iGIE最新文献

{"title":"Comparative analysis of early versus late feeding after an EGD-based intervention: meta-analysis","authors":"Priyadarshini Loganathan MD ,&nbsp;Babu P. Mohan MD ,&nbsp;Mahesh Gajendran MD ,&nbsp;Shreyas Saligram MD ,&nbsp;David Alderman MS ,&nbsp;Vishali Moond MD ,&nbsp;Saurabh Chandan MD ,&nbsp;Douglas G. Adler MD","doi":"10.1016/j.igie.2024.02.003","DOIUrl":"10.1016/j.igie.2024.02.003","url":null,"abstract":"<div><h3>Background and Aims</h3><p>The right time to restart feeding after EGD-based interventions is not well established. However, impaired nutrition from prolonged fasting may lead to unfavorable clinical outcomes. Herein, we performed a systematic review and meta-analysis to study the impact of early feeding (within 24 hours) versus late feeding (&gt;24 hours) in patients undergoing acute therapeutic EGD-based interventions.</p></div><div><h3>Methods</h3><p>Multiple databases, including MEDLINE, Scopus, and Embase, were searched (in May 2022) using specific terms for studies evaluating the outcomes of early versus late feeding after EGD-based interventions. Outcomes of interest were early recurrent bleed (&lt;7 days), late recurrent bleed (&gt;7 days), mortality rates, length of hospital stay, and rate of blood transfusion. Standard meta-analysis methods were used using the random-effects model. <em>I</em>²% heterogeneity was used to assess the heterogeneity. The Grading of Recommendations Assessment, Development and Evaluation Working Group approach was used to assess the certainty of evidence.</p></div><div><h3>Results</h3><p>Eight studies (813 patients) were included in the final analysis. The “early feeding” cohort included 411 patients (31% women) with a mean age of 58 years, and the “late feeding” cohort included 402 patients (26.4% women) with a mean age of 57 years. Four studies (283 patients) evaluated patients with band ligation/sclerotherapy in acute variceal bleeding (224 patients), 2 studies (309 patients) with endoscopic treatment of peptic ulcer bleeding, and 2 studies in endoscopic mucosal dissection for gastric mucosal epithelial neoplasia. The pooled risk ratio (RR) of early recurrent bleeding in early feeding versus late feeding was 1.6 (95% confidence interval [CI], .7-3.7; <em>I</em>² = 0%, <em>P</em> = .2). Similarly, the RR of late recurrent bleeding was .9 (95% CI, .4-2.3; <em>I</em>² = 0%, <em>P</em> = .9). The pooled RR of total recurrent bleeding was 1.2 (95% CI, .7-2.2; <em>I</em>² = 0%, <em>P</em> =.3). The pooled RR of mortality between the early feeding and late feeding groups was .6 (95% CI, .3-1.2; <em>I</em>² = 0%, <em>P</em> = .16). The pooled rate of the standard difference of the mean length of hospital stay was –1.184 (95% CI, –1.5 to –.81; <em>I</em>² = 92%, <em>P</em> = .00) between the early and late feeding groups. The pooled rate of the mean difference in blood transfusion between early and late feeding groups was .1 (95% CI, –.4 to .41; <em>I</em>² = 77.6%, <em>P</em> = .96).</p></div><div><h3>Conclusions</h3><p>Our meta-analysis demonstrates early enteral feeding within 24 hours does not appear to have a higher risk of recurrent bleeding and mortality than delayed enteral feeding in patients undergoing EGD-based therapeutic interventions. However, early feeding is associated with a shorter length of hospital stay compared","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 2","pages":"Pages 193-201.e12"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949708624000153/pdfft?md5=c938f1df9fde4a9b8e993541dc498a2a&pid=1-s2.0-S2949708624000153-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139821118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive management of a difficult bile leak after deroofing of hydatid cyst: it’s all about pressures","authors":"Sahaj Rathi MD, DM, MRCP ,&nbsp;Bhavin K. Davra MD, DrNB ,&nbsp;Lileswar Kaman MS, MRCS, PhD","doi":"10.1016/j.igie.2024.02.002","DOIUrl":"10.1016/j.igie.2024.02.002","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Surgery for hepatic hydatid cyst is often complicated by bile leak. In most cases, abolishing the gradient across the ampulla by a sphincterotomy or placing a stent heals the leak. Occasionally, surgical intervention may be required for repair. We share a case of a high-grade bile leak after hepatic hydatid deroofing in which surgical repair was prevented by applying basic principles of hydrostatics.</p></div><div><h3>Methods</h3><p>A 32-year-old man developed a high-grade bile leak after hydatid cyst surgery, with persistent bilious output from the surgical drain. We describe the basic principles, decision-making, and troubleshooting in this complex case that led to a successful outcome with minimally invasive techniques.