Pub Date : 2019-05-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.05.005
Yongqiu Wei, Qiaozhi Zhou, Peng Li, M. Ji, Y. Niu, Yong-jun Wang, Shutian Zhang
Objective To study the therapeutic value of endoscopy for primary duodenal lesions. Methods Data of 79 consecutive patients with primary duodenal lesions, who underwent endoscopic treatment from January 2015 to January 2018 at Beijing Friendship Hospital, were retrospectively analyzed. Patients were divided into the complication group and the non-complication group, and further grouped according to lesion locations and endoscopic categories. Baseline data of patients, endoscopic treatment, wound closure method, pathological results, the occurrence and outcome of complications were studied. Results A total of 79 patients successfully went through endoscopic treatment, including 59 cases of endoscopic mucosal resection (EMR), 5 cases of endoscopic submucosal dissection (ESD), 6 cases of full-thickness resection with OTSC metal clips, and 9 cases of endoscopic piecemeal mucosal resection (EPMR). In all 79 cases, complications occurred in 8 patients (10.1%) during the perioperative period, all at the duodenal descending segment and duodenal papilla. In all 47 cases whose lesions located at duodenal papilla and duodenal descending segment, the complication incidence was 17.0% (8/47), significantly higher than that of non-descending and papilla part [0 (0/32), P=0.012]. Two (2.5%) cases had complications requiring further intervention with endoscopy or surgery. Among 8 patients with complications, 1 patient (2.1%) developed intraoperative perforation, 1 patient (2.1%) developed delayed bleeding, 6 patients (12.8%) developed mild acute pancreatitis, and these 8 patients recovered after treatment. These 47 patients were further divided into the duodenoscopy group and the gastroscopy group according to endoscopic categories, the complications incidence in the duodenoscopy group (28.0%, 7/25) was also significantly higher than that in the gastroscopy group [4.5%(1/22), P=0.037]. Conclusion Endoscopic treatment is safe and effective for primary duodenal lesions. But for the operations in the duodenal descending segment and the duodenal papilla, as well as in the case of duodenoscopy, it is necessary to be more vigilant about the occurrence of complications. Key words: Duodenal disease; Endoscopy; Endoscopic mucosal resection; Endoscopic submucosal dissection
{"title":"Therapeutic value of endoscopy for primary duodenal lesions","authors":"Yongqiu Wei, Qiaozhi Zhou, Peng Li, M. Ji, Y. Niu, Yong-jun Wang, Shutian Zhang","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.05.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.05.005","url":null,"abstract":"Objective \u0000To study the therapeutic value of endoscopy for primary duodenal lesions. \u0000 \u0000 \u0000Methods \u0000Data of 79 consecutive patients with primary duodenal lesions, who underwent endoscopic treatment from January 2015 to January 2018 at Beijing Friendship Hospital, were retrospectively analyzed. Patients were divided into the complication group and the non-complication group, and further grouped according to lesion locations and endoscopic categories. Baseline data of patients, endoscopic treatment, wound closure method, pathological results, the occurrence and outcome of complications were studied. \u0000 \u0000 \u0000Results \u0000A total of 79 patients successfully went through endoscopic treatment, including 59 cases of endoscopic mucosal resection (EMR), 5 cases of endoscopic submucosal dissection (ESD), 6 cases of full-thickness resection with OTSC metal clips, and 9 cases of endoscopic piecemeal mucosal resection (EPMR). In all 79 cases, complications occurred in 8 patients (10.1%) during the perioperative period, all at the duodenal descending segment and duodenal papilla. In all 47 cases whose lesions located at duodenal papilla and duodenal descending segment, the complication incidence was 17.0% (8/47), significantly higher than that of non-descending and papilla part [0 (0/32), P=0.012]. Two (2.5%) cases had complications requiring further intervention with endoscopy or surgery. Among 8 patients with complications, 1 patient (2.1%) developed intraoperative perforation, 1 patient (2.1%) developed delayed bleeding, 6 patients (12.8%) developed mild acute pancreatitis, and these 8 patients recovered after treatment. These 47 patients were further divided into the duodenoscopy group and the gastroscopy group according to endoscopic categories, the complications incidence in the duodenoscopy group (28.0%, 7/25) was also significantly higher than that in the gastroscopy group [4.5%(1/22), P=0.037]. \u0000 \u0000 \u0000Conclusion \u0000Endoscopic treatment is safe and effective for primary duodenal lesions. But for the operations in the duodenal descending segment and the duodenal papilla, as well as in the case of duodenoscopy, it is necessary to be more vigilant about the occurrence of complications. \u0000 \u0000 \u0000Key words: \u0000Duodenal disease; Endoscopy; Endoscopic mucosal resection; Endoscopic submucosal dissection","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"323-327"},"PeriodicalIF":0.0,"publicationDate":"2019-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48822037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.05.004
