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Crohn's disease (CD) is a progressive, multifactorial, immune-mediated disease characterized by chronic inflammation of any part of the gastrointestinal (GI) tract. Pediatric patients present with a more extensive form of the disease, especially in the upper GI tract with various histopathological inflammatory patterns. Our study aims to analyze the clinical, laboratory, endoscopic, and histopathological findings in children with diagnosed CD and compare results on the initial and follow-up tests. We have included 100 children and adolescents with CD, with performed endoscopic and histopathological (HP) procedures. The results of multiple biopsies executed in these 8 years were matched and compared. We found a statistically significant frequency reduction in stool changes (65.52% to 18.18%), weight loss (35.24% to 4%), and abdominal pain (41.86% to 6.67%) as presenting symptoms. There was an improvement in all laboratory values: fecal calprotectin (1000 to 60,8 μg/g), C-reactive protein (12.2 to 1.9 mg/L), and albumin (36 to 41 g/L). On esophagogastroduodenoscopy and ileo-colonoscopy 36.59% and 64.86% patients had specific findings, respectively. A total of 32 patients had evidence of Crohn's disease in the upper GI tract. Non-caseating granulomas were found on 9% of oesophageal, 18% of gastric, and 12% of duodenal biopsies. In the lower GI tract, we have observed a disease progression in the rectum (72.29 to 82.22%) and descending colon (73.49 to 80%). There was no registered disease progression in the upper GI tract. Our study demonstrated a significant decline in the frequency of symptoms and an improvement in laboratory values on the follow-up examinations. More than a third of our patients had specific endoscopic and HP findings in the upper GI tract, and an additional 23% had HP findings highly suggestive of CD. We demonstrated the importance of regular clinical, laboratory, endoscopic, and histopathological assessments of pediatric CD patients. [ABSTRACT FROM AUTHOR]

Eosinophilic Gastrointestinal Disorders (EGIDs) are a group of conditions characterized by abnormal eosinophil accumulation in the gastrointestinal tract. Among these EGIDs, Eosinophilic Esophagitis (EoE) is the most well documented, while less is known about Eosinophilic Gastritis (EoG), Eosinophilic Enteritis (EoN), and Eosinophilic Colitis (EoC). The role of endoscopy in EGIDs is pivotal, with applications in diagnosis, disease monitoring, and therapeutic intervention. In EoE, the endoscopic reference score (EREFS) has been shown to be accurate in raising diagnostic suspicion and effective in monitoring therapeutic responses. Additionally, endoscopic dilation is the first-line treatment for esophageal strictures. For EoG and EoN, while the literature is more limited, common endoscopic findings include erythema, nodules, and ulcerations. Histology remains the gold standard for diagnosing EGIDs, as it quantifies eosinophilic infiltration. In recent years, there have been significant advancements in the histological understanding of EoE, leading to the development of diagnostic scores and the identification of specific microscopic features associated with the disease. However, for EoG, EoN, and EoC, precise eosinophil count thresholds for diagnosis have not yet been established. This review aims to elucidate the role of endoscopy and histology in the diagnosis and management of the three main EGIDs and to analyze their strengths and limitations, their interconnection, and future research directions. [ABSTRACT FROM AUTHOR]

Background: Ingested foreign bodies may become impacted in the upper gastrointestinal tract, requiring endoscopic removal. Aims: To establish and validate a nomogram to determine the risk of complications following endoscopic foreign body removal. Methods: We retrospectively analyzed the data of 1510 adult patients who underwent endoscopic removal of ingested foreign bodies between January 2019 and December 2022. All participants were randomly allocated in a 7:3 ratio to the training (n = 1057) and validation (n = 453) cohorts. A nomogram for the development of major complications associated with endoscopic foreign body removal was established based on risk factors identified by logistic regression analysis. Results: Four independent risk factors for the development of major complications were identified by multivariate regression analysis: older age, impaction time > 24 h, type of foreign body (animal bones and jujube pits), and number of pressure points exerted on the digestive tract wall (one and ≥ two). The nomogram constructed using these factors showed favorable discriminatory values, with an area under the curve of 0.76 (95% confidence interval, 0.73–0.78) in the training cohort and 0.74 (95% confidence interval, 0.72–0.76) in the validation cohort. Conclusions: Older patients who ingested bones or jujube pits with more pressure points exerted on the digestive tract wall more than 24 h earlier should be considered most at risk of major complications after endoscopic removal of foreign bodies. The nomogram established in this study can be conveniently used to assess patients and develop treatment plans for the management of foreign body ingestion. [ABSTRACT FROM AUTHOR]

Objective: Congenital defects/diseases Background: Duplication of the gastrointestinal tract is a rare congenital malformation that can develop in any part of the digestive tract. These duplications may be asymptomatic into adult age. Situs inversus totalis is a rare congenital anomaly characterized by a mirror transposition of thoracic and abdominal organs. We present a case of a pancreatic pseudocyst in a patient with a combination of situs inversus totalis and doubling of the esophagus, stomach, and first part of the duodenum. Case Report: A 64-year-old woman presented with epigastric pain. Abdominal computed tomography revealed a pancreatic pseudocyst and a previously identified duplication of the esophagus, stomach, and duodenum with situs inversus totalis. The patient underwent esophagogastroduodenoscopy (EGD) with endoscopic ultrasonography for pseudocyst drainage. During EGD, a bifurcation of the esophagus was found. Duplication of the esophagus, stomach, and first part of the duodenum was evident on further advancement. A week later, there was repeated filling of the pseudocyst with a liquid component, and the patient underwent cystogastrostomy with stenting. Five months after discharge, the stent was removed without complications. Conclusions: Duplication of the gastrointestinal tract and situs inversus totalis are very rare congenital malformations that require early diagnosis. While situs inversus totalis does not represent any medical disadvantage, physicians should be aware of abnormal anatomy before procedures to prepare specialists for this in case of the need for special techniques. Endoscopic treatment of pancreatic pseudocysts is safe and effective even in such rare cases. The use of endoscopic methods also minimizes intervention and decreases the length of the patients' stays in the hospital. [ABSTRACT FROM AUTHOR]

Iron deficiency anemia (IDA) can be caused by occult gastrointestinal (GI) blood loss; however, the endoscopic findings in children with anemia are unclear. The study aimed to determine the frequency and factors related to lesions in children with IDA undergoing endoscopy. We retrospectively analyzed the clinical and endoscopic findings of children with a laboratory-based diagnosis of IDA. Of 58 patients, 36 (62.1%) had upper GI tract lesions, with erosive gastritis being the most common lesion. Further, 26 patients underwent concomitant colonoscopy, and 12 (46.2%) had lower GI tract lesions. Overall, 44 (75.9%) patients had lesions in either the upper or lower GI tract. Helicobacter pylori infection was detected in 13 patients (22.4%). Patients with lesions found by endoscopy had significantly lower hemoglobin level (8.9 vs. 10.0 g/dL, p = 0.047) and mean corpuscular volume (75.5 vs. 80.9 fL, p = 0.038). The proportion of patients with previous treatment for IDA was also higher in those with lesions on endoscopy. In multivariate analysis, age of ≥10 years (odds ratio [OR], 6.00; 95% confidence Interval [CI], 0.56–10.75) and positive fecal occult blood test (FOBT) findings (OR, 2.25; 95% CI, 0.14–4.52) were factors related to GI lesions. The presence of GI symptoms was not associated with GI lesions. A high proportion of GI lesions were found by endoscopy in children with IDA in this study. Endoscopy should be considered in children with IDA even without GI symptoms, especially in older children, and those with positive FOBT results. [ABSTRACT FROM AUTHOR]