</p></div><div><h3>Results</h3><p>The patient had an inadequate response to standard endoscopic biliary drainage techniques, including sphincterotomy, plastic stent placement, and external nasobiliary drainage. We created a pressure gradient to drive the bile away from the percutaneous drain by positioning the nasobiliary drain at a lower height. Complete resolution of bile leak was achieved.</p></div><div><h3>Conclusions</h3><p>Differential positioning of drains may be used to alter pressure gradients in patients with bile leak. This technique can be used for minimally invasive management of persistent and/or high-output bile leaks not responsive to standard endoscopic management.</p></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 2","pages":"Pages 163-165"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949708624000141/pdfft?md5=b725882acfe8211c3b3f66ceba888be3&pid=1-s2.0-S2949708624000141-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139874011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an endoscopy technician training certificate program in a community college","authors":"Gottumukkala S. Raju MD ,&nbsp;Kalpesh Patel MD ,&nbsp;Sanjivini Suresh MEd ,&nbsp;Hao Chi Zhang MD ,&nbsp;Angela Diehl MA ,&nbsp;Laura G. Romero MBA ,&nbsp;Liben D. Mahometano MBA ,&nbsp;Sophia Reyes BSN ,&nbsp;Marcela Benitez-Romero BSN, MBA ,&nbsp;Tom Slocum BA ,&nbsp;Roy M. Soetikno MD, MS ,&nbsp;Jean M. Verdeyen BS ,&nbsp;Joanne M. Rach BA ,&nbsp;Edwin L. Dellert BSN, MBA ,&nbsp;Ramon Villegas EdD, MA ,&nbsp;Melissa Bruton BSHCA ,&nbsp;Jeffrey Gricar EdD ,&nbsp;Phillip Nicotera MD, MEd","doi":"10.1016/j.igie.2023.11.013","DOIUrl":"https://doi.org/10.1016/j.igie.2023.11.013","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Surgical operating room technicians require 2 years of formal training and certification before they can assist a surgeon, whereas endoscopy units recruit and train personnel. This discrepancy is because community colleges and other educational venues lack formal endoscopy training programs. We report the development of a training program for endoscopy technicians (ETs) at the Houston Community College (HCC).</p></div><div><h3>Methods</h3><p>We took the following steps to create and validate the ET training program at HCC. We proposed developing an ET training program to the chancellor of the HCC. Based on input from the Development of a Curriculum Conference, we recruited an advisory board of educators who developed a 1-year ET certificate program. The Southern Association of Colleges and Schools Commission on Colleges (SACSOC) approved the program. An endoscopist, a medical illustrator, and an educator developed the learning material. Practical training for the students at various endoscopy centers was arranged. Students took the American Society for Gastrointestinal Endoscopy (ASGE) Endoscopy Technician Training Certificate of Completion Assessment Examination at the end of their course.</p></div><div><h3>Results</h3><p>Successful development of the ET training certificate level II program at the community college required 6 years. Thirteen students enrolled in 2021, and 12 graduated in 2022. All 6 students enrolled in 2022 graduated from the program. All except 1 found employment soon after graduation. The first class obtained a mean score of 58% (range, 38%-77%), and the second class 80% (range, 75%-87%) on the ASGE Endoscopy Technician Training Certificate of Completion Assessment Examination.</p></div><div><h3>Conclusions</h3><p>A multidisciplinary collaborative approach between medical institutions, industry partners, and a community college led to the development of an ET training program, with the successful graduation of enrolled students and clearance of the ASGE certification. This program could be a blueprint for other community colleges to start a similar program.</p></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 2","pages":"Pages 153-162"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949708623001437/pdfft?md5=64289db33f4ee1d3b2175828e63b4f27&pid=1-s2.0-S2949708623001437-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EUS-guided pancreatic duct drainage: a single-center observational study","authors":"Elodie Romailler MD ,&nbsp;Anouk Voutaz MD ,&nbsp;Sarra Oumrani MD ,&nbsp;Mariola Marx MD ,&nbsp;Maxime Robert MD ,&nbsp;Fabrice Caillol MD ,&nbsp;Alain Schoepfer MD ,&nbsp;Sébastien Godat MD","doi":"10.1016/j.igie.2024.04.005","DOIUrl":"10.1016/j.igie.2024.04.005","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Pancreatic duct obstruction can cause pain and atrophy of the pancreatic parenchyma. Endoscopic drainage is the first-line treatment, usually by means of ERCP. However, in some patients, the classic transpapillary approach cannot be performed owing to anatomic inability to access the papilla, rupture of the main pancreatic duct, intracanal stones that cannot be crossed, or tight stenosis of the main pancreatic duct due to extrinsic compression by parenchymal calcifications. EUS-guided pancreatic duct drainage is an efficient and minimally invasive therapeutic alternative for these patients. We aimed to evaluate clinical success of EUS-guided pancreatic duct drainage in our center.