2 The aim of this study was to evaluate long term outcomes for patients with IDA and normal upper and lower gastrointestinal endoscopy managed in accordance with BSG guidelines.1 Methods Review of a large consecutive series of adult patients referred for investigation of IDA from 1999–2006 to a UK district general hospital. All patients underwent successful oesophago-gastro-duodenoscopy (OGD) and colonoscopy. Those who received a definitive diagnosis were excluded (colorectal/upper gastrointestinal carcinoma, coeliac disease or inflammatory bowel disease). If endoscopic assessment found no cause for IDA no further investigations were undertaken aside from colonic adenoma surveillance. Case notes, laboratory, endoscopy and radiology records were reviewed to determine recurrence and re-investigation of IDA in these patients, any significant gastrointestinal pathology and patient outcomes. Survival was determined using the Kaplan-Meier technique. Results 116 of 142 (82.3%) referred patients had no cause found for IDA on index endoscopic evaluations. Over a median follow up period of 12 years (153 months, range 108–192) there were 45 deaths in this cohort. 5- and 10 year survival rates were 91% and 74% respectively. 23 (19.8%) patients were re-referred for investigation of IDA of which 20 had further normal endoscopies. Overall 2 (1.7%) patients were diagnosed with gastrointestinal cancers during the period of follow up we reviewed. Neither could obviously be classified as a missed diagnosis; one oesophageal and one gastric cancer were diagnosed 12 years post index investigations. All endoscopies that patients subsequently underwent following index investigations were reviewed, including those for other indications and screening. In total 38 patients underwent endoscopy and one had a CT virtual colonoscopy. One patient was diagnosed with terminal ileal Crohn’s disease following re-referral with change in bowel habit 2 years after index investigations and one had haemorrhoids diagnosed on flexible sigmoidoscopy. Conclusion Patients with IDA and normal upper and lower gastrointestinal endoscopies who were managed in accordance with BSG guidelines had acceptable long term outcomes. Overall this data supports the recommendations made by the BSG. References 1 Goddard AF, et al. Gut 2011;60(10):1309–16. 2 Morris EJ, et al. Gut 2015;64(8):1248–56. Disclosure of Interest None Declared

Common Mechanism of Pathogenesis in Gastrointestinal Diseases Implied by Consistent Efficacy of Single Chinese Medicine Formula: A PRISMA-Compliant Systematic Review and Meta-Analysis.

Gastrointestinal (GI) disorders often manifest similar symptoms with overlapping clinical diagnosis and unmet medical needs. Traditional Chinese medicine (TCM) has history-proven benefits for GI diseases; albeit language barrier prevents Western readers from accessing the original reports in Chinese. The TCM formula Si-Ni-San (SNS) consists of 4 herbs targeting on homeostatic disturbances characterized by "reflux" and "irritable" problems. Here we used SNS as a therapeutic tool to explore the common mechanisms of pathogenesis in non-neoplastic GI diseases.Data sources from PUBMED, Chinese National Knowledge Infrastructure, and Wanfang databases were searched for clinical trials. Comparisons were SNS as intervention and Western conventional medicine as control, which treat patients with upper GI disorders (gastroesophageal reflux disease, peptic ulcer, chronic gastritis, duodenogastric reflux), lower GI diseases (irritable bowel syndrome, ulcerative colitis), and functional dyspepsia. Participants and studies in accordance with the Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement were eligible. We used the Jadad scale to assess methodological qualities, the fixed or random-effect model to evaluate therapeutic efficacy, and the funnel plots to explore publication bias. Outcome was clinical efficacy defined by symptom relief with normal GI endoscopy, radiology, and pathology.We included 83 studies involving 7762 participants: 1708 versus 1397 of the upper GI disorders in 34 studies, 901 versus 768 of the lower GI diseases in 19 studies, 1641 versus 1348 of functional dyspepsia in 30 studies, and 328 versus 287 of relapse rate in 8 studies. Six studies had a Jadad score >2 points and the rest were <2 points. Pooled data showed significant efficacy of SNS for the upper GI disorders (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 3.09-4.92), lower GI diseases (OR = 4.91, 95% CI = 3.71-6.51), and functional dyspepsia (N = 2989; OR = 3.94, 95% CI = 3.17-4.90). The relapse rate was 12.9% for SNS, significantly <46.5% for conventional therapies (OR = 0.16, 95% CI = 0.11-0.25).The consistent efficacy of the single TCM formula implicates common mechanisms of pathogenesis in GI disorders.

Consistent Efficacy of Wendan Decoction for the Treatment of Digestive Reflux Disorders.

