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BACKGROUND Accurate detection of gastric infection by Helicobacter pylori (H. pylori) and premalignant lesions are important for effective provision of treatment, preventing the development of gastric neoplasia. Optical enhancement systems with optical magnification improved the identification of mucosal superficial and vascular patterns in patients with dyspepsia. AIM To evaluate an optical enhancement system with high-definition magnification, for diagnosis of normal gastric mucosa, H. pylori-associated gastritis, and gastric atrophy. METHODS A cross-sectional, nonrandomized study from November 2015 to April 2016 performed in a single-tertiary academic center from Ecuador. Seventy-two consecutive patients with functional dyspepsia according to the Rome III criteria, were tested for H. pylori using a stool antigen test and were assigned to an Hp+ group or an Hp− control group. Esophagogastroduodenoscopy with high-definition optical magnification and digital chromoendoscopy was performed, and patients were classified into 4 groups, in accordance to the microvascular-architecture pattern of the mucosa. Interobserver and intraobserver agreement among operators were calculated. RESULTS Of the 72 participants, 35 were Hp+ and 37 were Hp−. Among 10 patients with normal mucosal histology in biopsy samples, 90% had a Type I pattern of microvascular architecture by endoscopy. Among participants with type IIa and type IIb patterns, significantly more were Hp+ than Hp− (32 vs 8), and most (31 out of 40) had histological diagnoses of chronic active gastritis. Two of the three participants with a histological diagnosis of atrophy had a type III microvascular pattern. The type I pattern predicted normal mucosa, type IIa–IIb predicted H. pylori infection, and type III predicted atrophy with sensitivities of 90.0%, 91.4%, and 66.7%, respectively. The intraobserver and interobserver agreements had kappa values of 0.91 and 0.89, respectively. CONCLUSION High-definition optical magnification with digital chromoendoscopy is useful for diagnosis of normal gastric mucosa and H. pylori-associated gastritis with high accuracy, but further studies are needed to determine whether endoscopic diagnosis of gastric atrophy is feasible.

Background and study aims Digital, per-oral cholangioscopy (POCS) allows diagnosis of biliary ducts disorders and treatment for complicated stones. We aimed to determine the diagnostic accuracy of digital POCS systems for stricture lesions and the factors precluding complete biliary stone clearance. Patients and methods We performed a retrospective analysis of a prospective database of 265 consecutive patients referred for POCS between December 2016 and July 2018. We first analyzed the diagnostic accuracy of digital POCS for malignant and benign stricture lesions in 147 patients. Then, we analyzed the factors associated with complete or partial biliary stone clearance achieved with electrohydraulic lithotripsy (EHL) delivered via POCS in 118 patients. Results In the diagnostic group, digital POCS achieved 91 % visual-impression sensitivity, 99 % specificity, 99 % positive and 91 % negative predictive values, and 63.64 positive and 0.09 negative likelihood ratios for malignancy diagnosis. In the therapeutic group, complete biliary stone clearance was achieved by EHL in 94.9 % patients; the mean stone size was 20 mm (10–40 mm). In multivariable analyses, a stone size > 20 mm (OR: 1.020, P Conclusions Digital POCS has excellent diagnostic efficacy for biliary lesions. EHL via POCS is effective for complicated biliary stone clearance. Stone size (> 20 mm) and the number of stones (≥ 3) are associated with partial biliary stone clearance.

Background and aims Irritable bowel syndrome (IBS) is considered to be a functional disease, but recent data indicate measurable organic alterations. We aimed to determine the presence of colorectal mucosa microinflammation in vivo via probe-confocal laser endomicroscopy (pCLE) and histological evaluation in IBS patients. Methods This was a prospective, controlled, nonrandomized single-blind diagnostic trial performed in a tertiary institution. pCLE images and targeted biopsy of each colon segment obtained during colonoscopies of IBS patients and controls were analyzed for inflammatory changes. Biopsies were classified using the Geboes scale, and the odds ratio and overall diagnostic accuracy were calculated. Results During the 15-month study period, 37 patients were allocated to each group. The mean age was 53.1 ± 14.3 years; 64.9 % were female. Signs of colonic mucosa inflammation were evident on 65.8 % of pCLE images from IBS patients compared to 23.4 % of images from controls (OR 6.28; 4.14–9.52; P 0 was attributed to 60.8 % of biopsies from patients in the IBS group compared to 27.5 % of biopsies from the control group. The sensitivity, specificity, positive and negative predictive values, observed and interrater agreement of pCLE-detected inflammatory changes in IBS using histology as gold standard were 76 %, 91 %, 76 %, 91 %, 86.5 %, and 66.8 %, respectively. Conclusions Patients with IBS have a six-fold higher prevalence of colorectal mucosa microinflammation than healthy controls. pCLE might be a reliable method to detect colorectal mucosa microinflammation in IBS patients.