Jiacheng Tan, S. Shrestha, Panpan Wang, Jinjun Shi, Yanjia Lu, Qi Gao, Tong Lu, Ruihua Shi
Objective To investigate the efficacy and safety of gastric peroral endoscopic myotomy (G-POEM) for postsurgical gastroparesis. Methods A retrospective analysis was performed on data of 47 patients with gastroparesis after subtotal gastrectomy, who underwent G-POEM at Zhongda Hospital Southeast University form August 2016 to June 2018. G-POEM procedure, complications related to G-POEM, and improvement of symptoms and gastric emptying function were observed. Results All patients underwent G-POEM successfully. No serious G-POEM-related complications were observed. During a follow-up period of 9.8±5.8 months (range 3-18 months), the scores of gastroparesis cardinal symptoms index (GCSI) were 1.6±0.5, 1.2±0.4, 1.1±0.6, 1.4±0.3 and 1.7±0.3 respectively at the 1st, 3rd, 6th, 12th, and 18th months after G-POEM, and all scores were lower than that before G-POEM (3.8±1.1, all P<0.01). The results showed the symptoms of gastroparesis were improved significantly. Gastric emptying imaging showed the hemi-emptying time was 23.8±8.8 min, 21.2±9.5 min, 20.9±8.3 min and 26.4±7.8 min at the 1st, 6th, 12th and 18th months after G-POEM, respectively, significantly shorter than that before G-POEM (67.8±12.5 min, all P<0.01). Three-dimensional ultrasonography results of gastric antrum volume showed that the hemi-emptying time was 26.4 (21.8, 40.3) min, 22.6 (13.9, 32.7) min, 24.3 (18.2, 36.5) min and 26.8 (16.4, 38.5) min at the 1st, 6th, 12th and 18th months after G-POEM, respectively, which were all significantly shorter than that before G-POEM [72.5 (48.3, 108.6) min, all P<0.01]. Conclusion G-POEM has a satisfactory long-term efficacy on the treatment of gastroparesis after subtotal gastrectomy with good safety. Key words: Gastroparesis; Efficiency; Safety; Gastric peroral endoscopic myotomy
{"title":"Clinical effects of gastric peroral endoscopic myotomy on the treatment of gastroparesis after subtotal gastrectomy","authors":"Jiacheng Tan, S. Shrestha, Panpan Wang, Jinjun Shi, Yanjia Lu, Qi Gao, Tong Lu, Ruihua Shi","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.05.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.05.004","url":null,"abstract":"Objective \u0000To investigate the efficacy and safety of gastric peroral endoscopic myotomy (G-POEM) for postsurgical gastroparesis. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed on data of 47 patients with gastroparesis after subtotal gastrectomy, who underwent G-POEM at Zhongda Hospital Southeast University form August 2016 to June 2018. G-POEM procedure, complications related to G-POEM, and improvement of symptoms and gastric emptying function were observed. \u0000 \u0000 \u0000Results \u0000All patients underwent G-POEM successfully. No serious G-POEM-related complications were observed. During a follow-up period of 9.8±5.8 months (range 3-18 months), the scores of gastroparesis cardinal symptoms index (GCSI) were 1.6±0.5, 1.2±0.4, 1.1±0.6, 1.4±0.3 and 1.7±0.3 respectively at the 1st, 3rd, 6th, 12th, and 18th months after G-POEM, and all scores were lower than that before G-POEM (3.8±1.1, all P<0.01). The results showed the symptoms of gastroparesis were improved significantly. Gastric emptying imaging showed the hemi-emptying time was 23.8±8.8 min, 21.2±9.5 min, 20.9±8.3 min and 26.4±7.8 min at the 1st, 6th, 12th and 18th months after G-POEM, respectively, significantly shorter than that before G-POEM (67.8±12.5 min, all P<0.01). Three-dimensional ultrasonography results of gastric antrum volume showed that the hemi-emptying time was 26.4 (21.8, 40.3) min, 22.6 (13.9, 32.7) min, 24.3 (18.2, 36.5) min and 26.8 (16.4, 38.5) min at the 1st, 6th, 12th and 18th months after G-POEM, respectively, which were all significantly shorter than that before G-POEM [72.5 (48.3, 108.6) min, all P<0.01]. \u0000 \u0000 \u0000Conclusion \u0000G-POEM has a satisfactory long-term efficacy on the treatment of gastroparesis after subtotal gastrectomy with good safety. \u0000 \u0000 \u0000Key words: \u0000Gastroparesis; Efficiency; Safety; Gastric peroral endoscopic myotomy","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"317-322"},"PeriodicalIF":0.0,"publicationDate":"2019-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48701353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.011
Shu Li, Dong-liang Yu, Xin Wang, Ai‐qin Li, M. Zou, Yuqi He