Gastroesophageal reflux disease (GERD) and bile reflux gastritis (BRG) are common gastrointestinal (GI) disorders with unmet medical needs. Traditional Chinese medicine has long been used for the treatment of GERD and BRG whereas the ginger-containing formula Wendan decoction (WDD) targets homeostatic disturbances characterized by "reflux" and "gut-juice exposure" problems. Here we used WDD as a therapeutic tool to unravel the common pathogenesis of GI reflux disorders. Control clinical trials reporting the WDD-treated patients with GERD and BRG were included in this systematic review and meta-analysis. Outcome measurements were clinical efficacy defined by symptom relief with normal GI endoscopy, radiology, and pathology. Eventually, 33 studies involved 3253 participants (1351 vs. 1035 of the BRG in 20 publications, 449 vs. 418 of the GERD in 13 studies, and 194 vs. 159 of relapse rate in 6 trials). Pooled data showed a consistent therapeutic efficacy of WDD on BRG (OR = 6.00, 95%C = 4.68-7.69) and GERD (OR = 4.39, 95%CI = 2.72-7.07). The relapse rate was 12.4% for WDD, significantly lower than 44.0% for conventional therapies (OR = 0.14, 95%CI = 0.08-0.26). The consistent therapeutic efficacy of the single TCM formula on GERD and BRD indirectly indicates reflux as a common pathogenesis in reflux-associated GI disorders.

Intérêt des biopsies duodénales dans l’exploration de l’anémie ferriprive chez le sujet âgé

Routine duodenal biopsy in adult patients with iron deficiency anaemia (IDA) is a recognised recommendation for adults. Chronic IDA is an uncommon presentation of celiac disease in elderly patients. To determine the usefulness of routine distal duodenal biopsy in diagnosing celiac disease in elderly patients with IDA whose endoscopy revealed no gastrointestinal cause of iron deficiency. Four hundred and forty-four patients with unexplained IDA aged between 16 and 85 years, who underwent routine duodenal biopsy were included in the study. These patients were divided into two groups according to their age (≤ 60 and > 60 years). Three hundred and thirty-five women and 109 men constituted the study population. The mean age was 40.5 years. Duodenal biopsy revealed typical histological features of celiac disease in 4.9%. In the group of patients below 60 years, the prevalence of celiac disease was 64%. No patients in a group above 60 years had celiac disease. Helicobacter pylori (HP) gastritis was present in 90% of the cases. No cases of duodenal villous atrophy has been noted in patients over 60 years. HP gastritis would be the most common cause of IDA in patients with normal gastrointestinal endoscopy in our country.

Primary Pancreatic Anaplastic Large Cell Lymphoma, ALK-: A Care Report.

INTRODUCTION: Primary pancreatic lymphomas constitute less than 0.5% of pancreatic malignancies and less than 2% of extranodal lymphomas. Primary pancreatic anaplastic large cell lymphomas (PPALCL) are extremely rare.AIMS-METHODS: To present an extremely rare case of PPALCLRESULTS: An 80-year-old man, who was under evaluation of a fever of unknown origin in a Private Health Center, was admitted to our Clinic for further investigation. He noted anorexia, weight loss and fatigue. On physical examination, he had a leg edema. His blood tests were unremarkable except for normochrome normocyte anaemia (Ht 31%, Hb 9,9 g/dl) and a great elevation of ESR (110 mm), LDH (1880 U/L)and β2-microglobulin (4,19 mg/L). In CT and MRI scan, available from patient's file, a soft tissue mass located in the pancreas, especially the uncinate process and a slow signal flow of inferior vena cava, due to mass compression, had been observed. He had undergone a normal gastrointestinal endoscopy at that time whereas a new endoscopy, after his admission to us, revealed an ulcerated mass-like deformity of the duodenal bulb with a friable surface. Explorative laparotomy confirmed a diffuse spread of an unresectable malignant mass of the pancreas extending to the adjacent organs. Biopsy specimen was taken from the adhesion of pancreatic surface and gastric serosa, because of the brittle consistency and and necrotic surface of the mass. The duodenal and surgical biopsy results identified an ALCL of T-cell lineage, ALK negative. Bone marrow biopsy showed no evidence of lymphoma involvement. Chemotherapy treatment was not initiated because he died in Intensive Care Unit two days after the explorative laparotomy, due to hemodynamic instability.CONCLUSIONS: Our case supports that primary pancreatic lymphoma should be a high diagnostic possibility in a patient with a pancreatic mass accompanied by elevated LDH and β2-microglobulin. Biopsy specimens' results, from the mass or the adjacent infiltrated organs, confirm the diagnosis, identify the lymphoma and lead to an appropriate and timeable treatment.