BACKGROUND Recently,it has been suggested that the duodenum may be the pathological locus of functional dyspepsia(FD).Additionally,an image-based artificial intelligence(AI)model was shown to discriminate colonoscopy ...BACKGROUND Recently,it has been suggested that the duodenum may be the pathological locus of functional dyspepsia(FD).Additionally,an image-based artificial intelligence(AI)model was shown to discriminate colonoscopy images of irritable bowel syndrome from healthy subjects with an area under the curve(AUC)0.95.AIM To evaluate an AI model to distinguish duodenal images of FD patients from healthy subjects.METHODS Duodenal images were collected from hospital records and labeled as"functional dyspepsia"or non-FD in electronic medical records.Helicobacter pylori(HP)infection status was obtained from the Japan Endoscopy Database.Google Cloud AutoML Vision was used to classify four groups:FD/HP current infection(n=32),FD/HP uninfected(n=35),non-FD/HP current infection(n=39),and non-FD/HP uninfected(n=33).Patients with organic diseases(e.g.,cancer,ulcer,postoperative abdomen,reflux)and narrow-band or dye-spread images were excluded.Sensitivity,specificity,and AUC were calculated.RESULTS In total,484 images were randomly selected for FD/HP current infection,FD/HP uninfected,non-FD/current infection,and non-FD/HP uninfected.The overall AUC for the four groups was 0.47.The individual AUC values were as follows:FD/HP current infection(0.20),FD/HP uninfected(0.35),non-FD/current infection(0.46),and non-FD/HP uninfected(0.74).Next,using the same images,we constructed models to determine the presence or absence of FD in the HP-infected or uninfected patients.The model exhibited a sensitivity of 58.3%,specificity of 100%,positive predictive value of 100%,negative predictive value of 77.3%,and an AUC of 0.85 in HP uninfected patients.CONCLUSION We developed an image-based AI model to distinguish duodenal images of FD from healthy subjects,showing higher accuracy in HP-uninfected patients.These findings suggest AI-assisted endoscopic diagnosis of FD may be feasible.展开更多
AIM: To assess the utility and safety of single-operator cholangiopancreatoscopy(SOCPS) using the Spy Glass system in widespread clinical application for biliary and pancreatic diseases.METHODS: This study was a prosp...AIM: To assess the utility and safety of single-operator cholangiopancreatoscopy(SOCPS) using the Spy Glass system in widespread clinical application for biliary and pancreatic diseases.METHODS: This study was a prospective case series conducted in 20 referral centers in Japan. There were 148 patients who underwent SOCPS; 124 for biliary diseases and 24 for pancreatic diseases. The attempted interventions were SOCPS examination, SOCPS-directed tissue sampling, and therapy for stone removal, among others. The main outcomes were related to the procedure success rate in terms of visualizing the target lesions, SOCPS-directed adequate tissue sampling, and complete stone removal. RESULTS: A total of 148 patients were enrolled for the diagnosis of indeterminate biliary and pancreatic lesions or treatment of biliary and pancreatic disease. The overall procedure success rate of visualizing the target lesions was 91.2%(135/148). The overall procedural success rates of visualizing the target lesions of diagnostic SOCPS in the bile duct and pancreatic duct were 95.5%(84/89) and 88.2%(15/17), respectively. Diagnosis: the overall adequate tissue for histologic examination was secured in 81.4% of the 86 patients who underwent biopsy under SOCPS(bile duct, 60/75, 80.0%; pancreatic duct, 10/11, 90.9%). The accuracy of histologic diagnosis using SOCPS-directed biopsies in indeterminate bile duct lesions was 70.7%(53/75). In the pancreatic duct, the accuracy of SOCPS visual impression of intraductal papillary mucinous neoplasm was 87.5%(14/16). Stone therapy: complete biliary and pancreatic stone clearance combined with SOCPS-directed stone therapy using electrohydraulic lithotripsy or laser lithotripsy was achieved in 74.2%(23/31) and 42.9%(3/7) of the patients, respectively. Others: SOCPS using the Spy Glass system was used in cannulation of the cystic duct in two patients and for passing across the obstructed self-expandable metallic stent for a malignant biliary stricture in two patients. All procedures were successful in both SOCPS-guided therapies. The incidence of procedure-related adverse events was 5.4%(8/148). CONCLUSION: SOCPS with direct visualization and biopsy for diagnosis and SOCPS-directed therapy for biliary and pancreatic diseases can be safely performed with a high success rate.展开更多
AIM: To evaluate the differences in the treatment outcomes between the unresectable and recurrent biliary tract cancer patients who received chemotherapy.
