Endoscopy is the cornerstone in the management of digestive diseases.Over the last few decades,technology has played an important role in the development of this field,helping endoscopists in better detecting and char...Endoscopy is the cornerstone in the management of digestive diseases.Over the last few decades,technology has played an important role in the development of this field,helping endoscopists in better detecting and characterizing luminal lesions.However,despite ongoing advancements in endoscopic technology,the incidence of missed pre-neoplastic and neoplastic lesions remains high due to the operator-dependent nature of endoscopy and the challenging learning curve associated with new technologies.Artificial intelligence(AI),an operator-independent field,could be an invaluable solution.AI can serve as a“second observer”,enhancing the performance of endoscopists in detecting and characterizing luminal lesions.By utilizing deep learning(DL),an innovation within machine learning,AI automatically extracts input features from targeted endoscopic images.DL encompasses both computer-aided detection and computer-aided diagnosis,assisting endoscopists in reducing missed detection rates and predicting the histology of luminal digestive lesions.AI applications in clinical gastrointestinal diseases are continuously expanding and evolving the entire digestive tract.In all published studies,real-time AI assists endoscopists in improving the performance of non-expert gastroenterologists,bringing it to a level comparable to that of experts.The development of DL may be affected by selection biases.Studies have utilized different AI-assisted models,which are heterogeneous.In the future,algorithms need validation through large,randomized trials.Theoretically,AI has no limit to assist endoscopists in increasing the accuracy and the quality of endoscopic exams.However,practically,we still have a long way to go before standardizing our AI models to be accepted and applied by all gastroenterologists.展开更多
Hepatic portal venous gas (HPVG), an ominous radiologic sign, is associated in some cases with a severe underlying abdominal disease requiring urgent operative intervention. HPVG has been reported with increasing freq...Hepatic portal venous gas (HPVG), an ominous radiologic sign, is associated in some cases with a severe underlying abdominal disease requiring urgent operative intervention. HPVG has been reported with increasing frequency in medical literature and usually accompanies severe or lethal conditions. The diagnosis of HPVG is usually made by plain abdominal radiography, sonography, color Doppler flow imaging or computed tomography (CT) scan. Currently, the increased use of CT scan and ultrasound in the inpatient setting allows early and highly sensitive detection of such severe illnesses and also the recognition of an increasing number of benign and non-life threatening causes of HPVG. HPVG is not by itself a surgical indication and the treatment depends mainly on the underlying disease. The prognosis is related to the pathology itself and is not influenced by the presence of HPVG. Based on a review of the literature, we discuss in this paper the pathophysiology, risk factors, radiographic findings, management, and prognosis of pathologies associated with HPVG.展开更多
Insulinomas continue to pose a diagnostic challenge to physicians, surgeons and radiologists alike. Most are intrapancreatic, benign and solitary. Biochemical diagnosis is obtained and imaging techniques to localize l...Insulinomas continue to pose a diagnostic challenge to physicians, surgeons and radiologists alike. Most are intrapancreatic, benign and solitary. Biochemical diagnosis is obtained and imaging techniques to localize lesions continue to evolve. Surgical resection is the treatment of choice. Despite all efforts, an occult insulinoma (occult insulinoma refers to a biochemically proven tumor with indeterminate anatomical site before operation) may still be encountered. New localization preoperative techniques decreases occult cases and the knowledge of the site of the mass before surgery allows to determine whether enucleation of the tumor or pancreatic resection is likely to be required and whether the tumor is amenable to removal via a laparoscopic approach. In absence of preoperative localization and intraoperative detection of an insulinoma, blind pancreatic resection is not recommended.展开更多