</p></div><div><h3>Methods</h3><p>Data of patients who underwent EUS-guided pancreatic duct drainage in our center from 2016 to 2022 were retrospectively reviewed. Clinical success was defined as pain ≤2 on the pain visual analog scale (VAS; 0-10) and no recurrence of obstructive pancreatitis after successful stent placement. If the indication for the procedure was chronic pancreatitis with painless weight loss, then clinical success was defined as weight stabilization or weight regain after the procedure.</p></div><div><h3>Results</h3><p>Forty-six patients (mean age 58 years, 69.6% male) were included. One indication of EUS-guided pancreatic duct drainage was chronic pancreatitis in 69.6% of patients (78.1% due to alcohol abuse). Other indications included postoperative adverse events, rupture of pancreatic duct, and pancreatic cancer. Technical success was achieved in 93.5% of patients. Forty patients had pancreaticogastrostomy and 3 patients pancreaticoduodenostomy. The mean hospital stay was 2 days. Clinical success was 93% in patients who achieved technical success. Remaining pain (VAS &gt;2) occurred in 9.3% of patients and obstructive pancreatitis recurrence in 6.9%. Adverse events occurred in 5 patients (11.6%). Eighteen stent dysfunctions, 16 stent migrations, and 2 stent obstructions were observed. No patients died from the procedure.</p></div><div><h3>Conclusions</h3><p>EUS-guided pancreatic duct drainage showed a high clinical success rate. It is therefore a good minimally invasive alternative to avoid pancreatic surgery in patients with symptomatic pancreatic duct stenosis of benign or malignant etiology who failed ERCP.</p></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 2","pages":"Pages 237-246"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949708624000384/pdfft?md5=a19d0fd7c4ea1a48085a35ada1d85f3b&pid=1-s2.0-S2949708624000384-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140774502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of a fully endoscopic one-anastomosis gastric bypass procedure after endoscopic sleeve gastroplasty in pigs","authors":"Sohaib Ouazzani MD ,&nbsp;Jean-Michel Gonzalez MD, PhD ,&nbsp;Loulia Leclercq MSc ,&nbsp;Flora Ferrari MS ,&nbsp;Stephane Berdah MD, PhD ,&nbsp;Joyce A. Peetermans PhD ,&nbsp;Ornela Gjata MS ,&nbsp;Marc Barthet MD, PhD","doi":"10.1016/j.igie.2024.04.002","DOIUrl":"10.1016/j.igie.2024.04.002","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Endoscopic sleeve gastroplasty (ESG) has become an adopted endoscopic gastric volume-reduction procedure, whereas endoscopic gastric bypass is a recent experimental procedure. We assessed the feasibility and safety of combining ESG with a recently developed fully endoscopic one-anastomosis gastric bypass (OAGB) procedure.</p></div><div><h3>Methods</h3><p>This was a 14-week prospective follow-up of 4 growing pigs using a dedicated gastrojejunal lumen-apposing metal stent (GJ-LAMS) to create a gastrojejunal anastomosis and a duodenal exclusion device (DED). ESG at baseline was followed by the OAGB procedure at weeks 8 to 10 and necropsy at week 14.</p></div><div><h3>Results</h3><p>In all 4 pigs, endoscopic gastroenterostomy realizing OAGB was possible after ESG. In 1 pig, all study procedures from day 0 to week 14 occurred as intended, with normal health and normal necropsy observations, confirming the feasibility of endoscopic OAGB after ESG. GJ-LAMS migration without DED placement occurred in a second pig. A third pig had an asymptomatic unintended gastrocolic anastomosis discovered at necropsy, and the fourth pig died on day 62 (6 days after GJ-LAMS placement) with the finding of ischemic volvulus on necropsy. At 14 weeks, all remaining stents were removed endoscopically uneventfully. Necropsy was then performed, showing limb lengths ranging from 110 cm to 170 cm, with no inflammation or leaks.</p></div><div><h3>Conclusions</h3><p>ESG followed by an endoscopic OAGB procedure with a controlled bypass length was technically feasible. One of 4 test animals died shortly after GJ-LAMS placement and before duodenal exclusion.