James Xu, M. Benson, Liam M. Granlund, Seth Gehrke, D. Stanfield, J. Weiss, P. Pfau, Anurag Soni, Ben L. Cox, G. Petry, R. Swader, M. Reichelderfer, Zhanhai Li, Tenzin Atrukstang, N. Banik, K. Eliceiri, D. Gopal
Abstract Background Screening for gastric cancer is known to be associated with reduced mortality in populations with high prevalence. However, many countries with high prevalence do not screen, with high costs being a significant reason for this. Aims To describe, develop, and assess the potential for a low-cost gastroscope for early cancer screening and patient risk stratification. Methods Our interdisciplinary team used both off-the-shelf and fabricated components to create multiple gastroscope prototypes (GP) in iterative fashion based off clinician feedback. Clinician endoscopists were surveyed using Likert scales regarding device potential, video quality, and handling when testing on a GI training device. Video quality comparison to clinically standard high-definition white light endoscopy (HD-WLE) was done using the absolute categorical ratings (ACR) method. Results A candidate cost-effective GP with clinical potential was developed. Although initial versions were scored as inferior via ACR on all views tested when compared to HD-WLE ( p < 0.001), participants agreed the concept may be beneficial (M = 4.52/5, SD = 0.72). In testing improved versions, participants agreed the device had the ability to identify discrete (M = 4.62/5, SD = 0.51) and subtle lesions (M = 4/5, SD = 0.7) but most felt video quality, although improved, was still less than HD-WLE. Sufficiency of maneuverability of device to visualize gastric views was rated as equivocal (M = 2.69/5, SD = 1.25). Conclusion The presented low-cost gastroscopic devices have potential for clinical application. With further device development and refinement including the possible addition of technologies in telemedicine and artificial intelligence, we hope the GP can help expand gastric cancer screening for populations in need.
{"title":"Development of a Low-Cost Gastroscope Prototype (GP) for Potential Cost-Effective Gastric Cancer Screening in Prevalent Regions","authors":"James Xu, M. Benson, Liam M. Granlund, Seth Gehrke, D. Stanfield, J. Weiss, P. Pfau, Anurag Soni, Ben L. Cox, G. Petry, R. Swader, M. Reichelderfer, Zhanhai Li, Tenzin Atrukstang, N. Banik, K. Eliceiri, D. Gopal","doi":"10.1055/s-0043-1762574","DOIUrl":"https://doi.org/10.1055/s-0043-1762574","url":null,"abstract":"Abstract Background Screening for gastric cancer is known to be associated with reduced mortality in populations with high prevalence. However, many countries with high prevalence do not screen, with high costs being a significant reason for this. Aims To describe, develop, and assess the potential for a low-cost gastroscope for early cancer screening and patient risk stratification. Methods Our interdisciplinary team used both off-the-shelf and fabricated components to create multiple gastroscope prototypes (GP) in iterative fashion based off clinician feedback. Clinician endoscopists were surveyed using Likert scales regarding device potential, video quality, and handling when testing on a GI training device. Video quality comparison to clinically standard high-definition white light endoscopy (HD-WLE) was done using the absolute categorical ratings (ACR) method. Results A candidate cost-effective GP with clinical potential was developed. Although initial versions were scored as inferior via ACR on all views tested when compared to HD-WLE ( p < 0.001), participants agreed the concept may be beneficial (M = 4.52/5, SD = 0.72). In testing improved versions, participants agreed the device had the ability to identify discrete (M = 4.62/5, SD = 0.51) and subtle lesions (M = 4/5, SD = 0.7) but most felt video quality, although improved, was still less than HD-WLE. Sufficiency of maneuverability of device to visualize gastric views was rated as equivocal (M = 2.69/5, SD = 1.25). Conclusion The presented low-cost gastroscopic devices have potential for clinical application. With further device development and refinement including the possible addition of technologies in telemedicine and artificial intelligence, we hope the GP can help expand gastric cancer screening for populations in need.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41419431","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}
With all the hard work and contribution by the authors and reviewers, Journal of Digestive Endoscopy (JDE), the official journal of Society of Gastrointestinal Endoscopy of India, has completed one more successful year with its impressive endoscopy-based articles under various categories. We should always take pride in how far we have come and have faith in how far we can go. We whole heartedly thank all the authors and reviewers who had sincerely contributed to JDE in 2022 and expect the same to continue for the coming year. In the past four decades, endoscopy has evolved to become an important tool in diagnosis and management of several gastrointestinal (GI) diseases. The focus on endoscopy quality not only ensures proper and effective delivery of treatment but also ensures competencyamongendoscopists. Various national societies have endorsed the quality metrics that help define the areas of endoscopy quality improvement. Various societies like American Society for Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy have taken the initiatives to propose several quality metrics and performance measures for endoscopy procedures.1,2 In the year 2022, we encouraged and published several articles directly or indirectly contributing to the literature on endoscopy quality improvement. Most commonly performed endoscopic procedure with wide