Computer-Aided Classification of Gastrointestinal Lesions in Regular Colonoscopy.

We have developed a technique to study how good computers can be at diagnosing gastrointestinal lesions from regular (white light and narrow banded) colonoscopic videos compared to two levels of clinical knowledge (expert and beginner). Our technique includes a novel tissue classification approach which may save clinician's time by avoiding chromoendoscopy, a time-consuming staining procedure using indigo carmine. Our technique also discriminates the severity of individual lesions in patients with many polyps, so that the gastroenterologist can directly focus on those requiring polypectomy. Technically, we have designed and developed a framework combining machine learning and computer vision algorithms, which performs a virtual biopsy of hyperplastic lesions, serrated adenomas and adenomas. Serrated adenomas are very difficult to classify due to their mixed/hybrid nature and recent studies indicate that they can lead to colorectal cancer through the alternate serrated pathway. Our approach is the first step to avoid systematic biopsy for suspected hyperplastic tissues. We also propose a database of colonoscopic videos showing gastrointestinal lesions with ground truth collected from both expert image inspection and histology. We not only compare our system with the expert predictions, but we also study if the use of 3D shape features improves classification accuracy, and compare our technique's performance with three competitor methods.

Mesalamine foam enema versus mesalamine liquid enema in active left-sided ulcerative colitis.

AIM: To determine in a noninferiority study whether mesalamine foam is as effective as mesalamine liquid enema for inducing clinical remission in patients with active left-sided ulcerative colitis (UC). METHODS: In a multicenter investigator-blind trial, 375 patients with mild-to-moderate UC were randomized to receive mesalamine foam 1 g/80 mL/day or mesalamine liquid enema 1 g/100 mL/day for 4 wk (W). Inclusion criteria were: disease extension at least 5 cm from anorectal junction and not above splenic flexure and Clinical Activity Index (CAI) 1-4 > or = 4. Primary end point was clinical remission at W4 defined as a CAI 1-4 < or = 2. Noninferiority of the foam to liquid enema was declared if the lower limit of the 97.5% unilateral confidence interval (97.5% CI) of the difference in remission rates between foam and liquid enema groups was greater than -15% . RESULTS: Remission rates at W4 in foam versus liquid were 68.3%versus 73.6% in per protocol (PP) population (lower limit of 97.5% CI -15.1%) and 66.7%versus 70.5% in intention-to-treat (ITT) population (97.5% CI -13.4%). Remission rates at W2 were 48.1 %versus 50.6% in ITT (97.5% CI -12.8%) and 49.1%versus 52.1% in PP (97.5% CI -13.8%) in foam versus liquid, respectively. Both treatments were well tolerated. CONCLUSIONS: A 4-wk treatment of 1 g mesalamine foam induced a clinical remission in 68% patients versus 73% with 1 g mesalamine liquid enema. Although the noninferiority of mesalamine foam could not be strictly demonstrated at W4 in the PP analysis, it was achieved in the ITT population and at W2 in both populations. Mesalamine foam represents a therapeutic alternative to mesalamine liquid enema in patients with mild-to-moderate active proctitis and proctosigmoiditis.

Tolerance and efficacy of an air-filled balloon in non-morbidly obese patients: results of a prospective multicenter study.

BACKGROUND: Intragastric balloons have been proposed to induce body weight loss in obese subjects. Most studies were performed using liquid-filled balloons. Air-filled balloons may increase digestive tolerance. Our goal was to study the tolerance and efficacy of a new air-filled intragastric balloon in nonmorbidly obese patients. METHODS: 32 patients were included, with a mean BMI of 35.0 (range 30.1-40.0). The balloon was inserted under general anaesthesia, inflated with 800 ml of air, and removed 4 months later. Tolerance and body weight were monitored until 12 months after removal. Ghrelin levels were measured before balloon insertion, 1 and 4 weeks after, and before removal. RESULTS: Weight loss was significant at 1, 2 and 4 months after balloon insertion (6, 7 and 10 kg, respectively, P<0.001). Early removal of the balloon occurred in 3 cases. 28 patients were contacted 12 months after balloon removal: 2 had undergone gastric banding; among the 26 remaining, the mean weight loss was 7 kg. 9 patients (30%) remained with a weight loss >10%, and satisfaction with the method was 87% for these 9 patients, and 22% for the other patients who had weight loss <10% (P<0.04). Fasting plasma ghrelin levels increased at week 1 and 4 after balloon insertion, and decreased at week 16 (P<0.001). CONCLUSIONS. The air-filled intragastric balloon was safe. Its effect on weight loss appeared equivalent to other balloons. 12 months after balloon removal, 30% of the patients maintained a weight loss >10%.

Safety and efficacy of combination therapy with peginterferon alfa-2a (40kD) and ribavirin in the outpatient setting: prospective analysis of 197 patients with chronic hepatitis C viral infection.

OBJECTIVES: Combination therapy using peginterferon alfa-2a (40 kD) plus ribavirin achieves viral eradication in nearly 60% of patients with chronic hepatitis C viral infection. However, because of the numerous side effects, use of the combination regimen might be restricted for patients consulting private practitioners specialized in hepatogastroenterology. PATIENTS AND METHOD: Conducted in this specific context, this prospective clinical trial investigated the safety and efficacy of combination therapy in 197 patients. Therapy was given in compliance with the recommendations of the French consensus conference on hepatitis C treatment. RESULTS: Commonly reported adverse effects were noted in 90% of patients, most occurring during the first three months, with a stable prevalence thereafter and resolution after treatment end. The most frequent adverse events were asthenia (35 to 37.5% according to the treatment group pruritus (25 to 26.3%) and flu-like syndrome (19 to 21.7%). A depressive syndrome was reported in 20 to 21% of patients. Grade 4 neutropenia was exceptional and never led to severe infections. At intent-to-treat analysis, the rate of sustained virological response was 54.8% for the entire population. It was 71.1% for patients with genotypes 2 or 3 (mainly treated for 24 weeks) and 44.6% for patients with genotype 1 (all treated 48 weeks). CONCLUSION: The characteristic features of combination therapy observed in the context of private hepatogastroenterology consultations are similar to those observed in randomized clinical trials.