Toward Automatic Detection of Gastric Lesion for Upper Gastrointestinal Endoscopy with Neural Network

In this paper, we compared the performance of several neural networks in the classification of early gastric cancer (EGC) images and proposed a method of converting the output value of the network into a calorific value to locate the lesion. The algorithm was improved using transfer learning and fine-tuning principles. The test set accuracy rate reached 0.72, sensitivity reached 0.67, specificity reached 0.77, and precision rate reached 0.78. The experimental results show the potential to meet clinical demands for automatic detection of gastric lesion.

Special Issue “The Next Generation of Upper Gastrointestinal Endoscopy”

Upper gastrointestinal endoscopy is now widely used as a first-line procedure to investigate upper gastrointestinal symptoms in most countries around the world [...]

Helicobacter pylori eradication in renal transplant candidates

Introduction: Treatment for Helicobacter pylori (H. pylori) infection is recommended in transplant candidates due to the association between this infection and gastrointestinal disorders, which could significantly increase morbidity after renal transplantation with the use of immunosuppression. The objective of this study was to analyze the rate of eradication of H. pylori after antimicrobial treatment in chronic kidney disease patients who are candidates for kidney transplantation. Methods: A multicenter prospective cohort study was conducted. All adult chronic kidney disease patients seen at our institution were included. In the pre-transplantation evaluation, 83 patients underwent an upper gastrointestinal endoscopy with 2 diagnostic methods to detect H. pylori: histology and the rapid urease test. In total, 33 patients with H. pylori infection received treatment with 20 mg omeprazole, 500 mg amoxicillin, and 500 mg clarithromycin once daily for 14 days. Another upper gastrointestinal endoscopy was performed 8 to 12 weeks after the end of treatment to check for healing. Results: The study showed a prevalence of H. pylori in 51 (61.4%) patients. Histology was positive in 50 (98%) patients and the rapid urease test was positive in 31 (60.8%). The infection eradication rate was 48.5% (16 patients). Conclusions: There was a high prevalence rate of H. pylori and a low eradication rate after the long-term antimicrobial triple scheme used. The association of the rapid urease test with gastric mucosa histology did not increase the detection rate of H. pylori.

Temporal observation of endoscopic and histological findings of gastritis after administration of an immune checkpoint inhibitor: a case report

A 71-year-old Japanese man was treated with 200 mg of pembrolizumab for lung adenocarcinoma with multiple bone metastases at the Department of Respiratory Medicine of Kameda General Hospital. After 19 treatment courses, he complained of epigastric pain before meals. Upper gastrointestinal endoscopy showed multiple erosions in the gastric antrum, and antacids were administered at follow-up. After 27 treatment courses, the patient underwent another endoscopy because of anorexia. The erosions were enlarged and had increased from the gastric antrum to the greater curvature of the body. Histological biopsy showed lymphocytic infiltration with a predominance of CD8-positive T cells. The patient had previously been treated for Helicobacter pylori infection, and we suspected drug-induced gastritis due to the administration of immune checkpoint inhibitors in the course of the disease. Pembrolizumab was discontinued, and the patient’s symptoms gradually improved. Endoscopic examinations were performed 2, 5, and 9 months after discontinuation of pembrolizumab, and improvement in mucosal findings and decreased lymphocyte infiltration were confirmed each time. The patient has remained without any relapse of symptoms for more than 1 year after discontinuing treatment.

