Introduction

Hepatobiliary and pancreatic ascariasis (HPA) is caused by entry of the nematode, Ascaris lumbricoides (A. lumbricoides), from the duodenum in to the biliary and pancreatic ductal lumen[1]. Patient present with wide spectrum of symptoms of biliary and pancreatic disease.i.e 1.biliary colic
2. acute cholangitis.3.acalculous cholecystitis.4 hepatic abscess
5. acute pancreatitis 6. recurrent pyogenic cholangitis. Ascariasis is prevalent worldwide with an overall prevalence of 25%. An estimated 1.4 billion people are infected.

Aims & Methods

To evaluate the prevalance,clinical features, technical success, complications, and role of ERCP in management of biliary ascariasis.The results of all the procedures were evaluated retrospectively and the prevalence of biliary parasitosis was evaluated.Technical success of the procedure was defined as achieving the diagnostic information or succeeding with endoscopic therapy.

Results

A total of 6070 patients were treated with ERCP for different indications in our departments
All ERCPs were analyzed during a 6-year period from jan 2018 to dec 2023.29 patients were identified with biliary ascariasis on the basis of ERCP results.There were 7 men and 22 women, with a mean age of 28.5 years ranging from 16 to 55 years. Most of the patients were from Karachi (25, 86.2%). Remaining patients were from Hyderabad (2, 6.89%) and Sukkur (2, 6.89%). abdominal pain was the predominant symptom in all patients with duration ranging from 1 week up to 3 years. Bilirubin was raised in 16 out of 29 (55.17%) patients with mean bilirubin of 7.7 mg/dl and range of 2.16 to 26.7 mg/dl.ALP was raised in 27 out of 29 patients (93.1%) with range of 140 u/L to 2670 u/l ( normal upper limit 120u/l and mean of 448.36 u/l.ultrasound abdomen showed worm in 12 out of 29 patients (41.3%) and Dilated cbd was seen in 25 out of 29 patients (86.21%) With mean of 1.1cm .4 patients had dilated IHD as well. On ERCP Worm were seen as linear filling defect in common bile duct (CBD) in 15 (51.72%) cases and CBD along with intrahepatic ducts in 3 cases (10.34%).11(37.93%) patients had worm coming out of ampullary orifice and was removed by a grasper. Out of 29 patients, 5 had stone in CBD and three had pus indicating cholangitis.Only 2 patients developed minor bleeding which was controlled without any intervention.
In all of the cases we successfully and safely removed all the worms endoscopically without having any surgical outcome.The worms were removed by balloon trawl.All the patients received mebendazole following the endoscopic therapy and were dewormed. There was no procedure-related mortality in our patients.

Conclusion

^​ERCP is a contemporary procedure; our results are the depiction of the fact that ERCP should be utilized for the treatment of biliary ascariasis as a prime procedure.

References

Biliary ascariasis. A common cause of biliary and pancreatic disease in an endemic area
M S Khuroo et al. Gastroenterology. 1985 Feb.

Clinical features and management of biliary ascariasis in a non-endemic area
S P Misra et al. Postgrad Med J. 2000 Jan.
Pancreatic-biliary ascariasis: experience of 300 cases

F Sandouk et al. Am J Gastroenterol. 1997 Dec.
Hepatobiliary and pancreatic ascariasis
Mohammad S Khuroo et al. World J Gastroenterol. 2016.

Hepatobiliary and pancreatic ascariasis in India
M S Khuroo et al. Lancet. 1990.
My 40-Year Encounter with ERCP: A Saga of Service, Syndromes, and Solutions
Mohammad S Khuroo. J Clin Exp Hepatol. 2023 Nov-Dec.

Introduction

Computer-Aided Diagnosis (CADx) allows for real-time characterisation of polyps. In a small number of studies to date, CADx accuracy in polyp characterisation has been similar to expert endoscopists and better than novel endoscopists. CADx may allow for a resect and discard strategy with sub-centimetre polyps which would have significant economic impacts on our health service. CADx may also be a useful tool in improving the accuracy and efficiency of polyp diagnosis and management in a training setting.

Aims & Methods

To compare the performance of expert endoscopists, trainee endoscopists and CADx in characterising colonic polyps.