Significance: Color differences between healthy and diseased tissue in the gastrointestinal (GI) tract are detected visually by clinicians during white light endoscopy; however, the earliest signs of cancer are often just a slightly different shade of pink compared to healthy tissue making it hard to detect. Improving contrast in endoscopy is important for early detection of disease in the GI tract during routine screening and surveillance. Aim: We aim to target alternative colors for imaging to improve contrast using custom multispectral filter arrays (MSFAs) that could be deployed in an endoscopic "chip-on-tip" configuration. Approach: Using an open-source toolbox, Opti-MSFA, we examined the optimal design of MSFAs for early cancer detection in the GI tract. The toolbox was first extended to use additional classification models (k-nearest neighbor, support vector machine, and spectral angle mapper). Using input spectral data from published clinical trials examining the esophagus and colon, we optimized the design of MSFAs with three to nine different bands. Results: We examined the variation of the spectral and spatial classification accuracies as a function of the number of bands. The MSFA configurations tested showed good classification accuracies when compared to the full hyperspectral data available from the clinical spectra used in these studies. Conclusion: The ability to retain good classification accuracies with a reduced number of spectral bands could enable the future deployment of multispectral imaging in an endoscopic chip-on-tip configuration using simplified MSFA hardware. Further studies using an expanded clinical dataset are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Unexpected hypermetabolic activity is often encountered in the gastrointestinal tract when PET/CT is performed for various indications, prompting endoscopic evaluation. Our aim was to characterize the types of lesions seen in segments of the gastrointestinal tract with unexpected PET/CT abnormalities as well as clinically significant lesions seen on endoscopy which did not produce a PET/CT abnormality to guide the endoscopist tasked with evaluating these imaging findings. Methods: We retrospectively reviewed a database of endoscopies performed at City of Hope Comprehensive Cancer Center between January 1, 2016 and September 30, 2021 for an indication of "abnormal PET." We divided the gastrointestinal tract into segments and defined categories of endoscopic/histologic findings for each segment. We counted the number of segments with an abnormal PET/CT finding and corresponding endoscopic/histologic abnormality as well as the number of segments with an endoscopic/histologic abnormality but normal PET/CT. Results: PET/CT identified 209 segments with hypermetabolic activity, 109 of which had corresponding endoscopic/histologic abnormalities. In the jejunum and ileum, all corresponding lesions were malignant. Seventy-three percent of corresponding lesions in the stomach were H. pylori positive. PET/CT failed to detect 34.7% of clinically significant lesions diagnosed endoscopically, including 1 malignancy in the transverse colon and many inflammatory or low-risk premalignant lesions. Conclusion: PET/CT abnormalities seen in the small bowel should be evaluated urgently as nearly all correlates were malignant, while abnormalities in the stomach should prompt workup for H. pylori. Most lesions missed by PET/CT were inflammatory or low-risk premalignant yet clinically significant, confirming the need to inspect the entirety of the upper or lower gastrointestinal tract during endoscopy. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal tract predominant Crohn's Disease (CD) remains an uncommon clinical entity, manifesting limited or vague symptomatology, thus delaying clinical suspicion and subsequent diagnostic evaluation. For that reason, it has not been widely described and there is a lack of clear recommendations for diagnosis or management. Standard Inflammatory Bowel Disease (IBD) evaluation including serologic testing, imaging, and endoscopy may initially not be fruitful. Furthermore, endoscopic evaluation may be inconclusive even in patients with long standing-disease. We describe a 30-year-old male who suffered long with persistent iron-deficiency anemia (IDA) and occasional melaena along with predominant axial arthropathy. Extensive inpatient testing including multiple endoscopic evaluation with standard biopsy were unfruitful. Ultimately, long standing recurrent gastric and duodenal ulcer, suggestive colonoscopy finding, and positive fecal calprotectin in a patient along with spondyloarthropathy drove us toward the diagnosis of Crohn's disease. We started steroid, PPI, sulfasalazine and the patient is on follow up. [ABSTRACT FROM AUTHOR]

Background/Aims: Upper gastrointestinal bleeding (UGIB) is a life-threatening condition that necessitates early identification and intervention and is associated with substantial morbidity, mortality, and socioeconomic burden. However, several diagnostic challenges remain regarding risk stratification and the optimal timing of endoscopy. The PillSense System is a noninvasive device developed to detect blood in patients with UGIB in real time. This study aimed to assess the safety and performance characteristics of PillSense using a simulated bleeding model. Methods: A preclinical study was performed using an in vivo porcine model (14 animals). Fourteen PillSense capsules were endoscopically placed in the stomach and blood was injected into the stomach to simulate bleeding. The safety and sensitivity of blood detection and pill excretion were also investigated. Results: All the sensors successfully detected the presence or absence of blood. The minimum threshold was 9% blood concentration, with additional detection of increasing concentrations of up to 22.5% blood. All the sensors passed naturally through the gastrointestinal tract. Conclusions: This study demonstrated the ability of the PillSense System sensor to detect UGIB across a wide range of blood concentrations. This ingestible device detects UGIB in real time and has the potential to be an effective tool to supplement the current standard of care. These favorable results will be further investigated in future clinical studies. [ABSTRACT FROM AUTHOR]

Toothpicks are commonly used but rarely ingested. Unlike most foreign bodies, if accidentally swallowed these rarely spontaneously pass. The duodenum has been reported as the most common site of toothpick foreign body lodgement in the upper gastrointestinal tract. We report the case of a 57-year-old presenting with recurrent urosepsis after non recognition of a toothpick impaction in the duodenum with fistulisation into the right renal pelvis. Endoscopic removal of the foreign body was successful in management of the urosepsis. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to analyze upper gastrointestinal system endoscopic examination findings from September 2021 to July 2022 at a state hospital. Materials and Methods: Sedated endoscopic examinations were conducted in the general surgical endoscopy unit, with retrospective evaluation of findings. Results: Among the patients, 272 (61.1%) were male and 173 (38.9%) were female. Common diagnoses included Duodenal ulcer (16.9%), Esophagitis (16.2%), Pangastritis (12.6%), Alkaline reflux (11.5%), Hiatal hernia (11.0%), Gastric polyp (7.6%), Gastric cancer (7.4%), Antral gastritis (6.5%), Gastric ulcer (6.1%), and Pyloric stenosis (2.5%). Conclusion: Esophagogastroduodenoscopy, a well-tolerated diagnostic procedure under sedation with minimal complications, is increasingly important in smaller, resource-limited hospitals. Its widespread use by healthcare professionals in such settings is crucial for diagnosing and treating patients. [ABSTRACT FROM AUTHOR]

