Introduction

Computer-Aided Diagnosis (CADx) is emerging as a tool to assist endoscopists in differentiating neoplastic from non-neoplastic small polyps during colonoscopy. In clinical practice, the application of optical diagnosis strategies, such as ‘’the resect and discard’’ and the ‘’leave-in-situ’’, vary according to the polyp location. This study aimed to evaluate the impact of polyp location (proximal colon vs. distal colon) on the diagnostic performance of CADx systems for small polyps (<5mm) identified during colonoscopy.

Aims & Methods

A comprehensive literature search was conducted in MEDLINE, Scopus, and Embase databases, with the last search performed on March 12, 2024. Studies evaluating the stand-alone performance of real-time CADx for predicting the histology of colorectal polyps ≤5mm in size were included. Studies without pathological confirmation or with fewer than 50 patients were excluded. The primary endpoints were the sensitivity and specificity of the CADx in the proximal and distal colon. Secondary outcomes were the negative predictive value (NPV), positive predictive value (PPV) and accuracy of the CADx alone in the proximal and distal colon. The distal colon comprised the rectum and sigmoid, while the proximal colon comprised the portion extending from the descending colon to the cecum.

Results

We included 11 studies for analysis with a total of 7,782 polyps (<5mm). CADx accuracy was significantly lower in the proximal colon compared to the rectosigmoid in terms of specificity (62% versus 84%; risk ratio (RR): 0.78 [95% confidence interval (CI): 0.72-0.84], I²=47.08%), NPV (64% versus 93%; RR: 0.71 [95% CI: 0.64-0.79], I²=74.69%), and accuracy (81% vs 86%; RR: 0.95 [95% CI: 0.91-0.99], I²=72.50%). On the other hand, sensitivity (87% vs 87%; RR: 1.00 [95% CI: 0.98-1.02], I²=0%) and PPV (87% vs 76%; RR: 1.11 [95% CI: 1.06-1.17], I²=53.85%) were comparable.

Conclusion

The diagnostic performance of CADx appears to depend on the location of the polyp, being substantially lower for proximal than distal lesions, mainly due to a lower specificity in the proximal colon.

Disclosure

Cesare Hassan: Fujifilm Co. (consultancy); Medtronic Co. (consultancy), Yuichi Mori: Olympus Corp (consultancy, speaking honorarium, equipment loan); Cybernet System (ownership interest), Alessandro Repici: Fujifilm Co. (consultancy); Olympus Corp (consultancy); Medtronic Co. (consultancy).

Introduction

Enteral feeding (EF) is recommended in the severe or predicted severe forms of acute pancreatitis (AP) to reduce mortality.

Aims & Methods

We aimed to investigate the factors leading to initiating EF in the acute phase (first three days of hospitalization) and the associations between EF and the disease outcome. 1429 prospectively collected cases from 31 centers and 12 countries were included in the analysis. EF and Non-EF patient groups were formed concerning tube feeding in the first three days of the hospital stay. We investigated the associations between pancreatic and inflammatory laboratory parameters (amylase, lipase, CRP, WBC, LDH), imaging alterations (necrosis, fluid collections, etc.), and clinical symptoms influencing the initiation of EF (abdominal pain, vomiting, etc.). We used Fisher's exact test for categorical variables and the Mann-Whitney U test for not normally distributed continuous variables. A p-value <0.05 indicates a statistically significant difference.

Results

EF was applied during hospitalization in 30%, 41%, and 55% of mild, moderately severe, and severe cases, respectively. Significantly higher WBC (p=0.042 p=0.019, p=0.002 on D1, D2, and D3), CRP (p<0.001 on D3), and LDH (p=0.004, p=0.036 on D1 and D3) were detected in the EF group before nutritional support compared to the non-EF cases. The frequency of necrosis, pseudocyst, abdominal fluid collection (all with p<0.004), and the intensity of abdominal pain (p<0.001) were also significantly higher in the EF group before nutrition initiation. The overall mortality in this cohort was 2.8%. Notably, the mortality in the non-EF severe group was 10% higher than in the EF severe group (38% vs. 28%, p=0.384).

Conclusion

All parameters influencing the EF initiation here are not part of the current guidelines. In conclusion, decision-making mechanisms for initiating EF rely on personal preferences; therefore, there is still a substantial proportion of patients with severe AP without EF (45%). Since EF is cost-effective and has a very low complication rate if applied correctly, it should be introduced to all AP cases regardless of laboratory parameters and imaging findings.