variety of indications is esophagogastroduodenoscopy (EGD). Documentation of complete examination of esophagus, stomach, and duodenum and targeted biopsies of suspected and established lesions is very important part of EGD. It is very important to improve the detection rate of Barrett’s esophagus (BE) in our busy endoscopy practice. In a review article, Dutta has highlighted the currently available and suitable options like acetic acid-based chromoendoscopy or image-enhanced endoscopy for the identification of dysplasia.3 The detection of BE can be improved by performing adequate and systemic examination during EGD. Among all qualitymetrics, themost studied and validated are related to colonoscopy. The proposed quality metrics for colonoscopy procedure are related to bowel preparation, cecal intubation rate, adenoma detection rate, and colonoscopy withdrawal time.4–6 For identification of all possible lesions and improving the adenoma detection rate, the complete examination of large intestine with good bowel preparation is essential.6 Poor bowel preparation not only increases the duration of procedure but also increases the chances of missing the lesions ultimately leading to increased healthcare cost due to repeat colonoscopy.7 Constipation is one of the important reason for poor bowel preparation. Theoretically, prucalopride which is the agonist of serotonin type 4 receptors may augment the effect of polyethylene glycol preparation, which is considered as one of the safest and efficacious agents for bowel preparation. In a study, Singh et al, however, found that prucalopride has no additi
{"title":"Prime Time to Focus on Gastrointestinal Endoscopy Quality Improvement","authors":"S. Afzalpurkar, Mahesh K Goenka","doi":"10.1055/s-0043-1762918","DOIUrl":"https://doi.org/10.1055/s-0043-1762918","url":null,"abstract":"With all the hard work and contribution by the authors and reviewers, Journal of Digestive Endoscopy (JDE), the official journal of Society of Gastrointestinal Endoscopy of India, has completed one more successful year with its impressive endoscopy-based articles under various categories. We should always take pride in how far we have come and have faith in how far we can go. We whole heartedly thank all the authors and reviewers who had sincerely contributed to JDE in 2022 and expect the same to continue for the coming year. In the past four decades, endoscopy has evolved to become an important tool in diagnosis and management of several gastrointestinal (GI) diseases. The focus on endoscopy quality not only ensures proper and effective delivery of treatment but also ensures competencyamongendoscopists. Various national societies have endorsed the quality metrics that help define the areas of endoscopy quality improvement. Various societies like American Society for Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy have taken the initiatives to propose several quality metrics and performance measures for endoscopy procedures.1,2 In the year 2022, we encouraged and published several articles directly or indirectly contributing to the literature on endoscopy quality improvement. Most commonly performed endoscopic procedure with wide variety of indications is esophagogastroduodenoscopy (EGD). Documentation of complete examination of esophagus, stomach, and duodenum and targeted biopsies of suspected and established lesions is very important part of EGD. It is very important to improve the detection rate of Barrett’s esophagus (BE) in our busy endoscopy practice. In a review article, Dutta has highlighted the currently available and suitable options like acetic acid-based chromoendoscopy or image-enhanced endoscopy for the identification of dysplasia.3 The detection of BE can be improved by performing adequate and systemic examination during EGD. Among all qualitymetrics, themost studied and validated are related to colonoscopy. The proposed quality metrics for colonoscopy procedure are related to bowel preparation, cecal intubation rate, adenoma detection rate, and colonoscopy withdrawal time.4–6 For identification of all possible lesions and improving the adenoma detection rate, the complete examination of large intestine with good bowel preparation is essential.6 Poor bowel preparation not only increases the duration of procedure but also increases the chances of missing the lesions ultimately leading to increased healthcare cost due to repeat colonoscopy.7 Constipation is one of the important reason for poor bowel preparation. Theoretically, prucalopride which is the agonist of serotonin type 4 receptors may augment the effect of polyethylene glycol preparation, which is considered as one of the safest and efficacious agents for bowel preparation. In a study, Singh et al, however, found that prucalopride has no additi","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47914655","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}
Pastor Joaquín Ortiz Mendieta, L. Tolentino, D. Centeno, John Alexander Lata Guacho, L. Felipe, F. Maluf-Filho
Abstract Extramedullary plasmacytoma is an immunoproliferative disease of mature B cell that produces immunoglobulins by clonal expansion. Plasma cell neoplasms are responsible for less than 0.1% of all pancreatic masses, they can be primary or secondary to multiple myeloma (MM). We present the case of a 56-year-old man with extramedullary solitary plasmacytoma located in the pancreas, presented with abdominal pain and jaundice. Imaging characteristics are similar to those of other pancreatic diseases, and the diagnosis is confirmed by immunohistochemistry due to the presence of a homogeneous infiltrate of monoclonal plasma cells, which typically express CD38 and CD 138 markers and the presence of kappa/lambda light chains.
