The complex pathophysiology and diverse manifestations of esophageal disorders pose challenges in clinical practice,particularly in achieving accurate early diagnosis and risk stratification.While traditional approach...The complex pathophysiology and diverse manifestations of esophageal disorders pose challenges in clinical practice,particularly in achieving accurate early diagnosis and risk stratification.While traditional approaches rely heavily on subjective interpretations and variable expertise,machine learning(ML)has emerged as a transformative tool in healthcare.We conducted a comprehensive review of published literature on ML applications in esophageal diseases,analyzing technical approaches,validation methods,and clinical outcomes.ML demonstrates superior performance:In gastroesophageal reflux disease,ML models achieve 80%-90%accuracy in potential of hydrogen-impedance analysis and endoscopic grading;for Barrett’s esophagus,ML-based approaches show 88%-95% accuracy in invasive diagnostics and 77%-85% accuracy in non-invasive screening.In esophageal cancer,ML improves early detection and survival prediction by 6%-10% compared to traditional methods.Novel applications in achalasia and esophageal varices demonstrate promising results in automated diagnosis and risk stratification,with accuracy rates exceeding 85%.While challenges persist in data standardization,model interpretability,and clinical integration,emerging solutions in federated learning and explainable artificial intelligence offer promising pathways forward.The continued evolution of these technologies,coupled with rigorous validation and thoughtful implementation,may fundamentally transform our approach to esophageal disease management in the era of precision medicine.展开更多
BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not scr...BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not screened.Current practice guidelines include male gender as a predisposing factor for BE and EAC.The population-based clinical evidence regarding female gender remains limited.AIM To study comparative trends of gender disparities in patients with BE in the United States.METHODS A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample(NIS)database.Patients with a primary or secondary diagnosis code of BE were identified.The major outcome of interest was determining the gender disparities in patients with BE.Trend analysis for respective outcomes for females was also reported to ascertain any time-based shifts.RESULTS We identified 1204190 patients with BE for the study period.Among the included patients,717439(59.6%)were men and 486751(40.4%)were women.The mean age was higher in women than in men(67.1±0.4 vs 66.6±0.3 years,P<0.001).The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019(P<0.001).The rate for females increased from 96.8 in 2009 to 148.7 in 2019(P<0.001).There was a higher frequency of obesity among women compared to men(17.4%vs 12.6%,P<0.001).Obesity prevalence among females increased from 12.3%in 2009 to 21.9%in 2019(P<0.001).A lower prevalence of smoking was noted in women than in men(20.8%vs 35.7%,P<0.001).However,trend analysis showed an increasing prevalence of smoking among women,from 12.9%in 2009 to 30.7%in 2019(P<0.001).Additionally,there was a lower prevalence of alcohol abuse,Helicobacter pylori(H.pylori),and diabetes mellitus among females than males(P<0.001).Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of H.pylori and diabetes mellitus among women(P<0.001).CONCLUSION The prevalence of BE among women has steadily increased from 2009 to 2019.The existing knowledge concerning BE development has historically focused on men,but our findings show that the risk in women is not insignificant.展开更多
There has been a rise in the incidence of esophageal adenocarcinoma(EAC)over the past five decades in the United States,and it remains a highly lethal ma-lignancy due to frequent late-stage diagnosis.Barrett’s esopha...There has been a rise in the incidence of esophageal adenocarcinoma(EAC)over the past five decades in the United States,and it remains a highly lethal ma-lignancy due to frequent late-stage diagnosis.Barrett’s esophagus(BE),a well-established precursor to EAC,presents a critical window for early intervention through screening,surveillance,and endoscopic eradication therapy.Despite gastrointestinal society guideline recommendations for screening,the majority of patients with BE or early EAC remain undiagnosed until symptoms of late-stage cancer emerge.This review outlines current challenges and evolving strategies in the United States in BE detection and management,including risk stratification models,non-endoscopic screening tools,high-quality endoscopic techniques,tissue-based biomarkers,and artificial intelligence-enhanced imaging.We high-light best practices for surveillance,emphasizing the importance of thorough inspection of high-risk anatomic zones and the integration of advanced imaging.Endoscopic eradication therapy,including endoscopic mucosal resection and ablation,achieves high rates of complete eradication when performed with meti-culous technique,especially with comprehensive treatment of the gastroeso-phageal junction and gastric cardia.Long-term surveillance remains essential due to the risk of recurrence.As new technologies continue to emerge,integrating precision tools into routine practice will be key to improving outcomes and reducing EAC mortality.展开更多