At present, the treatment of choice for uncomplicated acute appendicitis in adults continues to be surgical. The inflammation in acute appendicitis may sometimes be enclosed by the patient's own defense mechanisms...At present, the treatment of choice for uncomplicated acute appendicitis in adults continues to be surgical. The inflammation in acute appendicitis may sometimes be enclosed by the patient's own defense mechanisms, by the formation of an inflammatory phlegmon or a circumscribed abscess. The management of these patients is controversial. Immediate appendectomy may be technically demanding. The exploration often ends up in an ileocecal resection or a right-sided hemicolectomy. Recently, the conditions for conservative management of these patients have changed due to the development of computed tomography and ultrasound, which has improved the diagnosis of enclosed inflammation and made drainage of intra-abdominal abscesses easier. New efficient antibiotics have also given new opportunities for nonsurgical treatment of complicated appendicitis. The traditional management of these patients is nonsurgical treatment followed by interval appendectomy to prevent recurrence. The need for interval appendectomy after successful nonsurgical treatment has recently been questioned because the risk of recurrence is relatively small. After successful nonsurgical treatment of an appendiceal mass, the true diagnosis is uncertain in some cases and an underlying diagnosis of cancer or Crohn's disease may be delayed. This report aims at reviewing the treatment options of patients with enclosed appendiceal inflammation, with emphasis on the success rate of nonsurgical treatment, the need for drainage of abscesses, the risk of undetected serious disease, and the need for interval appendectomy to prevent recurrence.展开更多
Thyroid hormones def ine basal metabolism throughout the body, particularly in the intestine and viscera. Gastrointestinal manifestations of dysthyroidism are numerous and involve all portions of the tract. Thyroid ho...Thyroid hormones def ine basal metabolism throughout the body, particularly in the intestine and viscera. Gastrointestinal manifestations of dysthyroidism are numerous and involve all portions of the tract. Thyroid hormone action on motility has been widely studied, but more complex pathophysiologic mechanisms have been indicated by some studies although these are not fully understood. Both thyroid hormone excess and def iciency can have similar digestive manifestations, such as diarrhea, although the mechanism is different in each situation. The liver is the most affected organ in both hypo-and hyperthyroidism. Specifi c digestive diseases may be associated with autoimmune thyroid processes, such as Hashimoto's thyroiditis and Grave's disease. Among them, celiac sprue and primary biliary cirrhosis are the most frequent although a clear common mechanism has never been proven. Overall, thyroid-related digestive manifestations were described decades ago but studies are still needed in order to conf irm old concepts or elucidate undiscovered mechanisms. All practitioners must be aware of digestive symptoms due to dysthyroidism in order to avoid misdiagnosis of rare but potentially lethal situations.展开更多
Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow...Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, isthe only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.展开更多
The parathyroid glands are the main regulator of plasma calcium and have a direct influence on the digestive tract.Parathyroid disturbances often result in unknown long-standing symptoms.The main manifestation of hypo...The parathyroid glands are the main regulator of plasma calcium and have a direct influence on the digestive tract.Parathyroid disturbances often result in unknown long-standing symptoms.The main manifestation of hypoparathyroidism is steatorrhea due to a deficit in exocrine pancreas secretion.The association with celiac sprue may contribute to malabsorption.Hyperparathyroidism causes smooth-muscle atony,with upper and lower gastrointestinal symptoms such as nausea,heartburn and constipation.Hyperparathyroidism and peptic ulcer were strongly linked before the advent of proton pump inhibitors.Nowadays,this association remains likely only in the particular context of multiple endocrine neoplasia type 1/Zollinger-Ellison syndrome.In contrast to chronic pancreatitis,acute pancreatitis due to primary hyperparathyroidism is one of the most studied topics.The causative effect of high calcium level is confirmed and the distinction from secondary hyperparathyroidism is mandatory.The digestive manifestations of parathyroid malfunction are often overlooked and serum calcium level must be included in the routine workup for abdominal symptoms.展开更多