A 54-year-old woman was admitted to our hospital with the complaint of right upper quadrant pain. Upon physical examination the vital signs of the patient were within normal ranges. Ultrasonography and computed tomogr...A 54-year-old woman was admitted to our hospital with the complaint of right upper quadrant pain. Upon physical examination the vital signs of the patient were within normal ranges. Ultrasonography and computed tomography （CT） examination of the abdomen was obtained, which demonstrated a large dilatated cystic structure, measuring approximately 68.6 mm × 48.6 mm, with marked distension and inflammation. Additionally, the enhanced CT was characterized by the non-enhanced wall of the gallbladder. As the third examination in this study, magnetic resonance imaging （MRI）, namely coronal MRI and magnetic resonance cholangio-pancreatography （MRCP）, were performed. The MRCP demonstrated a dilatation of the gallbladder but detected no neck of the gallbladder. Simple cholecystectomy was performed. Macroscopic findings included a distended and gangrenous gallbladder, and closer examination revealed a counterclockwise torsion of 360 degrees on the gallbladder mesentery. Coronal MRI and MRCP showing characteristic radiography may be useful in making a definitive diagnosis.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)in hepatitis C virus(HCV)-infected patients has a high risk of recurrence.Although eradication of HCV is expected to reduce this risk,the risk in patients with a history of HCC ...BACKGROUND Hepatocellular carcinoma(HCC)in hepatitis C virus(HCV)-infected patients has a high risk of recurrence.Although eradication of HCV is expected to reduce this risk,the risk in patients with a history of HCC may be high after treatment with direct-acting antivirals(DAAs).AIM To determine the risk factors for HCC recurrence in patients with HCV and a history of HCC.METHODS The risk of HCC recurrence in patients with a history of HCC and/or of HCC occurrence in patients without a history of HCC after DAA therapy was retrospectively analyzed in 311 HCV patients treated at our institution and several neighboring hospitals.The frequency and predictors of HCC recurrence/occurrence after DAA treatment were included in these analyses.The clinical course of HCC before and after DAA treatment was also evaluated.RESULTS HCV patients with a history of HCC were older and had greater progression of liver fibrosis and diabetes than patients without a history of HCC.Median recurrence-free survival(RFS)was 1092 d in patients with a history of HCC,and post-DAA HCC recurrence/occurrence was observed in 29 patients(53.7%)with and 5(1.9%)without a history of HCC over 6 years(P<0.001).RFS in patients with a history of HCC did not differ significantly before and after DAA treatment.The frequency of HCC recurrence/occurrence in patients with a history of HCC was lower after than before DAA treatment.Multivariate analysis showed that the incidence rate of HCC recurrence/occurrence before DAA treatment was the only independent predictor of HCC recurrence/occurrence after DAA treatment.Liver function was well preserved and clinical course was good in patients with HCC recurrence/occurrence after DAA therapy.CONCLUSION DAA therapy in patients infected with HCV is also effective in patients with a history of HCC.Curative treatment for HCC is desirable before DAA therapy.The frequency of HCC recurrence/occurrence before DAA therapy was associated with a significantly increased risk of HCC recurrence after DAA therapy.Careful observation after DAA therapy is required in patients with a history of HCC.展开更多
文摘BACKGROUND Recently,it has been suggested that the duodenum may be the pathological locus of functional dyspepsia(FD).Additionally,an image-based artificial intelligence(AI)model was shown to discriminate colonoscopy images of irritable bowel syndrome from healthy subjects with an area under the curve(AUC)0.95.AIM To evaluate an AI model to distinguish duodenal images of FD patients from healthy subjects.METHODS Duodenal images were collected from hospital records and labeled as"functional dyspepsia"or non-FD in electronic medical records.Helicobacter pylori(HP)infection status was obtained from the Japan Endoscopy Database.Google Cloud AutoML Vision was used to classify four groups:FD/HP current infection(n=32),FD/HP uninfected(n=35),non-FD/HP current infection(n=39),and non-FD/HP uninfected(n=33).Patients with organic diseases(e.g.,cancer,ulcer,postoperative abdomen,reflux)and narrow-band or dye-spread images were excluded.Sensitivity,specificity,and AUC were calculated.RESULTS In total,484 images were randomly selected for FD/HP current infection,FD/HP uninfected,non-FD/current infection,and non-FD/HP uninfected.The overall AUC for the four groups was 0.47.The individual AUC values were as follows:FD/HP current infection(0.20),FD/HP uninfected(0.35),non-FD/current infection(0.46),and non-FD/HP uninfected(0.74).Next,using the same images,we constructed models to determine the presence or absence of FD in the HP-infected or uninfected patients.The model exhibited a sensitivity of 58.3%,specificity of 100%,positive predictive value of 100%,negative predictive value of 77.3%,and an AUC of 0.85 in HP uninfected patients.CONCLUSION We developed an image-based AI model to distinguish duodenal images of FD from healthy subjects,showing higher accuracy in HP-uninfected patients.These findings suggest AI-assisted endoscopic diagnosis of FD may be feasible.