ESOFAGITIS NECROTIZANTE AGUDA (ENA): REPORTE DE CASO

Introducción: La esofagitis necrotizante aguda (ENA) es una entidad patológica sumamente rara, cuya patogénesis no se ha identificado hasta la actualidad, pero se la asocia con la hipoperfusión tisular en pacientes de la tercera edad con antecedentes de patologías cardiovasculares (CV) o metabólicas. La ENA es identificada por endoscopia digestiva en ciertos pacientes con antecedentes de riesgo CV, quienes han presentado sintomatología como sangrado digestivo alto, disfagia súbita, epigastralgía intensa, vómitos, entre otros. Objetivo: describir un caso clínico de esofagitis necrotizante aguda, una entidad clínica poco estudiada, el manejo y la evolución clínica de la paciente. Caso clínico: paciente de 87 años con antecedentes de diabetes e hipertensión arterial, ingresada al Servicio de Medicina Interna por descompensación glicémica, quien en su estancia hospitalaria presentó disfagia súbita por lo que se realizó endoscopía digestiva alta, encontrándose un cuadro compatible con esofagitis necrotizante aguda, fue manejada con dieta absoluta, nutrición parenteral total, hidratación e inhibidores de la bomba de protones, siendo su evolución satisfactoria. Conclusiones: Se debería sospechar de ENA en pacientes adultos mayores quienes presentan sintomatología esófago-gástrica aguda y comorbilidades asociadas. Palabras clave: enfermedades del esófago, esofagitis, endoscopia, estenosis esofágica ABSTRACT Introduction: Acute necrotizing esophagitis (ENA) is an extremely rare pathological entity, the pathogenesis of which has not been identified to date, but it is associated with tissue hypoperfusion in elderly patients with a history of Cardiovascular disease (CVD) or metabolic pathologies. ENA is identified by digestive endoscopy in certain patients with a history of CVD risk, who have presented symptoms such as upper gastrointestinal bleeding, sudden dysphagia, intense epigastric pain, vomiting, among others. Objective: to describe a clinical case of acute necrotizing esophagitis, a little-studied clinical entity, the management and the clinical evolution of the patient. Clinical case: 87-year-old patient with a history of diabetes and arterial hypertension, admitted to the Internal Medicine Service due to glycemic decompensation, who during his hospital stay presented sudden dysphagia for which an upper gastrointestinal endoscopy was performed, finding a picture compatible with acute necrotizing esophagitis, was managed with absolute diet, total parenteral nutrition, hydration and proton pump inhibitors, and her evolution was satisfactory. Conclusions: ENA should be suspected in older adult patients who present acute esophageal-gastric symptoms and associated comorbidities. Keywords: diseases of the esophagus, esophagitis, endoscopy, esophageal stricture

How effective is laparoscopic redo-antireflux surgery?

Summary Background: The failure-rate after primary antireflux surgery ranges from 3 to 30%. Reasons for failures are multifactorial. The aim of this study is to gain insight into the complex reasons for, and management of, failure after antireflux surgery. Methods: Patients were selected for redo-surgery after a diagnostic workup consisting of history and physical examination, upper gastrointestinal endoscopy, quality-of-life assessment, screening for somatoform disorders, esophageal manometry, 24-hour-pH-impedance monitoring, and selective radiographic studies such as Barium-sandwich for esophageal passage and delayed gastric emptying. Perioperative and follow-up data were compiled between 2004 and 2017. Results: In total, 578 datasets were analyzed. The patient cohort undergoing a first redo-procedure (n = 401) consisted of 36 patients after in-house primary LF and 365 external referrals (mean age: 62.1 years [25–87]; mean BMI 26 [20–34]). The majority of patients underwent a repeated total or partial laparoscopic fundoplication. Major reasons for failure were migration and insufficient mobilization during the primary operation. With each increasing number of required redo-operations, the complexity of the redo-procedure itself increased, follow-up quality-of-life decreased (GIQLI: 106; 101; and 100), and complication rate increased (intraoperative: 6,4–10%; postoperative: 4,5–19%/first to third redo). After three redo-operations, resections were frequently necessary (morbidity: 42%). Conclusions: Providing a careful patient selection, primary redo-antireflux procedures have proven to be highly successful. It is often the final chance for a satisfying result may be achieved upon performing a second redo-procedure. A third revision may solve critical problems, such as severe pain and/or inadequate nutritional intake. When resection is required, quality of life cannot be entirely normalized.

