ABSTRACT
PURPOSE OF REVIEW: Inflammatory bowel diseases (IBD) are associated with several well described neoplastic and structural complications. Increasing disease prevalence, healthcare barriers, and medication refractory phenotypes contribute to ongoing complications despite significant strides in medical management. Enhancements in endoscopic technology and techniques have allowed a minimally invasive approach for what has historically required surgery. In this article, we review the current and future landscape of endoscopic IBD intervention. RECENT FINDINGS: Endoscopic resection is the first line for managing conventional and complex colitis-associated dysplasia. Evidence supporting endoscopic submucosal dissection is mounting, yet there is a paucity of studies evaluating modified endoscopic mucosal resection techniques or hybrid endoscopic submucosal dissection. We also have more clarity in how best to approach fibrostenotic disease, as we learn how to position endoscopic stricturotomy and stenting, relative to balloon dilation. Finally, applications in managing penetrating and postsurgical complications have been described, but still require further study. SUMMARY: While important knowledge gaps still exist, the application of endoscopic therapies in IBD is more refined, especially within the management of colitis-associated dysplasia and strictures. The indications for endoscopy in perianal disease and other penetrating manifestations of Crohn's disease presents exciting opportunities for growth.
Subject(s)
Inflammatory Bowel Diseases , Humans , Inflammatory Bowel Diseases/therapy , Inflammatory Bowel Diseases/surgery , Endoscopic Mucosal Resection/methods , Endoscopic Mucosal Resection/trends , Stents , Endoscopy, Gastrointestinal/methods , Endoscopy, Gastrointestinal/trendsABSTRACT
Background and aims: currently, most endoscopy software only provides limited statistics of past procedures, while none allows patterns to be extrapolated. To overcome this need, the authors applied business analytic models to predict future demand and the need for endoscopists in a tertiary hospital Endoscopy Unit. Methods: a query to the endoscopy database was performed to retrieve demand from 2015 to 2021. The graphical inspection allowed inferring of trends and seasonality, perceiving the impact of the COVID-19 pandemic, and selecting the best forecasting models. Considering COVID-19s impact in the second quarter of 2020, data for esophagogastroduodenoscopy (EGD) and colonoscopy was estimated using linear regression of historical data. The actual demand in the first two quarters of 2022 was used to validate the models. Results: during the study period, 53,886 procedures were requested. The best forecasting models were: a) simple seasonal exponential smoothing for EGD, colonoscopy and percutaneous endoscopic gastrostomy (PEG); b) double exponential smoothing for capsule endoscopy and deep enteroscopy; and c) simple exponential smoothing for endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). The mean average percentage error ranged from 6.1 % (EGD) to 33.5 % (deep enteroscopy). Overall, 8,788 procedures were predicted for 2022. The actual demand in the first two quarters of 2022 was within the predicted range. Considering the usual time allocation for each technique, 3.2 full-time equivalent endoscopists (40 hours-dedication to endoscopy) will be required to perform all procedures in 2022. Conclusions: the incorporation of business analytics into the endoscopy software and clinical practice may enhance resource allocation, improving patient-focused decision-making and healthcare quality (AU)
Subject(s)
Humans , Endoscopy, Gastrointestinal/trends , Decision Support Systems, Clinical/organization & administration , Decision Making , Quality of Health Care , Databases, FactualSubject(s)
Health Care Costs/trends , Health Resources/economics , Health Resources/trends , Pancreatitis/economics , Pancreatitis/therapy , Patient Acceptance of Health Care , Digestive System Surgical Procedures/economics , Digestive System Surgical Procedures/trends , Endoscopy, Gastrointestinal/economics , Endoscopy, Gastrointestinal/trends , Health Expenditures/trends , Hospital Costs/trends , Humans , Incidence , North America/epidemiology , Pancreatitis/diagnosis , Pancreatitis/epidemiology , Pancreatitis, Chronic/diagnosis , Pancreatitis, Chronic/economics , Pancreatitis, Chronic/epidemiology , Pancreatitis, Chronic/therapy , Patient Readmission/economics , Patient Readmission/trends , Prevalence , Time FactorsABSTRACT
PURPOSE OF REVIEW: Recently numerous researchers have shown remarkable progress using convolutional neural network-based artificial intelligence (AI) for endoscopy. In this manuscript we aim to summarize recent AI impact on endoscopy. RECENT FINDINGS: AI for detecting colon polyps has been the most promising area for application of AI in endoscopy. Recent prospective randomized studies showed that AI assisted colonoscopy increased adenoma detection rate and the mean number of adenomas per patient compared to standard colonoscopy alone. AI for optical biopsy of colon polyp showed a negative predictive value of ≥90%. For capsule endoscopy, applying AI to pre-read the video images decreased physician reading time significantly. Recently, researchers are broadening the area of AI to quality assessment of endoscopy such as bowel preparation and automated report generation. AI systems have shown great potential to increase physician performance by enhancing detection, reducing procedure time, and providing real-time feedback of endoscopy quality. To build a generally applicable AI, we need further investigations in real world settings and also integration of AI tools into pragmatic platforms.
