Gastrointestinal endoscopy最新文献

Background and aims: The integrity of image acquisition is critical for biliopancreatic EUS reporting, significantly affecting the quality of EUS examinations and disease-related decision-making. However, the quality of EUS reports varies among endoscopists. To address this issue, we developed a deep learning-based EUS automatic image report system (EUS-AIRS), aiming to achieve automatic photodocumentation in real-time during EUS, including capturing standard stations, lesions, and puncture procedures.

Methods: Eight deep learning models trained and tested using 235,784 images were integrated to construct the EUS-AIRS. The performance of EUS-AIRS was tested through man-machine comparisons at 2 levels: a retrospective test (include internal and external testing) and a prospective test. From May 2023 to October 2023, a total of 114 patients undergoing EUS at Renmin Hospital of Wuhan University were consecutively recruited for prospective testing. The primary outcome was the completeness of the EUS-AIRS for capturing standard stations.

Results: In terms of completeness in capturing biliopancreatic standard stations, EUS-AIRS exceeded the capabilities of endoscopists at all levels of expertise in retrospective internal testing (90.8% [95% confidence interval (CI), 88.7%-92.9%] vs 70.5% [95% CI, 67.2%-73.8%]; P < .001) and external testing (91.4% [95% CI, 88.4%-94.4%] vs 68.2% [95% CI, 63.3%-73.2%]; P < .001). EUS-AIRS exhibited high accuracy and completeness in capturing standard station images. The completeness of the EUS-AIRS significantly outperformed manual endoscopist reports (91.4% [95% CI, 89.4%-93.4%] vs 78.1% [95% CI, 75.1%-81.0%); P < .001).

Conclusions: EUS-AIRS exhibits exceptional capabilities in real-time, capturing high-quality and high-integrity biliopancreatic EUS images. This showcases the potential of applying an artificial intelligence image report system in the EUS field.

Background and aims: Effect of underwater endoscopic submucosal dissection (UESD) on clinical outcomes as compared with conventional ESD (CESD) remains unclear. We conducted a meta-analysis of the available data.

Methods: Online databases were searched for studies comparing UESD to CESD for colorectal lesions. The outcomes of interest were en bloc resection, R0 resection, procedure time (min), dissection speed (mm²/min), and adverse events. Pooled odds ratios (OR) and standardized mean difference (SMD), along with 95% confidence intervals (CI) were calculated.

Results: A total of 7 studies with 1,401 patients (n=452 UESD, n=949 CESD) were included. The mean age was 69 years and 57% patients were males. UESD had both lesser procedure time (SMD -1.33, 95% CI -2.34 to -0.32, p = 0.010) and greater dissection speed (SMD 1.01, 95% CI 0.35 to 1.68, p = 0.003) when compared with CESD. No significant differences were observed between the two groups with respect to en bloc resection (OR 1.13, 95% CI 0.37 to 3.41), R0 resection (OR 2.36, 95% CI 0.79 to 7.05), delayed bleeding (OR 1.34, 95% CI 0.65 to 2.74), perforation (OR 1.13, 95% CI 0.64 to 2.00) and post resection electrocoagulation syndrome (OR 0.38, 95% CI 0.10 to 1.42).

Discussion: UESD was faster in patients with colorectal lesions, but had comparable rates of en bloc resection, R0 resection and adverse events when compared with CESD.

Endoscopy plays a key role in diagnosis, monitoring of disease activity, assessment of treatment response, dysplasia surveillance, postoperative evaluation, and interventional therapy for patients with inflammatory bowel disease (IBD). Clinical practice patterns in the endoscopic management of IBD vary. A panel of experts consisting of IBD specialists, endoscopists, and GI pathologists participated in virtual conferences and developed this modified Delphi-based consensus document to address endoscopic aspects of IBD management.