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pISSN 2636-0004
eISSN 2636-0012
pISSN 2636-0004
eISSN 2636-0012
, Tayyab Saeed Akhtar , Sameen Abbas et al.Abstract : Colorectal cancer has substantial morbidity and mortality. Approximately one-quarter of cases are overlooked during screening colonoscopy, leading to interval colorectal cancer. The use of artificial intelligence (AI) through deep learning systems has demonstrated promising results in the detection of polyps and adenomas. Consequently, our objective was to evaluate the impact of AI on adenoma detection. To identify relevant studies, we searched the PubMed, MEDLINE, and Cochrane Library databases without restrictions on publication date. Ultimately, we analyzed 16 randomized controlled trials involving 13,685 participants. The primary outcome assessed was the effect of AI-assisted colonoscopy (AIAC) on the adenoma detection rate (ADR). Secondary outcomes included the polyp detection rate (PDR) and adenomas per colonoscopy (APC). A random-effects model was used to calculate pooled effect sizes, and statistical heterogeneity was evaluated using the Higgins I2 statistic, with I2 cutoff points of 25%, 50%, and 75% indicating low, moderate, and high heterogeneity, respectively. Publication bias was investigated using a funnel plot, and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation framework. The findings indicated a 26% greater ADR with AIAC than with standard colonoscopy (40.4% vs. 31.9%). Additionally, AIAC was associated with a 30% greater PDR (52.9% vs. 40.1%) and a 44% higher APC. The findings demonstrate that the integration of AI in colonoscopy improves ADR, PDR, and APC, potentially reducing the incidence of interval colorectal cancer.
, Stefano Cordio, and Concetta Maria PorrettoAbstract : Metastatic colorectal cancers with BRAF mutation are a class of tumors that have a poor prognosis compared to wild type patients. Even if this group has found some hope in targeted therapy with multi-targeted blockade of the mitogen-activated protein kinase (MAPK) signalling pathway, more work must be done to increase treatment efficacy, particularly for the microsatellite stability/DNA proficient mismatch repair (MSS/pMMR) subtype. Patients with BRAF mutant colorectal cancer and high microsatellite instability/DNA deficient mismatch repair (MSI-H/dMMR) are considered to have a high tumor mutation load and a lot of neoantigen, which makes immunotherapy likely to be effective. It is generally accepted that MSS/pMMR colorectal cancer is an immunologically “cold” tumor that is resistant to immunotherapy. Then, patients with BRAF mutant colorectal cancer appear to find hope with targeted therapy paired with immune checkpoint blockade therapy. The clinical effectiveness and developing new approaches of immune checkpoint blockade therapy for MSI-H/dMMR and MSS/pMMR BRAF mutant metastatic colorectal cancer are reviewed in this paper. We also address possible biomarkers in the tumor immune microenvironment for predicting immunotherapeutic response in BRAF mutant colorectal cancer.
, Christrijogo Sumartono Waloejo , and Hamzah Abstract : Gastrointestinal endoscopy, which includes procedures such as esophagogastroduodenoscopy, colonoscopy, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography, has become an increasingly routine part of cancer preventive care for the digestive system. Target-controlled infusion (TCI) has revolutionized total intravenous anesthesia by enabling precise control over the delivery of sedative and analgesic agents. This technique, often used with propofol or a combination of propofol and other agents like midazolam and fentanyl, facilitates personalized sedation that considers factors such as sex, age, body height, and weight. By employing TCI for endoscopy, clinicians can customize the dosage of sedative agents to meet the needs of each patient, ensuring optimal sedation and comfort. To date, the application of TCI in gastrointestinal endoscopy has not been standardized, and no review has covered its potential to provide safe sedation during these procedures. The present review explores the fundamentals of this technique and its use in gastrointestinal endoscopy, including the selection of drugs for TCI, the determination of the optimal dose for TCI target concentration, and a comparison of TCI with other sedation methods.
, Natalija Jevdokimova, and Aldis PukitisAbstract : Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive endoscopic method that is used for the diagnosis and treatment of pancreaticobiliary diseases. ERCP may have to be performed two or more times, which carries a risk of complications and even death. Various risk factors influence the likelihood of ERCP recurrence.Methods: A retrospective study was conducted at Pauls Stradins Clinical University Hospital. Fifty patients with a history of repeat ERCP were enrolled. The total ERCP count was 122. The total death rate, 30-day postprocedural mortality, laboratory markers, and primary diagnosis were analyzed, and the therapeutic interventions used during ERCP, common bile duct’s diameter, and causes of repeat ERCP were evaluated.Results: The postprocedural 30-day mortality of repeat ERCP was 3.3%, and the overall death rate was 8%. We found a significant difference between the number of repeat ERCPs and exitus letalis (mean = 2.25 vs. mean = 1.37). The most common primary diagnosis for repeat ERCP was choledocholithiasis (64%; n = 32). We found a significant relationship between choledocholithiasis and history of cholecystectomy (P < 0.001) and obesity (P < 0.001). The rate of successful cannulation for ERCP reached 88.5%, with a significant difference between the success of cannulation and bilirubin level (205.64 ± 234.42 μmol/L vs. 58.71 ± 97.65 μmol/L, P = 0.037). The results showed a significant relationship between the success of cannulation and the presence of jaundice (P = 0.014) and periampullary diverticulum (P = 0.017).Conclusion: A greater number of repeated ERCPs carries a higher risk of overall death outcome. The disturbances in laboratory markers (decreased hemoglobin; elevated leucocytes, bilirubin, creatinine, alkaline phosphatase, C-reactive protein) could be a risk factor for negative 30-day postprocedural outcome. The risk factors for repeating ERCP include adiposity, history of cholecystectomy, bilirubin level, jaundice, and periampullary diverticulum.