Subject(s)
Artificial Intelligence , Endoscopy, Gastrointestinal , Artificial Intelligence/trends , Endoscopy, Gastrointestinal/methods , Endoscopy, Gastrointestinal/trends , Humans , Neural Networks, ComputerABSTRACT
With advancements in the development of flexible endoscopes and endoscopic devices and the increased demand for minimally invasive treatments, the indications of therapeutic endoscopy have been expanded. Methods of endoscopic treatment used for tissue removal, hemostasis, and dilatation are as follows. Endoscopic submucosal dissection (ESD) is considered the gold standard curative method for removal of gastrointestinal node-negative neoplasms, regardless of their size or the presence of ulcer formation. Laparoscopic endoscopic cooperative surgery (LECS), which incorporates ESD, was introduced for removal of lesions in deeper layers. Another technique is endoscopic full-thickness resection, which is challenging without the assistance of laparoscopy. In terms of hemostasis, management of iatrogenic bleeding after endoscopic treatment is an important issue. Shielding methods and suturing techniques have been introduced for large mucosal defects after ESD, and their efficacy has been investigated clinically. Peroral endoscopic myotomy (POEM) is a new alternative surgical approach for minimally invasive treatment of esophageal achalasia. Furthermore, endoscopic fundoplication after POEM was devised to prevent post-POEM gastroesophageal reflux disease. Many endoscopic treatments, including ESD, LECS, and POEM, have been introduced in Japan. With the aging of the population, more attention will be directed toward therapeutic endoscopy for elderly patients, because it is less invasive. Development of endoscopic treatments with expanded indications is expected.
Subject(s)
Endoscopes, Gastrointestinal/trends , Endoscopy, Gastrointestinal/instrumentation , Endoscopy, Gastrointestinal/methods , Gastric Mucosa/surgery , Gastrointestinal Neoplasms/surgery , Laparoscopy/instrumentation , Laparoscopy/methods , Endoscopes, Gastrointestinal/adverse effects , Endoscopy, Gastrointestinal/adverse effects , Endoscopy, Gastrointestinal/trends , Esophageal Achalasia/surgery , Female , Fundoplication/methods , Gastroesophageal Reflux/prevention & control , Hemostasis, Endoscopic/instrumentation , Hemostasis, Endoscopic/methods , Humans , Laparoscopy/adverse effects , Male , Myotomy/adverse effects , Myotomy/instrumentation , Myotomy/methods , Postoperative Complications/prevention & control , Postoperative Hemorrhage/etiology , Postoperative Hemorrhage/surgerySubject(s)
COVID-19 , Digestive System Neoplasms/diagnosis , Early Detection of Cancer/trends , Endoscopy, Gastrointestinal/trends , Gastroenterology/trends , Databases, Factual , Digestive System Neoplasms/epidemiology , Humans , Predictive Value of Tests , Retrospective Studies , Time Factors , United States/epidemiologyABSTRACT
BACKGROUND: Although sedation during gastrointestinal endoscopy is widely used in China, the characteristics of sedation use, including regional distribution, personnel composition, equipment used, and drug selection, remain unclear. The present study aimed to provide insights into the current practice and regional distribution of sedation for gastrointestinal endoscopy in China. METHODS: A questionnaire consisting of 19 items was distributed to directors of anaesthesiology departments and anaesthesiologists in charge of endoscopic sedation units in mainland China through WeChat. RESULTS: The results from 2758 participating hospitals (36.7% of the total) showed that 9 808 182 gastroscopies (69.3%) and 4 353 950 colonoscopies (30.7%), with a gastroscopy-to-colonoscopy ratio of 2.3, were conducted from January to December 2016. Sedation was used with 4 696 648 gastroscopies (47.9%) and 2 148 316 colonoscopies (49.3%), for a ratio of 2.2. The most commonly used sedative was propofol (61.0% for gastroscopies and 60.4% for colonoscopies). Haemoglobin oxygen saturation (SpO2) was monitored in most patients (96.1%). Supplemental oxygen was routinely administered, but the availability of other equipment was variable (anaesthesia machine in 64.9%, physiological monitor in 84.4%, suction device in 72.3%, airway equipment in 75.5%, defibrillator in 32.7%, emergency kit in 57.0%, and difficult airway kit in 20.8% of centres responding). CONCLUSIONS: The sedation rate for gastrointestinal endoscopy is much lower in China than in the USA and in Europe. The most commonly used combination of sedatives was propofol plus an opioid (either fentanyl or sufentanil). Emergency support devices, such as difficult airway devices and defibrillators, were not usually available.