Introduction: Acute upper gastrointestinal bleeding is a common cause of emergency department admissions. The standard approach for the diagnosis and treatment of acute upper gastrointestinal bleeding (AUGIB) involves an endoscopy of the upper gastrointestinal tract. While daytime emergency endoscopy has been well studied, there is limited evidence regarding its effectiveness during the nighttime. Patients and Methods: We conducted a retrospective cohort study at a single center, analyzing adult patients with AUGIB referred for emergency endoscopy outside of regular hospital hours. Patients treated with endoscopic hemostatic methods were categorized into day-hours and night-hours groups based on the timing of the gastroscopy. The primary clinical endpoint was 120-day all-cause mortality, with secondary endpoints including hemostasis and recurrence. Results: In the population of 752 enrolled patients with acute upper gastrointestinal bleeding symptoms, 592 had a gastroscopy during the day hours between 8.00 a.m. and 10.00 p.m., while 160 had procedures performed at night between 10:00 p.m. and 8:00 a.m. In the day-hours group, the median time from symptom onset to endoscopy was 10 h (IQR 6–15), compared to 6 h (IQR 4–16) in the night-hours group. The gastroscopy duration (time to reach hemostasis during endoscopy) was significantly shorter during the night hours (p < 0.001). In both groups, endoscopic intervention after the sixth hour from symptom onset yielded improved outcomes, while treatment before the fifth hour resulted in poorer outcomes. Although the night-hours group had higher 120-day all-cause mortality, the difference was not statistically significant. Conclusions: Our findings indicate that emergency therapeutic gastroscopy for acute upper gastrointestinal bleeding is similarly effective during both day and night hours, particularly when performed after the sixth hour from symptom onset. [ABSTRACT FROM AUTHOR]

Background and aims: Common variable immunodeficiency disorder (CVID) patients may have gastrointestinal (GI) involvement and suffer from infections, which are poorly understood. This study aimed to evaluate the clinical, endoscopic, and histopathological features of CVID patients with GI symptoms and determine their correlation with infections. Methods: We performed a retrospective study on 21 CVID patients with GI symptoms who underwent endoscopic examination in Peking Union Medical College Hospital from 2000 to 2020. The clinical, infectious, endoscopic, and histopathological features were reassessed. Results: Chronic diarrhea was the most prevalent GI symptom, observed in 95.2% of our CVID cohort. Over 85% of patients had low body weight and malabsorption. Small bowel villous atrophy was found in 90.5% of patients under endoscopy and mostly confirmed by histopathology. GI infections were identified in 9 (42.9%) patients. Of these, 7 patients with diffuse and obvious nodular lymphoid hyperplasia (NLH) of small bowel under endoscopy had significantly higher infection rate (85.7% vs 21.4%, p < 0.05), predominantly with Giardia and bacteria. Small bowel biopsies showed 95% of patients lacked plasma cells and 60% had increased intraepithelial lymphocytes (IELs), but not significantly different between GI infection and non-infection group. Most patients improved after intravenous immunoglobulin and anti-infection therapy. Conclusions: CVID could involve GI tract, particularly small bowel. Obvious NLH under endoscopy could be a hint for GI infection in CVID patients. Comprehensive endoscopic and histopathological evaluation may be helpful in CVID diagnosis and identification of potential co-infection, leading to proper treatment. [ABSTRACT FROM AUTHOR]

Background: An esophageal diverticulum is a relatively rare disease, with reports of treatment for esophageal cancer in the diverticulum even rarer. Case presentation: The case involved a 72-year-old male with a chief complaint of dysphagia. He was diagnosed with an esophageal diverticulum (Zenker's diverticulum) measuring 10 cm in diameter. Five years later, an upper gastrointestinal endoscopy revealed an iodine-unstained 0–IIb lesion of 20 mm in diameter with type B1 vessels in the diverticulum. An endoscopic biopsy and CT revealed it to be squamous cell carcinoma, cT1a-EP/LPM N0 M0, cStage 0. Because the lesion was in the diverticulum and endoscopic resection was difficult with the risk of perforation, surgical resection was set as the course of treatment. Diverticulectomy was performed via a cervical approach, using a stapler, and the patient was discharged on the 16th day without any complications. The pathological diagnosis was pTis-EP, ly0, v0, R0. Conclusions: We think this case is very rare and diverticulectomy of early esophageal cancer in the diverticulum is available and safe. [ABSTRACT FROM AUTHOR]

Objective: Foreign body (FB) ingestion is a common problem in children and is an important public health problem in terms of causing serious complications. This study aims to evaluate the complication management and intervention rates of FBs crossing the gastroesophageal junction. Materials and Methods: The hospital records of all children who presented to our clinic because of ingestion of FB between August 2019 and August 2021 were retrospectively reviewed. Patients who had an FB crossing the esophagogastric junction on plain radiographs showing the entire gastrointestinal tract taken at the time of admission were included in this study. Patients who had an FB removed from the esophagus by endoscopy were excluded from this study. Results: Of the 127 patients included in this study, 66 (52%) were male and 61 (48%) were female, with a mean age of 4.94 ± 3.15 years (3 months-17 years), and 59% (n = 75) of the patients were under 5 years of age. The most common type of FB was a coin (47%). The first pediatric cases in the literature were a clothespin discovered in the stomach and a Meckel’s diverticulum perforated by a sunflower seed shell. Management included spontaneous passing (89%), endoscopy (7%), and open surgery (4%). Conclusion: Although FBs passing through the esophagogastric junction may be asymptomatic in most cases, the need for close monitoring and surgical intervention should be kept in mind in these patients. [ABSTRACT FROM AUTHOR]

Our review delves into the realm of peroral endoscopic myotomies (POEMs) in the upper gastrointestinal tract (UGT). In recent years, POEMs have brought about a revolution in the treatment of UGT motility disorders. Esophageal POEM, the first to be introduced, has now been validated as the primary treatment for achalasia. Subsequently developed, G-POEM displays promising results in addressing refractory gastroparesis. Over time, multiple endoscopic myotomy techniques have emerged for the treatment of Zenker's diverticulum, including Z-POEM, POES, and hybrid approaches. Despite the well-established efficacy outcomes, new challenges arise in the realm of POEMs in the UGT. For esophageal POEM, the future scenario lies in customizing the myotomy extent to the minimum necessary, while for G-POEM, it involves identifying patients who can optimally benefit from the treatment. For ZD, it is crucial to validate an algorithm that considers various myotomy options according to the diverticulum's size and in relation to individual patients. These challenges align with the concept of precision endoscopy, personalizing the technique for each subject. Within our text, we comprehensively examine each myotomy technique, analyzing indications, outcomes, and adverse events. Additionally, we explore the emerging challenges posed by myotomies within the context of the evolving field of precision endoscopy. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal postsurgical leaks are life-threatening conditions with high mortality rates and are one of the most feared complications of surgery. Leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Steady advancements in interventional endoscopy in recent decades have allowed the development of new endoscopic devices and techniques that provide a more effective and minimally invasive therapeutic option compared to surgery. Since there is no consensus regarding the most appropriate therapeutic approach for managing postsurgical leaks, this review aimed to summarize the best available current data. Our discussion specifically focuses on leak diagnosis, treatment aims, comparative endoscopic technique outcomes, and combined multimodality approach efficacy. [ABSTRACT FROM AUTHOR]