Barrett’s esophagus is a pathological process where the inflammatory milieu created within the esophagus leads to progressive changes over time that can lead eventually to frank malignancy.It is a pre-malignant condi...Barrett’s esophagus is a pathological process where the inflammatory milieu created within the esophagus leads to progressive changes over time that can lead eventually to frank malignancy.It is a pre-malignant condition and involves a metaplastic transformation of the distal epithelium of the esophagus.There is a conversion of the normal type of squamous epithelium into the columnar type of epithelium.There are several risk factors associated with this condition and it is typically diagnosed endoscopically.This review article provides a brief overview of this condition.展开更多
BACKGROUND Barrett esophagus(BE),a metaplastic adaptive process to gastrointestinal reflux,is associated with a higher risk of developing esophageal adenocarcinoma.However,the factors and mechanism that drive the mali...BACKGROUND Barrett esophagus(BE),a metaplastic adaptive process to gastrointestinal reflux,is associated with a higher risk of developing esophageal adenocarcinoma.However,the factors and mechanism that drive the malignant progression of BE is not well understood.AIM To investigate the role of bile acids,a component of the reflux fluid,in the malignant progression of BE.METHODS Using engineered green fluorescent protein-labeled adult tissue-resident stem cells isolated from BE clinical biopsies(BE-ASCs)as the target,we studied the effect of hydrophobic deoxycholic acid(DCA)and hydrophilic tetrahydroxylated bile acids(THBA)on cell viability by fluorescence intensity analysis,mucin production by dark density measurement,tissue structure by pathology analysis,expression of different pro-inflammatory factors gene by quantitative polymerase chain reaction and proteins by Western blot.RESULTS We found that hydrophobic DCA has cytotoxic and proinflammatory effects through activation of interleukin-1β(IL-1β)-nuclear factor kappa-B(NF-κB)inflammatory pathway on BE-ASCs.This action results in impaired cell viability,tissue intactness,reduced mucin production,and increased transition to disorganized atypical cells without intestinal features.In contrast,co-culture with hydrophilic THBA inhibited the IL-1β-NF-κB inflammatory pathway with maintenance of mature intestinal type cellular and histomorphology.CONCLUSION Our data indicates that the hydrophilic bile acid THBA can counteract the cytotoxic and proinflammatory effect of hydrophobic DCA and prevent the malignant progression of BE by inhibiting the IL-1β-NF-κB pathway.展开更多
Artificial intelligence(AI)is revolutionizing the field of gastrointestinal(GI)endoscopy,a technology that relies heavily on images and optical data.Precancerous lesions and early cancers of the GI tract can be subtle...Artificial intelligence(AI)is revolutionizing the field of gastrointestinal(GI)endoscopy,a technology that relies heavily on images and optical data.Precancerous lesions and early cancers of the GI tract can be subtle and easily missed even on high-definition endoscopy and chromoendoscopy.The advancements in machine learning and deep learning led to the development of computer-aided models of high performance in image analysis.The convolutional neural networks of these models are trained to analyze large datasets of endoscopic images through the supervised learning approach.Their utilization enhances lesion detection and visibility.This aids in real-time classification and risk stratification of GI luminal lesions,thus assisting endoscopists in making more accurate and timely decisions.AI has shown promising results in the detection and characterization of premalignant and early malignant lesions of the GI tract,such as Barrett’s esophagus,gastric atrophy,intestinal metaplasia,small bowel and colonic polyps,as well as early esophageal,gastric and colon cancers.This positive impact of AI is more established in the esophagus and stomach than in the colon.However,the impact of AI on patients’outcomes such as mortality and interval cancer incidence remains to be seen.This review highlights the breakthroughs and clinical applications of AI in the detection and characterization of premalignant lesions and early cancers of the GI tract.展开更多