Objective To evaluate the clinical value of epithelial vessel branch detected by non-magnifying narrow-band imaging (NM-NBI) in diagnosis of early esophageal cancer. Methods A retrospective analysis was performed on data of 59 patients, who underwent endoscopy with NM-NBI and iodine staining to screen early esophageal cancer in PLA General Hospital from January 2013 to May 2015. The final diagnosis for all lesions were determined by pathology. The diagnostic accuracy, sensitivity and specificity of NM-NBI and iodine staining for early esophageal cancer were compared. Results The accuracy, sensitivity and specificity of NM-NBI on the epithelial vessel branch in diagnosis of early esophageal cancer were 83.1% (49/59), 91.3% (21/23) and 77.8% (28/36), respectively, and the corresponding statistical values of iodine staining were 55.9% (33/59), 95.7% (22/23) and 30.6% (11/36), respectively. The accuracy (χ2=1.45, P=0.028) and specificity (χ2=21.4, P=0.000) of epithelial vessel branch by NM-NBI were significantly higher than those of iodine staining, and there was no significant difference in the sensitivity between the two methods (χ2=22.3, P=1.000). Conclusion The observation of epithelial vessel branch using NM-NBI was useful and reliable in diagnosis of early esophageal cancer with high accuracy and specificity, and can be possible for application in the clinic. Key words: Esophageal neoplasms; Early esophageal cancer; Narrow-band imaging; Epithelial vessel branch
{"title":"Diagnostic value of epithelial vessel branch using non-magnifying narrow-band imaging on early esophageal cancer","authors":"Shu Li, Dong-liang Yu, Xin Wang, Ai‐qin Li, M. Zou, Yuqi He","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.04.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.04.011","url":null,"abstract":"Objective \u0000To evaluate the clinical value of epithelial vessel branch detected by non-magnifying narrow-band imaging (NM-NBI) in diagnosis of early esophageal cancer. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed on data of 59 patients, who underwent endoscopy with NM-NBI and iodine staining to screen early esophageal cancer in PLA General Hospital from January 2013 to May 2015. The final diagnosis for all lesions were determined by pathology. The diagnostic accuracy, sensitivity and specificity of NM-NBI and iodine staining for early esophageal cancer were compared. \u0000 \u0000 \u0000Results \u0000The accuracy, sensitivity and specificity of NM-NBI on the epithelial vessel branch in diagnosis of early esophageal cancer were 83.1% (49/59), 91.3% (21/23) and 77.8% (28/36), respectively, and the corresponding statistical values of iodine staining were 55.9% (33/59), 95.7% (22/23) and 30.6% (11/36), respectively. The accuracy (χ2=1.45, P=0.028) and specificity (χ2=21.4, P=0.000) of epithelial vessel branch by NM-NBI were significantly higher than those of iodine staining, and there was no significant difference in the sensitivity between the two methods (χ2=22.3, P=1.000). \u0000 \u0000 \u0000Conclusion \u0000The observation of epithelial vessel branch using NM-NBI was useful and reliable in diagnosis of early esophageal cancer with high accuracy and specificity, and can be possible for application in the clinic. \u0000 \u0000 \u0000Key words: \u0000Esophageal neoplasms; Early esophageal cancer; Narrow-band imaging; Epithelial vessel branch","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"273-276"},"PeriodicalIF":0.0,"publicationDate":"2019-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48216045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Application and development of artificial intelligence in digestive endoscopy improvement","authors":"Chen Zhiyuan, Zhang Zifan, Luowei Wang","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.04.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.04.003","url":null,"abstract":"随着人工智能在各领域的应用，消化内镜质量控制能否踏着这个科技浪潮进行一次全新的变革，智能化的质控管理方式如何在消化内镜领域提高质控效率及质量越来越受到关注。本文从消化内镜质量控制的现状和面临的问题出发，着重探讨了人工智能在消化内镜质量控制方面的应用现状和发展前景，为消化内镜质量控制的智能化发展提供了一种现实可行的构想。","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"236-239"},"PeriodicalIF":0.0,"publicationDate":"2019-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42169921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.010
Xin-yang Liu, Jing Cheng, Zuqiang Liu, Quan-Lin Li
Objective To evaluate the safety, feasibility, perioperative and long-term efficacy of peroral endoscopic myotomy (POEM) for achalasia (AC) in geriatric patients. Methods Data of 41 patients aged over 65 diagnosed with achalasia and treated with POEM in Zhongshan Hospital from August 2010 to December 2014 were retrospectively studied. Perioperative complications, preoperative and postoperative Eckardt score and pressure of the lower esophageal sphincter, esophageal reflux and clinical failure were analyzed. Results All 41 patients underwent POEM successfully, with median operation time of 42 min. Median hospitalization was 3 days. Major perioperative adverse events occurred in 4 cases (9.75%), whose hospitalization was longer than 5 days for perioperative adverse events. During median follow-up period of 40 months (interquartile range 24-57 months), median Eckardt score decreased from 8 to 1(P<0.001)and pressure of the lower esophageal sphincter decreased from 23.85 mmHg(1 mmHg=0.133 kPa) to 9.05 mmHg (P=0.005). Clinical reflux occurred in 12 cases (29.27%) and the 5-year success rate of POEM was 87.80% (36/41). Conclusion POEM is a safe and reliable treatment for geriatric AC patients with confirmed short-term and long-term effectiveness. Key words: Esophageal achalasia; Geriatrics; Peroral endoscopic myotomy
