Early gastric cancer detection and lesion segmentation based on deep learning and gastroscopic images.

Gastric cancer is a highly prevalent disease that poses a serious threat to public health. In clinical practice, gastroscopy is frequently used by medical practitioners to screen for gastric cancer. However, the symptoms of gastric cancer at different stages of advancement vary significantly, particularly in the case of early gastric cancer (EGC). The manifestations of EGC are often indistinct, leading to a detection rate of less than 10%. In recent years, researchers have focused on leveraging deep learning algorithms to assist medical professionals in detecting EGC and thereby improve detection rates. To enhance the ability of deep learning to detect EGC and segment lesions in gastroscopic images, an Improved Mask R-CNN (IMR-CNN) model was proposed. This model incorporates a "Bi-directional feature extraction and fusion module" and a "Purification module for feature channel and space" based on the Mask R-CNN (MR-CNN). Our study includes a dataset of 1120 images of EGC for training and validation of the models. The experimental results indicate that the IMR-CNN model outperforms the original MR-CNN model, with Precision, Recall, Accuracy, Specificity and F1-Score values of 92.9%, 95.3%, 93.9%, 92.5% and 94.1%, respectively. Therefore, our proposed IMR-CNN model has superior detection and lesion segmentation capabilities and can effectively aid doctors in diagnosing EGC from gastroscopic images.

Effective doses of ciprofol combined with alfentanil in inhibiting responses to gastroscope insertion, a prospective, single-arm, single-center study.

BACKGROUND: Ciprofol is a novel intravenous sedative and anesthetic. Studies have shown that it features a rapid onset of action, a fast recovery time, slight inhibition of respiratory and cardiovascular functions, and a low incidence of adverse reactions. This study aims to explore the median effective dose (ED50) and the 95% effective dose (ED95) of ciprofol in inhibiting responses to gastroscope insertion when combined with a low dose of alfentanil, and to evaluate its safety, to provide a reference for the rational use of ciprofol in clinical practices. METHODS: We included 25 patients aged 18-64 years of either sex who underwent gastroscopy under intravenous general anesthesia, with a Body Mass Index (BMI) 18-28 kg/m2, and an American Society of Anesthesiologists (ASA) grade I or II. In this study, the dose-finding strategy of ciprofol followed a modified Dixon's up-and-down method with an initial dose of 0.30 mg/kg and an increment of 0.02 mg/kg. Ciprofol was administered after intravenous injection of 7 µg/kg of alfentanil, and 2 min later a gastroscope was inserted. When the insertion response of one participant was positive (including body movement, coughing, and eye opening), an escalation of 0.02 mg/kg would be given to the next participant; otherwise, a de-escalation of 0.02 mg/kg would be administered. The study was terminated when negative response and positive response alternated 8 times. A Probit model was used to calculate the ED50 and ED95 of ciprofol in inhibiting responses to gastroscope insertion when combined with alfentanil. Patients' recovery time, discharge time, vital signs and occurrence of adverse reactions were recorded. RESULTS: The ED50 of single-dose intravenous ciprofol injection with 7 µg/kg of alfentanil in inhibiting gastroscope insertion responses was 0.217 mg/kg, and the ED95 was 0.247 mg/kg. Patients' recovery time and discharge time were 11.04 ± 1.49 min and 9.64 ± 2.38 min, respectively. The overall incidence of adverse reactions was 12%. CONCLUSION: The ED50 of ciprofol combined with 7 µg/kg of alfentanil in inhibiting gastroscope insertion responses was 0.217 mg/kg, and the ED95 was 0.247 mg/kg. Ciprofol showed a low incidence of anesthesia-related adverse events. TRIAL REGISTRATION: http://www.chictr.org.cn (ChiCTR2200061727).

The safety of remimazolam versus propofol in gastroscopic sedation: a meta-analysis.

BACKGROUND: This meta-analysis was designed to compare the safety and efficiency of remimazolam with those of propofol in patients undergoing gastroscope sedation. METHODS: We searched PubMed, Cochrane Library, Embase, Ovid, Wanfang Database, China National Knowledge Infrastructure, SINOMED, and ClinicalTrials.gov for studies that reported on remimazolam versus propofol for gastroscope sedation from establishment to February 25, 2023. The sedative efficiency and the incidence of adverse events were assessed as outcomes. Version 2 of the Cochrane risk-of-bias assessment tool was used to assess the risk of bias. Review Manager 5.4 and STATA 17 were used to perform all statistical analyses. RESULTS: A total of 26 randomized controlled trials involving 3,641 patients were included in this meta-analysis. The results showed that remimazolam had a significantly lower incidence of respiratory depression (risk ratio [RR] = 0.40, 95% confidence interval [CI]: 0.28-0.57; p < 0.01, GRADE high), hypoxemia (RR = 0.34, 95% CI: 0.23-0.49; p < 0.01, GRADE high), bradycardia (RR = 0.34, 95% CI: 0.23-0.51; p < 0.01, GRADE high), dizziness (RR = 0.45, 95% CI: 0.31-0.65; p < 0.01, GRADE high), injection site pain (RR = 0.06, 95% CI: 0.03-0.13; p < 0.01, GRADE high), nausea or vomiting (RR = 0.79, 95% CI: 0.62-1.00; p = 0.05, GRADE moderate), and hypotension (RR = 0.36, 95% CI: 0.26-0.48; p < 0.01, GRADE low). CONCLUSIONS: Remimazolam can be used safely in gastroscopic sedation and reduces the incidence of respiratory depression, hypoxemia, bradycardia, injection site pain, and dizziness compared with propofol, and doesn't increase the incidence of nausea and vomiting.