Subject(s)
Anesthesia/methods , Endoscopy, Gastrointestinal/methods , Endoscopy, Gastrointestinal/trends , Health Personnel/trends , Hospitals/trends , Surveys and Questionnaires , Analgesics, Opioid/administration & dosage , Anesthetics, Intravenous/administration & dosage , China/epidemiology , Humans , Pilot Projects , Retrospective StudiesSubject(s)
COVID-19/prevention & control , Endoscopy, Gastrointestinal/trends , Gastroenterology/trends , Practice Patterns, Physicians'/trends , COVID-19/epidemiology , Endoscopy, Gastrointestinal/methods , Endoscopy, Gastrointestinal/standards , Forecasting , Gastroenterology/methods , Gastroenterology/standards , Global Health , Health Policy , Humans , Infection Control/standards , Infection Control/trends , Pandemics , Patient Safety , United States/epidemiologyABSTRACT
White-light endoscopy with biopsy is the current gold standard modality for detecting and diagnosing upper gastrointestinal (GI) pathology. However, missed lesions remain a challenge. To overcome interobserver variability and learning curve issues, artificial intelligence (AI) has recently been introduced to assist endoscopists in the detection and diagnosis of upper GI neoplasia. In contrast to AI in colonoscopy, current AI studies for upper GI endoscopy are smaller pilot studies. Researchers currently lack large volume, well-annotated, high-quality datasets in gastric cancer, dysplasia in Barrett's esophagus and early esophageal squamous cell cancer. This review will look at the latest studies of AI in upper GI endoscopy, discuss some of the challenges facing researchers, and predict what the future may hold in this rapidly changing field.
Subject(s)
Artificial Intelligence/trends , Barrett Esophagus/diagnosis , Barrett Esophagus/pathology , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/pathology , Endoscopy, Gastrointestinal/methods , Endoscopy, Gastrointestinal/trends , Stomach Neoplasms/diagnosis , Stomach Neoplasms/pathology , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/pathology , Forecasting , Gastritis/diagnosis , Gastritis/microbiology , Gastritis/pathology , Helicobacter Infections , Humans , Precancerous Conditions/diagnosis , Precancerous Conditions/pathologyABSTRACT
BACKGROUND: Gastrointestinal hemorrhage (GIH) has been reported as one of the most common GI complications in patients with pulmonary hypertension (PH). There is paucity of data on the national burden of GIH in patients with PH. We aimed to assess the prevalence, trends and outcomes of endoscopic interventions in patients with PH who were admitted with GIH. METHOD: We queried National Inpatient Sample (NIS) database from 2005 to 2014 and identified the patients hospitalized with primary or secondary discharge diagnosis of PH (ICD 9 CM Code: 416.0, 416.8, and 416.9). Using Clinical Classification Software Coding system (153) patients with concurrent diagnosis of GIH were then identified. We studied the prevalence and trends of GIH in PH, factors associated with GIH, use of endoscopy, factors associated with utilization of endoscopic interventions, endoscopy outcomes including mortality, and overall healthcare burden. RESULTS: Out of 7,586,973 PH hospitalizations 3.2% (N = 246,358) had concurrent GIH, with a rising prevalence of GIH in PH patients during the last decade. Clinical predictors for GIH in PH included older age, congestive heart failure, anticoagulation therapy and concurrent alcohol abuse. Mean length of stay (LOS) in PH patients hospitalized with GIH was significantly higher than without GIH (8.6 vs. 6.4 days, p < 0.01) along with a significant increase in hospitalization cost ($20,189 vs. $14,807, p < 0.01). Similarly, odds of in-hospital mortality increase by ~ 1.5 times in PH patients with GIH than those without it (adjusted odds ratio [aOR: 1.45, 95%CI: 1.43-1.47]). Endoscopic interventions were performed in 48.6% of patients with PH and GIH during their hospitalization. Older patients were more likely to undergo endoscopy, as well as the patients who received blood transfusion, and those with hypovolemic shock. Patients with acute respiratory failure and acute renal failure were less likely to get endoscopy. Mean LOS in patients undergoing endoscopic intervention was significantly higher than those who did not receive any intervention (8.7 vs. 8.4 days, p < 0.01), without a substantial increase in hospitalization cost ($20,344 vs. $20,041, p < 0.01). Also, there was a significant decrease in in-hospital mortality in patients undergoing endoscopic interventions. CONCLUSION: Concurrent GIH in patients with PH increases length of stay; healthcare costs and increases in-hospital mortality. Use of endoscopic interventions in these patients is associated with reduced length of stay, in-hospital mortality without significantly increasing the overall health care burden and should be considered in hospitalized patients with PH who are admitted with GIH. Future studies comparing GIH patients with and without PH should be done to assess if PH is a risk factor for worse outcomes. CLINICAL TRIAL REGISTRATION NUMBER: No IRB required due to use of national de-identified data.