{"title":"Effects of peroral endoscopic myotomy on achalasia in geriatric patients","authors":"Xin-yang Liu, Jing Cheng, Zuqiang Liu, Quan-Lin Li","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.04.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.04.010","url":null,"abstract":"Objective \u0000To evaluate the safety, feasibility, perioperative and long-term efficacy of peroral endoscopic myotomy (POEM) for achalasia (AC) in geriatric patients. \u0000 \u0000 \u0000Methods \u0000Data of 41 patients aged over 65 diagnosed with achalasia and treated with POEM in Zhongshan Hospital from August 2010 to December 2014 were retrospectively studied. Perioperative complications, preoperative and postoperative Eckardt score and pressure of the lower esophageal sphincter, esophageal reflux and clinical failure were analyzed. \u0000 \u0000 \u0000Results \u0000All 41 patients underwent POEM successfully, with median operation time of 42 min. Median hospitalization was 3 days. Major perioperative adverse events occurred in 4 cases (9.75%), whose hospitalization was longer than 5 days for perioperative adverse events. During median follow-up period of 40 months (interquartile range 24-57 months), median Eckardt score decreased from 8 to 1(P<0.001)and pressure of the lower esophageal sphincter decreased from 23.85 mmHg(1 mmHg=0.133 kPa) to 9.05 mmHg (P=0.005). Clinical reflux occurred in 12 cases (29.27%) and the 5-year success rate of POEM was 87.80% (36/41). \u0000 \u0000 \u0000Conclusion \u0000POEM is a safe and reliable treatment for geriatric AC patients with confirmed short-term and long-term effectiveness. \u0000 \u0000 \u0000Key words: \u0000Esophageal achalasia; Geriatrics; Peroral endoscopic myotomy","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"269-272"},"PeriodicalIF":0.0,"publicationDate":"2019-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41398665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.004
Xia Li, Lianlian Wu
Objective To analyze the blind area monitoring and independent image acquisition function of gastroscopic elves (a real-time gastroscopic monitoring system) in gastroscopy. Methods A total of 38 522 gastroscopic images from the database of Digestive Endoscopy Center of Renmin Hospital of Wuhan University were collected to train and validate the gastroscopic elves.Using computer to generate random numbers, 91 gastroscopic videos were selected to assess the position recognition accuracy of the gastroscopic elves, and 45 gastroscopic videos and matching gastroscopic images collected by endoscopists were selected to compare the coverage number and rate of gastroscopy sites between gastroscopic elves and endoscopists image acquisition. Two endoscopists entered the study to perform gastroscopies with or without gastroscopic elves. Forty-five gastroscopies respectively performed by the endoscopist A before and after usage of gastroscopic elves were collected, and 42 gastroscopies divided into 20 and 22 performed by the endoscopist B without use of gastroscopic elves in the same period were also collected. The coverage rate of gastroscopy sites was compared between the two endoscopists. Results The total position recognition accuracy of gastroscopic elves was 85.125% (1 156/1 358). The coverage rate of gastroscopic sites for the endoscopist A was (76.790±8.848)% and (87.325±7.065)%, respectively, before and after using gastroscopic elves, and the coverage rate in the same period for the endoscopist B was (75.926 ±11.565)% and (75.253 ±14.662)%, respectively. The coverage rate before using gastroscopic elves had no statistical difference between the two endoscopists (t=0.324, P=0.747). The coverage rate for the endoscopist A after using gastroscopic elves was higher than that before using gastroscopic elves (t=6.222, P=0.001), and that of the endoscopist B in the same period (t′=3.588, P=0.002). The coverage number and rate of gastroscopy sites for gastroscopic elves and endoscopists image acquisition were 20.956 ±3.406 and (77.613±12.613)%, and 15.467±2.296 and (57.284±8.503)%, respectively, with statistical differences (t=11.523, P=0.000; t=11.523, P=0.000). Conclusion Gastroscopic elves can improve the coverage number and rate of gastroscopy sites, and is worthy of promotion in clinics. Key words: Gastroscopy; Artificial intelligence; Blind area monitoring; Independent image acquisition
{"title":"Application of artificial intelligence gastroscope in blind area monitoring and independent image acquisition","authors":"Xia Li, Lianlian Wu","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.04.