In this multi-centre prospective comparison study, two endoscopists performed high-definition colonoscopies with GI Genius (Medtronic, Dublin, Ireland) between August and November 2022. All detected polyps were photo-documented (white light imaging, narrow band imaging and near focus), resected and retrieved. CADx diagnosis was recorded (adenoma/non-adenoma/no prediction). Histologic diagnosis was recorded. Blinded to both CADx and histologic diagnosis, expert and trainee endoscopists independently predicted polyp type based on photo documentation. Comparison of diagnosis was made between experts, trainees & CADx and compared against final histologic diagnosis. Sensitivity and specificity was calculated for each group using histologic diagnosis as gold standard.

Results

139 polyps across two centres were photo-documented during the study timeframe. Expert endoscopists (Sensitivity 91.67% [95% CI 77.53-98.25%]) were better at polyp characterisation than both CADx (Sensitivity 84.31% [95% CI 71.41-92.98%]) and trainee endoscopists (Sensitivity 87.23% [95% CI 74.26-95.17%]). Expert endoscopists (Sensitivity 77.27% [95% CI 54.63-92.18%] and trainee endoscopists (Sensitivity 63.16% [95% CI 38.36-83.71%]) performed better than CADx (Sensitivity 42.11% [95% CI 20.25-66.50%]) in the characterisation of non-adenomatous polyps.

Conclusion

Our data corresponds with previously published studies. Interestingly, trainee characterisation was similar to CADx predictions in our study. Both trainee endoscopists are experienced endoscopists nearing the end of their respective training schemes. CADx polyp characterisation may be useful in an earlier training phase but further studies are necessary. A resect and discard strategy utilising CADx does not at present appear feasible.

References

1. Hassan C, Wallace MB, Sharma P, et al. New artificial intelligence system: first validation study versus experienced endoscopists for colorectal polyp detection. Gut. 2020; 69:799-800.

2. Li, MD., Huang, ZR., Shan, QY. et al. Performance and comparison of artificial intelligence and human experts in the detection and classification of colonic polyps. BMC Gastroenterol 22, 517 (2022). https://doi.org/10.1186/s12876-022-02605-2

Introduction

Superficial esophageal squamous cell carcinoma (SESCC) was enabled detection by the innovation of Narrow Band Imaging (NBI). However, NBI has insufficient sensitivity for detecting SESCC when used by inexperienced endoscopists.¹⁾ To solve these problems, the construction and usefulness of endoscopic detection models for SESCC using artificial intelligence (AI) have been reported.²⁾ On the other hand, the assistant effect of the AI model for endoscopists has not been fully examined.

Aims & Methods

The aim of this study is to create an AI model to assist in detecting SESCC and to assess the effect of the AI assistance on the endoscopist's diagnostic performance using endoscopic video. We collected endoscopic videos of cases with lesions and without lesions from May 2020 to September 2021 for training data to create an AI model for detecting SESCC and from October 2021 to January 2022 for test data. All videos were taken 3 to 5 seconds at National Cancer Center Hospital East by using NBI. Eligibility criteria for cases with lesions were as follows: i) histopathologically diagnosed ESCC or high-grade intraepithelial neoplasia (HGIN); ii) the depth of lesion shallower than cMM/SM1. Residual lesions after endoscopic resection for ESCC were excluded. The eligibility criteria for cases without lesions were the absence of ESCC or HGIN by endoscopic diagnosis. Patients with a history of chemotherapy, radiotherapy, chemoradiotherapy, or surgery for ESCC were excluded. The performances of the AI model and 18 endoscopists (8 experts and 10 non-experts) for detecting SESCC were evaluated using the test data. Furthermore, to explore the assistance ability of the AI model, the endoscopists were required to diagnose again on the same test data after 4 weeks, referring to the results predicted by the AI model. The diagnostic performance of the endoscopists with and without the AI assistance was compared to assess the sensitivity, specificity, accuracy, and interobserver agreement. The recognition to the lesions by the AI model was defined to detect with Intersection over the Union > 0.3 for 5 consecutive frames for each video. The results of the endoscopists were presented as averages.

