Effectiveness of Dual-Focus Magnification on Confidence Levels in Optical Diagnosis of Small Colorectal Polyps.

Background and objectives Achieving accurate real-time optical diagnoses of colorectal polyps with high-confidence predictions is crucial for appropriate decision-making in daily practice. The dual-focus (DF) magnification mode helps endoscopists scrutinize subtle features of polyp surfaces and vessel patterns. This prospective study aimed to evaluate the impact of DF imaging on enhancing the rate of high-confidence narrow-band imaging (NBI)-based optical diagnosis. Methods Consecutive adult patients who underwent colonoscopy and had small colorectal polyps (<10 mm) were enrolled between September 2022 and May 2023. The optical diagnosis of each polyp was evaluated during colonoscopy in two stages by the same endoscopist, utilizing NBI with DF magnification (NDB-DF). A confidence level was assigned to each prediction. High confidence was indicated by clinical judgment when a polyp exhibited distinctive features associated solely with one histological subtype and lacked characteristics of any other subtype. All procedures were carried out with a prototype 190 series Exera III NBI system (Olympus Corporation, Tokyo, Japan) with DF magnification. Results The study included 413 patients with 623 polyps, comprising 483 ≤ 5 mm and 140 measuring 6-9 mm. The majority were low-grade adenomas (343 lesions), with 17 identified as high-grade adenomas, and none characterized as deep submucosal invasive carcinomas. NBI-DF significantly improved the rate of high-confidence optical diagnoses compared to NBI for both ≤ 5 mm polyps (93.1% vs. 87.5%, p < 0.0001) and 6-9 mm polyps (97.9% vs. 94.2%, p = 0.03). Furthermore, DF significantly facilitated the assessment of microvessel and surface pattern criteria (p < 0.01). Conclusion DF magnification markedly enhanced the rate of high-confidence NBI-based optical predictions for small colorectal polyps. This technique demonstrates the potential for improving the diagnostic yield in real-time optical diagnosis of colorectal polyps in the Vietnamese setting.

A Clinicopathologic Continuum of Eosinophilic Gastrointestinal Diseases in an Adult With Tuberculosis and Latent Hepatitis B Virus Infection.

Eosinophilic gastroenteritis (EGE) is considered distinct from eosinophilic colitis (EC). A 59-year-old man presented with a colonic tumor, who had resolution of pain and diarrhea after surgery, then 7 months later developed proton-pump inhibitor-responsive dysphagia with esophagitis, and 9 months later presented again with pain and diarrhea where EGE with concurrent eosinophilic esophagitis was diagnosed. Review of the resected tumor specimen identified EC with an adenoma. Workup revealed tuberculosis and latent hepatitis B virus requiring treatment before commencing immunosuppressive therapy plus a 6-food elimination diet that led to complete resolution within 3 weeks. EC may precede EGE and eosinophilic esophagitis.

Prevalence, causes, medical interventions, and mortality outcome of acute gastrointestinal bleeding among COVID-19 inpatients.

OBJECTIVE: This study aimed to evaluate the prevalence, causes, medical interventions, and mortality outcome of acute gastrointestinal bleeding (AGIB) among COVID-19 patients hospitalized during the delta pandemic in Vietnam. METHODS: The medical records of COVID-19 patients hospitalized in a tertiary hospital in Vietnam from July to October 2021 were retrospectively collected. Data regarding age, sex, comorbidities, COVID-19 severity, onset time of AGIB, therapeutic interventions for AGIB, and mortality outcome were analyzed. RESULTS: Of 1567 COVID-19 inpatients, 56 (3.6%) had AGIB. The independent risk factors for AGIB in COVID-19 inpatients included age (OR = 1.03, 95% CI: 1.01-1.04, p = .003), male sex (OR = 1.86, 95% CI: 1.06-3.26, p = .03), chronic liver disease (OR = 6.21, 95% CI: 2.97-13.00, p < .001), and chronic kidney disease (OR = 2.17, 95% CI: 1.01-4.65, p = .047). Among 34 AGIB patients undergoing endoscopy, upper AGIB was determined in 24 (70.6%) patients. Peptic ulcer disease and hemorrhagic erosive gastritis were the most common causes (64.7%, 22/34). The therapeutic interventions for AGIB included blood transfusion (76.8%, 43/56), endoscopic hemostasis (23.5%, 8/34), and surgery (1.8%, 1/56). The mortality rate in the AGIB group was significantly higher than that in the non-AGIB group (46.4% vs. 27.7%, OR = 2.26, 95% CI: 1.32-3.87, p = .002). However, the majority (76.9%) of deaths in COVID-19 inpatients with AGIB were not bleeding-related. CONCLUSIONS: Age, male sex, chronic liver disease, and chronic kidney disease are risk factors for AGIB among COVID-19 inpatients. Peptic ulcer disease is the most common cause. COVID-19 inpatients with AGIB have a higher risk of mortality, but a large percentage of deaths are not bleeding-related.