{"title":"Extramedullary Plasmacytoma: A Rare Entity","authors":"Pastor Joaquín Ortiz Mendieta, L. Tolentino, D. Centeno, John Alexander Lata Guacho, L. Felipe, F. Maluf-Filho","doi":"10.1055/s-0042-1759511","DOIUrl":"https://doi.org/10.1055/s-0042-1759511","url":null,"abstract":"Abstract Extramedullary plasmacytoma is an immunoproliferative disease of mature B cell that produces immunoglobulins by clonal expansion. Plasma cell neoplasms are responsible for less than 0.1% of all pancreatic masses, they can be primary or secondary to multiple myeloma (MM). We present the case of a 56-year-old man with extramedullary solitary plasmacytoma located in the pancreas, presented with abdominal pain and jaundice. Imaging characteristics are similar to those of other pancreatic diseases, and the diagnosis is confirmed by immunohistochemistry due to the presence of a homogeneous infiltrate of monoclonal plasma cells, which typically express CD38 and CD 138 markers and the presence of kappa/lambda light chains.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47917397","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}
A 36-year-old man underwent chemoradiotherapy followed by surgery for Ewing’s sarcoma of paranasal sinuses. Post-treatment he recovered well. Two years later he presented with abdomen pain, vomiting, and melena. Contrast-enhanced computed tomography of abdomen showed mass lesion in right colon, involving cecum and ascending colon along with abdomen lymphadenopathy and ascites (►Fig. 1). Colonoscopy was performed that detected large ulceroproliferative growth with luminal narrowing in ascending colon, which could not negotiate scope further to visualize cecum (►Fig. 2). Endoscopically lesion was looking like adenocarcinoma; however, histopathology examination was suggestive of metastatic round cell tumor. In the background of Ewing’s tumor in the past, immunohistopathology examination was done and CD-99 and vimentin were found strongly positive (►Figs. 3 and 4) with high Ki-index (90%) suggestive of colonic Ewing’s sarcoma. Patient was managed with right hemicolectomy plus ileocecal anastomosis followed by chemotherapy. Ewing’s sarcoma is amalignant tumor that primarily involves bone and soft tissue. Among extraosseous tumors, the most common sites of disease are trunk, extremities, head and neck, and retroperitoneum. However, involvement of colon is rare.1 Management of Ewing’s sarcoma has evolved over the last few decades to the present treatment involving multiagent chemotherapy combined with surgery and/or radiotherapy. Combination chemotherapy has traditionally included vincristine, doxorubicin, cyclophosphamide, and dactinomycin.2 Our case
{"title":"Metastatic Ewing's Sarcoma in Right Colon","authors":"S. Kothakota, S. Nistala, Satish Babu Boddeplli","doi":"10.1055/s-0043-1762573","DOIUrl":"https://doi.org/10.1055/s-0043-1762573","url":null,"abstract":"A 36-year-old man underwent chemoradiotherapy followed by surgery for Ewing’s sarcoma of paranasal sinuses. Post-treatment he recovered well. Two years later he presented with abdomen pain, vomiting, and melena. Contrast-enhanced computed tomography of abdomen showed mass lesion in right colon, involving cecum and ascending colon along with abdomen lymphadenopathy and ascites (►Fig. 1). Colonoscopy was performed that detected large ulceroproliferative growth with luminal narrowing in ascending colon, which could not negotiate scope further to visualize cecum (►Fig. 2). Endoscopically lesion was looking like adenocarcinoma; however, histopathology examination was suggestive of metastatic round cell tumor. In the background of Ewing’s tumor in the past, immunohistopathology examination was done and CD-99 and vimentin were found strongly positive (►Figs. 3 and 4) with high Ki-index (90%) suggestive of colonic Ewing’s sarcoma. Patient was managed with right hemicolectomy plus ileocecal anastomosis followed by chemotherapy. Ewing’s