, Mobin Gholami , Ahmad Kadkhodaei et al.Abstract : Background: Hepatic encephalopathy (HE) is an adverse prognostic indicator of liver cirrhosis, often triggered by various precipitating factors, with gastrointestinal bleeding being the most common. Comparing the Child–Pugh and Model for End-Stage Liver Disease (MELD) scores to predict the severity and outcome of complications in patients with cirrhosis could help establish an accurate prognosis.Methods: We retrospectively reviewed the records of patients with cirrhosis aged 18 and older who were referred to the Gastroenterology Department at Imam Khomeini Hospital in Ahvaz from April to September 2023. A statistical analysis was conducted to compare MELD and Child-Pugh score (CPS) in 95 patients with cirrhosis.Results: The in-hospital mortality rate was strongly correlated with certain complications of cirrhosis. Gastrointestinal bleeding and HE showed statistical significance (P < 0.05). Additionally, the co-occurrence of cirrhosis complications, particularly HE in conjunction with others, was associated with increased mortality rates. Abnormal levels of the international normalized ratio, prothrombin time, partial thromboplastin time, bilirubin, and liver enzymes (alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase) were also associated with mortality (P < 0.05). Specific laboratory factors in ascites fluid, namely total cell count and red blood count, were linked to the 6-month survival rate (P < 0.05). Furthermore, CPS was identified as a more specific and sensitive independent predictor of 6-month in-hospital survival than the MELD score (logistic regression: odds ratio, 2.3; standard error, 0.0189; P < 0.05).Conclusion: We recommend continuing to use the CPS for predicting in-hospital mortality in patients with cirrhosis and for the individual evaluation of liver disease in daily clinical practice.
, Ahmed Ebrahim , Ihab Samih et al.Abstract : Background: Endoscopic ultrasound (EUS) tissue acquisition requires rapid on-site evaluation to improve diagnostic yield with less needle passes; however, this is not readily available in all centers, also it increases the duration and the cost of the procedure. Macroscopic on-site evaluation (MOSE) is the direct assessment of the tissue sample provided by EUS-guided fine needle biopsy (EUS-FNB) macroscopically, to detect whether it is sufficient or not. Aim of this study was to define the role of MOSE in judging the adequacy of the tissue core specimens and to evaluate its diagnostic yield and accuracy.Methods: This prospective study was conducted at our institution with 215 participants of both genders presenting for evaluation of solid or mixed solid and cystic lesions by MOSE technique by EUS-fine needle aspiration (FNA) or FNB.Results: In obtaining conclusive sample MOSE score 1 sensitivity was 68.2%, specificity was 75%, positive predictive value (PPV) was 99.3, negative predictive value (NPV) was 4.3 and overall accuracy was 68.4, in MOSE score 2 sensitivity was 88%, specificity was 75%, PPV was 99.5, NPV was 10 and overall accuracy was 87, in MOSE 2 (FNB) sensitivity was 92%, Specificity was 67%, PPV was 99.4, NPV was 12, 5 and overall accuracy was 92. There was no statistically significant difference between the two groups with conclusive and inconclusive cytopathological results regarding size of the needle, number of needle passes, type of the needle and the specimen acquisition method.Conclusion: Using MOSE for assessment of adequacy of the sample obtained by EUS-FNB showed higher diagnostic yield compared to conventional method using different needle sizes.
, Thanh Dung Le , Van Sy Than et al.Abstract : The liver is commonly injured after blunt abdominal trauma. The choice of treatment for liver trauma depends not only on injury severity but also on the patient’s hemodynamic status. Most minor- and moderate-grade liver injuries in hemodynamically stable patients allow for conservative treatment or minimal intervention, while emergency laparotomy is indicated for patients with severe-grade liver trauma and hypotensive shock. We describe a 19-year-old male patient with traumatic shock due to grade IV liver injury and multiple fractures. An emergency laparotomy was performed, but the bleeding could not be controlled, and the patient remained hemodynamically unstable. Hyperacute transarterial embolization was successfully performed. In this case report, we emphasize the importance of transarterial embolization in cases of residual bleeding after initial damage-control surgery, even in hemodynamically unstable patients.
Hyung Ku Chon and Seong-Hun Kim
Int J Gastrointest Interv 2023; 12(1): 7-15
https://doi.org/10.18528/ijgii220037
Se Hwan Kwon , Seung Yeon Noh , and Joo Hyeong Oh
Int J Gastrointest Interv 2023; 12(1): 37-42
https://doi.org/10.18528/ijgii220005
Nam Hee Kim and Hong Joo Kim
Int J Gastrointest Interv 2023; 12(2): 57-63
https://doi.org/10.18528/ijgii220004
Partha Mandal , Barrett P. O'Donnell , Eric Reuben Smith , Osamah Al-Bayati , Adam Khalil , Serena Jen , Mario Vela , and Jorge Lopera
Int J Gastrointest Interv 2022; 11(1): 18-23
https://doi.org/10.18528/ijgii210028
Young Koog Cheon
Int J Gastrointest Interv 2021; 10(3): 96-100
https://doi.org/10.18528/ijgii210032
Dominic Andre Staudenmann , Ellie Patricia Skacel , Tatiana Tsoutsman , Arthur John Kaffes , and Payal Saxena
Int J Gastrointest Interv 2021; 10(3): 128-132
https://doi.org/10.18528/ijgii200050
pISSN 2636-0004
eISSN 2636-0012
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