Results

We collected 280 cases (140 with lesions and 140 without lesions) videos as training data and 115 cases (52 with lesions and 63 without lesions) videos as test data. The clinicopathological characteristics of the lesions were as follow: median lesion size was 15mm (range:1-100mm), and the pathological depth of tumor were EP/LPM/MM/SM1/SM2=10/17/0/4/4/4. The sensitivity, specificity, and accuracy of the AI model were 76.0%, 79.4% and 77.2% respectively. With the AI assistance, the sensitivity and accuracy of the endoscopists were significantly improved (without vs with the AI assistance: 57.4% vs 66.5%, P<0.05, 68.6% vs 75.9%, p<0.05), while the specificity were slightly improved (87.0% vs 91.6%, P=0.059). For experts, the sensitivity and accuracy were significantly improved (59.1% vs 70.0%, P<0.05, 72.1% vs 79.3%, p<0.05). For non-experts, the accuracy was significantly improved (65.8% vs 73.3%, P<0.05), while the sensitivity and specificity were slightly improved (56.1% vs 63.7%, P=0.07, 81.9% vs 89.2%, p=0.07). The interobserver agreement for diagnosis among the endoscopists was improved with the AI assistance (κ=0.429 vs κ=0.547).

Conclusion

The assistance of the AI model improved the endoscopist's sensitivity of detection of SESCC without reducing the specificity, regardless of their experience. The AI model would be effective in improving the endoscopist's ability to detect SESCC in practice.

References

1) Ishihara R, Takeuchi Y, Chatani R et al. Prospective evaluation of narrow-band imaging endoscopy for screening of esophageal squamous mucosal high-grade neoplasia in experienced and less experienced endoscopists. Dis Esophagus 2010; 23: 480–6.
2) Waki K, Ishihara R, Kato Y et al. Usefulness of an artificial intelligence system for the detection of esophageal squamous cell carcinoma evaluated with videos simulating overlooking situation. Digestive Endoscopy 2021; 33: 1101–1109.

Introduction

Patients with ulcerative colitis (UC) report that UC negatively affects their quality of life (QoL), including sexual functioning, satisfaction, and drive.^1,2 These effects are rarely discussed with or by gastroenterologists in clinical practice. The CONFIDE study aims to elucidate the impact of symptoms on the lives of patients with moderate to severe UC in the United States (US), Europe (EU5; France, Germany, Italy, Spain, and UK), and Japan. Data presented here are from the US and EU5.

Aims & Methods

Online, quantitative, cross-sectional surveys were conducted (July–September 2021). Criteria based on previous treatment, steroid use, and/or hospitalization were used to define moderate-to-severe UC. Data collected included patient perspectives on the impact of UC on sexual activity. Sexual activity was not limited to intercourse and included activities such as masturbation.

Results

Surveys were completed by 200 US patients (male [M]=62%, mean age 40 years) and 556 EU5 patients (M=57%, mean age 39 years). Of these, 77% US and 54% EU5 patients were receiving advanced therapy (biologic/novel oral) and 52% and 73% were receiving steroids at the time of survey completion, respectively. Overall, 63% US patients (M=55%, female [F]=77%) and 53% EU5 patients (M=47%, F=60%) reported avoiding or decreasing sexual activity due to UC in the 3 months prior to the survey. Among these patients (US: N=126; EU5: N=292), most frequently reported reasons for avoidance of sexual activity were bowel urgency (BU; 41%), decreased sexual desire (37%), and fear of BU-related accidents (34%) in the US and fear of faecal seepage (37%), fear of BU-related accidents (36%), and BU itself (31%) in EU5. Although reasons for avoiding sexual activity were broadly similar between sexes, higher percentage of male patients from both US and EU5 (US: M=33%, F=24%; EU5: M=42%, F=33%) reported fear of faecal seepage as a factor affecting sexual activity. Conversely, higher percentages of female patients reported perianal pain (M=13%, F=19%) and self-consciousness (M=13%, F=24%) as reasons for avoiding sexual activity in the US and decreased sexual desire (M=16%, F=26%), BU (M=26%, F=36%) and fatigue (M=14%, F=22%) in EU5.

Conclusion

In both US and EU5 populations, >50% patients with moderate-to-severe UC reported avoiding or decreasing sexual activity due to UC, with bowel urgency and bowel urgency-related accidents being among the top three reasons. In addition to other QoL parameters, impact of UC on patients’ sexual health needs to be assessed in routine clinical practice.

References

¹Bulut AE, et al. Turk J Gastroenterol. 2019;30:33-39.
²Jedel S, et al. Inflamm Bowel Dis. 2015;21:923-38.

