American Journal of Gastroenterology最新文献

{"title":"Accuracy of Visual Estimation for Measuring Colonic Polyp Size: A Systematic Review and Meta-Analysis.","authors":"Abraham Z Cheloff, Leah Kim, Mark B Pochapin, Aasma Shaukat, Violeta Popov","doi":"10.14309/ajg.0000000000003391","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003391","url":null,"abstract":"<p><strong>Background: </strong>Measurement of colorectal polyps is typically performed via visual estimation, which is prone to bias. Studies have evaluated the accuracy of visual estimation and utility of assistive tools, but results have been mixed. This study aims to clarify the accuracy of visual estimation as a measurement tool, and the benefits of artificial intelligence.</p><p><strong>Methods: </strong>MEDLINE and Embase were searched through October 2024. Extraction and quality assessment were performed independently by two authors. The primary outcome was the pooled absolute mean difference in size between visual estimation and control. Secondary outcomes included subgroup analysis of expert vs trainee status, accuracy of artificial intelligence, study origin (East vs. West), comparator type, definition of accuracy, polyp size, direction of estimation, and image type.</p><p><strong>Results: </strong>35 studies with 42,964 polyp measurements were included in our analysis. All studies were of high quality and there was no evidence of publication bias. The pooled absolute mean difference from comparator was 1.68mm (CI 1.21-2.15) with high variability explained by differences in the comparator, the direction of estimation, image type, and size of the polyp. Overall accuracy was 60% with high variability as well, with increased accuracy with video displayed over photos. Artificial intelligence improved accuracy with an odds ratio of 7.46.</p><p><strong>Conclusion: </strong>Visual estimation is an inaccurate and imprecise way to measure colorectal polyps. Further research is needed to determine the impact on clinical outcomes related to colorectal cancer. Investment in new technology to aid in polyp measurement is an important next step.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Real-time Classification of Disease Severity in Ulcerative Colitis: Artificial Intelligence as the Trigger for a Second Opinion.","authors":"Bobby Lo, Bjørn Møller, Christian Igel, Signe Wildt, Ida Vind, Flemming Bendtsen, Johan Burisch, Bulat Ibragimov","doi":"10.14309/ajg.0000000000003382","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003382","url":null,"abstract":"<p><strong>Objective: </strong>Endoscopic classification of ulcerative colitis (UC) shows high interobserver variation. Previous research demonstrated that artificial intelligence (AI) can match the accuracy of central reading in scoring still images. We now extend this assessment to longer colon segments and integrate AI into clinical workflows, evaluating its use for real-time, video-based classification of disease severity, and as a support system for physicians.</p><p><strong>Methods: </strong>We trained a convolutional neural network with the Mayo Endoscopic Subscores (MES) of 2,561 images and 53 videos from 645 patients. The model differentiated scoreable from unscoreable endoscopy sections through open-set recognition. Validation involved 140 video clips from 44 UC patients. Six inflammatory bowel disease (IBD) experts and 16 non-experts rated these videos, with expert scores as the gold standard. We assessed the model's performance and the value as a supporting system. Lastly, the model underwent an alpha test on a real-world patient as a real-time endoscopic support.</p><p><strong>Results: </strong>The model achieved an accuracy of 82%, with no significant differences between the experts and the AI. When used as a supporting system, it improved non-IBD experts' performance by 12% and disagreed with the primary physician in 20-39% of cases. During the alpha test, it was successfully integrated into clinical practice, accurately distinguishing between MES 0 and MES 1, consistent with endoscopists' assessments.</p><p><strong>Conclusions: </strong>Our innovative AI model shows significant potential for enhancing the accuracy of UC severity classification and improving the proficiency of non-IBD experts. It is designed for clinical use and has proven feasible in real-world testing.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unrecognized threat: An evaluation of exposure to air pollutants during smoke-generating endoscopy procedures.","authors":"Trent Walradt, Daniel Szvarca, Jaime Hart, Gary Adamkiewicz, Qiyue Nie, Madeleine Wissoker, Khushi Desai, Yuzhu Wang, Hiroyuki Aihara, Christopher C Thompson","doi":"10.14309/ajg.0000000000003388","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003388","url":null,"abstract":"<p><strong>Introduction: </strong>To characterize the smoke generated during several endoscopic procedures and evaluate the efficacy of a smoke evacuation system as a preventative measure.</p><p><strong>Methods: </strong>Monitoring devices in closure proximity to patients measured particulate matter (PM) and volatile organic compounds (VOCs) during endoscopic procedures. The impact of a smoke evacuator system was also assessed.