</p></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 2","pages":"Pages 166-170.e2"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949708624000359/pdfft?md5=40523386e5fff5af3359083009012fea&pid=1-s2.0-S2949708624000359-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140791233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical impact of delayed plastic biliary stent removal because of the COVID-19 pandemic: the experience from a tertiary ERCP referral center","authors":"Dennis Lim MD,&nbsp;Steven Gruchy MD, MSc,&nbsp;Angela Tsai MD,&nbsp;Dana Farina MD,&nbsp;Geoff Williams MD,&nbsp;Jennifer Jones MD, MSc,&nbsp;Kevork Peltekian MD,&nbsp;Navjot Sandila MPH,&nbsp;Ali Kohansal MBBS, MEd","doi":"10.1016/j.igie.2024.04.015","DOIUrl":"10.1016/j.igie.2024.04.015","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Plastic biliary endoprosthesis is widely used because of its high efficacy and low cost. Delays in the removal or exchange of plastic biliary stents may lead to stent occlusion and subsequent sepsis,^1,2 with consensus recommendation of stent removal or exchange within 3 months.^3-7 We postulated that delayed plastic biliary stent removal observed during the pandemic would increase stent-related adverse events. We aim to report our single-center experience with adverse events arising from delayed plastic biliary stent removal.</p></div><div><h3>Methods</h3><p>All individuals who had ERCP-guided plastic biliary stent placement in the Queen Elizabeth II Health Sciences Center hospital in Halifax, Nova Scotia, between December 2019 and March 2022 were included. Stent lifespan was defined as days between stent deployment and removal. Kaplan-Meier survival analysis was used to represent the duration of stent patency. Only 10F-diameter stents were studied. Linear regression was used to analyze possible predictors of stent-related adverse events.</p></div><div><h3>Results</h3><p>In total, 286 cases were analyzed, of which 187 had delayed stent removal. Overall, 216 stents were removed without adverse events; 21 cases required urgent reintervention for adverse events; and in 26 cases, patients died of non-stent-related causes. Twenty-one stents had fully migrated out without causing adverse events. There was no difference in overall adverse events between the nondelayed versus delayed groups (23.2% vs 21.4%; odds ratio [OR], 0.899). Stent adverse events and emergent removal were marginally increased, at an OR of 1.21 and OR of 1.18, respectively, in indications related to stone disease.</p></div><div><h3>Conclusions</h3><p>A significant increase was not observed in stent-related adverse events in individuals with stents removed after 90 days. Plastic biliary stent longevity may be longer than previously thought. Our findings suggest that the majority of inserted plastic biliary stents remain patent up to 6 months without adverse outcomes. Larger studies are required to better characterize other predictors of biliary stent obstruction.</p></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 2","pages":"Pages 264-273"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949708624000487/pdfft?md5=0eaebf3534b18d4909d30c8c91c0afd5&pid=1-s2.0-S2949708624000487-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141058273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mentorship in advanced endoscopy: a conversation with Dr Christopher Thompson","authors":"Vivek Kaul MD, FASGE ,&nbsp;Christopher Thompson MD, FASGE","doi":"10.1016/j.igie.2024.04.014","DOIUrl":"https://doi.org/10.1016/j.igie.2024.04.014","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 2","pages":"Pages 302-306"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949708624000475/pdfft?md5=c35a694a009206c87529f75ab9d58897&pid=1-s2.0-S2949708624000475-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic submucosal dissection for advanced rectal cancer after neoadjuvant chemotherapy: optimizing treatment strategies","authors":"Bao-Hui Song MD ,&nbsp;Rong-Kui Luo MD ,&nbsp;Yun-Shi Zhong MD, PhD ,&nbsp;Ping-Hong Zhou MD, PhD, FASGE ,&nbsp;Ming-Yan Cai MD, PhD, FASGE","doi":"10.1016/j.igie.2023.12.003","DOIUrl":"https://doi.org/10.1016/j.igie.2023.12.003","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 1","pages":"Pages 35-40"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949708623001590/pdfft?md5=924baccc2e8447545da7c4d59346e821&pid=1-s2.0-S2949708623001590-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140290298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced accuracy for classification of video capsule endoscopy images using multiple deep learning convolutional neural networks","authors":"Dongguang Li PhD ,&nbsp;David Cave MD, PhD ,&nbsp;April Li ,&nbsp;Shaoguang Li MD, PhD","doi":"10.1016/j.igie.2023.11.007","DOIUrl":"https://doi.org/10.1016/j.igie.2023.11.007","url":null,"abstract":"<div><h3>Background and aims</h3><p>Video capsule endoscopy (VCE) is widely used in the detection of abnormalities in the small intestine. However, it remains challenging to correctly identify a limited number of possible abnormal images from tens of thousands of total images, and this impediment has limited expansion of the technology. More recently, artificial intelligence (AI) technology has been used in classifying VCE images from patients, but clinical-grade diagnostic accuracy (&gt;99%) has not been achieved.