Hemostatic agents are used extensively in endoscopic management of gastrointestinal (GI) bleed. Conventional endoscopic techniques such as thermal, mechanical (clipping), and injection treatment fail in up to 5%–10%. These agents are used particularly in anatomically challenging areas, lesions with poor visibility, diffuse bleeding, and friable tissues. We present an endoscopic management of gastric bleed in a 17-year-old male with leukemia (early T-cell precursor acute lymphoblastic leukemia), who underwent haplotransplant. Posttransplant patient developed pneumonia with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation support with multiorgan dysfunction syndrome, graft versus host disease. During his hospital stay, he developed persistent GI bleed from multiple large excavating gastric ulcers. Multiple sessions of conventional hemostatic endoscopic procedures such as hemoclips, glue injection, and sclerosants failed to achieve hemostasis. Mucosal surface bleeds are difficult to manage hence we used Hemospray for achieving good hemostasis. [ABSTRACT FROM AUTHOR]

We held four upper gastrointestinal tract advanced diagnostic endoscopy sessions from the 89th to the 92nd Congress of the Japan Gastroenterological Endoscopy Society. The most common region addressed was the stomach in 25 presentations, followed by the esophagus in 23, duodenum in five, and other in one. Looking at techniques discussed, the most common image enhancement method discussed was narrowband imaging in 29 presentations, blue laser imaging, and linked color imaging (LCI) in 10 each, dual red imaging in three, and autofluorescence imaging in one. Furthermore, there were presentations of new techniques such as M‐Chromo‐LCI and acetic acid‐indigo carmine mixture LCI. There were also six presentations regarding probe‐based confocal laser endomicroscopy, and one of endocytoscopy techniques. We also saw presentations of images of gastric subepithelial tumors within the submucosa, 3D endoscopy, the development of computer‐aided detection systems for early cancers, and fluorescent imaging. [ABSTRACT FROM AUTHOR]

The global obesity epidemic shows no signs of slowing down. Endoscopic bariatric and metabolic therapies (EBMTs) are being increasingly adopted as treatment options for obesity and obesity‐related comorbidities, due to their minimally invasive nature and ease of delivery. According to the site of action along the gastrointestinal tract, EBMTs can be divided into two categories: gastric EBMTs, and small intestine‐targeted EBMTs. Unlike gastric EBMTs, which work through a volume‐restricting mechanism leading to early satiety and reduced caloric intake, small intestine‐targeted EBMTs can be metabolically beneficial through foregut and/or hindgut pathways independent of weight loss, and therefore have great potential for the treatment of obesity‐related metabolic comorbidities such as type 2 diabetes. Although none of the small intestine‐targeted EBMTs have been approved by the US Food and Drug Administration to date, their clinical efficacy and safety have been extensively explored in investigational trials. This review aims to summarize and provide a comprehensive understanding of small intestine‐targeted EBMTs in clinical and preclinical settings, and to further discuss their potential mechanisms of action. [ABSTRACT FROM AUTHOR]

Background: Incidental gastrointestinal tract (GIT) uptake is found in up to 6.3% of patients undergoing positron emission tomography (PET). This may be physiologic or pathologic and requires endoscopic assessment. Aim: To determine the diagnostic yield of endoscopy in this setting and characterise PET avidity as a predictor of clinically significant findings. Methods: We retrospectively reviewed all consecutive patients undergoing upper endoscopy or colonoscopy for incidental 18FDG PET positivity in the GIT. Results: A total of 255 patients (62% male, median age 67 years) underwent colonoscopy or sigmoidoscopy for 276 separate areas of PET avidity in the colon. Malignancy was found in 44 cases (16%), and a significant polyp was found in an additional 103 cases (37%). Neoplastic change was found more often in the case of intense compared with non‐intense PET avidity (odds ratio (OR) 3.40, 95% confidence interval (CI) 1.95–5.93, P < 0.001), and in focal compared with diffuse uptake (OR 5.97, 95% CI 2.9–12.2, P < 0.001). Upper GIT endoscopy was performed in 75 patients (46 male, median age 63 years) for 77 isolated areas with PET avidity. Malignancy was found in 16 cases (21%), and all were new primary lesions. Numerically, malignant findings were more common in intense (29.7%) than non‐intense (12.5%) PET avidity (OR 2.96, 95%, CI 0.92–9.57, P = 0.069). Conclusions: Both focal and intense colonic 18FDG uptake correlate strongly with a high‐risk polyp or malignant lesion. Up to 21% of all gastroscopies performed for evaluation of incidental PET uptake diagnosed a new primary malignancy. These referrals need appropriate triaging and timely endoscopic assessment. [ABSTRACT FROM AUTHOR]

Magnifying endoscopy is advantageous in detecting precancerous lesions. Our study aimed to clarify its ability to detect easily missed neoplastic lesions on the upper gastrointestinal tract. A retrospective analysis of clinical, endoscopic, and pathological data of cases undergoing gastroscopy was performed using magnifying and routine endoscopy. The detection rates of overall lesions, the ability to identify flat-type neoplastic lesions, and the easily missed neoplastic lesions were compared between the two groups. Endoscopic data from 32,367 patients was analyzed in this study. The use of magnifying endoscopy was an independent factor in identifying flat lesions (OR 2.236, 95% CI 1.969–2.540, p < 0.001), particularly type IIb lesions (OR 3.117, 95% CI 2.333–4.165, p < 0.001). For neoplastic lesions, magnifying endoscopy was also identified as having better sensitivity than routine endoscopy (sensitivity, 90.4% vs. 78.9%, p < 0.001). Similarly, magnifying endoscopy was an independent factor for identifying flat lesions (OR 2.927, 95% CI 2.365–3.621, p < 0.001), especially type IIc lesions (OR 4.415, 95% CI 3.076–6.339, p < 0.001). Magnifying endoscopy was also identified as having superior sensitivity (44.7% vs. 13.3%, p = 0.034) for early cancerous lesions. Compared to routine endoscopy, magnification endoscopy is advantageous in detecting and identifying neoplastic lesions in the upper gastrointestinal tract, especially flat neoplastic lesions and early cancers. [ABSTRACT FROM AUTHOR]

Metastasis to the gastrointestinal tract is rare. A 59-year-old woman who had a history of an invasive lobular carcinoma of breast with clinical complete response visited our hospital and complained of an upper abdominal pain and distension. We performed an upper gastrointestinal endoscopy which showed only a gastric ulcer without any malignant findings. She experienced a recurrence of symptoms 2 months after this visit. An endoscopy revealed pyloric stenosis, which did not improve with balloon dilatation. We performed a gastro-jejunal and cecal-transverse colonic bypass surgery. Diffuse wall thickening of the antrum was verified during the surgery, and a biopsy sample was collected. The diagnosis of gastric metastasis from breast was confirmed since it showed the same immunohistochemistry pattern as the prior breast lesion. Pyloric stenosis has still been confirmed with an endoscopy, she has been alive with satisfactory oral food intake for >10 years. [ABSTRACT FROM AUTHOR]