Disclosure

Simon Travis, Grants: Ferring Pharmaceuticals, AbbVie, Schering-Plough, MSD, Procter & Gamble, Warner Chilcott, International Organization for the Study of IBD, ECCO, UCB, Vifor Pharma, Normal Collision Foundation, Buhlmann, Takeda, Janssen, Pfizer, and Eli Lilly and Company.
Marla C. Dubinsky, Consultancy fees: AbbVie, Arena Pharmaceuticals, Boehringer Ingelheim International GmbH, Bristol Myers Squibb, Celgene Corporation, Eli Lilly and Company, F. Hoffman-La Roche Ltd, Genentech Inc., Gilead Sciences, Janssen, LLC, Pfizer, Prometheus Biosciences, Takeda Pharmaceuticals USA, Inc., and UCB; Stockholder: Trellus Health Inc.; Research support: AbbVie, Janssen, LLC, Pfizer, and Prometheus Biosciences.
Toshifumi Hibi, Consultancy fees/grant/research support/speaker: AbbVie GK, ActivAid, Alfresa Pharma Corporation, Apo Plus Station, Aspen Japan K.K, Bristol-Myers Squibb, Celltrion, EA Pharma, Eli Lilly and Company, Ferring Pharmaceuticals, Gilead Sciences, Janssen, JIMRO, JMDC Inc., Kyorin, Mitsubishi-Tanabe Pharma Corporation, Mochida Pharmaceutical, Nichi-Iko Pharmaceutical, Nippon Kayaku Co. Pfizer, Takeda Pharmaceutical, Zeria Pharmaceutical, and MIYARISAN Pharmaceutical.
David T. Rubin, Grants/contracts: Takeda; Consultancy fees: AbbVie, Altrubio Inc., Allergan, Inc., American College of Gastroenterology, Arena Pharmaceuticals, Athos Therapeutics, Bellatrix Pharmaceuticals, Boehringer Ingelheim International GmbH, Bristol Myers Squibb, Celgene Corp/Syneos, Cornerstones Health, Inc. (non-profit), GalenPharma/Atlantica, Genentech/Roche, Gilead Sciences, GODURN, LLC, InDex Pharmaceuticals, Ironwood Pharmaceuticals, Iterative Scopes, Janssen, Eli Lilly and Company, Materia Prima, Pfizer, Prometheus Biosciences, Reistone Biopharma, Takeda, and Techlab Inc; Stockholder: Altrubio and Datos Health.
Remo Panaccione, Consultancy/speaker fees and/or advisory board member: AbbVie, Amgen, Arena Pharmaceuticals, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Ferring, Fresenius Kabi, Gilead Sciences, Janssen, Merck, Organon, Pfizer, Roche, Sandoz, Shire, and Takeda; Consultancy fees and/or advisory board member: Alimentiv, AstraZeneca, Biogen, Boehringer Ingelheim, Genentech, Glaxo-Smith Kline, JAMP Bio, Mylan, Novartis, Oppilan Pharma, Pandion Pharma, Progenity, Protagonist Therapeutics, Sublimity Therapeutics; Consultancy fees: Abbott, Celltrion, Cosmos Pharmaceuticals, Eisai, Elan, Galapagos, JAMP Bio, Pendopharm, Satisfai Health, Theravance Biopharma, Trellus, Viatris, and UCB.
Stefan Schreiber, Consultancy and lecture fees: AbbVie, Amgen, Arena Pharmaceuticals, Bristol Myers Squibb, Celltrion, Falk, Ferring Pharmaceuticals, Galapagos/Gilead, Genentech/Roche, Eli Lilly and Company, Janssen, MSD, Pfizer, and Takeda.
Christian Atkinson, Employee: Adelphi Real World; Consultancy: Eli Lilly and Company in connection with this study.
Alison P. Bleakman, Cem Kayhan, Theresa H. Gibble, Christophe Sapin, and Eoin J. Flynn are employees and stockholders of Eli Lilly and Company.

Introduction

Gastroenterology (GE) is a medical discipline that studies all diseases of the digestive system. It comprises several areas of study and offers a large variety of sub-specializations: proctology, interventional endoscopy or even digestive oncology. The decisive elements in the choice of this specialty vary among interns. The aim of our study is to determine the various factors influencing the choice of gastroenterology as a specialty among medical interns.