Subject(s)
Endoscopy, Gastrointestinal/trends , Gastrointestinal Hemorrhage/therapy , Hemostasis, Endoscopic/trends , Hypertension, Pulmonary/therapy , Adolescent , Adult , Aged , Databases, Factual , Endoscopy, Gastrointestinal/adverse effects , Endoscopy, Gastrointestinal/economics , Endoscopy, Gastrointestinal/mortality , Female , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/economics , Gastrointestinal Hemorrhage/mortality , Health Care Costs/trends , Hemostasis, Endoscopic/adverse effects , Hemostasis, Endoscopic/economics , Hemostasis, Endoscopic/mortality , Hospital Mortality/trends , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/economics , Hypertension, Pulmonary/mortality , Inpatients , Length of Stay/trends , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , United States/epidemiology , Young AdultABSTRACT
BACKGROUND: IBD management has been significantly affected during the COVID-19 lockdown with potential clinical issues. AIMS: The aim of this study was to analyse the impact of COVID-19 pandemic on the Italian paediatric IBD cohort. METHODS: This was a multicentre, retrospective, cohort investigation including 21 different Italian IBD referral centres. An electronic data collection was performed among the participating centres including: clinical characteristics of IBD patients, number of COVID-19 cases and clinical outcomes, disease management during the lockdown and the previous 9 weeks. RESULTS: 2291 children affected by IBD were enrolled. We experienced a significant reduction of the hospital admissions [604/2291 (26.3%) vs 1281/2291 (55.9%); p < 0.001]. More specifically, we observed a reduction of hospitalizations for new diagnosis (from nâ¯=â¯44 to nâ¯=â¯27) and endoscopic re-evaluations (from nâ¯=â¯46 to nâ¯=â¯8). Hospitalization for relapses and surgical procedures remained substantially unchanged. Biologic infusions did not significantly vary [393/2291 (17.1%) vs 368/2291 (16%); pâ¯=â¯0.3]. Telemedicine services for children with IBD were activated in 52.3% of the centres. In 42/2291(1.8%) children immunosuppressive therapies were adapted due to the concurrent COVID-19 pandemic. CONCLUSION: Due to the several limitations of the lockdown, cares for children with IBD have been kept to minimal standards, giving priorities to the urgencies and to biologics' infusions and implementing telemedicine services.
Subject(s)
Biological Products/therapeutic use , Colitis, Ulcerative/drug therapy , Crohn Disease/drug therapy , Endoscopy, Gastrointestinal/trends , Gastrointestinal Agents/therapeutic use , Hospitalization/trends , Telemedicine/trends , Adolescent , COVID-19/epidemiology , Child , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/epidemiology , Crohn Disease/diagnosis , Crohn Disease/epidemiology , Disease Management , Female , Humans , Immunosuppressive Agents/therapeutic use , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/drug therapy , Inflammatory Bowel Diseases/epidemiology , Italy/epidemiology , Male , Recurrence , SARS-CoV-2ABSTRACT
In line with the current trajectory of healthcare reform, significant emphasis has been placed on improving the utilization of data collected during a clinical encounter. Although the structured fields of electronic health records have provided a convenient foundation on which to begin such efforts, it was well understood that a substantial portion of relevant information is confined in the free-text narratives documenting care. Unfortunately, extracting meaningful information from such narratives is a non-trivial task, traditionally requiring significant manual effort. Today, computational approaches from a field known as Natural Language Processing (NLP) are poised to make a transformational impact in the analysis and utilization of these documents across healthcare practice and research, particularly in procedure-heavy sub-disciplines such as gastroenterology (GI). As such, this manuscript provides a clinically focused review of NLP systems in GI practice. It begins with a detailed synopsis around the state of NLP techniques, presenting state-of-the-art methods and typical use cases in both clinical settings and across other domains. Next, it will present a robust literature review around current applications of NLP within four prominent areas of gastroenterology including endoscopy, inflammatory bowel disease, pancreaticobiliary, and liver diseases. Finally, it concludes with a discussion of open problems and future opportunities of this technology in the field of gastroenterology and health care as a whole.