Introduction: Foreign body (FB) ingestion is a common indication for urgent esophagogastroduodenoscopy (EGD). Nevertheless, most pass spontaneously through the gastrointestinal (GI) tract. Differently from GI bleeding, there is no validated score aiming to identify "low‐risk" patients in suspected FB ingestion. We aimed to create a score able to discriminate patients who are candidates to emergent EGD in this scenario. Methods: Retrospective study of consecutive patients admitted for suspected FB in the upper GI tract between 2016 and 2021. The evaluated outcome was endoscopic confirmation of FB in the esophagus. Variables significantly associated with the outcome on multivariate analysis were computed into a score predicting endoscopic confirmation. Results: We included 228 patients. From these, 97 (42.5%) had a confirmed FB in EGD. Time since ingestion <6 h (OR = 4.0; P = 0.042), absence of any meal after FB ingestion (OR = 7.1; P = 0.005), dysphagia (OR = 11.8; P < 0.001), odynophagia (OR = 4.6; P = 0.004), and drooling (OR = 15.1; P < 0.001) were independent predictors of confirmed FB. These variables were used to compute a FB predicting score—the Decision‐To‐Scope (DTS) Score: time since ingestion <6 h (+1 point), absence of meals (+2 points), dysphagia (+3 points), odynophagia (+1 point), and drooling (+4 points). DTS‐Score had excellent accuracy to predict the outcome (AUC = 0.953; 95%CI = 0.928–0.977; P < 0.001). The optimal cutoff to identify low‐risk patients was a score ≤5 (sensitivity 85.0% and specificity 94.7%). Conclusions: More than half of the suspected FB were not confirmed by EGD. The DTS‐Score presented excellent accuracy at stratifying patients' risk and may contribute to the decision to perform emergent EGD in suspected FB ingestion. [ABSTRACT FROM AUTHOR]

The gastrointestinal system contains the upper and lower gastrointestinal tracts. The main tasks of the gastrointestinal system are to break down food and convert it into essential elements that the body can benefit from and expel waste in the form of feces. If any organ is affected, it does not work well, which affects the body. Many gastrointestinal diseases, such as infections, ulcers, and benign and malignant tumors, threaten human life. Endoscopy techniques are the gold standard for detecting infected parts within the organs of the gastrointestinal tract. Endoscopy techniques produce videos that are converted into thousands of frames that show the disease's characteristics in only some frames. Therefore, this represents a challenge for doctors because it is a tedious task that requires time, effort, and experience. Computer-assisted automated diagnostic techniques help achieve effective diagnosis to help doctors identify the disease and give the patient the appropriate treatment. In this study, many efficient methodologies for analyzing endoscopy images for diagnosing gastrointestinal diseases were developed for the Kvasir dataset. The Kvasir dataset was classified by three pre-trained models: GoogLeNet, MobileNet, and DenseNet121. The images were optimized, and the gradient vector flow (GVF) algorithm was applied to segment the regions of interest (ROIs), isolating them from healthy regions and saving the endoscopy images as Kvasir-ROI. The Kvasir-ROI dataset was classified by the three pre-trained GoogLeNet, MobileNet, and DenseNet121 models. Hybrid methodologies (CNN–FFNN and CNN–XGBoost) were developed based on the GVF algorithm and achieved promising results for diagnosing disease based on endoscopy images of gastroenterology. The last methodology is based on fused CNN models and their classification by FFNN and XGBoost networks. The hybrid methodology based on the fused CNN features, called GoogLeNet–MobileNet–DenseNet121–XGBoost, achieved an AUC of 97.54%, accuracy of 97.25%, sensitivity of 96.86%, precision of 97.25%, and specificity of 99.48%. [ABSTRACT FROM AUTHOR]

• Thermal esophageal injury is a relevant side effect of atrial fibrillation ablation. • Endoscopy for early detection of thermal injury and impending severe complications. • Postinterventional endoscopy also reveals clinically relevant incidental findings. • Incidental endoscopic findings in a high proportion of the asymptomatic population. • Screening upper endoscopy seems to be reasonable in the general older population. High-power short-duration ablation (HPSD) is an effective therapy for atrial fibrillation with thermal esophageal injury as a rare but relevant side effect. In this retrospective single-center analysis we evaluated the incidence and relevance of ablation-induced findings and the prevalence of ablation-independent incidental gastrointestinal findings. For 15 months all patients undergoing ablation were screened by postablation esophagogastroduodenoscopy. Pathological findings were followed up and treated if necessary. 286 consecutive patients (66±10 years; 54.9% male) were included. 19.6% of patients showed ablation-associated alterations (10.8% esophageal lesions, 10.8% gastroparesis, 1.7% both findings). Logistic multivariable regression analysis confirmed an influence of lower BMI on the occurrence of RFA-associated endoscopic findings (OR 0.936, 95% CI 0.878–0.997, p <0.05). 48.3% of patients demonstrated incidental gastrointestinal findings. In 1.0% neoplastic lesions were present, 9.4% showed precancerous lesions and in 4.2% neoplastic lesions of unknown dignity were found requiring further diagnostics or therapy. 18.1% of patients demonstrated findings associated with a potentially increased risk of bleeding under anticoagulation. Patients with clinically relevant incidental findings were significantly more often male, 68.8% vs. 49.5% (p <0.01). HPSD ablation is safe, no devasting complication occurred in any patient. It resulted in 19.6% ablation-induced thermal injury whereas incidental findings of the upper GI tract were found in 48.3% of patients. Due to the high prevalence of 14.7% of findings requiring further diagnostics, therapy, or surveillance in a cohort that is mimicking the general population, screening endoscopy of the upper GI tract seems to be reasonable in the general population. [Display omitted] [ABSTRACT FROM AUTHOR]

Incidental gastrointestinal tract (GIT) [18F]-Fluorodeoxyglucose (FDG) uptake in positron emission technology/computed tomography (PET/CT) is an unexpected and often complicated finding for clinicians. This retrospective study reviewed 8991 charts of patients who underwent PET/CT: 440 patients had incidental GIT uptake, of which 80 underwent endoscopy. Patient characteristics, imaging parameters, and endoscopic findings were studied. Of the 80 patients, 31 had cancer/pre-cancer lesions (16 carcinomas; 15 pre-malignant polyps). Compared to patients with benign/absent lesions, patients with cancer/pre-cancer lesions were significantly older (p = 0.01), underwent PET/CT for primary evaluation/staging of cancer (p = 0.03), had focal GIT uptake (p = 0.04), and had lower GIT uptake (p = 0.004). Among patients with focal uptake, an SUVmax of 9.2 had the highest sensitivity (0.76) and specificity (0.885) in detecting cancer/pre-cancerous lesions. Lower GIT uptake was most common in the sigmoid colon, and upper GIT uptake was most frequent in the stomach. In a bivariate analysis, predictors of cancer/pre-cancer were older age, PET/CT indicated for primary evaluation, focal uptake, uptake in the lower GIT, and higher SUVmax. Further endoscopic investigation is warranted for patients with incidental GIT uptake, especially in the elderly or those presenting for primary evaluation with PET/CT, with the following findings on imaging: lower GIT uptake, focal uptake, or high SUVmax. [ABSTRACT FROM AUTHOR]

Aim: It was aimed to evaluate endoscopy reports in patients who had lower gastrointestinal system complaints and underwent endoscopy in Şırnak to determine up-to-date findings and their frequency and to compare them with the literature data. Materials and Methods: Demographic characteristics, endoscopy, and pathology results of patients who underwent lower gastrointestinal system endoscopy in the gastroenterology clinic endoscopy unit of Şırnak State Hospital between November 2019 and August 2021 were evaluated retrospectively. The findings were described with the help of the SPPS 25 statistical program. Results: Of the 728 patients in the study, colonoscopy was performed in 632, and rectosigmoidoscopy was performed in 96 patients. 57.8% (n: 421) were male. The mean age was 46±18.46 (range 18–120 years). The most common indication was rectal bleeding, hematochezia, or, rarely, unexplained melena in 139 (19.1%) patients. Unexplained anemia was the second most common indication in 120 (16.5%) patients. Four hundred and fifty (61.8%) patients had pathological findings. The most common results were 44% (n: 317) hemorrhoids and 19.1% (n: 139) colorectal polyps. The frequency of colorectal cancer, inflammatory bowel disease, solitary rectal ulcer, and diverticulum was 3.4% (n: 25), 9.2% (n: 67), 4.4% (n: 32), and 3.6% (n: 26), respectively. Conclusion: In this study, epidemiological data of lower gastrointestinal system endoscopy in Şırnak were obtained for the first time and compared with literature data. This study, with its up-to-date data, will contribute to regional epidemiological studies. [ABSTRACT FROM AUTHOR]