Background/aims Capsule endoscopy is a diagnostic method for evaluating the small bowel lumen and can detect undiagnosed lesions. The aim of this study was to evaluate the diagnostic yield and clinical impact of capsule endoscopy in patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain. Methods This study involved a retrospective analysis of prospectively collected data, maintained in a database. Patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain within the period of March 2012 to March 2014 were included. Capsule endoscopy was used to detect small bowel pathologies in both groups. Results Sixty-five patients (53.8% female) fulfilled the inclusion criteria and had a mean (±standard deviation) age of 50.9±15.9 years. Clinically significant lesions were detected via capsule endoscopy in 32.5% of the patients in the abdominal pain group and 54.5% of the patients in the diarrhea group. Overall, 48% of patients had small bowel pathologies detected during the capsule endoscopy study. Inflammatory lesions and villous atrophy were the most frequent lesions identified in 16.9% and 15.3% of patients in the abdominal pain and the diarrhea groups, respectively. Conclusion Routine use of capsule endoscopy in patients with irritable bowel syndrome should not be recommended. However, in patients with refractory conditions, capsule endoscopy may identify abnormalities.

Introducción: la estenosis hipertrófica de píloro es un engrosamiento anormal del musculo pilórico que produce obstrucción del vaciamiento gástrico; afecta con mayor frecuencia a la raza blanca, cuya característica clínica son los vómitos no biliosos y explosivos; su diagnóstico se realiza con el ultrasonido vs tránsito gástrico. Su tratamiento es la piloromiotomía. Objetivo: evaluar el ultrasonido abdominal (US) en el diagnóstico de la Estenosis hipertrófica del píloro (EHP) en niños del servicio de cirugía del hospital Dr. Roberto Gilbert Elizalde (HRGE), período “enero 2010-junio 2013”. Materiales y métodos: estudio descriptivo, longitudinal, retrospectivo de pacientes que ingresaron al HRGE con sospecha clínica de EHP. Se analizó: características epidemiológicas, motivo de consulta, estancia hospitalaria usando promedio, desviación estándar (DS), rango; y, sensibilidad, especificidad, valor predictivo positivo y negativo del ultrasonido. Resultados: se analizaron 130 historias clínicas, 11 tenían datos incompletos. 119 pacientes ingresaron con sospecha de EHP; se confirmó el diagnóstico en 101, 87 (86%) fueron varones y 14 (14%) mujeres. La edad en días promedio±DS fue 36.97 ±18.24, rango (16 a 150). El US tuvo una sensibilidad del 100%, especificidad del 83%, valor predictivo positivo del 97% y valor predictivo negativo del 100% para el diagnóstico de EHP. El principal motivo de consulta fueron los vómitos (100% de los casos). El promedio de días de hospitalización fue 5.92±3.38. Conclusión: el US es el mejor método diagnóstico para la EHP en los pacientes con sospecha clínica, sugiriéndose la utilización de otros estudios solo en caso de alta duda diagnóstica.

Fasciolosis is a parasitic infection caused by 2 types of fasciola, being the most common of hepatic type, the infective form is the metacercariae. Its prevalence lies in low socio-economic zones and livestock areas. The objective is to present a case of atypical presentation in which the patient was avoided to undergo an unnecessary surgical treatment. We present a case of a 69-year-old male patient who presented Cholangitis, his sonography and tomography evidenced dilatation of the bile duct, and one was performed with endoscopic retrograde cholangiopancreatography (ERCP), showing a choledochal stenosis near the bile bifurcation And a liver fasciola larva, confocal endomicroscopy (MS) was inconclusive, biopsy of the stenosis that reported cholangiocarcinoma was reported, but since the patient had no pathological weight loss and negative tumor markers, he was given antiparasitic treatment and was performed A new ERCP that showed in the inflammatory mucosa of chronic non-tumor aspect that was confirmed with the new biopsy, the patient had a favorable evolution, thus avoiding an unnecessary treatment.