Aims & Methods

This is a cross-sectional, multicentric, survey-type study, conducted from September 1 to 30, 2023, involving 7 national medical faculties. All medical interns, regardless of sex or age, participated in our study.
An electronic survey with 29 items was created using Google Forms®. It was divided into two parts: the first part contained 13 questions on socio-demographic characteristics and exposure to GE during the academic curriculum, while the second part concerned the factors motivating the choice or not of GE as a specialty.
A statistical analysis using the Fisher’s exact test was performed. P values of <0.05 were considered statistically significant. Data were analyzed using Jamovi (Version 2.3).

Results

A total of 329 responses were collected: the majority were women 208 (63.2) with a F/M sex ratio of 1.7 and a median age of 27 [25; 28] years. The majority had already completed a GE rotation during their training course n=205 (62.3), of which 90 (44.1) had found it "satisfactory". More than half of the participants n= 178 (54.1) had already considered GE as a future specialty, and this choice was mostly made during GE lectures given in medical school n= 66 (36.9). Among those who had never considered GE, the main reasons were lack of interest in the specialty, the fact that it is a medical specialty, lack of information about GE, potential remuneration, and dissatisfaction with GE rotation during the training course (59.2%, 28.9%, 13.9%, 10.4% and 10% respectively).
Among those who finally opted for GE, the majority were women (70.2% vs. 29.8%, p=0.004). Satisfaction with the GE rotation during the training course had an impact on the final choice: "satisfactory" vs. "mediocre" (43.8% vs. 6.3% p=0.009).
Multivariate analysis showed that early interest in fields such as endoscopy (OR= 4.46, CI95%: 1.44-13.78, p=0.009) or proctology (OR= 4.26, CI95%: 1.01-18.01, p=0.05) increased the chance of choosing GE.

Conclusion

This study showed that there is a gender disparity in the choice of GE as a specialty. The fact that it is a medical discipline may lead men to choose another path. Our study also highlighted the importance of GE training courses during the medical curriculum to motivate interns to join our specialty, as well as the need to spotlight certain areas such as endoscopy or proctology.

Introduction

Bevacizumab is an anti-angiogenic monoclonal antibody targeting vascular endothelial growth factor used to treat advanced colorectal cancer (CRC). Self-expandable metal stents (SEMS) are employed in cases of advanced obstructive CRC but are linked to adverse events like bleeding, stent migration, and bowel perforation. To date, it is unclear whether bevacizumab-based chemotherapy increases the risk of perforation in patients with SEMS. Therefore, we conducted a systematic review and meta-analysis to evaluate the risk of bevacizumab-related perforation in these patients.

Aims & Methods

We conducted a comprehensive literature search from major databases until December 2023. We identified all potential studies that evaluated the risk of colonic perforation in patients with bevacizumab-based chemotherapy after SEMS insertion. We compared the risk of colonic perforation in patients who received bevacizumab-based chemotherapy with patients who received chemotherapy without bevacizumab or best supportive care. We calculated the odds ratio (OR) and 95% confidence interval (CI) using a M-H random-effects model and I-square method.

Results

Twelve studies, including 1,599 patients, met our inclusion criteria and were included in the meta-analysis. Of 1,559 SEMS patients, 320 received bevacizumab-based chemotherapy, and 1,274 received chemotherapy without bevacizumab or best supportive care. A total of 106 perforations have been reported. The risk ratio for colonic perforation in bevacizumab-based chemotherapy was 2.78 (95% CI: 1.21-6.38, p=0.02; I2=57%) when compared to non-bevacizumab-based therapy. In sub-group analysis, bevacizumab-based chemotherapy showed an increased risk of perforation when compared with chemotherapy without bevacizumab (OR, 3.71; 95% CI: 1.43-93.5; p=0.007; I2=0), but no statistically significant difference when compared with SEMS alone (OR, 3.75; 95% CI: 0.64-22.08; p=0.14; I2=62%).

Conclusion

Bevacizumab-based chemotherapy appears to increase the risk of perforation in advanced CRC patients after SEMS compared with non-bevacizumab-based therapy. These results were especially pronounced in chemotherapy without bevacizumab than in SEMS alone.

References

1. van Hooft JE, Veld JV, Arnold D, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy 2020;52:389-407.
2. van Halsema EE, van Hooft JE, Small AJ, et al. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc 2014;79:970-82.
3. Lee JH, Emelogu IE, Kukreja K, et al. Safety and efficacy of metal stents for malignant colonic obstruction in patients treated with bevacizumab. Gastrointest Endosc 2019;90:116-124.