Subject(s)
Electronic Health Records/trends , Gastroenterology/trends , Natural Language Processing , Endoscopy, Gastrointestinal/methods , Endoscopy, Gastrointestinal/trends , Forecasting , Gastroenterology/methods , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/therapy , HumansABSTRACT
PURPOSE OF REVIEW: Obesity is a chronic relapsing disease that results in cardiovascular disease, diabetes mellitus, and non-alcoholic fatty liver disease. Currently, surgery represents the most effective treatment. However, the advent of minimally invasive endoscopic bariatric therapy (EBT) has shifted the treatment paradigm to less invasive, cost-effective procedures with minimal complications and recovery time that are preferred by patients. In this review, we will describe current and future EBTs, focusing on outcomes and safety. RECENT FINDINGS: The endoscope has provided an incisionless portal into the gastrointestinal tract for placement of space-occupying devices and intraluminal procedures. EBTs are no longer solely manipulating anatomic alterations; instead, they aim to improve metabolic parameters such as glycated hemoglobin, low-density lipoprotein, cholesterol, and hepatic indices by targeting the mucosal layer of the gastrointestinal tract. The endoscope has succeeded in facilitating clinically meaningful weight loss and improvement of metabolic parameters. Future, solutions to the obesity epidemic will likely entail genetic testing, evaluation of the microbiome, and delivery of personalized therapy, utilizing combination endoscopic modalities that change the anatomy and physiology of individual patients, with new targets such as the abnormal metabolic signal.
Subject(s)
Endoscopy, Gastrointestinal , Epidemics , Obesity/therapy , Bariatrics/methods , Bariatrics/trends , Endoscopy, Gastrointestinal/methods , Endoscopy, Gastrointestinal/trends , Humans , Obesity/complications , Obesity/epidemiology , Weight LossABSTRACT
INTRODUCTION: During the COVID-19 pandemic, endoscopic procedures are associated with a high risk of SARS-CoV-2 infection. However, in cases of upper gastrointestinal bleeding (UGIB), priority should be given to an early endoscopy. OBJECTIVE: The main objective was to compare the time since arrival at the hospital and the performance of the endoscopy between both groups. MATERIALS AND METHODS: We performed a retrospective study. Data contains information of patients who attended to the hospital with UGIB and underwent an endoscopy between October 19th, 2019 and June 6th, 2020. Patients were divided into 2 phases: pre-pandemic and pandemic. The time between arrival at the hospital and the performance of the endoscopy in both phases were compared as well as other indicators such hospital stay and in-hospital mortality. RESULTS: With information from 219 patients, the median age was 69 years. 154 and 65 endoscopies were performed in pre-pandemic and pandemic phase, respectively. The time between arrival at the hospital and the performance of the endoscopy was significantly longer during the pandemic (10.00 vs. 13.08 hours, p-value = 0.019). Nevertheless, there were no significant differences in hospital stay or mortality. CONCLUSION: The management of patients with UGIB during the COVID-19 pandemic is complex and requires the application of clinical judgment to decide the best timing to perform an endoscopy without affecting patient care.
Subject(s)
Coronavirus Infections , Endoscopy, Gastrointestinal/trends , Gastrointestinal Hemorrhage/diagnostic imaging , Pandemics , Pneumonia, Viral , Practice Patterns, Physicians'/trends , Time-to-Treatment/trends , Upper Gastrointestinal Tract/diagnostic imaging , Adult , Aged , Aged, 80 and over , COVID-19 , Clinical Decision-Making , Coronavirus Infections/prevention & control , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/mortality , Gastrointestinal Hemorrhage/therapy , Hospital Mortality/trends , Humans , Infection Control/methods , Length of Stay/trends , Male , Middle Aged , Pandemics/prevention & control , Peru , Pneumonia, Viral/prevention & control , Retrospective StudiesABSTRACT
Surgeons have been involved, since the beginning, in the development and evolution of endoscopy. They have been instrumental in developing new methods and have been actively involved in most of the therapeutic applications. The continued evolution of endoscopic technique is inevitable and will involve the integration of new technology with innovative thinking.
Subject(s)
Endoscopes, Gastrointestinal/history , Endoscopy, Gastrointestinal/history , Fiber Optic Technology/history , Endoscopy, Gastrointestinal/instrumentation , Endoscopy, Gastrointestinal/trends , Europe , Fiber Optic Technology/instrumentation , History, 19th Century , History, 20th Century , History, Ancient , Humans , Optics and Photonics/history , Optics and Photonics/trends , United StatesABSTRACT
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