GOALS The goal of this study was to evaluate the safety and feasibility of routine segmental retroflexed withdrawal viewing (RV) of the colon with the RetroView colonoscope. MATERIALS AND METHODS This was a prospective, single-center, 2-stage diagnostic trial. After cecal intubation, mucosal evaluation by forward viewing (FV) and RV was performed by segment (right, transverse, left, and sigmoid colon, and rectum). Lesions detected during FV were removed and/or marked before retroflexion. Safety and feasibility were measured through adverse event and technical success rates. All lesions detected and removed endoscopically were recorded. RESULTS Two hundred twenty-five patients underwent colonoscopy with the RetroView colonoscope. Retroflexion by segment was successful in the right, transverse, left, and sigmoid colon, and rectum in 98.9%, 100%, 100%, 82.6%, and 100% of cases, respectively. The mean total procedure time was 16.6 minutes. Ninety-four lesions were detected through retroflexion evaluation, for an increase in the lesions' detection rate of 30.7%. The per-adenoma miss rate of standard colonoscopy (FV) was 35.71%. The adenoma detection rate (ADR) for FV was 16%, whereas, when performing FV and RV, the ADR increased to 24.9%. Adverse events were recorded in 0.4% of cases. Therapeutic procedures were performed successfully through the retroflexed position in 81/225 patients. CONCLUSIONS Routine retroflexion evaluation of the colonic mucosa by segment using the RetroView colonoscope is safe and feasible. Retroflexion evaluation increases the detection rate of colonic lesions behind folds, including the number of adenomas per colonoscopy and ADR, offering a complete screening colonoscopy. All therapeutic procedures are feasible through retroflexion.

Rapunzel syndrome is an unusual and rare form of gastric trichobezoar that extends into the small intestine. The formation is due to the continuous ingestion of hair which leads to the impaction of the hair along with mucus and food, but it is rare that gastric perforation occurs. We report the case of a female patient of 16 years of age admitted to our institution with a history of depression and clinical symptoms characterized by nausea, severe epigastralgia and pathological loss of weight. The physical examination showed a tense abdomen with a peritoneal reaction. Contrast-enhanced tomography showed a distended stomach with a heterogeneous content that extended to the duodenum, hydro pneumoperitoneum, Douglas sack bottom liquid, and it was decided to perform an exploratory laparotomy. Showed perforation in the anterior face of the stomach which is infrequent, so we proceeded to the extraction of giant trichobezoar with duodenal extension; Evolving favorably, the patient being referred to outpatient controls with psychiatry; Finally, a high endoscopy was performed at 6 months, which evidenced the scar of the surgical procedure.

Dieulafoy's lesions are vascular anomalies that produce gastrointestinal bleeding of the mucosa from an abnormally long and tortuous submucosal artery. It is found predominately in the stomach (80%) and less frequently in the duodenum. They constitute the 6% of all non-variceal bleeding and the 1 to 2% of all gastrointestinal bleeding source. We report a case of a 60-year-old man with hematemesis, melena and signs of hypovolemic shock with a hemoglobin level of 9 g/dL. After adequate fluid resuscitation, an upper endoscopy showed an actively bleeding Dieulafoy lesion in the second portion of the duodenum. After epinephrine injection over lesion borders, an adequate hemostasis was not achieved. An over-the-scope clip was placed. Follow-up endoscopy 24 hours later showed an effective hemostasis and the patient was discharged without complications or re-bleeding.

Background and study aims The aim of this study was to evaluate the diagnostic yield of endoscopy using optical enhancement (OE system) with optical magnification to predict reflux in non-erosive reflux disease (NERD) patients. Patients and methods A prospective, non-randomized, single-blind study was performed from September 2015 to January 2016. Participants suffered from gastroesophageal reflux disease (GERD) symptoms and were assigned to the NERD group or the non-reflux disease control group based on endoscopic findings and a 24-hour pH-impedance-monitoring test. Endoscopy using the OE system with optical magnification was performed in all patients to detect minimal mucosal esophageal lesions (MMEL), specifically abnormalities in the numbers, dilation, and tortuosity of intrapapillary capillary loops (IPCLs). Biopsies were obtained from each esophageal segment, and diagnoses from images were compared to diagnoses of reflux and inflammation using 24-hour pH-impedance monitoring and histology, respectively. Results Fifty-seven patients were included (36 in the NERD group, 21 in the control group). IPCLs were observed in 94.4 % of cases in the NERD group and 38 % of cases in the control group (P Conclusion The OE system with optical magnification can detect MMEL and predict NERD with high sensitivity, accuracy, and interobserver and intraobserver agreement. Presence of IPCLs highly correlates with histologically identified inflammation.

