Endoscopy International Open最新文献

Background and study aims: Artificial intelligence (AI) is expected to enhance the ability of endoscopists to detect gastric neoplastic lesions; however, its effectiveness among highly skilled Japanese expert endoscopists has not been validated. We developed a novel AI-assisted diagnostic tool for detection of gastric neoplastic lesions and evaluated its utility by comparing the diagnostic performance of endoscopists with and without AI assistance.

Patients and methods: Diagnostic performance of gastric neoplastic lesions without and with AI assistance was compared among 14 expert endoscopists and 12 non-expert endoscopists using an evaluation dataset consisting of 150 images containing neoplastic lesions and 350 images without lesions. A general linear mixed model was applied for comparative analysis. The primary outcome was to demonstrate superiority of sensitivity and non-inferiority of specificity among expert endoscopists using AI compared with those without AI. The significance level for sensitivity was set at 2.5% and the non-inferiority margin for specificity was defined as a log odds ratio of -0.25.

Results: Our AI demonstrated superiority in sensitivity (66.4% without AI vs. 83.5% with AI; odds ratio [OR] 2.562, 97.5% confidence interval [CI] 2.069-3.172) and non-inferiority in specificity (90.8% without AI vs. 92.9% with AI; OR 1.326, 95% CI 1.122-1.565) among expert endoscopists.

Conclusions: AI contributed to improved diagnostic performance even among Japanese expert endoscopists in detecting gastric neoplastic lesions. These findings suggest that the AI system may have potential to support consistently high diagnostic performance across varying levels of endoscopic expertise.

Background and study aims: Post-endoscopy esophageal adenocarcinomas (PEEC) challenge timely diagnosis of esophageal adenocarcinomas (OAs). This study aimed to determine prevalence of PEECs in Auckland region and elucidate the most plausible causes through a root-cause analysis framework.

Patients and methods: OA cases diagnosed in Auckland from 2013 to 2022 were retrieved from the New Zealand Cancer Registry (NZCR). Electronic clinical data were collected via the Regional Clinical Portal software. The primary outcome was PEEC prevalence, defined as OA diagnosed 6 to 36 months following an esophagogastroduodenoscopy (EGD) that failed to detect the cancer. Identified PEECs were classified into six categories.

Results: Among 633 OA cases, 45 (7.1%) were PEECs. A higher prevalence of PEEC was observed in patients with Barrett's esophagus (BE) (18.1% vs 2.7%), undergoing surveillance EGDs (52.6% vs 3.6%) and with early-stage cancers. Root-cause analysis delineated the PEEC causes, classified as follows: A (17.8%): lesion was identified, endoscopic assessment was adequate, follow-up was appropriately planned and executed, yet PEEC developed; B (17.8%): follow-up was delayed due to administrative factors; C (22.2%): follow-up decisions were inappropriate; D (22.2%): inadequate endoscopic assessment; E (11.1%): lesion was unidentified despite adequate assessment; and F (8.9%): lesion was unidentified and assessment was inadequate. Categories B, C, D, and F comprised 71.1% of cases deemed potentially avoidable.

Conclusions: Auckland's PEEC prevalence aligns with international post-endoscopy upper gastrointestinal cancer rates. Root-cause analysis underscores that a significant proportion of PEECs may be preventable with improved clinical practice.

Background and study aims: "Leaky gut," caused by increased mucosal permeability, plays a pivotal role in various diseases. However, few methods are available to evaluate intestinal mucosal permeability in the living human body. We established a novel method for evaluation of mucosal permeability using indigo carmine (IC).

Patients and methods: Subjects undergoing colonic endoscopy for screening of colon polyps or evaluation of ulcerative colitis (UC) severity were enrolled. IC was endoscopically sprayed in the cecum, and blood samples were obtained before spraying and at 30 and 60 minutes after. Serum IC level was analyzed by liquid chromatographer/mass spectrometer equipped with a Nexera HPLC system.

Results: In both the control (subjects screened for colon polyps) and UC groups, all subjects had their highest serum IC levels at 30 minutes after spraying. Serum IC level was significantly higher in UC patients than in the controls at both 30 and 60 minutes after spraying. In the UC group, serum IC levels at both 30 and 60 minutes were significantly higher in patients with a Mayo endoscopic subscore (MES) 1 at the cecum than in those with MES 0 in the same area.

Conclusions: Endoscopic spraying with IC is useful for evaluation of intestinal mucosal permeability.

Background and study aims: Although the endoscopic pressure study integrated system (EPSIS) is useful to evaluate competency of lower esophageal sphincter as a major part of the anti-reflux barrier, its availability is limited. This study aimed to assess whether gastric fold stretching during insufflation can predict intragastric pressure (IGP) without special equipment.