</p></div><div><h3>Methods</h3><p>This study proposes a system for the automatic classification of a number of categories of unbounded VCE images with high accuracy by means of a transfer learning approach using multiple convolutional neural networks (CNNs). With this new approach, it is not necessary to implement image segmentation; thus, the feature extraction becomes automatic, and the existing models can be fine-tuned to obtain specific classifiers.</p></div><div><h3>Results</h3><p>More than 16,000 VCE GI images from normal individuals, including those with normal clean mucosa, the pylorus, the ileocecal valve, a reduced mucosal view due to luminal contents and lymphangiectasia (a normal variant), and patients with 5 pathologic states (angioectasia, bleeding, erosions, ulcers, and foreign bodies), were obtained from a publicly available data set. These were used in building, testing, and validating AI models for evaluating the diagnostic accuracy of our combined 17-CNN deep learning approach. Compared with a single CNN approach used by other research groups, our AI method, using 17 CNNs, achieved an overall diagnostic accuracy of 99.79%, with an accuracy of 100% for identifying bleeding and foreign bodies. The high accuracy was further shown in the confusion matrices, precision, recall, and F1 score.</p></div><div><h3>Conclusions</h3><p>We have developed accurate AI deep learning models for unbounded VCE image classification of various medical conditions in medical practice.</p></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 1","pages":"Pages 72-81"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949708623001371/pdfft?md5=bd53bbbf38460b8793ef89e37ac1f248&pid=1-s2.0-S2949708623001371-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140290880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence rates of Barrett’s esophagus and esophageal adenocarcinoma: a systematic review and meta-analysis","authors":"Jin Lin Tan MBBS ,&nbsp;Kingjin Heng MBBS ,&nbsp;Mohamed Asif Chinnaratha PhD ,&nbsp;Norma B. Bulamu PhD ,&nbsp;Billingsley Kaambwa PhD ,&nbsp;Rajvinder Singh MPhil","doi":"10.1016/j.igie.2024.01.001","DOIUrl":"https://doi.org/10.1016/j.igie.2024.01.001","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Barrett’s esophagus (BE) surveillance is commonly performed to detect early dysplasia and esophageal adenocarcinoma (EAC). However, high-quality incidence rates for the development of dysplasia and EAC in patients with BE are limited. The aim of this study was to perform a systematic review and meta-analysis to provide updated incidence rates for the development of low-grade dysplasia (LGD), high-grade dysplasia (HGD), and EAC in a population of patients with BE undergoing endoscopic surveillance.</p></div><div><h3>Methods</h3><p>We performed a systematic search of Embase and MEDLINE from inception to September 2022. The goal was to identify studies reporting the incidence rates of LGD, EAC, or HGD/EAC as an outcome in patients with nondysplastic BE (NDBE), LGD, or HGD. Respective pooled incidence rates were estimated by using a meta-analysis.</p></div><div><h3>Results</h3><p>Twenty-five studies were included in this meta-analysis comprising 2587 patients with a combined follow-up of 218,351 person-years. For patients with NDBE, pooled incidence rates for progression to LGD, HGD, EAC, and HGD/EAC were 4.29, .52, .21, and .57 per 100 person-years, respectively. For patients with LGD, pooled incidence rates were 3.18 (HGD), 1.16 (EAC), and 5.05 (HGD/EAC) per 100 person-years. For those with HGD, the pooled incidence rate for EAC was 14.16 per 100 person-years.</p></div><div><h3>Conclusions</h3><p>Progression to EAC and HGD/EAC remained low for patients with NDBE. Patients with confirmed (by ≥2 pathologists) LGD may be more likely to develop EAC, prompting a need to assess current BE surveillance strategies in this group.</p></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 1","pages":"Pages 92-103.e3"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949708624000013/pdfft?md5=c13600bdc215cfcef5672eec9f140c6c&pid=1-s2.0-S2949708624000013-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140290882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}