BACKGROUND Obesity is a significant global health concern,with laparoscopic sleeve gastrectomy(LSG)being the most commonly performed bariatric surgery in the Middle East,including Saudi Arabia,due to its simplicity an...BACKGROUND Obesity is a significant global health concern,with laparoscopic sleeve gastrectomy(LSG)being the most commonly performed bariatric surgery in the Middle East,including Saudi Arabia,due to its simplicity and effectiveness in achieving weight loss.However,the long-term effects of LSG on gastroesophageal reflux disease(GERD)and Barrett’s esophagus(BE)remain areas of active investigation.AIM To determine the prevalence of GERD and BE 5 years post-LSG in a Saudi Arabian population.METHODS A retrospective cohort study was conducted at a tertiary bariatric referral center in Saudi Arabia.Patients who underwent LSG 5 years prior and completed postoperative gastroscopy were included.Data on demographics,comorbidities,GERD symptoms,and endoscopic findings were extracted.GERD was defined clinically,esophagitis was graded per the Los Angeles classification,and BE was defined histologically.Multivariate logistic regression was used to identify predictors of GERD,endoscopic esophagitis(EE),and BE.RESULTS The study included 114 patients(mean age:44 years;61%female).GERD prevalence increased from 16%preoperatively to 64%5 years post-LSG,with 54%of cases representing de novo GERD.EE prevalence rose to 30%,with 23%of cases being de novo.BE was detected in 2.6%of patients,all presenting with short-segment BE without intestinal metaplasia.On univariate analysis,the pre-LSG body mass index was significantly associated with EE(P=0.038),and age was significantly associated with BE(P=0.037).However,on multivariate analysis,only hypertension was independently associated with GERD development(odds ratio=5.09;P=0.01).No factors were significantly associated with EE or BE on multivariate analysis.CONCLUSION This study highlights the significant increase in GERD and EE prevalence 5 years post-LSG,with a relatively low but notable incidence of BE.The findings underscore the need for long-term endoscopic surveillance,particularly for older patients,even in populations with lower baseline.展开更多
Objective:Esophageal carcinoma(EC)is a primary global health concern,ranking as the eighth most common cancer and the sixth leading cause of cancer-related mortality.Endoscopic mucosal resection(EMR)and endoscopic sub...Objective:Esophageal carcinoma(EC)is a primary global health concern,ranking as the eighth most common cancer and the sixth leading cause of cancer-related mortality.Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)are widely used to manage early-stage EC and Barrett’s esophagus.However,their comparative efficacyand safety remain debated.This study aims to systematically compare the safety and efficacyof ESD and EMR in the treatment of early EC and Barrett’s esophagus.Methods:A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines.Databases,including MEDLINE(via PubMed),Google Scholar,and the Cochrane Library were searched for studies published up to October 2024.Twenty-two studies involving 3309 patients(1425 with ESD and 1884 with EMR)met the inclusion criteria.The outcomes assessed included en bloc resection,R0 resection,curative resection,local recurrence,bleeding,perforation,and stricture formation.Risk ratios(RR)with 95%CIs were calculated via a random-effects model via RevMan 5.4.Results:ESD significantlyoutperformed EMR in en bloc resection(RR=2.22,95%CI:1.69–2.90;p<0.001),R0 resection(RR=1.93,95%CI:1.28–2.91;p=0.002),and curative resection rates(RR=2.29,95%CI:1.52–3.46;p<0.001).ESD was associated with lower local recurrence in patients with squamous cell carcinoma(SCC)(RR=0.13,95%CI:0.06–0.30;p<0.001),whereas recurrence was greater in patients with Barrett’s esophagus(RR=1.67,95%CI:1.30–2.14;p<0.001).No significant difference was observed in bleeding rates;however,ESD was associated with a greater risk of perforation(RR=2.94,95%CI:1.31–6.60;p=0.009).Conclusion:ESD is more effective than EMR in achieving complete and curative resections for early EC and SCC,particularly for lesions>20 mm.However,it has a higher complication rate,especially perforation.Careful patient selection and procedural expertise are essential when choosing between the two techniques.展开更多
基金Supported by the Central Funds Guiding the Local Science and Technology Development,No.202207AB110017Key Research and Development Program of Yunnan,No.202302AD080004+1 种基金Yunnan Academician and Expert Workstation,No.202205AF150023the Scientific and Technological Innovation Team in Kunming Medical University,No.CXTD202215.