Prevalence of Peptic Ulcer Disease and Associated Factors Among Dyspeptic Patients At Endoscopy Unit, University of Gondar Hospital, Northwest Ethiopia

Background: Dyspepsia is a common complaint in upper gastrointestinal disorders. It is described as predominant epigastric pain lasting for at least one month. Peptic Ulcer Disease (PUD) occurs in 5-15% of patients with dyspepsia. Helicobacter pylori (H.pylori) infection and non-steroidal anti-inflammatory drugs (NSAIDs)/aspirin (ASA) use are widely known risk factors for PUD. This research article aimed to determine the prevalence of PUD and associated factors among dyspeptic patients at the endoscopy unit, University of Gondar hospital, Northwest Ethiopia.Methods: A hospital-based cross-sectional study was conducted at University of Gondar hospital. A sample of 218 adults who presented with the complaint of dyspepsia, and underwent endoscopic evaluation were interviewed from June 1 to November 30, 2020. A consecutive sampling method was used to recruit the study subjects. Relevant clinical history was obtained from patients’ medical records. Upper gastrointestinal endoscopy was used to confirm the presence of peptic ulcer disease. The Data were entered into EpiData version 4.6.0.2 and exported to SPSS version 20 for analysis. Logistic regression analysis was used to identify associated factors with the occurrence of PUD among dyspeptic patients. P-value <0.05 was used to declare a statistically significant association.Results: A total of 218 dyspeptic patients who underwent upper gastrointestinal endoscopic evaluations were included in the study. The PUD was diagnosed in one-third of patients with dyspepsia. Dyspeptic patients with active H. pylori infection (AOR=6.3, 95%CI: 2.96-13.38) and NSAIDs/ASA use (AOR=6.2, 95%CI: 2.93-13.36) were at higher risk of developing PUD.Conclusion: The magnitude of active H. pylori infection among symptomatic PUD patients was high. So then, a “test-and-treat” strategy is advised. Cautious use of NSAIDs/ASA is required as it is readily available over-the-counter.

Rituximab in Remission Induction and Maintenance Therapy for Microscopic Polyangiitis Associated with Gastric Cancer: A Case Report

We herein report a case of a patient with gastric cancer-associated microscopic polyangiitis (MPA) who was treated with combination glucocorticoids and rituximab (RTX) for remission induction and maintenance, and finally to discontinue glucocorticoids without recurrence of gastric cancer or MPA in a year. A 69-year-old man was suspected of having MPA because of fever, high C-reactive protein levels, neuritis, and a high titer of myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA). Upper gastrointestinal endoscopy indicated early-stage gastric cancer, for which he underwent surgery preceded by immunosuppressive therapy for vasculitis. Histopathological images showed vasculitis in the vicinity of the cancerous tissue, suggesting an association between gastric cancer and vasculitis. Postoperatively, fever and inflammatory response improved, but MPO-ANCA increased further and the patient developed alveolar hemorrhage. He resulted in remission with high-dose glucocorticoids and RTX, and he received maintenance therapy with RTX without additional immunosuppressive agents. After 1 year of treatment, he was able to discontinue glucocorticoids without recurrence of gastric cancer or vasculitis. There is no established treatment for malignancy-associated vasculitis other than glucocorticoids. Although more cases need to be accumulated in the future, RTX is expected to be useful in malignancy-associated vasculitis.

Endoscopic Findings of Gastro-Esophageal Reflux Disease in Elderly and Younger Age Groups

Objective: To determine and compare the clinical features and endoscopic findings of gastro-esophageal reflux disease (GERD) in elderly and younger age groups.Materials and Methods: The clinical and endoscopic features were evaluated for all patients with GERD between January 2017 and September 2020. The criteria for inclusion were being aged over 65 and under 50 years and having an upper gastrointestinal endoscopy with reflux symptoms resistant to ppi theraphy. The exclusion criteria included prior surgery, age under 18 years, and pregnancy. The diagnosis of GERD was made according to the patients' symptoms. The SPSS 11.0 for Windows pocket program was used for statistical analysis.Results: Two hundred eighty-six patients aged over 65 years and 261 patients aged below 50 years were enrolled in this study. The mean age of the older group was 68.2 ± 4.5 years and the mean age of the young group was 38 ± 7.2 years. The male/female ratio was 5/3 and 2/1 in the young and older groups, respectively. The older patients had less severe and rare typical symptoms than the young patients. However, significantly more serious endoscopic findings were noted in the older patients compared with the younger patients.Conclusion: The older and young patients with GERD were predominantly male and typical reflux problems were less common in older patients with GERD. Older patients had more important endoscopic findings such as hernia, esophagitis, and cancer.