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.04.004","url":null,"abstract":"Objective \u0000To analyze the blind area monitoring and independent image acquisition function of gastroscopic elves (a real-time gastroscopic monitoring system) in gastroscopy. \u0000 \u0000 \u0000Methods \u0000A total of 38 522 gastroscopic images from the database of Digestive Endoscopy Center of Renmin Hospital of Wuhan University were collected to train and validate the gastroscopic elves.Using computer to generate random numbers, 91 gastroscopic videos were selected to assess the position recognition accuracy of the gastroscopic elves, and 45 gastroscopic videos and matching gastroscopic images collected by endoscopists were selected to compare the coverage number and rate of gastroscopy sites between gastroscopic elves and endoscopists image acquisition. Two endoscopists entered the study to perform gastroscopies with or without gastroscopic elves. Forty-five gastroscopies respectively performed by the endoscopist A before and after usage of gastroscopic elves were collected, and 42 gastroscopies divided into 20 and 22 performed by the endoscopist B without use of gastroscopic elves in the same period were also collected. The coverage rate of gastroscopy sites was compared between the two endoscopists. \u0000 \u0000 \u0000Results \u0000The total position recognition accuracy of gastroscopic elves was 85.125% (1 156/1 358). The coverage rate of gastroscopic sites for the endoscopist A was (76.790±8.848)% and (87.325±7.065)%, respectively, before and after using gastroscopic elves, and the coverage rate in the same period for the endoscopist B was (75.926 ±11.565)% and (75.253 ±14.662)%, respectively. The coverage rate before using gastroscopic elves had no statistical difference between the two endoscopists (t=0.324, P=0.747). The coverage rate for the endoscopist A after using gastroscopic elves was higher than that before using gastroscopic elves (t=6.222, P=0.001), and that of the endoscopist B in the same period (t′=3.588, P=0.002). The coverage number and rate of gastroscopy sites for gastroscopic elves and endoscopists image acquisition were 20.956 ±3.406 and (77.613±12.613)%, and 15.467±2.296 and (57.284±8.503)%, respectively, with statistical differences (t=11.523, P=0.000; t=11.523, P=0.000). \u0000 \u0000 \u0000Conclusion \u0000Gastroscopic elves can improve the coverage number and rate of gastroscopy sites, and is worthy of promotion in clinics. \u0000 \u0000 \u0000Key words: \u0000Gastroscopy; Artificial intelligence; Blind area monitoring; Independent image acquisition","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"240-245"},"PeriodicalIF":0.0,"publicationDate":"2019-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45950957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.012
Lei Zhang, Yong-Na Wu, Jing Zhang, Tuo Chen, Xun Li, Guangxiu Liu
Objective To investigate the community structure of intestinal bacteria from patients with cirrhosis and its influencing factors. Methods From 2016 to 2017, 24 patients with liver cirrhosis (the LC group) and 23 healthy family members of patients (the HC group) were enrolled at the First Hospital of Lanzhou University. A comparative analysis of the community structure of intestinal bacteria was performed using 16S rRNA gene sequencing in LC and HC groups. Combined with LEfSe analysis and NMDS analysis, the differential markers were screened and the factors affecting the intestinal community structure of subjects were studied. Results The dominant six phylum of bacteria in intestines in LC and HC groups included Firmicutes, Bacteroides, Proteobacteria, Actinobacteria, Fusobacteria and Tenericumes. However, in the LC sample, Firmicutes was significantly reduced, while Bacteroides was significantly increased. The diversity of intestinal bacteria was significantly reduced, and the Firmicutes/Bacteroides ratio was significantly decreased, suggesting a variation of the community structure in intestinal bacteria of cirrhosis patients. The LEfSe result indicated that the abundance of Enterococcus, Lactobacillales, Bacilli, and Bacteroidetes showed a significant difference in the LC sample, which may be used as potential marked bacterial groups for cirrhosis. The NMDS analysis revealed a positive relationship between the concentration of Cd and Pb and the abundance of intestinal bacteria in the LC sample. Conclusion The community structure of intestinal bacteria from patients with cirrhosis has changed. Enterococcus, Lactobacillales, Bacilli, and Bacteroidetes are potential marked bacterial groups. The concentration of Cd and Pb in the intestinal tract of cirrhosis patients may interact with the abundance and structure of bacteria, and further affect the occurrence and development of cirrhosis. Key words: Cirrhosis; Intestinal bacteria; Bacterial community structure; Influencing factor
{"title":"The community structure of intestinal bacteria from cirrhosis patients and its influence factors","authors":"Lei Zhang, Yong-Na Wu, Jing Zhang, Tuo Chen, Xun Li, Guangxiu Liu","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.04.