文摘The complex pathophysiology and diverse manifestations of esophageal disorders pose challenges in clinical practice,particularly in achieving accurate early diagnosis and risk stratification.While traditional approaches rely heavily on subjective interpretations and variable expertise,machine learning(ML)has emerged as a transformative tool in healthcare.We conducted a comprehensive review of published literature on ML applications in esophageal diseases,analyzing technical approaches,validation methods,and clinical outcomes.ML demonstrates superior performance:In gastroesophageal reflux disease,ML models achieve 80%-90%accuracy in potential of hydrogen-impedance analysis and endoscopic grading;for Barrett’s esophagus,ML-based approaches show 88%-95% accuracy in invasive diagnostics and 77%-85% accuracy in non-invasive screening.In esophageal cancer,ML improves early detection and survival prediction by 6%-10% compared to traditional methods.Novel applications in achalasia and esophageal varices demonstrate promising results in automated diagnosis and risk stratification,with accuracy rates exceeding 85%.While challenges persist in data standardization,model interpretability,and clinical integration,emerging solutions in federated learning and explainable artificial intelligence offer promising pathways forward.The continued evolution of these technologies,coupled with rigorous validation and thoughtful implementation,may fundamentally transform our approach to esophageal disease management in the era of precision medicine.
文摘BACKGROUND Barrett's esophagus(BE)is a known premalignant precursor to esophageal adenocarcinoma(EAC).The prevalence rates continue to rise in the United States,but many patients who are at risk of EAC are not screened.Current practice guidelines include male gender as a predisposing factor for BE and EAC.The population-based clinical evidence regarding female gender remains limited.AIM To study comparative trends of gender disparities in patients with BE in the United States.METHODS A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample(NIS)database.Patients with a primary or secondary diagnosis code of BE were identified.The major outcome of interest was determining the gender disparities in patients with BE.Trend analysis for respective outcomes for females was also reported to ascertain any time-based shifts.RESULTS We identified 1204190 patients with BE for the study period.Among the included patients,717439(59.6%)were men and 486751(40.4%)were women.The mean age was higher in women than in men(67.1±0.4 vs 66.6±0.3 years,P<0.001).The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019(P<0.001).The rate for females increased from 96.8 in 2009 to 148.7 in 2019(P<0.001).There was a higher frequency of obesity among women compared to men(17.4%vs 12.6%,P<0.001).Obesity prevalence among females increased from 12.3%in 2009 to 21.9%in 2019(P<0.001).A lower prevalence of smoking was noted in women than in men(20.8%vs 35.7%,P<0.001).However,trend analysis showed an increasing prevalence of smoking among women,from 12.9%in 2009 to 30.7%in 2019(P<0.001).Additionally,there was a lower prevalence of alcohol abuse,Helicobacter pylori(H.pylori),and diabetes mellitus among females than males(P<0.001).Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of H.pylori and diabetes mellitus among women(P<0.001).CONCLUSION The prevalence of BE among women has steadily increased from 2009 to 2019.The existing knowledge concerning BE development has historically focused on men,but our findings show that the risk in women is not insignificant.