Introduction: While foreign bodies in the gastrointestinal tract are observed more frequently and accidentally in the childhood age group, they may occur to attract attention, sexual satisfaction, self-harming behavior, abuse, secondary gain, or during self-treatment in young people and adults. In the United States, 1500 people die yearly from ingested foreign bodies. The leading cause of mortality is obstruction and perforation due to impaction in the gastrointestinal system. In this study, we evaluated the clinical findings, risk factors, and clinical output data of foreign bodies in the gastrointestinal tract and presented the most accurate approach considering the literature. Materials and Methods: This is a retrospective and descriptive study analyzing data from a prospective database. Adult patients admitted to the emergency department of our 3rd level university hospital between January 2015 and January 2022 due to foreign bodies in the gastrointestinal tract were included in the study. Results: Transanal rectal body removal in the operating room was performed using the Crede maneuver in seven patients. Laparotomy or thoracotomy was performed in nine patients, and thirty-six patients were treated with endoscopic methods. Endoscopy and laparotomy were performed simultaneously in one patient. It was determined that the foreign body of 29 patients was removed by conservative methods. Conclusion: For treating of foreign bodies, a multidisciplinary approach, including advanced endoscopic and surgery, is required according to the localization and content of the foreign body, underlying cause and patient population. [ABSTRACT FROM AUTHOR]

Graft-versus-host disease (GvHD) involving the intestine is a threat to patients after allogeneic hematopoietic stem cell transplantation (alloHSCT). We evaluated biopsies from different sites of the upper gastrointestinal tract (GIT) of 97 patients after alloHSCT. Forty-six patients with clinical symptoms consistent with upper GI GvHD revealed histological features of GvHD in the esophagus, stomach, and/or duodenum. Biopsies of the duodenum and esophagus were significantly more sensitive for signs of GvHD than those of the gastric antrum or corpus. The histological features of GvHD were significantly correlated with the endoscopic findings of ulcers, erosion, atrophy, and white plaques; however, the sensitivity and specificity of the latter were low. In univariate analysis, overall mortality was significantly associated with histological GvHD signs in all four sites. Nonrelapse mortality was associated with histologic GvHD features in the antrum only. Regarding GvHD diagnosis, biopsies of the upper gastrointestinal tract should include the duodenum and/or esophagus. [ABSTRACT FROM AUTHOR]

Endoscopic submucosal dissection (ESD) is globally performed to treat early epithelial tumors of the gastrointestinal tract, but delayed perforation is a problematic procedure‐related complication. To address this problem, closure of ESD‐induced mucosal defects with a detachable snare has been reported. However, one problem is that this method usually requires some degree of skill and replacing a single‐channel scope with a two‐channel scope. We developed the clip stopper closure (CSC) method using a detachable snare in combination with the ZEOCLIP, which can be easily performed with a single‐channel scope, for ESD‐induced mucosal defects. Six consecutive cases were treated with this closure method for colonic ESD‐induced mucosal defects. The median closure time was 12.5 (10–24) min, and the success rate of this procedure was 100%. Our CSC method was able to be performed in any part of the colon. In conclusion, the CSC method using a detachable snare in combination with the ZEOCLIP is a simple but promising closure technique for ESD‐induced mucosal defects. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of precancerous or cancerous lesions in the upper gastrointestinal tract in acromegalic patients is not well known. The aim of this study is to evaluate the endoscopic findings of the upper gastrointestinal system (GIS) of patients with acromegaly and to assess whether the pathological findings are related to the disease and the use of somatostatin analogs. Materials and Methods: Between January 2010 and October 2021, patients diagnosed with acromegaly were identified by retrospective medical record scanning. This study included 49 patients with acromegaly who underwent upper GIS endoscopy. The acromegaly patients were divided into two groups: those who were taking somatostatin analogs at the time of endoscopy and those who were not. It was investigated whether there was a difference between these two groups in terms of lesion development. The patients with acromegaly and the control group were compared in terms of endoscopic findings and biopsy results. Results: Of these patients, 53% (n=26) were male and 46.9% (n=23) were female. The incidence of Helicobacter pylori (HP) was significantly higher in the acromegaly patients than in the control subjects. In the acromegaly group, 62.5% (n=15) of the 24 patients with antral and pangastritis were taking somatostatin analogs. There was no significant difference between the use of somatostatin analogs and the development of gastritis. The development of esophagitis was statistically higher in patients with acromegaly taking somatostatin analogs. Conclusion: The incidence of HP was higher in patients with acromegaly than in the normal population. No clear results were found regarding the development of gastritis. The incidence of esophagitis was high in acromegalic patients taking somatostatin analogs. Large-scale studies are needed to uncover the relationship between the etiology of the disease and the drugs taken. [ABSTRACT FROM AUTHOR]

Gastrointestinal motility disorders have a wide range of symptoms and affect patients' quality of life. With the advancement of endoscopy, the diagnostic and therapeutic roles of endoscopy in motility disorders is becoming more significant. Endoscopy is necessary to rule out possible organic diseases in patients with suspected motility disorders and provide significant clues for their diagnosis. Moreover, interventional endoscopy may be a primary or alternative treatment option for selected patients with motility disorders, and it is becoming a promising field as new therapeutic applications are developed and utilized for various motility disorders. This review may provide suitable indications for the use of endoscopy in diagnosing and treating motility disorders of the upper gastrointestinal tract. [ABSTRACT FROM AUTHOR]

Introduction: Gastrointestinal system cancers are the most common malignant neoplasms in the world. Endoscopic diagnostic methods have an active role in the early diagnosis of gastrointestinal system cancers and in improving treatment outcomes. In this study, a single surgeon's gastrointestinal system endoscopic procedures were evaluated to determine the cancer incidence rate. Materials and Methods: The data obtained from 3217 endoscopic procedures were evaluated retrospectively. Results: Of the cases examined, 1818 (56.52%) were female and 1399 (43.48%) were male. The mean age was 44.3 for women and 46.5 for men. Of the procedures, 2245 were esophagogastroduodenoscopy (EGD) and 972 were colonoscopy. Of the EGD cases, 1443 (64.27%) were female and 802 (35.72%) were male. Of the colonoscopic procedures, 375 (38.58%) were female and 597 (61.41%) were male. While the malignancy rate was 0.44% in esophagogastroduodenoscopies, this rate was found as 2.46% in colonoscopic examinations. Conclusion: Endoscopic examination is the most important diagnostic method in diagnosing cancers in the gastrointestinal tract early. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the opinions and anxiety levels of individuals undergoing before and after gastrointestinal endoscopy. Method: The sample of the study consisted of 220 individuals. Participants undergoing gastrointestinal endoscopy evaluated by the researchers before and after the procedure. The data were collected with Personal Information Form, Beck Anxiety Scale, and Visual Analogue Scale. Results: It was found that 57.7% of the participants were female, and average age was 51.50 ± 15.67. Upper gastrointestinal endoscopy was performed to 51.8% of the participants, lower gastrointestinal endoscopy to 40%, and both upper and lower gastrointestinal endoscopy to 8.2%. Before the under upper gastrointestinal endoscopy described as an frightening procedure by 20.9% of the participants, this rate was found to be 5% after the procedure. On the other hand, lower upper gastrointestinal endoscopy procedure described as an frightening procedure by 12.3% of the participants, this rate was found to be less than 1% after the procedure. The opinions about the procedure changed positively, showing a significant difference after the procedure (p<0.001). While the state of willing to be informed about the procedure affected the anxiety score before the procedure (p<0.05), being informed about the procedure did not affect the anxiety. Performing the procedure with sedation affects the anxiety score after the procedure (p<0.001). Conclusions: It may be recommended to disseminate public service advertisements, inform individuals with a structured education before the procedure, perform the procedures with sedation when appropriate, and perform the procedures of individuals undergoing both upper and lower gastrointestinal endoscopy in a single staged. [ABSTRACT FROM AUTHOR]