Since there is not enough information of sudden digestive tract bleeding among Asian populations with COVID-19, this study aimed to measure the proportion of existing cases, causes, medical treatments and deaths of sudden digestive tract bleeding in COVID-19 patients who were hospitalized during the Delta-variant pandemic in Vietnam. We collected medical records of 1567 COVID-19 patients from a specialty hospital in Vietnam from July to October 2021. Sudden digestive tract bleeding was present in 3.6% of COVID-19 inpatients. The risk of sudden digestive tract bleeding was higher in COVID-19 patients who were old, male, or had long-term liver or kidney disease. The most common cause of sudden digestive tract bleeding among COVID-19 inpatients were stomach ulcers. In addition, COVID-19 inpatients with sudden digestive tract bleeding had a higher risk of death, but a large proportion of deaths were not bleeding-related.

Clinical characteristics and risk factors of gastroesophageal reflux disease in Vietnamese patients with upper gastrointestinal symptoms undergoing esophagogastroduodenoscopy.

BACKGROUND AND AIM: The risk factors associated with the increase in prevalence of gastroesophageal reflux disease (GERD) are not consistent across countries and there have been few studies in Asia in the past 10 years. This study was conducted to assess the features and risk factors of GERD in Vietnamese patients. METHODS: A cross-sectional study was conducted on 1947 out-patients ≥18 years of age who were presented with upper gastrointestinal symptoms and underwent esophagogastroduodenoscopy. Reflux esophagitis was graded according to the Los Angeles classification. Endoscopically suspected Barrett's esophagus (BE) was recorded according to the Prague C and M criteria and biopsy was taken for histologic examination. RESULTS: There were 511 (26.2%) patients with GERD, 242 (47.4%) with nonerosive reflux disease, and 269 (52.6%) with reflux esophagitis and/or BE. Epigastric pain, regurgitation, and heartburn were the chief complaints in 36.8%, 27.0%, and 9.2% of patients, respectively. Most of the patients with mucosal injury had reflux esophagitis in mild grade and BE in the form of C0M ≤2 (99.6%, 231/232 and 97.8%, 46/47, respectively). In multivariate analysis, hiatal hernia, male gender, waist-to-hip ratio (independent from general obesity), and smoking were risk factors for GERD while Helicobacter pylori infection was negatively associated with GERD. CONCLUSIONS: The majority of GERD patients had none or mild mucosal injury. Typical reflux symptoms, however, may not be the chief complaints. Central obesity would be more important than general obesity as a risk factor, while H. pylori infection was a "protective" factor for GERD in Vietnamese patients.

Prevalence, clinical characteristics, and risk factors of Barrett esophagus in Vietnamese patients with upper gastrointestinal symptoms.