</p><p><strong>Results: </strong>PM and VOC levels were significantly elevated during all procedures. The smoke evacuator reduced exposure.</p><p><strong>Discussion: </strong>Smoke produced during endoscopy is a potential health risk for endoscopy staff. Protective measures and further research on long-term exposure effects are warranted.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Surveillance Colonoscopy Timing on Colorectal Cancer Incidence Following Advanced Adenoma Resection.","authors":"Munenori Honda, Yasushi Oda, Ryosuke Gushima, Hideaki Miyamoto, Hideaki Naoe, Kiwamu Hasuda, Kouichi Sakurai, Yoshitaka Murakami, Yasuhito Tanaka","doi":"10.14309/ajg.0000000000003390","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003390","url":null,"abstract":"<p><strong>Introduction: </strong>Index colonoscopy findings can affect surveillance decisions that have an impact on the future risk of colorectal cancer (CRC). However, the effectiveness of surveillance colonoscopy in reducing CRC risk remains unclear. This study aimed to evaluate whether the timing of the first surveillance colonoscopy affected CRC incidence rates.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at two community endoscopy clinics between 2005 and 2021, including 20,397 individuals. Based on the findings at index colonoscopy, we categorized into four groups: advanced adenoma (AA), ≥3 non-AAs, 1-2 non-AAs, and no adenoma. We compared the cumulative incidence of CRC among these groups, focusing on whether the first surveillance interval was less than or greater than 3 years after index colonoscopy.</p><p><strong>Results: </strong>Index colonoscopy findings identified 11,601 subjects with no adenoma, 5,288 with 1-2 non-AA, 1,484 with ≥3 non-AA, and 2,024 with AA. There were 50 cases of CRC: 23 in the no adenoma, 10 in the 1-2 non-AA, six in the ≥3 non-AA, and 11 in the AA group. First surveillance after 3 years was associated with a higher incidence of subsequent CRC in the AA group (hazard ratio, 3.49; 95% confidence interval, 1.06-11.46; P=0.04).</p><p><strong>Discussion: </strong>In the AA group, surveillance colonoscopy within 3 years was associated with a lower risk of CRC. These findings suggest that a first surveillance within 3 years is particularly effective in patients with AA.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dry suction versus wet suction of endoscopic ultrasound-guided fine-needle biopsy for diagnosis of solid pancreatic lesions:a multicenter randomized controlled non-inferiority trial.","authors":"Shenglin Xu, Jianian Guo, Mengbin Qin, Yiteng Meng, Fang Xie, Weiguang Qiao, Haiyan Hu, Peng Peng, Jahan Rownoak, Socheat Heng, Finang Ung, Yaping Ye, Jing Wang, Weixin Li, Yingying Zou, Li Zou, Shaohui Huang, Side Liu, Junfen Wang, Jun Yao, Yue Li","doi":"10.14309/ajg.0000000000003389","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003389","url":null,"abstract":"<p><strong>Background and aims: </strong>Conclusions regarding the suction techniques of EUS-FNB remain controversial. This study aimed to compare the diagnostic accuracy of the dry suction versus wet suction technique in solid pancreatic lesions (SPLs) and determine the optimal number of passes for EUS-FNB.</p><p><strong>Methods: </strong>This investigation was conducted as a multicenter, randomized, controlled, non-inferiority trial. Patients with SPLs were randomly allocated to receive either the dry or wet suction technique. The primary outcome was diagnostic accuracy. The secondary outcomes included sensitivity, specificity, optimal number of needle passes, specimen quality, procedure time, and adverse events.</p><p><strong>Results: </strong>Of the 200 patients, 193 were included in the final analysis, with 96 in the dry suction group and 97 in the wet suction group. The diagnostic accuracies were 97.92% and 96.91% in the dry and wet groups, respectively, with a 1.01% difference between the study groups (two-sided 95% CI, -3.47% to 5.48%, P=0.659). The overall adverse event rate was 2.6%. No significant differences were observed in sample adequacy (98.9% vs. 98.9%, P = 1) or blood contamination (P = 0.796). Regarding procedure time, there was no statistical difference (18.68±8.03 min vs. 19.36±8.89 min, P=0.626); however, more procedural steps were required in the wet suction technique. No significant difference was found between the cumulative diagnostic accuracy of each needle (1st pass 93.78% vs. 2nd pass 95.34% vs. 3rd pass 97.41%, P = 0.225).</p><p><strong>Disscussion: </strong>The dry suction technique is non-inferior to the wet suction technique for EUS-FNB in SPLs. In the absence of rapid on-site evaluation (ROSE), only one pass was required to achieve more than 90% diagnostic accuracy. (ClinicalTrial.gov number NCT05549856.).