文摘There has been a rise in the incidence of esophageal adenocarcinoma(EAC)over the past five decades in the United States,and it remains a highly lethal ma-lignancy due to frequent late-stage diagnosis.Barrett’s esophagus(BE),a well-established precursor to EAC,presents a critical window for early intervention through screening,surveillance,and endoscopic eradication therapy.Despite gastrointestinal society guideline recommendations for screening,the majority of patients with BE or early EAC remain undiagnosed until symptoms of late-stage cancer emerge.This review outlines current challenges and evolving strategies in the United States in BE detection and management,including risk stratification models,non-endoscopic screening tools,high-quality endoscopic techniques,tissue-based biomarkers,and artificial intelligence-enhanced imaging.We high-light best practices for surveillance,emphasizing the importance of thorough inspection of high-risk anatomic zones and the integration of advanced imaging.Endoscopic eradication therapy,including endoscopic mucosal resection and ablation,achieves high rates of complete eradication when performed with meti-culous technique,especially with comprehensive treatment of the gastroeso-phageal junction and gastric cardia.Long-term surveillance remains essential due to the risk of recurrence.As new technologies continue to emerge,integrating precision tools into routine practice will be key to improving outcomes and reducing EAC mortality.
文摘Barrett’s esophagus is a pathological process where the inflammatory milieu created within the esophagus leads to progressive changes over time that can lead eventually to frank malignancy.It is a pre-malignant condition and involves a metaplastic transformation of the distal epithelium of the esophagus.There is a conversion of the normal type of squamous epithelium into the columnar type of epithelium.There are several risk factors associated with this condition and it is typically diagnosed endoscopically.This review article provides a brief overview of this condition.
文摘BACKGROUND Barrett esophagus(BE),a metaplastic adaptive process to gastrointestinal reflux,is associated with a higher risk of developing esophageal adenocarcinoma.However,the factors and mechanism that drive the malignant progression of BE is not well understood.AIM To investigate the role of bile acids,a component of the reflux fluid,in the malignant progression of BE.METHODS Using engineered green fluorescent protein-labeled adult tissue-resident stem cells isolated from BE clinical biopsies(BE-ASCs)as the target,we studied the effect of hydrophobic deoxycholic acid(DCA)and hydrophilic tetrahydroxylated bile acids(THBA)on cell viability by fluorescence intensity analysis,mucin production by dark density measurement,tissue structure by pathology analysis,expression of different pro-inflammatory factors gene by quantitative polymerase chain reaction and proteins by Western blot.RESULTS We found that hydrophobic DCA has cytotoxic and proinflammatory effects through activation of interleukin-1β(IL-1β)-nuclear factor kappa-B(NF-κB)inflammatory pathway on BE-ASCs.This action results in impaired cell viability,tissue intactness,reduced mucin production,and increased transition to disorganized atypical cells without intestinal features.In contrast,co-culture with hydrophilic THBA inhibited the IL-1β-NF-κB inflammatory pathway with maintenance of mature intestinal type cellular and histomorphology.CONCLUSION Our data indicates that the hydrophilic bile acid THBA can counteract the cytotoxic and proinflammatory effect of hydrophobic DCA and prevent the malignant progression of BE by inhibiting the IL-1β-NF-κB pathway.
文摘Artificial intelligence(AI)is revolutionizing the field of gastrointestinal(GI)endoscopy,a technology that relies heavily on images and optical data.Precancerous lesions and early cancers of the GI tract can be subtle and easily missed even on high-definition endoscopy and chromoendoscopy.The advancements in machine learning and deep learning led to the development of computer-aided models of high performance in image analysis.The convolutional neural networks of these models are trained to analyze large datasets of endoscopic images through the supervised learning approach.Their utilization enhances lesion detection and visibility.This aids in real-time classification and risk stratification of GI luminal lesions,thus assisting endoscopists in making more accurate and timely decisions.AI has shown promising results in the detection and characterization of premalignant and early malignant lesions of the GI tract,such as Barrett’s esophagus,gastric atrophy,intestinal metaplasia,small bowel and colonic polyps,as well as early esophageal,gastric and colon cancers.This positive impact of AI is more established in the esophagus and stomach than in the colon.However,the impact of AI on patients’outcomes such as mortality and interval cancer incidence remains to be seen.This review highlights the breakthroughs and clinical applications of AI in the detection and characterization of premalignant lesions and early cancers of the GI tract.