sarcoma is amalignant tumor that primarily involves bone and soft tissue. Among extraosseous tumors, the most common sites of disease are trunk, extremities, head and neck, and retroperitoneum. However, involvement of colon is rare.1 Management of Ewing’s sarcoma has evolved over the last few decades to the present treatment involving multiagent chemotherapy combined with surgery and/or radiotherapy. Combination chemotherapy has traditionally included vincristine, doxorubicin, cyclophosphamide, and dactinomycin.2 Our case","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49092946","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}
Colorectal cancer (CRC) is one of the leading cause of cancer deaths worldwide and increasing use of screening colonoscopy has reduced the CRC related mortality. 1,2 The adenoma miss ratehas been shown to be 25% for anyadenoma and 27% for serrated polyps in a meta-analysis. 3 This may explain the occurrence of interval cancer. Adenoma detection rate (ADR) is one of the important quality indicators of colonoscopy. An improvement in the ADR is associated with lower interval CRCs and lower mortality. 4,5 New technologies have been reported in the literature to improve ADR, including en-hanced optics, endocuff attachments, extra wide angle endo-scopes and cap-assisted techniques to have a better mucosa visualization and eventually reduce the adenoma miss rate. In the
{"title":"Artificial Intelligence for Colonic Polyp and Adenoma Detection: The Way Forward","authors":"G. Rodge","doi":"10.1055/s-0043-1762917","DOIUrl":"https://doi.org/10.1055/s-0043-1762917","url":null,"abstract":"Colorectal cancer (CRC) is one of the leading cause of cancer deaths worldwide and increasing use of screening colonoscopy has reduced the CRC related mortality. 1,2 The adenoma miss ratehas been shown to be 25% for anyadenoma and 27% for serrated polyps in a meta-analysis. 3 This may explain the occurrence of interval cancer. Adenoma detection rate (ADR) is one of the important quality indicators of colonoscopy. An improvement in the ADR is associated with lower interval CRCs and lower mortality. 4,5 New technologies have been reported in the literature to improve ADR, including en-hanced optics, endocuff attachments, extra wide angle endo-scopes and cap-assisted techniques to have a better mucosa visualization and eventually reduce the adenoma miss rate. In the","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48292857","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}
S. Afzalpurkar, V. Rai, Nikhil Sonthalia, G. Rodge, Awanesh Tewary, Mahesh K Goenka
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.
{"title":"Comparison of Endoscopic Ultrasound-Guided Fine-Needle Aspiration with Fine-Needle Biopsy for Solid Gastrointestinal Lesions: A Randomized Crossover Single-Center study","authors":"S. Afzalpurkar, V. Rai, Nikhil Sonthalia, G. Rodge, Awanesh Tewary, Mahesh K Goenka","doi":"10.1055/s-0042-1760276","DOIUrl":"https://doi.org/10.1055/s-0042-1760276","url":null,"abstract":"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.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42002116","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}
Abstract Radio frequency ablation (RFA) involves use of thermal energy to perform ablation of tissues. It has a wide range of application in gastrointestinal tract. Over the last few years, several studies have reported successful and safe application in the biliary and pancreatic tissues. It is particularly beneficial in patients with biliary malignancies in whom it has shown to improve survival. Additionally, it can be applied in occluded metal stents secondary to tumor ingrowth to prolong the patency of stents. In pancreas, RFA can successfully ablate cystic lesions and neuroendocrine tumors. It has also been applied in unresectable pancreatic cancers. This review discusses the application of endobiliary and pancreatic RFAs.