This article discusses a new technique for training in gastrointestinal (GI) endoscopy using human cadavers. Traditionally, training has involved mechanical and virtual reality devices, as well as animal-based models. However, the quality and reproducibility of these models have been limited. The new technique described in the article preserves the cadavers and their GI tracts in a superior quality, making the experience more realistic. A hands-on course was conducted with gastroenterology trainees, who reported significant improvement in their endoscopy skills. This new human cadaver-based model has the potential to enhance GI endoscopy training in the future. [Extracted from the article]

This article discusses the use of a self-assembling peptide (SAP) solution for the treatment of post-resection defects in the gastrointestinal (GI) tract after advanced endoscopy therapy. The study analyzed the outcomes of SAP treatment in patients who underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for non-pedunculated lesions in the GI tract. The results showed that SAP treatment was effective in reducing delayed bleeding and promoting healing of the post-resection defects. The study suggests that SAP solution could be a promising method for improving outcomes in advanced endoscopy therapy in the GI tract. [Extracted from the article]

Follicular lymphoma (FL) is a common form of non-Hodgkin's lymphoma that rarely occurs in the gastrointestinal (GI) tract. The majority of GI FL cases are indolent in nature and are incidentally detected. They arise in the duodenum and more specifically near the ampulla of Vater. Multiple lesions are usually present upon endoscopic examination with mucosal and submucosal involvement. We hereby report the rare diagnosis of primary GI FL that presented as a solitary lesion exclusively involving the mucosal layer of the GI tract and was not located in the classic periampullary region of the duodenum, using a combination of advanced endoscopic techniques. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate management pathways, outcomes and safety of rigid endoscopy (RE) and flexible endoscopy (FE) for the treatment of impacted foreign bodies of the upper gastrointestinal tract (UGIT) in adults. Methods: Retrospective study, included all patients undergoing RE or FE for impacted UGIT foreign body over an 11-year-period. Results: A total of 144 patients were included (95 FE and 49 RE). FE were performed under local anaesthetic or sedation, and RE under GA. Success rate of FE and RE were 95.8% and 95.9% respectively. During FE an intra-procedural biopsy was performed in 45/95 (47.3%); with 26/95(27.4%) identifying mucosal pathology. Complications was significantly higher in patients having RE (40.8% versus 6.3%, p =.001). Conclusion: FE and RE are effective for the therapeutic management of impacted UGIT foreign bodies. However, FE can be performed under LA and was associated with fewer complications, favouring FE where possible as a first line option. [ABSTRACT FROM AUTHOR]

With the epidemic prevalence of obesity in today's society, bariatric surgery has become very popular in treating severe obesity. Although the complications of this surgery have decreased with the advancement of medicine and post-treatment care, there are still complications that can lead to death if neglected. In this case report, we present a 44-year-old patient who underwent redo bariatric surgery. She was discharged from the hospital in good general condition but returned a few days later with a major complaint of abdominal pain and sudden bleeding from the upper gastrointestinal tract. After performing CT and endoscopy and considering the results, the patient underwent laparotomy, which showed a fistula between the splenic artery and the remnant of the stomach. After surgery and after the recovery period, the patient was discharged from the hospital. In this case report, we describe for the first time an uncommon and unique complication following redo bariatric surgery. We suggest that a fistula between the splenic artery and the remnant of the stomach should be considered in patients with abdominal pain and upper gastrointestinal bleeding who underwent redo bariatric surgery. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (H pylori) leads to gastric diseases as well as causing many extra -gastric involvements. Although contradictory findings are reported in some studies; it is indicated that some eye -related diseases are linked to H pylori. In our study, we aimed at investigating the relationship between presence of blepharitis and H Pylori positivity. Demographic data, drug, smoking and alcohol use, endoscopic, histological findings and presence of blepharitis were documented. Endoscopic and histopathological findings are compared between patients with blepharitis and control group. The data is analysed statistically. Values with p<0.05 were considered significant. 36 patients with blepharitis and 84 patients without blepharitis were included in the study. Presence of helicobacter pylori was found significantly in higher rate at patients with blepharitis. Esophagitis, gastric ulcer and bulbitis were found significantly in higher rate at patients with blepharitis. There is no difference between the groups in terms of other endoscopic findings. While causing gastro duodenal diseases, particularly peptic ulcer and stomach adenocarcinoma by interaction between bacterial virulence factors and host and/or environmental factors, H pylori is known to be related to many extra -gastric involvements. Thus, in the presence of eye diseases such as blepharitis, we consider that; it is necessary to investigate presence of H pylori and treatment shall be done when positivity is detected. [ABSTRACT FROM AUTHOR]

Background: In March 2020, the World Health Organization declared coronavirus 2019 (COVID-19) a global pandemic. We aimed to assess the ability of COVID-19 screening to detect preprocedural infection at the gastrointestinal units. One hundred and three patients indicated for gastrointestinal tract interventional procedures were included. All patients surveyed for COVID-19-related symptoms and COVID-19 rapid IgM/IgG antibodies. Symptomatic and COVID-19 antibody-positive patients further tested for COVID-19 reverse transcriptase by polymerase chain reaction (RT-PCR). All patients contacted, 14 days after the procedure and asked about the possible development of COVID-19. All health care workers (HCWs) (n=18) were screened weekly for COVID-19-related symptoms. Results: The mean age was 46.11 ± 17.16 years of them 58.25% were males. 2.9% patients had COVID-19-related symptoms and 97.1% were asymptomatic. All symptomatic patients tested positive for COVID-19 IgM antibody and RT-PCR. Among asymptomatic patients 23% had positive COVID-19 antibodies, of them 56.5%patients had positive RT-PCR. One HCW developed COVID-19 during the study. None of the included patients developed new onset of COVID-19 infection, two weeks after the procedure. Conclusion: COVID-19 antibody test may be a reasonable preprocedural screening method for low-income countries and COVID-19 RT-PCR screening for symptomatic patients and those with positive COVID-19 antibody test. [ABSTRACT FROM AUTHOR]