Inflammatory fibroid polyps(IFPs), or Vanek's tumor, are one of the least common benign small bowel tumors.IFP affects both sexes and all age groups, with a peak of incidence in the fifth and seventh decades.They ...Inflammatory fibroid polyps(IFPs), or Vanek's tumor, are one of the least common benign small bowel tumors.IFP affects both sexes and all age groups, with a peak of incidence in the fifth and seventh decades.They can be found throughout the gastrointestinal tract but most commonly in the gastric antrum or ileum.The underlying cause of IFPs is still unknown.Genetic study of IFP showed mutations in platelet derived growth factor alpha in some cases.At the time of diagnosis most IFPs have a diameter of 3 to 4 cm.The lesions have always been recorded as solitary polyps.Symptoms depend on the location and the size of the lesion, including abdominal pain, vomiting, altered small bowel movements, gastrointestinal bleeding and loss of weight.IFPs arising below the Treitz ligament can present with an acute abdomen, usually due to intussusceptions.Abdominal computed tomography is currently considered the most sensitive radiological method to show the polyp or to confirm intussusceptions.Most inflammatory fibroid polyps can be removed by endoscopy.Surgery is rarely needed.Exploratory laparoscopy or laparotomy is frequently recommended as the best treatment for intussusceptions caused by IFP.The operation should be performed as early as possible in order to prevent the intussusceptions from leading to ischemia, necrosis and subsequent perforation of the invaginated bowel segment.This report aims at reviewing the diagnosis, etiology, genetics, clinical presentation, endoscopy, radiology, and best treatment of IFP.展开更多
Acute appendidtis is an exceptional cause of left lower quadrant abdominal pain. Computed tomography scan is the key to its diagnosis and helps to establish its early treatment. We present a case of a 35-year-old male...Acute appendidtis is an exceptional cause of left lower quadrant abdominal pain. Computed tomography scan is the key to its diagnosis and helps to establish its early treatment. We present a case of a 35-year-old male patient who presented acute appendicitis with redundant and loosely attached cecum which was diagnosed based on his left lower quadrant abdominal pain.展开更多
We are reporting the rare case of splenic artery aneurysm of 4 cm of diameter presenting as a sub mucosal lesion on gastro-duodenal endoscopy. This aneurysm was treated by endovascular coil embolization and stent graf...We are reporting the rare case of splenic artery aneurysm of 4 cm of diameter presenting as a sub mucosal lesion on gastro-duodenal endoscopy. This aneurysm was treated by endovascular coil embolization and stent graft implantation. The procedure was uneventful. On day 1, the patient presented an acute severe epigastric pain and cardiovascular arrest. Abdominal computed tomography scan showed an active leak of the intravenous contrast dye in the peritoneum from the splenic aneurysm. We performed an emergent resection of the aneurysm, and peritoneal lavage. Postoperatively, hemorrhagic choc was refractory to large volumes replacement, and intravenous vaso-active drugs. On day 2, he presented massive hematochezia. We performed a total colectomy with splenectomy and cholecystectomy for ischemic colitis, with spleen and gallbladder infarction. Despite vaso-active drugs and aggressive treatment with Factor VIIa, the patient died after uncontrolled disseminated intravascular coagulation.展开更多
文摘Endoscopy is the cornerstone in the management of digestive diseases.Over the last few decades,technology has played an important role in the development of this field,helping endoscopists in better detecting and characterizing luminal lesions.However,despite ongoing advancements in endoscopic technology,the incidence of missed pre-neoplastic and neoplastic lesions remains high due to the operator-dependent nature of endoscopy and the challenging learning curve associated with new technologies.Artificial intelligence(AI),an operator-independent field,could be an invaluable solution.AI can serve as a“second observer”,enhancing the performance of endoscopists in detecting and characterizing luminal lesions.By utilizing deep learning(DL),an innovation within machine learning,AI automatically extracts input features from targeted endoscopic images.DL encompasses both computer-aided detection and computer-aided diagnosis,assisting endoscopists in reducing missed detection rates and predicting the histology of luminal digestive lesions.AI applications in clinical gastrointestinal diseases are continuously expanding and evolving the entire digestive tract.In all published studies,real-time AI assists endoscopists in improving the performance of non-expert gastroenterologists,bringing it to a level comparable to that of experts.The development of DL may be affected by selection biases.Studies have utilized different AI-assisted models,which are heterogeneous.In the future,algorithms need validation through large,randomized trials.Theoretically,AI has no limit to assist endoscopists in increasing the accuracy and the quality of endoscopic exams.However,practically,we still have a long way to go before standardizing our AI models to be accepted and applied by all gastroenterologists.