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.04.012","url":null,"abstract":"Objective \u0000To investigate the community structure of intestinal bacteria from patients with cirrhosis and its influencing factors. \u0000 \u0000 \u0000Methods \u0000From 2016 to 2017, 24 patients with liver cirrhosis (the LC group) and 23 healthy family members of patients (the HC group) were enrolled at the First Hospital of Lanzhou University. A comparative analysis of the community structure of intestinal bacteria was performed using 16S rRNA gene sequencing in LC and HC groups. Combined with LEfSe analysis and NMDS analysis, the differential markers were screened and the factors affecting the intestinal community structure of subjects were studied. \u0000 \u0000 \u0000Results \u0000The dominant six phylum of bacteria in intestines in LC and HC groups included Firmicutes, Bacteroides, Proteobacteria, Actinobacteria, Fusobacteria and Tenericumes. However, in the LC sample, Firmicutes was significantly reduced, while Bacteroides was significantly increased. The diversity of intestinal bacteria was significantly reduced, and the Firmicutes/Bacteroides ratio was significantly decreased, suggesting a variation of the community structure in intestinal bacteria of cirrhosis patients. The LEfSe result indicated that the abundance of Enterococcus, Lactobacillales, Bacilli, and Bacteroidetes showed a significant difference in the LC sample, which may be used as potential marked bacterial groups for cirrhosis. The NMDS analysis revealed a positive relationship between the concentration of Cd and Pb and the abundance of intestinal bacteria in the LC sample. \u0000 \u0000 \u0000Conclusion \u0000The community structure of intestinal bacteria from patients with cirrhosis has changed. Enterococcus, Lactobacillales, Bacilli, and Bacteroidetes are potential marked bacterial groups. The concentration of Cd and Pb in the intestinal tract of cirrhosis patients may interact with the abundance and structure of bacteria, and further affect the occurrence and development of cirrhosis. \u0000 \u0000 \u0000Key words: \u0000Cirrhosis; Intestinal bacteria; Bacterial community structure; Influencing factor","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"277-282"},"PeriodicalIF":0.0,"publicationDate":"2019-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47838284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.009
Qingwei Jiang, Xi Wu, Fang Yao, Dong-sheng Wu, Z. Meng, A. Yang
Objective To conclude the intraductal ultrasonography (IDUS) characteristics of cholangiocarcinoma and improve endoscopic diagnosis for cholangiocarcinoma by comparing manifestations of IDUS between cholangiocarcinoma and benign bile duct stricture. Methods A total of 52 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and IDUS with definite diagnosis of cholangiocarcinoma from January 2012 to January 2017 were included in this retrospective study, and 59 patients undergoing ERCP and IDUS during the same period with definite diagnosis of benign bile duct stricture were included as control. Clinical data, indices of laboratory tests, and manifestations of IDUS (including length of stricture, echo feature, thickness of bile duct, symmetry, and integrity of outer membrane of bile duct wall) were collected and compared between the two groups. Results The clinical manifestations and results of laboratory examination showed no significant differences between the two groups. Intraductal brushing cytology and forceps biopsy showed 28.9% and 40.0% malignant evidence respectively. IDUS showed thicker bile duct in the cholangiocarcinoma group (6.8±4.0 mm VS 4.1±2.3 mm, P<0.01). Proportion of hypoechoic and nonsymmetrical thickened bile duct was higher in the cholangiocarcinoma group (78.8% VS 44.1%, 92.3% VS 50.8%, respectively, all P<0.01). Outer membrane of bile duct destruction occurred in 8 cases (15.4%) in the cholangiocarcinoma group, whereas none was seen in the control group. Conclusion Hypoecho and nonsymmetrical thickness on IDUS may be indicators of cholangiocarcinoma, and destruction of bile duct outer membrane is highly suggestive of cholangiocarcinoma. Key words: Endosonography; Cholangiopancreatography, endoscopic retrograde; Bile duct neoplasms; Diagnosis
目的通过比较胆管癌和良性胆管狭窄的导管内超声表现，总结胆管癌的导管内声像图特征，提高胆管癌的内镜诊断水平。方法回顾性研究纳入2012年1月至2017年1月接受内镜逆行胰胆管造影（ERCP）和IDUS确诊为胆管癌的52例患者，并将同期接受ERCP和IDUS的59例确诊为良性胆管狭窄的患者作为对照。收集两组的临床数据、实验室检查指标和IDUS表现（包括狭窄长度、回声特征、胆管厚度、胆管壁对称性和外膜完整性），并进行比较。结果两组患者的临床表现及实验室检查结果无明显差异。导管内刷毛细胞学和钳子活检分别显示28.9%和40.0%的恶性证据。胆管癌组IDUS显示胆管较厚（6.8±4.0mm VS 4.1±2.3mm，P<0.01）。胆管低回声和不对称增厚的比例在胆管癌组中较高（分别为78.8%VS 44.1%、92.3%VS 50.8%，均P<0.01），而在对照组中没有观察到。结论IDUS低回声和不对称厚度可能是胆管癌的标志，胆管外膜破坏高度提示胆管癌。关键词：腔内超声；胰胆管造影，内镜逆行；胆管肿瘤；诊断
{"title":"Comparison of intraductal ultrasonography characteristics between cholangiocarcinoma and benign bile duct stricture","authors":"Qingwei Jiang, Xi Wu, Fang Yao, Dong-sheng Wu, Z. Meng, A. Yang","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.04.