{"title":"Endobiliary and Pancreatic Radiofrequency Ablations","authors":"Anurag S. Lavekar, Saurabh S. Mukewar","doi":"10.1055/s-0042-1756485","DOIUrl":"https://doi.org/10.1055/s-0042-1756485","url":null,"abstract":"Abstract Radio frequency ablation (RFA) involves use of thermal energy to perform ablation of tissues. It has a wide range of application in gastrointestinal tract. Over the last few years, several studies have reported successful and safe application in the biliary and pancreatic tissues. It is particularly beneficial in patients with biliary malignancies in whom it has shown to improve survival. Additionally, it can be applied in occluded metal stents secondary to tumor ingrowth to prolong the patency of stents. In pancreas, RFA can successfully ablate cystic lesions and neuroendocrine tumors. It has also been applied in unresectable pancreatic cancers. This review discusses the application of endobiliary and pancreatic RFAs.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45015015","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}
Anudeep Katrevula, Goutham Reddy Katukuri, A. Singh, P. Inavolu, H. Rughwani, Siddhartha Reddy Alla, M. Ramchandani, N. Duvvur
Abstract Background and Aims Precise optical diagnosis of colorectal polyps could improve the cost-effectiveness of colonoscopy and reduce polypectomy-related complications. We conducted this study to estimate the diagnostic performance of visual inspection alone (WLI + NBI) and of EndoBRAIN (endocytoscopy-computer-aided diagnosis [EC-CAD]) in identifying a lesion as neoplastic or nonneoplastic using EC in real-world scenario. Methods In this observational, prospective, pilot study, a total of 55 polyps were studied in the patients aged more than or equal to 18 years. EndoBRAIN is an artificial intelligence (AI)-based system that analyzes cell nuclei, crypt structure, and vessel pattern in differentiating neoplastic and nonneoplastic lesion in real-time. Endoscopist assessed polyps using white light imaging (WLI), narrow band imaging (NBI) initially followed by assessment using EC with NBI and EC with methylene blue staining. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of endoscopist and EndoBRAIN in identifying the neoplastic from nonneoplastic polyp was compared using histopathology as gold-standard. Results A total of 55 polyps were studied, in which most of them were diminutive (36/55) and located in rectum (21/55). The image acquisition rate was 78% (43/55) and histopathology of the majority was identified to be hyperplastic (20/43) and low-grade adenoma (16/43). EndoBRAIN identified colonic polyps with 100% sensitivity, 81.82% specificity (95% confidence interval [CI], 59.7–94.8%), 90.7% accuracy (95% CI, 77.86–97.41%), 84% positive predictive value (95% CI, 68.4–92.72%), and 100% negative predictive value. The sensitivity and negative predictive value were significantly greater than visual inspection of endoscopist. The diagnostic accuracy seems to be superior; however, it did not reach statistical significance. Specificity and positive predictive value were similar in both groups. Conclusion Optical diagnosis using EC and EC-CAD has a potential role in predicting the histopathological diagnosis. The diagnostic performance of CAD seems to be better than endoscopist using EC for predicting neoplastic lesions.
{"title":"Real-World Experience of AI-Assisted Endocytoscopy Using EndoBRAIN—An Observational Study from a Tertiary Care Center","authors":"Anudeep Katrevula, Goutham Reddy Katukuri, A. Singh, P. Inavolu, H. Rughwani, Siddhartha Reddy Alla, M. Ramchandani, N. Duvvur","doi":"10.1055/s-0042-1758535","DOIUrl":"https://doi.org/10.1055/s-0042-1758535","url":null,"abstract":"Abstract Background and Aims Precise optical diagnosis of colorectal polyps could improve the cost-effectiveness of colonoscopy and reduce polypectomy-related complications. We conducted this study to estimate the diagnostic performance of visual inspection alone (WLI + NBI) and of EndoBRAIN (endocytoscopy-computer-aided diagnosis [EC-CAD]) in identifying a lesion as neoplastic or nonneoplastic using EC in real-world scenario. Methods In this observational, prospective, pilot study, a total of 55 polyps were studied in the patients aged more than or equal to 18 years. EndoBRAIN is an artificial intelligence (AI)-based system that analyzes cell nuclei, crypt structure, and vessel pattern in differentiating neoplastic and nonneoplastic lesion in real-time. Endoscopist assessed polyps using white light imaging (WLI), narrow band imaging (NBI) initially followed by assessment using EC with NBI and EC with methylene blue staining. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of endoscopist and EndoBRAIN in identifying the neoplastic from nonneoplastic polyp was compared using histopathology as gold-standard. Results A total of 55 polyps were studied, in which most of them were diminutive (36/55) and located in rectum (21/55). The image acquisition rate was 78% (43/55) and histopathology of the majority was identified to be hyperplastic (20/43) and low-grade adenoma (16/43). EndoBRAIN identified colonic polyps with 100% sensitivity, 81.82% specificity (95% confidence interval [CI], 59.7–94.8%), 90.7% accuracy (95% CI, 77.86–97.41%), 84% positive predictive value (95% CI, 68.4–92.72%), and 100% negative predictive value. The sensitivity and negative predictive value were significantly greater than visual inspection of endoscopist. The diagnostic accuracy seems to be superior; however, it did not reach statistical significance. Specificity and positive predictive value were similar in both groups. Conclusion Optical diagnosis using EC and EC-CAD has a potential role in predicting the histopathological diagnosis. The diagnostic performance of CAD seems to be better than endoscopist using EC for predicting neoplastic lesions.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42981835","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}
G. Patil, Amol Vadgaonkar, A. Dalal, Sanil Parekh, Animesh Shah, Poorva Haridas, P. Gupte, Sehajad Vora, A. Maydeo
Abstract A 35-year female with Plummer Vinson syndrome (PVS) presented with a history of progressive dysphagia over six months, not responding to iron therapy and endoscopic dilatations. Her upper gastrointestinal endoscopy showed a post-cricoid web dilated using a Savary-Gilliard dilator. On NBI, a long segment circumferential lesion with abnormal microvascular architecture was noted in the mid esophagus. Biopsy showed high-grade dysplastic squamous epithelium. The patient underwent minimally invasive, circumferential endoscopic submucosal dissection (ESD) and received oral prednisolone to prevent stricture formation. Resected margins were free of dysplasia. At follow-up there was no evidence of recurrence or stricture formation. To our knowledge, this is the first case of PVS with squamous proliferation with high-grade dysplasia that was successfully treated with circumferential ESD. Screening endoscopy helps in the downstaging of early cancer, and timely intervention helps to treat this with a minimally invasive approach like ESD.
{"title":"Endoscopic Submucosal Dissection for Esophageal Squamous Cell High-grade Dysplasia in a Patient with Plummer Vinson Syndrome","authors":"G. Patil, Amol Vadgaonkar, A. Dalal, Sanil Parekh, Animesh Shah, Poorva Haridas, P. Gupte, Sehajad Vora, A. Maydeo","doi":"10.1055/s-0042-1759510","DOIUrl":"https://doi.org/10.1055/s-0042-1759510","url":null,"abstract":"Abstract A 35-year female with Plummer Vinson syndrome (PVS) presented with a history of progressive dysphagia over six months, not responding to iron therapy and endoscopic dilatations. Her upper gastrointestinal endoscopy showed a post-cricoid web dilated using a Savary-Gilliard dilator. On NBI, a long segment circumferential lesion with abnormal microvascular architecture was noted in the mid esophagus. Biopsy showed high-grade dysplastic squamous epithelium. The patient underwent minimally invasive, circumferential endoscopic submucosal dissection (ESD) and received oral prednisolone to prevent stricture formation. Resected margins were free of dysplasia. At follow-up there was no evidence of recurrence or stricture formation. To our knowledge, this is the first case of PVS with squamous proliferation with high-grade dysplasia that was successfully treated with circumferential ESD. Screening endoscopy helps in the downstaging of early cancer, and timely intervention helps to treat this with a minimally invasive approach like ESD.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48022763","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}
Laura Tejerizo-García, Ana Meníndez-Ramos, Carmen Villar-Lucas, A. Velasco-Guardado
Abstract We present the case of a patient with upper gastrointestinal bleeding caused by an atrioesophageal fistula secondary to radiofrequency ablation for the treatment of refractory atrial fibrillation. Atrioesophageal fistula is a rare but serious complication. The endoscopic treatment is not established in the case of vascular-enteric fistulas and is still a challenge for endoscopists, which requires in most cases a multidisciplinary approach.
{"title":"Gastrointestinal Bleeding Caused by Atrioesophageal Fistula Secondary to Atrial Fibrillation Ablation","authors":"Laura Tejerizo-García, Ana Meníndez-Ramos, Carmen Villar-Lucas, A. Velasco-Guardado","doi":"10.1055/s-0042-1759509","DOIUrl":"https://doi.org/10.1055/s-0042-1759509","url":null,"abstract":"Abstract We present the case of a patient with upper gastrointestinal bleeding caused by an atrioesophageal fistula secondary to radiofrequency ablation for the treatment of refractory atrial fibrillation. Atrioesophageal fistula is a rare but serious complication. The endoscopic treatment is not established in the case of vascular-enteric fistulas and is still a challenge for endoscopists, which requires in most cases a multidisciplinary approach.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48696491","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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