Radiofrequency ablation for ampullary neoplasia with intraductal extension after endoscopic papillectomy: Systematic review and meta-analysis.

Background and study aims Noninvasive ampullary neoplasms may be removed by surgery or endoscopy. However, given the morbidity and mortality associated with surgery, endoscopic papillectomy (EP) is the preferred approach. Radiofrequency ablation (RFA) after EP has emerged as a promising alternative therapy to avoid surgery after incomplete EP. Our goal was to evaluate the efficacy and safety of RFA for residual or recurrent lesions with intraductal extension after endoscopic papillectomy. Patients and methods The inclusion criteria include clinical trials, cohort studies, and case series evaluating patients with residual or recurrent lesions with intraductal extension after EP treated with RFA. Case reports, duplicated data, and studies with follow-up periods < 10 months were excluded. The metanalysis evaluated adverse events, surgical conversion rate, clinical success and recurrence. Results Seven studies were selected, totaling 124 patients. RFA was associated with a clinical success rate of 75.7% (95% confidence interval [CI] 65.0-88.0%; I 2 = 23.484) in a mean follow-up period < 10 months. However, the biliary stricture rate was 22.2% (95% CI 12.1-28.4%; I 2 = 61.030), 14.3% of pancreatitis (95% CI 8.8-22.3%; I 2 < 0.001), 7.0% of cholangitis (95% CI 3.3-14.5%; I 2 < 0.001), 4.0% of bleeding (95% CI 1.7-9.3%; I 2 < 0.001), and recurrence of 24.3% (95% CI 16.0-35.0%; I 2 = 23.484). Conclusions RFA is feasible and appears to be effective for managing residual or recurrent lesions with intraductal extension after EP. However, long-term follow-up and high-quality studies are required to confirm our findings.

Endoscopic ultrasound artificial intelligence-assisted for prediction of gastrointestinal stromal tumors diagnosis: A systematic review and meta-analysis.

BACKGROUND: Subepithelial lesions (SELs) are gastrointestinal tumors with heterogeneous malignant potential. Endoscopic ultrasonography (EUS) is the leading method for evaluation, but without histopathological analysis, precise differentiation of SEL risk is limited. Artificial intelligence (AI) is a promising aid for the diagnosis of gastrointestinal lesions in the absence of histopathology. AIM: To determine the diagnostic accuracy of AI-assisted EUS in diagnosing SELs, especially lesions originating from the muscularis propria layer. METHODS: Electronic databases including PubMed, EMBASE, and Cochrane Library were searched. Patients of any sex and > 18 years, with SELs assessed by EUS AI-assisted, with previous histopathological diagnosis, and presented sufficient data values which were extracted to construct a 2 × 2 table. The reference standard was histopathology. The primary outcome was the accuracy of AI for gastrointestinal stromal tumor (GIST). Secondary outcomes were AI-assisted EUS diagnosis for GIST vs gastrointestinal leiomyoma (GIL), the diagnostic performance of experienced endoscopists for GIST, and GIST vs GIL. Pooled sensitivity, specificity, positive, and negative predictive values were calculated. The corresponding summary receiver operating characteristic curve and post-test probability were also analyzed. RESULTS: Eight retrospective studies with a total of 2355 patients and 44154 images were included in this meta-analysis. The AI-assisted EUS for GIST diagnosis showed a sensitivity of 92% [95% confidence interval (CI): 0.89-0.95; P < 0.01), specificity of 80% (95%CI: 0.75-0.85; P < 0.01), and area under the curve (AUC) of 0.949. For diagnosis of GIST vs GIL by AI-assisted EUS, specificity was 90% (95%CI: 0.88-0.95; P = 0.02) and AUC of 0.966. The experienced endoscopists' values were sensitivity of 72% (95%CI: 0.67-0.76; P < 0.01), specificity of 70% (95%CI: 0.64-0.76; P < 0.01), and AUC of 0.777 for GIST. Evaluating GIST vs GIL, the experts achieved a sensitivity of 73% (95%CI: 0.65-0.80; P < 0.01) and an AUC of 0.819. CONCLUSION: AI-assisted EUS has high diagnostic accuracy for fourth-layer SELs, especially for GIST, demonstrating superiority compared to experienced endoscopists' and improving their diagnostic performance in the absence of invasive procedures.

USE OF METABOLOMICS TO THE DIAGNOSIS OF INFLAMMATORY BOWEL DISEASE.