文摘BACKGROUND Obesity is a significant global health concern,with laparoscopic sleeve gastrectomy(LSG)being the most commonly performed bariatric surgery in the Middle East,including Saudi Arabia,due to its simplicity and effectiveness in achieving weight loss.However,the long-term effects of LSG on gastroesophageal reflux disease(GERD)and Barrett’s esophagus(BE)remain areas of active investigation.AIM To determine the prevalence of GERD and BE 5 years post-LSG in a Saudi Arabian population.METHODS A retrospective cohort study was conducted at a tertiary bariatric referral center in Saudi Arabia.Patients who underwent LSG 5 years prior and completed postoperative gastroscopy were included.Data on demographics,comorbidities,GERD symptoms,and endoscopic findings were extracted.GERD was defined clinically,esophagitis was graded per the Los Angeles classification,and BE was defined histologically.Multivariate logistic regression was used to identify predictors of GERD,endoscopic esophagitis(EE),and BE.RESULTS The study included 114 patients(mean age:44 years;61%female).GERD prevalence increased from 16%preoperatively to 64%5 years post-LSG,with 54%of cases representing de novo GERD.EE prevalence rose to 30%,with 23%of cases being de novo.BE was detected in 2.6%of patients,all presenting with short-segment BE without intestinal metaplasia.On univariate analysis,the pre-LSG body mass index was significantly associated with EE(P=0.038),and age was significantly associated with BE(P=0.037).However,on multivariate analysis,only hypertension was independently associated with GERD development(odds ratio=5.09;P=0.01).No factors were significantly associated with EE or BE on multivariate analysis.CONCLUSION This study highlights the significant increase in GERD and EE prevalence 5 years post-LSG,with a relatively low but notable incidence of BE.The findings underscore the need for long-term endoscopic surveillance,particularly for older patients,even in populations with lower baseline.
文摘Objective:Esophageal carcinoma(EC)is a primary global health concern,ranking as the eighth most common cancer and the sixth leading cause of cancer-related mortality.Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)are widely used to manage early-stage EC and Barrett’s esophagus.However,their comparative efficacyand safety remain debated.This study aims to systematically compare the safety and efficacyof ESD and EMR in the treatment of early EC and Barrett’s esophagus.Methods:A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines.Databases,including MEDLINE(via PubMed),Google Scholar,and the Cochrane Library were searched for studies published up to October 2024.Twenty-two studies involving 3309 patients(1425 with ESD and 1884 with EMR)met the inclusion criteria.The outcomes assessed included en bloc resection,R0 resection,curative resection,local recurrence,bleeding,perforation,and stricture formation.Risk ratios(RR)with 95%CIs were calculated via a random-effects model via RevMan 5.4.Results:ESD significantlyoutperformed EMR in en bloc resection(RR=2.22,95%CI:1.69–2.90;p<0.001),R0 resection(RR=1.93,95%CI:1.28–2.91;p=0.002),and curative resection rates(RR=2.29,95%CI:1.52–3.46;p<0.001).ESD was associated with lower local recurrence in patients with squamous cell carcinoma(SCC)(RR=0.13,95%CI:0.06–0.30;p<0.001),whereas recurrence was greater in patients with Barrett’s esophagus(RR=1.67,95%CI:1.30–2.14;p<0.001).No significant difference was observed in bleeding rates;however,ESD was associated with a greater risk of perforation(RR=2.94,95%CI:1.31–6.60;p=0.009).Conclusion:ESD is more effective than EMR in achieving complete and curative resections for early EC and SCC,particularly for lesions>20 mm.However,it has a higher complication rate,especially perforation.Careful patient selection and procedural expertise are essential when choosing between the two techniques.