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.04.009","url":null,"abstract":"Objective \u0000To conclude the intraductal ultrasonography (IDUS) characteristics of cholangiocarcinoma and improve endoscopic diagnosis for cholangiocarcinoma by comparing manifestations of IDUS between cholangiocarcinoma and benign bile duct stricture. \u0000 \u0000 \u0000Methods \u0000A total of 52 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and IDUS with definite diagnosis of cholangiocarcinoma from January 2012 to January 2017 were included in this retrospective study, and 59 patients undergoing ERCP and IDUS during the same period with definite diagnosis of benign bile duct stricture were included as control. Clinical data, indices of laboratory tests, and manifestations of IDUS (including length of stricture, echo feature, thickness of bile duct, symmetry, and integrity of outer membrane of bile duct wall) were collected and compared between the two groups. \u0000 \u0000 \u0000Results \u0000The clinical manifestations and results of laboratory examination showed no significant differences between the two groups. Intraductal brushing cytology and forceps biopsy showed 28.9% and 40.0% malignant evidence respectively. IDUS showed thicker bile duct in the cholangiocarcinoma group (6.8±4.0 mm VS 4.1±2.3 mm, P<0.01). Proportion of hypoechoic and nonsymmetrical thickened bile duct was higher in the cholangiocarcinoma group (78.8% VS 44.1%, 92.3% VS 50.8%, respectively, all P<0.01). Outer membrane of bile duct destruction occurred in 8 cases (15.4%) in the cholangiocarcinoma group, whereas none was seen in the control group. \u0000 \u0000 \u0000Conclusion \u0000Hypoecho and nonsymmetrical thickness on IDUS may be indicators of cholangiocarcinoma, and destruction of bile duct outer membrane is highly suggestive of cholangiocarcinoma. \u0000 \u0000 \u0000Key words: \u0000Endosonography; Cholangiopancreatography, endoscopic retrograde; Bile duct neoplasms; Diagnosis","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"265-268"},"PeriodicalIF":0.0,"publicationDate":"2019-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44853784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.006
Xiao Chen, Jianting Cai, Jiamin Chen, Li-ming Shao, Qingwei Chen, Chuangao Xie, Dan-dan Zhong, Rong Bai, Yin Bai
Objective To establish an artificial intelligence deep learning model using clinical colonoscopy images and video to assist the diagnosis by colonoscopy. Methods More than 600 000 colonoscopy images were collected in endoscopic center of the Second Affiliated Hospital of Zhejiang University School of Medicine from 2014 to 2018, and endoscopic experts recorded a large number of high-quality operation video of colonoscopy as analysis data. After repeated discussion by six experts, the classified intestinal sites and pathological features were determined, and fuzzy and confusable images were deleted. The final selection result was approximately 1 out of 4. And then the features of images were marked using an independently developed software. The deep learning algorithm was developed using TensorFlow platform of Google. Results After repeated comparison and analysis of the results of machine training and judgment results combined with pathology from endoscopic experts, the sensitivity of the model for some diseases (such as colon polyps) was 99% under laboratory conditions. In the clinical colonoscopy test, the sensitivity, specificity, and overall accuracy of this model for diagnosis of colon polyps were 98.30% (4 187/4 259), 88.10% (17 620/20 000), and 92.92% [2×98.30%×88.10%/(98.30%+ 88.10%)], respectively. The sensitivity and specificity for ulcerative colitis were 78.32% (2 671/3 410), and 67.06% (13 412/20 000), respectively. The diagnosis time spent on a single image was 0.5±0.03 s, and it was the real time for application, including system recognition, text prompt in video image, background record and storage. Conclusion The artificial intelligence assisted diagnosis model developed by our team can identify colonic polyps, colorectal cancer, colorectal eminence, colonic diverticulum, ulcerative colitis, etc. The auxiliary diagnosis model of colon disease can guide beginners to carry out colonoscopy, and can improve lesion detection rate, reduce misdiagnosis rate, and improve the overall operating efficiency of endoscopic center, which is conducive to the quality control of colonoscopy. Key words: Colonoscopy; Artificial intelligence; Quality control; Assisted diagnosis
{"title":"Construction of artificial intelligence assisted diagnosis model for colonoscopy","authors":"Xiao Chen, Jianting Cai, Jiamin Chen, Li-ming Shao, Qingwei Chen, Chuangao Xie, Dan-dan Zhong, Rong Bai, Yin Bai","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.04.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.04.006","url":null,"abstract":"Objective \u0000To establish an artificial intelligence deep learning model using clinical colonoscopy images and video to assist the diagnosis by colonoscopy. \u0000 \u0000 \u0000Methods \u0000More than 600 000 colonoscopy images were collected in endoscopic center of the Second Affiliated Hospital of Zhejiang University School of Medicine from 2014 to 2018, and endoscopic experts recorded a large number of high-quality operation video of colonoscopy as analysis data. After repeated discussion by six experts, the classified intestinal sites and pathological features were determined, and fuzzy and confusable images were deleted. The final selection result was approximately 1 out of 4. And then the features of images were marked using an independently developed software. The deep learning algorithm was developed using TensorFlow platform of Google. \u0000 \u0000 \u0000Results \u0000After repeated comparison and analysis of the results of machine training and judgment results combined with pathology from endoscopic