文摘Hepatic portal venous gas (HPVG), an ominous radiologic sign, is associated in some cases with a severe underlying abdominal disease requiring urgent operative intervention. HPVG has been reported with increasing frequency in medical literature and usually accompanies severe or lethal conditions. The diagnosis of HPVG is usually made by plain abdominal radiography, sonography, color Doppler flow imaging or computed tomography (CT) scan. Currently, the increased use of CT scan and ultrasound in the inpatient setting allows early and highly sensitive detection of such severe illnesses and also the recognition of an increasing number of benign and non-life threatening causes of HPVG. HPVG is not by itself a surgical indication and the treatment depends mainly on the underlying disease. The prognosis is related to the pathology itself and is not influenced by the presence of HPVG. Based on a review of the literature, we discuss in this paper the pathophysiology, risk factors, radiographic findings, management, and prognosis of pathologies associated with HPVG.
文摘Insulinomas continue to pose a diagnostic challenge to physicians, surgeons and radiologists alike. Most are intrapancreatic, benign and solitary. Biochemical diagnosis is obtained and imaging techniques to localize lesions continue to evolve. Surgical resection is the treatment of choice. Despite all efforts, an occult insulinoma (occult insulinoma refers to a biochemically proven tumor with indeterminate anatomical site before operation) may still be encountered. New localization preoperative techniques decreases occult cases and the knowledge of the site of the mass before surgery allows to determine whether enucleation of the tumor or pancreatic resection is likely to be required and whether the tumor is amenable to removal via a laparoscopic approach. In absence of preoperative localization and intraoperative detection of an insulinoma, blind pancreatic resection is not recommended.
文摘At present, the treatment of choice for uncomplicated acute appendicitis in adults continues to be surgical. The inflammation in acute appendicitis may sometimes be enclosed by the patient's own defense mechanisms, by the formation of an inflammatory phlegmon or a circumscribed abscess. The management of these patients is controversial. Immediate appendectomy may be technically demanding. The exploration often ends up in an ileocecal resection or a right-sided hemicolectomy. Recently, the conditions for conservative management of these patients have changed due to the development of computed tomography and ultrasound, which has improved the diagnosis of enclosed inflammation and made drainage of intra-abdominal abscesses easier. New efficient antibiotics have also given new opportunities for nonsurgical treatment of complicated appendicitis. The traditional management of these patients is nonsurgical treatment followed by interval appendectomy to prevent recurrence. The need for interval appendectomy after successful nonsurgical treatment has recently been questioned because the risk of recurrence is relatively small. After successful nonsurgical treatment of an appendiceal mass, the true diagnosis is uncertain in some cases and an underlying diagnosis of cancer or Crohn's disease may be delayed. This report aims at reviewing the treatment options of patients with enclosed appendiceal inflammation, with emphasis on the success rate of nonsurgical treatment, the need for drainage of abscesses, the risk of undetected serious disease, and the need for interval appendectomy to prevent recurrence.
文摘Thyroid hormones def ine basal metabolism throughout the body, particularly in the intestine and viscera. Gastrointestinal manifestations of dysthyroidism are numerous and involve all portions of the tract. Thyroid hormone action on motility has been widely studied, but more complex pathophysiologic mechanisms have been indicated by some studies although these are not fully understood. Both thyroid hormone excess and def iciency can have similar digestive manifestations, such as diarrhea, although the mechanism is different in each situation. The liver is the most affected organ in both hypo-and hyperthyroidism. Specifi c digestive diseases may be associated with autoimmune thyroid processes, such as Hashimoto's thyroiditis and Grave's disease. Among them, celiac sprue and primary biliary cirrhosis are the most frequent although a clear common mechanism has never been proven. Overall, thyroid-related digestive manifestations were described decades ago but studies are still needed in order to conf irm old concepts or elucidate undiscovered mechanisms. All practitioners must be aware of digestive symptoms due to dysthyroidism in order to avoid misdiagnosis of rare but potentially lethal situations.