Background The aim of this study was to propose a novel, comprehensive, macroscopic classification for bile duct lesions. Methods A two-stage protocol was designed. In Stage I, a retrospective study (September 2013 to September 2015) of patients with bile duct lesions detected by peroral cholangioscopy (POCS) was performed. A total of 315 images with at least 6 months of follow-up were recorded, analyzed, and correlated to histology, and were classified as non-neoplastic (one of three types, 1 – 3) or neoplastic (one of four types, 1 – 4) based on morphological and vascular patterns. In Stage II, a prospective, nonrandomized, double-blind study was performed from December 2015 to December 2016 to validate the proposed classification. Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios (LR + and LR – , respectively) were calculated (gold standard: 6-month follow-up). Inter- and intraobserver agreement (kappa value, κ) among experts and non-experts were calculated. Results 171 patients were included (65 retrospective; 106 prospective). In Stage I, 28/65 cases were neoplastic and 37 /65 were non-neoplastic, according to the final diagnosis. In Stage II, 56/106 were neoplastic with a sensitivity, specificity, PPV, NPV, LR + , and LR – for neoplastic diagnosis of 96.3 %, 92.3 %, 92.9 %, 96 %, 12.52, and 0.04, respectively. The proposed classification presented high reproducibility among observers, for both neoplastic and subtypes categories. However, it was better for experts (κ > 80 %) than non-experts (κ 64.7 % – 81.9 %). Conclusion The novel classification system could help physicians to distinguish non-neoplastic from neoplastic bile duct lesions.

Mo1553 Is the Recent Who Pathological Classification for Gastric Cancer Helpful in Applying to Endoscopic Resection? Hae Won Kim*, Jie-Hyun Kim, Hyunki Kim, Hoguen Kim, Yong Chan Lee, Sang Kil Lee, Sung Kwan Shin, Yong Hoon Kim, Jun Chul Park, DA Hyun Jung, Jae Jun Park, Young Hoon Youn, Hyojin Park, Sung Hoon Noh, Seung Ho Choi Gastroenterology, Seoul, Korea (the Republic of); pathology, Yonsei university college of medicine, Seoul, Korea (the Republic of); Surgery, Yonsei college of medicine, Seoul, Korea (the Republic of) Background/Aims: Endoscopic resection (ER) has been performed in early gastric cancer with undifferentiated histology (UD-EGC) based on Japanese classification. Whereas, we previously found that different approach is necessary between poorly differentiated (PD) & signet ring cell carcinoma (SRC) for curative resection. However, according to 2010 WHO classification, diffuse type PD and SRC are categorized into the same group as poorly cohesive carcinoma. Thus, we assessed whether the WHO classification is helpful to perform ER of UD-EGC. Methods: Among 3,419 EGC underwent surgery, we analyzed the clinicopathologic features of 1,295 lesions with SRC and PD. We recategorized into intestinal PD, poorly cohesive carcinoma (SRC, diffuse PD), and compared in terms of clinical behavior such as lymph node metastasis (LNM). We also recategorized 190 lesions (63 PD; 127 SRC) treated by ER into intestinal PD, poorly cohesive carcinoma (SRC, diffuse PD), and compared in terms of outcomes of ER. Results: According to surgical data, the rate of LNM was high in order from intestinal PD, diffuse PD and SRC (15.8%, 13.5%, and 6.3%). Similarly, the rate of LVI was significantly lowest in SRC compared with diffuse and intestinal PD. When compared between diffuse PD and SRC categorized as poorly cohesive carcinoma, the rate of LNM and LVI was significantly higher in diffuse PD than SRC. According to ER data, there was no recurrence in all of them if curatively resected. However, the most common cause of non-curative resection was different between SRC and PD irrespective of intestinal or diffuse type. The most common cause was positive lateral margin in SRC, whereas positive vertical margin in both intestinal and diffuse PD. Conclusions: Clinical behaviors are different between diffuse PD and SRC categorized as poorly cohesive carcinoma in WHO classification. Considering LNM and outcomes of ER, the recent WHO classification may not be helpful to perform ER for UD-EGC.