Artificial intelligence for characterization of colorectal polyps: Prospective multicenter study.

Background and study aims Optical diagnosis poses challenges to implementation of "resect and discard" strategies. This study aimed to assess the feasibility and performance of a new commercially available system for colorectal polyps. Patients and methods Nine expert endoscopists in three centers performed colonoscopies using artificial intelligence-equipped colonoscopes (CAD EYE, Fujifilm). Histology and predictions were compared, with hyperplastic polyps and sessile serrated lesions grouped for analysis. Results Overall, 253 polyps in 119 patients were documented (n=152 adenomas, n=78 hyperplastic polyps, n=23 sessile serrated lesions). CAD EYE detected polyps before endoscopists in 81 of 253 cases (32%). The mean polyp size was 5.5 mm (SD 0.6 mm). Polyp morphology was Paris Ip (4 %), Is (28 %), IIa (60 %), and IIb (8 %). CAD EYE achieved a sensitivity of 80%, specificity of 83%, positive predictive value (PPV) of 96%, and negative predictive value (NPV) of 72%. Expert endoscopists had a sensitivity of 88%, specificity of 83%, PPV of 96%, and NPV of 72%. Diagnostic accuracy was similar between CAD EYE (81%) and endoscopists (86%). However, sensitivity was greater with endoscopists as compared with CAD EYE ( P <0.05). CAD EYE classified sessile serrated lesions as hyperplasia in 22 of 23 cases, and endoscopists correctly classified 16 of 23 cases. Conclusions The CAD EYE system shows promise for detecting and characterizing colorectal polyps. Larger studies are needed, however, to confirm these findings.

[Screening for preneoplastic lesions of the upper gastrointestinal tract]. / Dépistage des lésions prénéoplasiques du tube digestif haut.

Preneoplastic lesions of the esophagus and stomach are cellular abnormalities that have the potential to develop into cancer over time. They are detected during endoscopy and can be classified according to their specific cellular characteristics. Their treatment depends on the severity of the lesion and the individual factors of each patient. Treatment options may include regular endoscopic monitoring, treatment to reduce the risk of progression to cancer (anti-reflux therapy, antibiotics for H. pylori eradication), or endoscopic removal of the lesion. It is important to discuss any concerns about these lesions with a gastroenterologist and to follow recommendations for proper screening and treatment.

Les lésions prénéoplasiques de l'œsophage et de l'estomac sont des anomalies cellulaires ayant le potentiel de se développer en cancer au fil du temps. Elles sont détectées lors d'une endoscopie et peuvent être classées en fonction de leurs caractéristiques cellulaires spécifiques. Leur traitement dépend de la gravité de la lésion et des facteurs individuels de chaque patient. Les options de traitement peuvent inclure la surveillance endoscopique régulière, la prise de traitement permettant de réduire le risque de progression vers le cancer (traitement antireflux, antibiotique pour l'éradication de H. pylori) ou l'ablation endoscopique de la lésion afin de prévenir sa progression vers un cancer. Il est important de discuter avec un gastroentérologue de toute préoccupation concernant ces lésions et de suivre les recommandations de dépistage et de traitement appropriées.

Efficacy and safety of endoscopic ultrasound guided drainage of pseudocysts and walled-off necrosis after failure of percutaneous drainage.

BACKGROUND: Endoscopic Ultrasound (EUS) represents the gold standard for initial drainage of pancreatic fluid collections (PFC) due to various etiologies. However, data concerning salvage EUS drainage after initial percutaneous drainage are limited. The purpose of our study was to evaluate the clinical outcomes and safety of EUS-guided drainage of pancreatic collections after failure of percutaneous drainage. METHODS: This retrospective study was conducted in a single, tertiary university center from August 2013 to January 2020. Indication was pancreatic collection after acute pancreatitis with PFC requiring EUS-guided drainage after failure of percutaneous drainage. RESULTS: Twenty-two patients with PFC after acute pancreatitis were included (mean age 64.1 ± 11.3 years) of which 4/22 (18.2%) had pancreatic pseudocyst and 18/22 (81.8%) presented with a walled-off necrosis. Seventy-six interventions were performed among the 22 patients. Lumen-Apposing Metal Stent (LAMS) were used in 5/22 (22.7%) and double pigtail plastic stents in 17/22 (77.3%) of interventions with a median number intervention of 3 per patient (range 1 to 7). Technical success rate was 98.7% (75/76) with an overall clinical success of 81.8% (18/22). Procedure related adverse events rate was 9.1% (2/22) including one bleeding and one pancreatic fistula. Two non-procedure related deaths were observed. CONCLUSION: EUS-guided pancreatic collection drainage is clinically effective and safe after clinical/technical failure of radiological percutaneous management.

[Management of a cystic lesion of the pancreas discovered incidentally]. / Prise en charge d'une lésion kystique du pancréas de découverte fortuite.

Pancreatic cysts (PC) are common and often discovered incidentally. The distinction between PC is essential, because of the potential malignancy of some lesions requiring surgical resection. The clinical orientation will depend on the clinical history and the radiological characteristics. Indeed, in front of all PCs, it is essential to characterize them using cross-sectional imaging (MRI) in order to highlight the worrisome features requiring further examinations by endoscopic ultrasonography and fine needle aspiration of the cysts to guide the diagnosis. Referral to an expert center will allow to propose to each patient an adequate approach: surgical resection, surveillance according to the recommendations or therapeutic abstention.

Les lésions kystiques du pancréas (LKP) sont fréquentes et souvent découvertes de manière fortuite. La distinction entre les différentes LKP est primordiale, en raison du potentiel dégénératif de certaines lésions. L'orientation clinique dépendra des antécédents personnels, du profil clinique et des caractéristiques radiologiques. Devant tout kyste du pancréas, il est primordial de caractériser les LKP à l'aide d'une imagerie en coupe (IRM) afin de mettre en évidence les signes péjoratifs nécessitant un complément d'examen par écho-endoscopie digestive (EED) avec ponction du liquide intrakystique afin de guider le diagnostic. L'orientation vers un centre expert permettra de proposer une attitude adaptée à la lésion et au patient : résection chirurgicale, surveillance selon les recommandations ou abstention thérapeutique.

Recent advances in the management of autoimmune pancreatitis in the era of artificial intelligence.

Autoimmune pancreatitis (AIP) is a type of immune-mediated pancreatitis subdivided into two subtypes, type 1 and type 2 AIP. Furthermore, type 1 AIP is considered to be the pancreatic manifestation of the immunoglobulin G4 (IgG4)-related disease. Nowadays, AIP is increasingly researched and recognized, although its diagnosis represents a challenge for several reasons: False positive ultrasound-guided cytological samples for a neoplastic process, difficult to interpret levels of IgG4, the absence of biological markers to diagnose type 2 AIP, and the challenging clinical identification of atypical forms. Furthermore, 60% and 78% of type 1 and type 2 AIP, respectively, are retrospectively diagnosed on surgical specimens of resected pancreas for suspected cancer. As distinguishing AIP from pancreatic ductal adenocarcinoma can be challenging, obtaining a definitive diagnosis can therefore prove difficult, since endoscopic ultrasound fine-needle aspiration or biopsy of the pancreas are suboptimal. This paper focuses on recent innovations in the management of AIP with regard to the use of artificial intelligence, new serum markers, and new therapeutic approaches, while it also outlines the current management recommendations. A better knowledge of AIP can reduce the recourse to surgery and avoid its overuse, although such an approach requires close collaboration between gastroenterologists, surgeons and radiologists. Better knowledge on AIP and IgG4-related disease remains necessary to diagnose and manage patients.