Background: Artificial intelligence (AI)-assisted colonoscopy has emerged as a tool to enhance adenoma detection rates (ADRs) and improve lesion characterization. However, its performance in real-world settings, especially in developing countries, remains uncertain.
Aims: The aim of this study was to evaluate the impact of AI on ADRs and its concordance with histopathological diagnosis.
Methods: A matched case-control study was conducted at a colorectal cancer (CRC) referral center, including 146 patients aged 45-75 years who underwent colonoscopy for CRC screening or surveillance. Patients were allocated into two groups: AI-assisted colonoscopy (n=74) and high-definition conventional colonoscopy (n=72). The primary outcome was ADR, and the secondary outcome was the agreement between AI-based lesion characterization and histopathology. Statistical analysis was performed with a significance level of p<0.05.
Results: ADR was higher in the AI group (60%) than in the control group (50%), but this difference was not statistically significant (p>0.05). AI-assisted lesion characterization showed substantial agreement with histopathology (kappa=0.692). No significant difference was found in withdrawal time (29 min vs. 27 min; p>0.05), indicating that AI did not delay the procedure.
Conclusions: Although AI did not significantly increase ADR compared to conventional colonoscopy, it demonstrated strong histopathological concordance, supporting its reliability in lesion characterization. AI may reduce interobserver variability and optimize real-time decision-making, reinforcing its clinical utility in CRC screening.
Background: Groove pancreatitis is an unusual form of chronic pancreatitis that can be mistaken for a pancreatic head neoplasm.
Background: Once the diagnosis is confirmed, clinical management follows the standard recommendations for chronic pancreatitis.
Background: Surgery is indicated when clinical treatment fails or when there is diagnostic uncertainty regarding pancreatic neoplasia.
Background: Pancreatoduodenectomy is an effective treatment option when performed in high-volume referral centers.
Background: Groove pancreatitis (GP) is a rare, segmental form of chronic pancreatitis that primarily affects individuals between 40 and 50 years of age. It has been referred to by various other names, such as paraduodenal pancreatitis, cystic dystrophy of heterotopic pancreas, duodenal dystrophy, duodenal pancreatic hamartoma, paraduodenal wall cyst, and myoadenomatosis. This distinct and sporadic form of pancreatitis (GP) can be classified, depending on the affected segment, into a segmental form - affecting the entire pancreatic head - and a pure form limited to the pancreaticoduodenal groove, with preservation of the remaining pancreatic parenchyma. Its true incidence, as well as its pathophysiological mechanisms, remains unknown.
Background: Groove pancreatitis is a rare, segmental form of chronic pancreatitis that, in some cases, may be mistaken for pancreatic head neoplasia, with imaging modalities including endoscopic ultrasound currently playing a key role in its diagnosis. A review of the medical papers indicates that initial treatment should be multidisciplinary, similar to the management of classic chronic pancreatitis. When there is little or no response to conservative and/or endoscopic treatment, surgical intervention is indicated, and pancreatoduodenectomy is a good option, provided it is performed in centers with extensive experience in pancreatobiliary surgery.
Background: Groove pancreatitis (GP) is a rare and segmental form of chronic pancreatitis that affects the pancreaticoduodenal sulcus. Its pathophysiology is still not well known, and several etiological factors have been attributed, with chronic alcohol consumption being the most common association. Its treatment still generates controversy. The initial clinical approach followed by endoscopic therapies prevails. Surgery is indicated when these treatment options fail.
Aims: The aim of this study was to analyze the clinical, imaging, and surgical treatment data of a series of patients diagnosed with GP.
Methods: The clinical, radiological, surgical, and postoperative follow-up data were analyzed, in addition to the histopathological results of chronic pancreatitis, in patients undergoing pancreaticoduodenectomy.
Results: A total of eight patients were i
Background: Liver transplantation (LT) in patients aged ≥70 years is feasible with selected donors.
Background: Short-term outcomes were comparable to those in younger recipients.
Background: Elderly patients had higher intensive care unit (ICU) stay and transfusion needs.
Background: Advanced age should not be a contraindication for LT when carefully evaluated.
Background: A retrospective analysis of liver transplants was performed, comparing patients over and under 70 years of age. The elderly group was transplanted with careful donor selection and obtained results comparable to those of the younger group.
Background: This study aims to show that elderly patients over 70 years of age can have good results after liver transplantation, comparable to patients under 70 years of age, with good donor selection and perhaps additional points to favor their position on the waiting list.
Background: Liver transplantation (LT) is increasingly recognized as a treatment option for various diseases affecting a growing elderly population. However, its use in patients over 70 years of age remains controversial in centers with suboptimal outcomes or high waitlist mortality.
Aim: The aim of this study was to evaluate the effectiveness of LT as a treatment option for elderly patients aged 70 years or older, in comparison with younger recipients.
Methods: This retrospective study was conducted based on medical record data from 309 liver transplant recipients treated by the same surgical team across three hospitals - two located in São Paulo, São Paulo state (SP) and one in Rio Branco, Acre state (AC). Patients were divided into two groups for comparison: those aged up to 69 years (Group I) and those aged 70 years or older (Group II).
Results: Donor characteristics were similar between the two groups, except for a higher norepinephrine dose in Group I (p<0.05). Group II showed greater transfusion requirements and longer intensive care unit (ICU) stays (p<0.05), as well as higher rates of malnutrition and comorbidities. Notably, 90-day survival was comparable between the groups.
Conclusions: Patients aged 70 years or older can achieve outcomes comparable to those of younger recipients, provided they receive grafts from carefully selected donors. This population should not be excluded from transplant waitlists, and specific allocation policies or scoring adjustments should be considered to ensure equitable access.
Background: Pancreatic cancer is still a terrifying condition that has a high mortality rate due to its rapid progression and treatment complexity. However, there is still no consensus on what the gold standard of treatment for locally advanced pancreatic cancer (LAPC) is.
Aims: The aim of this study was to review the current evidence-based data on treatment strategies for LAPC, comparing pancreatoduodenectomy with vascular reconstruction (PDVR) and chemotherapy alone (CA).
Methods: This systematic review was performed according to the PRISMA 2020 guidelines. Overall survival (OS) was the primary endpoint, while progression-free survival (PFS) was the secondary endpoint. The included studies were published between 2013 and 2023.
Results: A total of 16 relevant papers were found in the literature search. The median PFS duration for CA varied from 3.22 to 11.7 months, whereas the median overall survival (mOS) varied from 5.95 to 23.0 months. The mOS ranged from 12.7 to 24.9 months and the median PFS time ranged from 8.5 to 22.5 months for patients submitted to neoadjuvant therapy followed by PDVR.
Conclusions: LAPC presents worse outcomes when patients are submitted to CA with gemcitabine only, or when patients undergo upfront PDVR.
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