BACKGROUND: Crohn's disease and ulcerative colitis are the primary inflammatory bowel diseases (IBD), and its pathogenesis is related to genetic and environmental factors. Currently, the diagnosis of IBD results in a multidisciplinary approach with significant disadvantages, such as its invasive nature, time spent, and the fact that 10% of patients remain without diagnostic classification. However, new methodologies of analysis have emerged that allowed the expansion of knowledge about IBD, as the metabolomics, the study of metabolites. The presence and prevalence of such metabolites may prove to be useful as biomarkers in the diagnosis of IBD. OBJECTIVE: Analyze fecal samples for metabolic analysis in the diagnosis of inflammatory bowel diseases (IBD), providing differentiation between Crohn's disease and ulcerative colitis. METHODS: This is an observational study with 21 patients diagnosed with IBD (ulcerative colitis 11 and Crohn's disease 10) and 15 healthy controls, all with the consent and clarification. The fecal extracts of all patients are submitted to a high-resolution Nuclear Magnetic Resonance Hydrogen (1H-NMR) spectroscopy combined with multivariate and univariate pattern recognition techniques. Through the metabolomics of fecal extracts, gives us a characterization of employing a noninvasive approach. RESULTS: We identify some metabolites, such as lactate, succinate, alanine, and tyrosine, in the Crohn's disease fecal samples, and leucine, alanine, and tyrosine in the ulcerative colitis fecal samples. All the amino acids presented positive covariance for disease correlation. CONCLUSION: The results showed different metabolic profiles between IBD patients and healthy volunteers based on 1H-NMR analysis of fecal extracts. Moreover, the approach discriminated patients with Crohn's disease and ulcerative colitis. The metabolomics analysis is promising as a novel diagnostic technique for further IBD recognition and surveillance. New studies are necessary to validate these findings.

Uso da metabolômica no diagnóstico de doenças inflamatórias intestinais / Use of metabolomics to the diagnosis of inflammatory bowel disease

ABSTRACT BACKGROUND: Crohn's disease and ulcerative colitis are the primary inflammatory bowel diseases (IBD), and its pathogenesis is related to genetic and environmental factors. Currently, the diagnosis of IBD results in a multidisciplinary approach with significant disadvantages, such as its invasive nature, time spent, and the fact that 10% of patients remain without diagnostic classification. However, new methodologies of analysis have emerged that allowed the expansion of knowledge about IBD, as the metabolomics, the study of metabolites. The presence and prevalence of such metabolites may prove to be useful as biomarkers in the diagnosis of IBD. OBJECTIVE: Analyze fecal samples for metabolic analysis in the diagnosis of inflammatory bowel diseases (IBD), providing differentiation between Crohn's disease and ulcerative colitis. METHODS: This is an observational study with 21 patients diagnosed with IBD (ulcerative colitis 11 and Crohn's disease 10) and 15 healthy controls, all with the consent and clarification. The fecal extracts of all patients are submitted to a high-resolution Nuclear Magnetic Resonance Hydrogen (1H-NMR) spectroscopy combined with multivariate and univariate pattern recognition techniques. Through the metabolomics of fecal extracts, gives us a characterization of employing a noninvasive approach. RESULTS: We identify some metabolites, such as lactate, succinate, alanine, and tyrosine, in the Crohn's disease fecal samples, and leucine, alanine, and tyrosine in the ulcerative colitis fecal samples. All the amino acids presented positive covariance for disease correlation. CONCLUSION: The results showed different metabolic profiles between IBD patients and healthy volunteers based on 1H-NMR analysis of fecal extracts. Moreover, the approach discriminated patients with Crohn's disease and ulcerative colitis. The metabolomics analysis is promising as a novel diagnostic technique for further IBD recognition and surveillance. New studies are necessary to validate these findings.

RESUMO CONTEXTO: A doença de Crohn e retocolite ulcerativa são as principais doenças inflamatórias intestinais (DII), e sua patogênese está relacionada a fatores genéticos e ambientais. Atualmente, o diagnóstico de DII resulta em uma abordagem multidisciplinar e apresenta desvantagens significativas, como sua natureza invasiva, tempo gasto e o fato de 10% dos pacientes permanecerem sem classificação diagnóstica. No entanto, surgiram novas metodologias de análise que permitiram ampliar o conhecimento sobre a DII, como a metabolômica, o estudo dos metabólitos. A presença e a prevalência desses metabólitos podem ser úteis como biomarcadores no diagnóstico da DII. OBJETIVO: Avaliar as amostras fecais por análise metabolômica no diagnóstico de DII, diferenciando os perfis metabólicos entre doença de Crohn e retocolite ulcerativa. MÉTODOS: Estudo observacional com 36 indivíduos (doença de Crohn 11, retocolite ulcerativa 10 e 15 controles saudáveis), todos com consentimento esclarecido. Os extratos fecais de todos os pacientes são submetidos a uma espectroscopia de alta resolução por ressonância magnética nuclear de hidrogênio (1H-RMN) combinada com técnicas de reconhecimento de padrões multivariados e univariados. Por meio da metabolômica utilizando extratos fecais, foi possível obter uma caracterização adequada das doenças inflamatórias intestinais através de uma abordagem não invasiva. RESULTADOS: Foi possível identificar os seguintes metabólitos nos pacientes com doen­ça de Crohn: lactato, succinato, alanina e tirosina e, no grupo retocolite ulcerativa encontrou-se leucina, alanina e tirosina. Todos os aminoácidos apresentaram covariância positiva para a doença. CONCLUSÃO: Os resultados demonstraram diferentes perfis metabólicos entre pacientes com DII e voluntários saudáveis, com base na análise por 1H-RMN dos extratos fecais. Além disso, pacientes com doença de Crohn e retocolite ulcerativa também podem ser discriminados usando essa abordagem. A análise metabolômica é promissora como uma nova técnica não invasiva de diagnóstico para melhor reconhecimento das DII. Novos estudos são necessários para validar esses achados.