experts, the sensitivity of the model for some diseases (such as colon polyps) was 99% under laboratory conditions. In the clinical colonoscopy test, the sensitivity, specificity, and overall accuracy of this model for diagnosis of colon polyps were 98.30% (4 187/4 259), 88.10% (17 620/20 000), and 92.92% [2×98.30%×88.10%/(98.30%+ 88.10%)], respectively. The sensitivity and specificity for ulcerative colitis were 78.32% (2 671/3 410), and 67.06% (13 412/20 000), respectively. The diagnosis time spent on a single image was 0.5±0.03 s, and it was the real time for application, including system recognition, text prompt in video image, background record and storage. \u0000 \u0000 \u0000Conclusion \u0000The artificial intelligence assisted diagnosis model developed by our team can identify colonic polyps, colorectal cancer, colorectal eminence, colonic diverticulum, ulcerative colitis, etc. The auxiliary diagnosis model of colon disease can guide beginners to carry out colonoscopy, and can improve lesion detection rate, reduce misdiagnosis rate, and improve the overall operating efficiency of endoscopic center, which is conducive to the quality control of colonoscopy. \u0000 \u0000 \u0000Key words: \u0000Colonoscopy; Artificial intelligence; Quality control; Assisted diagnosis","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"251-254"},"PeriodicalIF":0.0,"publicationDate":"2019-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46980410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.005
S. Cai, Ayimukedisi Yalikong, Ran Li, Yan Bo, L. Yao, P. Zhou, Y. Zhong
Objective To improve the detection rate of early esophageal cancer during endoscopy by construction of artificial intelligence assistant diagnosis system. Methods A total of 2 400 esophageal images were collected from Zhongshan Hospital of Fudan University from January 2016 to December 2017, including 1 200 images of early esophageal cancer and 1 200 images of normal esophageal mucosa. The lesions in pictures were marked with rectangular box by using computer program. Among them, 2 000 pictures were divided into the training set and 400 pictures into the test set. An assistant diagnostic model of early esophageal cancer was established by back propagation algorithm in computer deep learning. The training model was tested and the sensitivity and specificity of the system at different cut-off points in the test set was calculated. Receiver operating characteristic (ROC) curve was used to evaluate the performance of the diagnostic model. Results The area under ROC curve (AUC) of the auxiliary diagnostic model was 0.996 1. The sensitivity and specificity were satisfactory. Conclusion The deep learning model constructed in this study has good specificity, sensitivity and AUC value in the diagnosis of early esophageal cancer, and can assist endoscopists in real-time diagnosis in clinical examination. Key words: Endoscopy, digestive system; Early esophageal cancer; Deep learning; Computer-assisted diagnosis
{"title":"Application of artificial intelligence assisted diagnosis based on deep learning for early esophageal cancer","authors":"S. Cai, Ayimukedisi Yalikong, Ran Li, Yan Bo, L. Yao, P. Zhou, Y. Zhong","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.04.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.04.005","url":null,"abstract":"Objective \u0000To improve the detection rate of early esophageal cancer during endoscopy by construction of artificial intelligence assistant diagnosis system. \u0000 \u0000 \u0000Methods \u0000A total of 2 400 esophageal images were collected from Zhongshan Hospital of Fudan University from January 2016 to December 2017, including 1 200 images of early esophageal cancer and 1 200 images of normal esophageal mucosa. The lesions in pictures were marked with rectangular box by using computer program. Among them, 2 000 pictures were divided into the training set and 400 pictures into the test set. An assistant diagnostic model of early esophageal cancer was established by back propagation algorithm in computer deep learning. The training model was tested and the sensitivity and specificity of the system at different cut-off points in the test set was calculated. Receiver operating characteristic (ROC) curve was used to evaluate the performance of the diagnostic model. \u0000 \u0000 \u0000Results \u0000The area under ROC curve (AUC) of the auxiliary diagnostic model was 0.996 1. The sensitivity and specificity were satisfactory. \u0000 \u0000 \u0000Conclusion \u0000The deep learning model constructed in this study has good specificity, sensitivity and AUC value in the diagnosis of early esophageal cancer, and can assist endoscopists in real-time diagnosis in clinical examination. \u0000 \u0000 \u0000Key words: \u0000Endoscopy, digestive system; Early esophageal cancer; Deep learning; Computer-assisted diagnosis","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"246-250"},"PeriodicalIF":0.0,"publicationDate":"2019-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47180274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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