</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoplasia detection via colonic surveillance among young individuals with MSH6 and PMS2-associated Lynch Syndrome.","authors":"Alicia Latham, Ying L Liu, Gillain Constantino, Matilde Borio, Sean McCoy, Christina Dudzik, Jordan Heiman, Yelena Kemel, Chinedu Ukaegbu, Maria I Carlo, Megha Ranganathan, Sarah Kane, Jessica Long, Sapna Syngal, Arnold J Markowitz, Zsofia K Stadler, Matthew B Yurgelun, Bryson W Katona","doi":"10.14309/ajg.0000000000003369","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003369","url":null,"abstract":"<p><strong>Purpose: </strong>The age to initiate colonoscopy in MSH6/PMS2-associated Lynch Syndrome (LS) remains uncertain. Herein we characterize colonoscopy findings among young individuals with MSH6/PMS2-associated LS.</p><p><strong>Methods: </strong>Retrospective review of a multi-institutional cohort of individuals with MSH6/PMS2-LS undergoing colonoscopy prior to age 50 was performed. Neoplastic lesions were defined as colorectal cancer (CRC), adenomas, or non-hyperplastic serrated lesions.</p><p><strong>Results: </strong>Among 285 individuals [161 (56%) MSH6; 124 (44%) PMS2], 125 (44%) had a neoplastic finding inclusive of 53 (19%) with CRC [32 (20%) MSH6; 21 (17%) PMS2], with median age at CRC diagnosis of 38 and 38% reporting CRC family history. Among 824 available pooled procedures, there were 194 (24%) procedures with neoplastic lesions identified, including 21(2.6%) with advanced adenomas, 5 (0.5%) with advanced serrated lesions, and 34 (4.1%) with CRC. Among 122 procedures performed under age 30, 16 (13%) had neoplastic findings and 4 (3.3%) had CRC, of which all were found prior to LS diagnosis. Findings did not differ between MSH6 and PMS2 carriers.</p><p><strong>Conclusions: </strong>Among individuals with MSH6/PMS2-associated LS undergoing early colonoscopy, neoplasia was common, even in those under 30. Current recommendations suggesting delayed initiation of surveillance among such patients may lead to missed preventive opportunities.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polypoid Gastric Metastasis as Initial Finding of Prostate Cancer: A Rare Case Report.","authors":"Di Zhang, Ying Jiang, Ruzhen Jia","doi":"10.14309/ajg.0000000000003376","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003376","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Extensive colonic ulceration due to mucormycosis after renal transplantation.","authors":"Aoli Diao, Jie Xu, Bota Cui","doi":"10.14309/ajg.0000000000003377","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003377","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Gastric Plexiform Fibromyxoma Associated With Secondary Hypertension: A Case Report (S5145).","authors":"Megan Costello, Lavina Thadani, Vinay Jahagirdar, Erin Algeo, Jason Singh, John Campbell","doi":"10.14309/ajg.0000000000003316","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003316","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of 1 L polyethylene glycol plus ascorbic acid with linaclotide versus senna for bowel preparation: A multicenter, endoscopist-blinded, randomized controlled trial (Apple trial).","authors":"Natsumi Maeda, Akira Higashimori, Daijiro Kabata, Ikki Yamamoto, Tsuyoshi Yanagida, Daiyu Kin, Yuji Matsumoto, Rieko Nakata, Atsushi Hashimoto, Akinari Sawada, Hirotsugu Maruyama, Junichi Okamoto, Takayuki Katsuno, Yuji Nadatani, Masaki Ominami, Shusei Fukunaga, Kenichi Morimoto, Shuhei Hosomi, Fumio Tanaka, Masami Nakatani, Koichi Taira, Eiji Sasaki, Takashi Fukuda, Keiko Ota, Hisako Yoshida, Toshio Watanabe, Yasuhiro Fujiwara","doi":"10.14309/ajg.0000000000003370","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003370","url":null,"abstract":"<p><strong>Objectives: </strong>No bowel preparation for colonoscopy achieves optimal efficacy and tolerability. Combining polyethylene glycol plus ascorbic acid (PEG-Asc) with adjuvants has been explored to enhance cleansing efficacy and reduce the required volume. This study aimed to evaluate whether adding 0.5 mg linaclotide to 1-L PEG-Asc (1 L-PEG/AL) improves superior cleansing compared to adding 24 mg senna (1 L-PEG/AS), which we previously reported to be non-inferior to the standard regimen of 2 L PEG-Asc.</p><p><strong>Methods: </strong>A multicenter, endoscopist-blinded, randomized controlled trial was conducted at five centers in Japan with outpatients scheduled for colonoscopy. The primary outcome was adequate bowel preparation (BP), evaluated using the Boston Bowel Preparation Scale. Analyses were stratified based on low- and high-risk groups for inadequate BP.</p><p><strong>Results: </strong>Between April 2022 and April 2023, 1,464 patients were randomized to the 1L-PEG/AL (n=733) or 1L-PEG/AS (n=731). The 1L-PEG/AL demonstrated higher adequate BP rates (92% vs. 86%, P=0.001) compared to 1L-PEG/AS. Both groups experienced similar adverse events and expressed high willingness for repeat BP (83% vs. 81%, P=0.49). In high-risk patients (n=892), 1L-PEG/AL had significantly higher adequate BP rates (94% vs. 86%, P<0.001), whereas rates were comparably high in low-risk patients (n=539) (94% vs. 94%, P=0.66).</p><p><strong>Conclusions: </strong>The linaclotide regimen was superior to the senna regimen in terms of BP efficacy without reducing tolerability. It can be a promising new option for BP, especially in patients at a high-risk of inadequate BP.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}