Cáncer gástrico precoz: reporte de dos casos y revisión de la literatura: Servicio de Cirugía General del Hospital Universitario de Los Andes-Mérida / Early gastric cancer: report of a two cases and review of the literature: Service General of Surgery del Hospital Universitario de Los Andes-Mérida

Presentar dos casos clínicos de una patología frecuente, pero con diagnóstico precoz infrecuente. Revisión de la literatura y descripción de dos casos clínicos tratados en el Servicio de Cirugía General del Instituto Autónomo Hospital Universitario de Los Andes, Mérida-Venezuela, uno de ellos con el diagnóstico de cáncer gástrico precoz III antral, histológicamente adenocarcinoma bien diferenciado con compromiso de la submucosa, y otro con el diagnóstico de cáncer gástrico precoz lla + llc en cuerpo, histológicamente adenocarcinoma bien diferenciado que infiltra hasta la mitad superior de la submucosa sin linfoadenopatías, al que se le hizo ganglio centinela con azul patente infiltrado intramucoso, ambos fueron tratados quirúrgicamente con gastrectomía subtotal distal 75 por ciento D2 con una buena evolución post-operatoria y una sobrevida a los 5 años y 16 meses respectivamente. El carcinoma gástrico precoz de la clasificación de la Sociedad Japonesa de Gastroenterología se define como aquella neoplasia maligna confinada a la mucosa o submucosa del órgano, independientemente de la presencia de metástasis. Los programas de pesquisa para cáncer gástrico en zonas de alta incidencia, como Japón y China han permitido el diagnóstico de lesiones incipientes cercanas al 50 por ciento, pero en países subdesarrollados como el nuestro, estas lesiones se diagnóstican tan sólo en alrededor de 7-10 por ciento de los casos. El diasnóstico es basado en el examen histopatológico del fragmento resecado endoscópicamente o quirúrgicamente. Por considerarse como curable, es que su diagnóstico revise fundamental importancia en el pronóstico y sobrevida, la cual a los 5 años es mayor del 90 por ciento.

Análise microbiológica de gastroscópios descontaminados em aparelho Cleantop WM-1 por uso de água eletrolítica ácida / Microbiological evaluation of gastroscope decontamination by electrolysed acid water (Clentop WM-1)

RACIONAL: O método com utilização manual de glutaraldeído é amplamente empregado para desinfecção de endoscópios. A elevada rotina nos serviços de gastroscopia, pequena quantidade de equipamentos e a falta de conhecimento técnico sobre os processos de descontaminação contribuem para desinfecção inadequada dos endoscópios, intensificando o risco de transmissão de microrganismos. A água eletrolítica ácida tem apresentado eficácia na inativação e destruição de microrganismos e vem sendo usada na descontaminação de endoscópios. OBJETIVO: Verificar a eficiência microbicida da água eletrolítica ácida, produzida pelo aparelho Cleantop WM-1, em 20 gastroscópios contaminados após uso em pacientes. MATERIAL E MÉTODOS: Amostras coletadas do canal de biopsia dos endoscópios, após uso em pacientes (n = 20) e depois da desinfecção (n = 20), foram cultivadas em ágar tripticaseína de soja, MacConkey e Sabouraud dextrose. RESULTADOS: Dezessete das 20 amostras coletadas após o uso do aparelho em pacientes revelaram a presença de bacilos gram-negativos, cocos gram-positivos e leveduras em taxas de 103 a 105 ufc/mL. Nenhuma amostra, das 20 coletadas após a descontaminação, apresentou contaminação microbiana. CONCLUSÃO: Nesse estudo preliminar, a desinfecção mecânica realizada pelo aparelho Cleantop com água eletrolítica ácida revelou resultados satisfatórios pela eliminação de microrganismos e otimização no tempo de processamento dos gastroscópios.

Evaluación endoscópica de la mucosa gástrica del canino después de la administración oral de ácido acetil-salicílico en dosis terapéuticas durante 28 días / Canine gastric mucosal endoscopic evaluation after oral acetil-salicylic acid administration at therapeutic doses during 28 days

La mucosa gástrica de 18 caninos sanos fue examinada con un gastroscopio cada 7 días, durante la administración oral de ácido acetil-salicílico (aspirina) dos veces al día por un período de 28 días. Los caninos fueron divididos en 3 grupos, cada grupo constituido por seis. El grupo A como grupo control al cual no se le administró tratamiento. El grupo B al cual se le administró aspirina a dosis de 10mg/kg. El grupo C quienes recibieron una dosis de 20mg/kg. Los signos clínicos observados fueron anorexia y hematemesis, este último estuvo presente en un solo canino. Las lesiones gástricas fueron observadas sólo en los grupos B y C, las cuales aparecieron como lesiones petequiales, de petequiales a víbices, víbices, víbices a esquimóticas y úlcera. Utilizando el modelo estadístico de Kruskall-Wallis se observó que la presencia de lesiones en los grupos experimentales B y C con respecto al grupo control se debieron a la administración de aspirina. De acuerdo al modelo estadístico U de Mann-Whitney con respecto a la presencia de lesiones entre grupos B y C, no hubo diferencia significativa, es decir, ambas dosis ocasionaron efectos similares. Con respecto a la ubicación de la lesión las mismas fueron observadas en el cardias, cuerpo, fundus, antro, píloro e incisura angularis

Gastrostomía endoscópica percutánea: una alternativa para la alimentación enteral a largo plazo / Percutaneous endoscopic gastrostomy: an alternative for long-term enteral feeding

This study shows that, in our environment, percutaneous endoscopic gastrostomy is feasible in most patients who need it, and at the same time it is a fast, safe and inexpensive procedure. The complication rate is low and most can be resolved rapidly medically or endoscopically. It also allows the placement of a permanent means for the administration of nutrients and for drainage of gastroduodenal secretions in those patients who warrant it