文摘AIM: To assess the utility and safety of single-operator cholangiopancreatoscopy(SOCPS) using the Spy Glass system in widespread clinical application for biliary and pancreatic diseases.METHODS: This study was a prospective case series conducted in 20 referral centers in Japan. There were 148 patients who underwent SOCPS; 124 for biliary diseases and 24 for pancreatic diseases. The attempted interventions were SOCPS examination, SOCPS-directed tissue sampling, and therapy for stone removal, among others. The main outcomes were related to the procedure success rate in terms of visualizing the target lesions, SOCPS-directed adequate tissue sampling, and complete stone removal. RESULTS: A total of 148 patients were enrolled for the diagnosis of indeterminate biliary and pancreatic lesions or treatment of biliary and pancreatic disease. The overall procedure success rate of visualizing the target lesions was 91.2%(135/148). The overall procedural success rates of visualizing the target lesions of diagnostic SOCPS in the bile duct and pancreatic duct were 95.5%(84/89) and 88.2%(15/17), respectively. Diagnosis: the overall adequate tissue for histologic examination was secured in 81.4% of the 86 patients who underwent biopsy under SOCPS(bile duct, 60/75, 80.0%; pancreatic duct, 10/11, 90.9%). The accuracy of histologic diagnosis using SOCPS-directed biopsies in indeterminate bile duct lesions was 70.7%(53/75). In the pancreatic duct, the accuracy of SOCPS visual impression of intraductal papillary mucinous neoplasm was 87.5%(14/16). Stone therapy: complete biliary and pancreatic stone clearance combined with SOCPS-directed stone therapy using electrohydraulic lithotripsy or laser lithotripsy was achieved in 74.2%(23/31) and 42.9%(3/7) of the patients, respectively. Others: SOCPS using the Spy Glass system was used in cannulation of the cystic duct in two patients and for passing across the obstructed self-expandable metallic stent for a malignant biliary stricture in two patients. All procedures were successful in both SOCPS-guided therapies. The incidence of procedure-related adverse events was 5.4%(8/148). CONCLUSION: SOCPS with direct visualization and biopsy for diagnosis and SOCPS-directed therapy for biliary and pancreatic diseases can be safely performed with a high success rate.
文摘AIM: To evaluate the differences in the treatment outcomes between the unresectable and recurrent biliary tract cancer patients who received chemotherapy.
文摘A 54-year-old woman was admitted to our hospital with the complaint of right upper quadrant pain. Upon physical examination the vital signs of the patient were within normal ranges. Ultrasonography and computed tomography （CT） examination of the abdomen was obtained, which demonstrated a large dilatated cystic structure, measuring approximately 68.6 mm × 48.6 mm, with marked distension and inflammation. Additionally, the enhanced CT was characterized by the non-enhanced wall of the gallbladder. As the third examination in this study, magnetic resonance imaging （MRI）, namely coronal MRI and magnetic resonance cholangio-pancreatography （MRCP）, were performed. The MRCP demonstrated a dilatation of the gallbladder but detected no neck of the gallbladder. Simple cholecystectomy was performed. Macroscopic findings included a distended and gangrenous gallbladder, and closer examination revealed a counterclockwise torsion of 360 degrees on the gallbladder mesentery. Coronal MRI and MRCP showing characteristic radiography may be useful in making a definitive diagnosis.
文摘BACKGROUND Hepatocellular carcinoma(HCC)in hepatitis C virus(HCV)-infected patients has a high risk of recurrence.Although eradication of HCV is expected to reduce this risk,the risk in patients with a history of HCC may be high after treatment with direct-acting antivirals(DAAs).AIM To determine the risk factors for HCC recurrence in patients with HCV and a history of HCC.METHODS The risk of HCC recurrence in patients with a history of HCC and/or of HCC occurrence in patients without a history of HCC after DAA therapy was retrospectively analyzed in 311 HCV patients treated at our institution and several neighboring hospitals.The frequency and predictors of HCC recurrence/occurrence after DAA treatment were included in these analyses.The clinical course of HCC before and after DAA treatment was also evaluated.RESULTS HCV patients with a history of HCC were older and had greater progression of liver fibrosis and diabetes than patients without a history of HCC.Median recurrence-free survival(RFS)was 1092 d in patients with a history of HCC,and post-DAA HCC recurrence/occurrence was observed in 29 patients(53.7%)with and 5(1.9%)without a history of HCC over 6 years(P<0.001).RFS in patients with a history of HCC did not differ significantly before and after DAA treatment.The frequency of HCC recurrence/occurrence in patients with a history of HCC was lower after than before DAA treatment.Multivariate analysis showed that the incidence rate of HCC recurrence/occurrence before DAA treatment was the only independent predictor of HCC recurrence/occurrence after DAA treatment.Liver function was well preserved and clinical course was good in patients with HCC recurrence/occurrence after DAA therapy.CONCLUSION DAA therapy in patients infected with HCV is also effective in patients with a history of HCC.Curative treatment for HCC is desirable before DAA therapy.The frequency of HCC recurrence/occurrence before DAA therapy was associated with a significantly increased risk of HCC recurrence after DAA therapy.Careful observation after DAA therapy is required in patients with a history of HCC.