The current barrier for investigation of Barrett esophagus (BE) in Asia is diagnostic standardization, which is a challenge to identify its true risk factors. This study aimed to investigate the prevalence, clinical characteristics and risk factors of BE in Vietnamese patients with upper gastrointestinal symptoms.A cross-sectional study was conducted on consecutive outpatients who underwent upper gastrointestinal endoscopy. Endoscopically suspected esophageal metaplasia (ESEM) which was clearly visible at least 1 cm above the gastroesophageal junction at endoscopy was taken biopsy. At least 1 biopsy per 2 cm in tongues of ESEM and 4 biopsies per 2 cm of circumferential ESEM were taken. The diagnostic criterion for BE was replacement of the normal squamous epithelial lining by columnar epithelium confirmed by histology.A total of 1947 patients were recruited. Forty-seven out of 58 patients with ESEM were histologically confirmed BE. The prevalences of BE and hiatal hernia (HH) were 2.4% (95% confidence interval [CI], 1.7-3.1%) and 2.3% (95% CI, 1.6-2.9%), respectively. Heartburn and/or regurgitation presented in only 61.7% (95% CI, 46.4-75.5%) of patients with BE. In multivariate analysis, the only 2 factors significantly associated with BE were HH (OR 7.53; 95% CI, 3.13-18.11; P < .001) and typical reflux symptom (OR 2.07; 95% CI, 1.12-3.83; P = .020).BE is not uncommon in Vietnamese patients with upper gastrointestinal symptoms. In addition, typical reflux symptoms and HH are the risk factors for BE in Vietnamese.

Improving Efficacy of Endoscopic Diagnosis of Early Gastric Cancer: Gaps to Overcome from the Real-World Practice in Vietnam.

OBJECTIVE: To identify factors associated with increased proportion of early gastric cancer to total detected gastric cancer among patients undergoing diagnostic esophagogastroduodenoscopy. METHODS: A nationwide survey was conducted across 6 central-type and 6 municipal-type Vietnamese hospitals. A questionnaire regarding annual esophagogastroduodenoscopy volume, esophagogastroduodenoscopy preparation, the use of image-enhanced endoscopy, and number of gastric cancer diagnosed in 2018 was sent to each hospital. RESULTS: The total proportion of early gastric cancer was 4.0% (115/2857). Routine preparation with simethicone and the use of image-enhanced endoscopy were associated with higher proportion of early gastric cancer (OR 1.9, 95% CI: 1.1-3.2, p = 0.016; OR 2.7, 95% CI: 1.8-4.0, p < 0.001, respectively). Esophagogastroduodenoscopies performed at central-type hospitals were associated with higher proportion of early gastric cancer (OR 1.9, 95% CI: 1.1-3.2, p = 0.017). Esophagogastroduodenoscopies performed at hospitals with an annual volume of 30.000-60.000 were associated with higher proportion of early gastric cancer than those performed at hospitals with an annual volume of 10.000-<30.000 (OR 2.7, 95% CI: 1.6-4.8, p < 0.001) and with a volume of >60.000-100.000 (OR 2.7, 95% CI: 1.7-4.2, p < 0.001). Only four (33.3%) hospitals reported all endoscopic types of early gastric cancer. CONCLUSIONS: The detection of early gastric cancer is still challenging even for endoscopists working in regions with relatively high prevalence. The real-world evidence showed that endoscopic detection of early gastric cancer could potentially improve with simple adjustments of esophagogastroduodenoscopy protocols.

Value of a new stick-type rapid urine test for the diagnosis of Helicobacter pylori infection in the Vietnamese population.

AIM: To assess the value of a new test for the diagnosis of Helicobacter pylori (H. pylori) infection, Rapirun H. pylori Antibody Stick (Rapirun Stick), in a Vietnamese population. METHODS: Eligible patients without previous history of H. pylori eradication were recruited. Rapid urease test (RUT) and histologic examination were used to diagnose the H. pylori infection. Patients were considered H. pylori positive when the RUT results were positive and/or the bacteria were detected histologically. Rapirun Stick tests were performed using urine samples, and the results were compared with the other 2 methods. RESULTS: We enrolled 200 patients with a mean age of 36 (range, 18-76) years. There were 116 females and 84 males. Of the 200 patients, 111 (55.5%) were diagnosed as being H. pylori positive. The sensitivity, specificity, and accuracy of the Stick test were 84.7%, 89.9%, and 87.0%, respectively. There were 17 (8.5%) false-negative patients and 9 (4.5%) false-positive patients. CONCLUSION: The Rapirun Stick test has high sensitivity, specificity, and accuracy for the diagnosis of H. pylori infection in the Vietnamese population. The test can be clinically applied in Vietnamese populations.