文摘Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, isthe only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.
文摘The parathyroid glands are the main regulator of plasma calcium and have a direct influence on the digestive tract.Parathyroid disturbances often result in unknown long-standing symptoms.The main manifestation of hypoparathyroidism is steatorrhea due to a deficit in exocrine pancreas secretion.The association with celiac sprue may contribute to malabsorption.Hyperparathyroidism causes smooth-muscle atony,with upper and lower gastrointestinal symptoms such as nausea,heartburn and constipation.Hyperparathyroidism and peptic ulcer were strongly linked before the advent of proton pump inhibitors.Nowadays,this association remains likely only in the particular context of multiple endocrine neoplasia type 1/Zollinger-Ellison syndrome.In contrast to chronic pancreatitis,acute pancreatitis due to primary hyperparathyroidism is one of the most studied topics.The causative effect of high calcium level is confirmed and the distinction from secondary hyperparathyroidism is mandatory.The digestive manifestations of parathyroid malfunction are often overlooked and serum calcium level must be included in the routine workup for abdominal symptoms.
文摘Inflammatory fibroid polyps(IFPs), or Vanek's tumor, are one of the least common benign small bowel tumors.IFP affects both sexes and all age groups, with a peak of incidence in the fifth and seventh decades.They can be found throughout the gastrointestinal tract but most commonly in the gastric antrum or ileum.The underlying cause of IFPs is still unknown.Genetic study of IFP showed mutations in platelet derived growth factor alpha in some cases.At the time of diagnosis most IFPs have a diameter of 3 to 4 cm.The lesions have always been recorded as solitary polyps.Symptoms depend on the location and the size of the lesion, including abdominal pain, vomiting, altered small bowel movements, gastrointestinal bleeding and loss of weight.IFPs arising below the Treitz ligament can present with an acute abdomen, usually due to intussusceptions.Abdominal computed tomography is currently considered the most sensitive radiological method to show the polyp or to confirm intussusceptions.Most inflammatory fibroid polyps can be removed by endoscopy.Surgery is rarely needed.Exploratory laparoscopy or laparotomy is frequently recommended as the best treatment for intussusceptions caused by IFP.The operation should be performed as early as possible in order to prevent the intussusceptions from leading to ischemia, necrosis and subsequent perforation of the invaginated bowel segment.This report aims at reviewing the diagnosis, etiology, genetics, clinical presentation, endoscopy, radiology, and best treatment of IFP.
文摘Acute appendidtis is an exceptional cause of left lower quadrant abdominal pain. Computed tomography scan is the key to its diagnosis and helps to establish its early treatment. We present a case of a 35-year-old male patient who presented acute appendicitis with redundant and loosely attached cecum which was diagnosed based on his left lower quadrant abdominal pain.
文摘We are reporting the rare case of splenic artery aneurysm of 4 cm of diameter presenting as a sub mucosal lesion on gastro-duodenal endoscopy. This aneurysm was treated by endovascular coil embolization and stent graft implantation. The procedure was uneventful. On day 1, the patient presented an acute severe epigastric pain and cardiovascular arrest. Abdominal computed tomography scan showed an active leak of the intravenous contrast dye in the peritoneum from the splenic aneurysm. We performed an emergent resection of the aneurysm, and peritoneal lavage. Postoperatively, hemorrhagic choc was refractory to large volumes replacement, and intravenous vaso-active drugs. On day 2, he presented massive hematochezia. We performed a total colectomy with splenectomy and cholecystectomy for ischemic colitis, with spleen and gallbladder infarction. Despite vaso-active drugs and aggressive treatment with Factor VIIa, the patient died after uncontrolled disseminated intravascular coagulation.