Patients and methods: A retrospective analysis included 33 patients who underwent esophagogastroduodenoscopy and EPSIS between June and July 2024. Gastric fold stretching along the greater curvature at the level of the cardia, observed in a retroflex view during insufflation, was compared with EPSIS results by reviewing recorded videos. Time ranges were defined as follows, and IGP was measured at the end of each range: Time range 1, until the ratio of longitudinal fold thickness to the groove width between folds reached 1:2; Time range 2, until the ratio reached 1:4; and Time range 3, until the folds or mucosal ridges were almost flattened. Variability was assessed using the coefficient of variation (CV), calculated as the standard deviation divided by the mean.

Results: Time ranges 1, 2, and 3 were fully observed in 100%, 97%, and 70% of patients, respectively. Mean IGPs at the end of Time ranges 1, 2, and 3 were 8.9, 11.1, and 17.7 mmHg, with CVs of 0.32, 0.28, and 0.08, respectively.

Conclusions: Flattening of gastric folds or mucosal ridges during insufflation is a reliable predictor of IGP. This finding may help identify patients with anti-reflux barrier dysfunction during regular endoscopic examination.

[This corrects the article DOI: 10.1055/a-2645-7506.].

Background and study aims: Local injection of a small amount of blue dye into the submucosa can facilitate recognizing the dissection line in endoscopic submucosal dissection (ESD). Amber-red color imaging (ACI), which hardly affects the submucosal blue color, is suitable for the entire ESD. This study aimed to clarify characteristics of ACI during ESD.

Patients and methods: Nine endoscopic images were selected during submucosal dissection in four cases of gastric ESD to evaluate endoscopic ACI and white light imaging (WLI). Visibility of the dissection line and the submucosal vessel were evaluated by eight endoscopists using a 5-point Likert scale. The blue submucosal area of each endoscopic image and color signal surrounding the submucosa were compared between ACI and WLI. In addition, the color signals in gradient dilutions of blue solutions were compared in ex vivo experiments.

Results: Visibility of the dissection line was better in ACI than in WLI and visibility of the submucosal vessels was slightly better in ACI. The size ratio of the blue area in ACI and WLI (i.e., ACI/WLI) ranged from 0.53 to 0.65, indicating that the blue area in the ACI was narrower. The red signal intensity of the surroundings with respect to the submucosa was greater in ACI than in WLI, which was related to the narrower blue area in ACI. Ex vivo experiments corroborated this observation.

Conclusions: ACI highlights the submucosa in blue only where sufficient solution is injected, which facilitates recognition of the dissection line during ESD.

Background and study aims: Analyses of colonoscopy (CS) and esophagogastroduodenoscopy (EGD) complications is crucial for further promoting use of endoscopy. This study analyzed rates of severe complications of CS compared with those of EGD using big data.

Patients and methods: As a study population, we retrospectively used commercially anonymized health insurance claims data covering 3,050,954 patients from January 2010 to December 2020. Patients ≥ 50 years old who underwent CS or EGD without treatment were included in the study. The main outcomes were differences in rates of hemorrhage, perforation, and fatal events between EGD and CS, and risk factors of each complication comparing CS with EGD.

Results: Among 290,470 CSs (male: 182,910, female: 107,560, median age [range]: 58 [50-75]) and 726,075 EGDs (male: 412,365, female: 313,710, 58 [50-75]), rates of hemorrhage, perforation, and fatal events for EGD and CS were 0.0069% vs. 0.0069% ( P = 0.558), 0.0006% vs. 0.0024% ( P = 0.008), and 0.00028% vs. 0.00034% ( P = 0.648), respectively. Rates of hemorrhage for cases aged 50 to 64 and 65 to 75 years were 0.0059% vs. 0.0110% ( P = 0.042) for EGD and 0.0061% vs. 0.0108% for CS ( P = 0.264). Risks of hemorrhage for comparing CS to EGD were significant for biopsy (adjusted odds ratio [aOR] 95% confidence interval [CI] 2.75 [1.15-6.21]; P = 0.017) and antithrombotics (aOR 12.48; 95% CI 1.80-247.14; P = 0.026). Those for perforation were significant for ages 50 to 64 years (aOR 9.58; 95% CI 2.17-66.10; P = 0.006) and male sex (11.76 [1.85-222.65], P = 0.025).

Conclusions: Compared with EGD, CS had a higher rate of perforation but not hemorrhage. Complication rates in CS did not differ by age.