The Japan Gastroenterological Endoscopy Society held four serial symposia between 2019 and 2020 on the state‐of‐the‐art of issues related to upper GI inflammatory diseases. This review discusses some of the topics addressed in these symposia. The papers regarding nonerosive reflux disease, recent improvements in intraesophageal pH‐impedance monitoring and endoscopic diagnosis using image‐enhanced endoscopy have been published. Many publications have addressed its usefulness in endoscopic treatment of gastroesophageal reflux disease such as anti‐reflux mucosectomy. In the management of eosinophilic esophagitis, since the symptoms are subjective, objective indicators have been sought, and ultrasonography and high‐resolution manometry may be useful tools for evaluation. The natural course of this condition, especially of asymptomatic cases, is not well clarified. Some newly developed anti‐acid or anti‐inflammatory medicines are now under investigation. With regard to autoimmune gastritis, because of widespread medical examinations, diagnosis of asymptomatic cases has been increasing. Recently, its endoscopic characteristics have become clear and the natural history of these conditions is being elucidated. The Kyoto Classification of Gastritis has been reported to be useful not only for Helicobacter pylori diagnosis but also for identification of risks of gastric cancer. Its usefulness is now recognized in Asia and Europe. [ABSTRACT FROM AUTHOR]

Pseudomelanosis of the upper gastrointestinal tract is a rare diagnosis of undetermined significance, most commonly affecting the duodenum. Endoscopically, it is characterized by dark spickled pigmentation. Its development has been linked to certain conditions and medications. Involvement of the stomach is extremely rare with very few cases reported in the literature to date. We report an 85-year-old male who is known to have type 2 diabetes mellitus, dyslipidemia, iron deficiency anemia, and chronic kidney disease who underwent an esophagogastroduodenoscopy for evaluation of upper gastrointestinal bleeding and was found to have gastric and duodenal pseudomelanosis confirmed by biopsy. It is an extremely rare benign condition, but metastatic melanoma has to be ruled out, as was done in this case. [ABSTRACT FROM AUTHOR]

Background: Anastomotic insufficiency and perforations in the gastrointestinal tract are severe complications associated with a high complication rate and mortality. Conventional treatment options (particularly re-operations) are often unsatisfactory. Endoscopic vacuum therapy (EVT) is increasingly being used as a promising alternative. Problem: The use of EVT requires a high level of competence in interventional flexible endoscopy, which is primarily not available to every surgeon. Special training programs are required here. Methods: Based on this need the long-proven Tuebingen training system for flexible endoscopy was modified to meet the special requirements of surgeons and is currently being extended by a special training module for EVT. Results: In addition to the theoretical principles, the training is focused on learning the manual skills for flexible endoscopy. A 2-stage process was developed for this purpose: 1) to become familiar with handling of the flexible endoscope and to learn spatial orientation by means of a didactically optimized abstract phantom ("Tuebingen Orientophant") and 2) learning and training of EVT using a newly developed patient-analogous training model with various insufficiencies and abscess cavities in the upper and lower gastrointestinal tract ("Tuebinger Spongiophant"). The procedure can be trained hands-on step by step exactly as with the patient, whereby the sponge can be applied using different methods, such as overtube and dragging procedures. The consequences of mistakes and complication management can also ideally be trained hands-on using the phantom. Discussion: Evaluations of the first course series show that surgeons achieve endoscopic competence very quickly and learn to master the new procedure. The structure of such a course must, however, be designed according to long-term experience in an optimal didactic manner. Decision-makers in healthcare policy should give much more support to such courses in order to improve patient care and to increase patient safety. [ABSTRACT FROM AUTHOR]

Background: The definitive diagnosis of upper gastrointestinal disorders depends on histopathological confirmation and is the basis for planning treatment. Aim: To study the spectrum of lesions of upper git through endoscopic biopsies and determine incidence of H. pylori among gastric lesions through giemsa stain. Material and Methods:A 2 years prospective study was conducted on upper gastrointestinal tract in a sample size of 266 endoscopic biopsies from 257 patients. Clinical data was obtained from hospital records and requisition form submitted along with tissue specimens received in the department and the lesions were classified based on their clinico-morphological findings. Giemsa stain for H pylori wherever required, was applied. Results:Endoscopic biopsies were studied on patients ranging from 04 to 97 years with a male to female ratio of 1.44:1. The most common site of biopsy was Duodenum (36.9%), closely followed by Stomach (34.9%). The histopathology revealed 80.1% non-neoplastic lesions and 19.9% neoplastic lesions.. H. Pylori was found to be associated with 35.3% cases of chronic gastritis. Conclusion:The key principal of gastrointestinal biopsy interpretation is correlation with clinical data and endoscopic information in order to identify the true pathology. [ABSTRACT FROM AUTHOR]

Background: This study was aimed to develop a computer-aided diagnosis (CAD) system with deep-learning technique and to validate its efficiency on detecting the four categories of lesions such as polyps, advanced cancer, erosion/ulcer and varices at endoscopy. Methods: A deep convolutional neural network (CNN) that consists of more than 50 layers were trained with a big dataset containing 327,121 white light images (WLI) of endoscopy from 117,005 cases collected from 2012 to 2017. Two CAD models were developed using images with or without annotation of the training dataset. The efficiency of the CAD system detecting the four categories of lesions was validated by another dataset containing consecutive cases from 2018 to 2019. Results: A total of 1734 cases with 33,959 images were included in the validation datasets which containing lesions of polyps 1265, advanced cancer 500, erosion/ulcer 486, and varices 248. The CAD system developed in this study may detect polyps, advanced cancer, erosion/ulcer and varices as abnormality with the sensitivity of 88.3% and specificity of 90.3%, respectively, in 0.05 s. The training datasets with annotation may enhance either sensitivity or specificity about 20%, p = 0.000. The sensitivities and specificities for polyps, advanced cancer, erosion/ulcer and varices reached about 90%, respectively. The detect efficiency for the four categories of lesions reached to 89.7%. Conclusion: The CAD model for detection of multiple lesions in gastrointestinal lumen would be potentially developed into a double check along with real-time assessment and interpretation of the findings encountered by the endoscopists and may be a benefit to reduce the events of missing lesions. [ABSTRACT FROM AUTHOR]

Background Thermal damage to the muscle layer during mucosal application of argon plasma coagulation (APC) may be avoided by creating a fluid cushion within the submucosal layer, but the minimum injection volume needed or the ideal injection fluid are yet to be established. We conducted a systematic ex vivo study with this aim. Methods All experiments were performed in an ex vivo porcine gastrointestinal tract model. Five different fluids (saline, Glyceol, Gelafundin, Voluven, and Eleview) of different volumes were injected into the submucosa of different parts of the gastrointestinal tract. APC was applied to the mucosa at different power settings. Immediately after APC treatment, the temperature was measured through a thermocouple placed inside the fluid cushion, just on top of the muscle layer. The minimum volume of fluid needed to protect the muscle layer from thermal damage was determined. Results There was no difference in the temperature measured among the different injection fluids at the surface of the muscle, in all the locations, at equal injection volumes and power settings. The minimum amounts of fluid needed to protect the muscle layer were 2 and 3 mL for power settings of 30-90 W and 90-120 W, respectively. Conclusions Normal saline and 4 commercially available submucosal injection fluids possess similar thermal protective effects. To reduce the likelihood of thermal damage to deeper layers when APC is applied, a minimum injection volume of 3 mL is recommended if less than 90 W power will be utilized over 3 sec. [ABSTRACT FROM AUTHOR]