Clinical Case Summary

Extra intestinal digestive involvement of tuberculosis (TB) remains a rare entity, even in endemic countries.3 cases of extra intestinal digestive TB in immunocompetent patients are reported.
Case 1: A 50-year-old man was admitted for exploration of weight loss and weakness, with chronic abdominal pain. A computed tomography (CT) scan of the abdomen showed multiple hypodense hepatics and splenic nodules; an ultrasound-guided percutaneous liver biopsy was performed. The patient was diagnosed to have primary hepatosplenic TB. Images:
1:CT scan:multiple lesions in the liver and spleen
2:Liver tissue showing granulomatos reaction)
Case 2: A 24-year-old woman,admitted for exploration of chronic epigastralgia.Abdominal and pelvic CT scan and pancreaticobiliary Magnetic Resonance Imaging (MRI)showed a mass at the isthmus and tail of the pancreas associated with adenopathies.The endoscopic ultrasound (EUS)showed a cystic lesion at the pancreatic corporal-caudal junction. Given the strong suspicion of a pseudo papillary and solid tumor of the pancreas,a caudal splenopancreatectomy was decided. Intraoperatively, exploration revealed,whitish pinhead-sized lesions disseminated over the entire pancreatic parenchyma,suggesting pancreatic TB.An anatomopathological examination of an adenopathy confirmed the diagnosis of TB. Images:
1:MRI showing a mixed lesion in the pancreas
2:EUS image showing the heterogeneous lesion of the pancreas)
Case 3: a 28-year-old man, was admitted for exploration of abdominal pain with fever and weight loss.The physical examination found an abdominal tenderness and hepatomegaly.Hepatic nodular lesions were revealed on CT and MRI.The diagnosis of hepatic tuberculosis was confirmed after anatomopathological analysis of the biopsies of the hepatic nodules obtained during laparoscopy. images:
1: Abdominal CT scan:multiple hypodense hepatic lesions
2: A hepatic MRI:a dysmorphic liver,with heterogeneous lesions)

Introduction

A successful colonoscopy requires ideal stool preparation, yet the percentage of insufficient bowel preparation is still very high. Frequently, the patients use website information on colonoscopy preparation. Conversely, the daily activity of the hospital staff consists of spending time with patients, communicating with them and giving answers to a high number of questions coming from patients regarding the preparation for the procedure or the exam itself. Hence, the idea to adopt a rapid and intuitive patient-oriented digital service to respond to their needs, the virtual assistant Eric.

Aims & Methods

Endo-Chat is an automated online communication platform, powered by AI (Artificial Intelligence) with the use of the Natural Language Processing and Deep Learning technologies, that answers procedure-related questions in real-time. The engine is named ERIC, stands for "Endoscopy Robot for Intelligent Chat" and is an intelligent chatbot, capable of answering autonomously to most of the doubts of a patient who is supposed to undergo an endoscopic examination.

Results

Since the introduction of the conversational artificial intelligence system at the Policlinico Gemelli starting from 24^th of January 2022 to the 16^th of March 2023, Eric has been able to autonomously manage 94% of the questions sent by patients, thus forwarding only the remaining 6% (of the requests) to specialized human operators.
We calculated that in the pre-pilot phase, a large part of the daily activity of nurses was dedicated to communicating with patients, around 40 hours per week, while in the post-pilot phase, the time spent for communication was significantly reduced to 15 hours per week. According to OECD Health Statistics 2022, the average annual salary of a European nurse is 35,300 euros, with an annual hypothetical saving of 22,062 euros, comparable to a part-time contract.
Also, the number of cancelled procedures for poor patient preparation has fallen from 22 to 7 per week, considering a volume of 200 procedures per week.
Regarding patient's experience, users can leave voluntary feedback on their virtual assistant experience directly on the ERIC website, evaluating the quality of the service. Patient service evaluations were enthusiastic till now, as 63% rated the service as excellent.

Conclusion

In our observational pilot study, the first in Europe to our knowledge, we assessed the benefits measurement for patients and Hospital staff. Starting from these preliminary interesting results, we can speculate that the introduction of Endo-Chat in high-volume endoscopy service is feasible and useful not only for patients but also for hospital staff.

Disclosure

The authors declare no conflict of interest