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Does computer-aided diagnostic endoscopy improve the detection of commonly missed polyps? A meta-analysis

  • Arun Sivananthan;Scarlet Nazarian;Lakshmana Ayaru;Kinesh Patel;Hutan Ashrafian;Ara Darzi;Nisha Patel
    • Clinical Endoscopy
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    • v.55 no.3
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    • pp.355-364
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    • 2022
  • Background/Aims: Colonoscopy is the gold standard diagnostic method for colorectal neoplasia, allowing detection and resection of adenomatous polyps; however, significant proportions of adenomas are missed. Computer-aided detection (CADe) systems in endoscopy are currently available to help identify lesions. Diminutive (≤5 mm) and nonpedunculated polyps are most commonly missed. This meta-analysis aimed to assess whether CADe systems can improve the real-time detection of these commonly missed lesions. Methods: A comprehensive literature search was performed. Randomized controlled trials evaluating CADe systems categorized by morphology and lesion size were included. The mean number of polyps and adenomas per patient was derived. Independent proportions and their differences were calculated using DerSimonian and Laird random-effects modeling. Results: Seven studies, including 2,595 CADe-assisted colonoscopies and 2,622 conventional colonoscopies, were analyzed. CADe-assisted colonoscopy demonstrated an 80% increase in the mean number of diminutive adenomas detected per patient compared with conventional colonoscopy (0.31 vs. 0.17; effect size, 0.13; 95% confidence interval [CI], 0.09-0.18); it also demonstrated a 91.7% increase in the mean number of nonpedunculated adenomas detected per patient (0.32 vs. 0.19; effect size, 0.05; 95% CI, 0.02-0.07). Conclusions: CADe-assisted endoscopy significantly improved the detection of most commonly missed adenomas. Although this method is a potentially exciting technology, limitations still apply to current data, prompting the need for further real-time studies.

Epidemiology of early esophageal adenocarcinoma

  • Thuy-Van P. Hang;Zachary Spiritos;Anthony M. Gamboa;Zhengjia Chen;Seth Force;Vaishali Patel;Saurabh Chawla;Steven Keilin;Nabil F. Saba;Bassel El-Rayes;Qiang Cai;Field F. Willingham
    • Clinical Endoscopy
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    • v.55 no.3
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    • pp.372-380
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    • 2022
  • Background/Aims: Endoscopic resection has become the preferred treatment approach for select early esophageal adenocarcinoma (EAC); however, the epidemiology of early stage disease has not been well defined. Methods: Surveillance Epidemiology and End Results (SEER) data were analyzed to determine age-adjusted incidence rates among major epithelial carcinomas, including EAC, from 1973 to 2017. The percent change in incidence over time was compared according to tumor subtype. Early T-stage, node-negative EAC without metastasis was examined from 2004 to 2017 when precise T-stage data were available. Results: The percent change in annual incidence from 1973 to 2017 was 767% for EAC. Joinpoint analysis showed that the average annual percent change in EAC from 1973 to 2017 was 5.11% (95% confidence interval, 4.66%-5.56%). The annual percent change appeared to plateau between 2004 and 2017; however, early EAC decreased from 2010 to 2017, with an annual percent change of -5.78%. Conclusions: There has been a 7-fold increase in the incidence of EAC, which was significantly greater than that of the other major epithelial malignancies examined. More recently, the incidence of early EAC has been decreasing. Approximately one in five patients has node negative, potentially resectable early stage disease.

Endoscopic internal drainage with double pigtail stents for upper gastrointestinal anastomotic leaks: suitable for all cases?

  • Bin Chet Toh;Jingli Chong;Baldwin PM Yeung;Chin Hong Lim;Eugene KW Lim;Weng Hoong Chan;Jeremy TH Tan
    • Clinical Endoscopy
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    • v.55 no.3
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    • pp.401-407
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    • 2022
  • Background/Aims: Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population. Methods: From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion. Results: Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining 10 patients, nine did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the 1st week and a soft diet in the 2nd week. One patient was allowed clear oral feeds on the 8th day after DPT insertion. Conclusions: Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.

Laser-cut-type versus braided-type covered self-expandable metallic stents for distal biliary obstruction caused by pancreatic carcinoma: a retrospective comparative cohort study

  • Koh Kitagawa;Akira Mitoro;Takahiro Ozutsumi;Masanori Furukawa;Yukihisa Fujinaga;Kenichiro Seki;Norihisa Nishimura;Yasuhiko Sawada;Kosuke Kaji;Hideto Kawaratani;Hiroaki Takaya;Kei Moriya;Tadashi Namisaki;Takemi Akahane;Hitoshi Yoshiji
    • Clinical Endoscopy
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    • v.55 no.3
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    • pp.434-442
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    • 2022
  • Background/Aims: Covered self-expandable metallic stents (CMSs) are widely used for malignant distal biliary obstructions (MDBOs) caused by pancreatic carcinoma. This study compared the efficacy and safety of the laser-cut-type and braided-type CMSs. Methods: To palliate MDBOs caused by pancreatic carcinoma, the laser-cut-type CMSs was used from April 2014 to March 2017, and the braided-type CMSs was used from April 2017 to March 2019. The tested self-expandable metallic stents were equipped with different anti-migration systems. Results: In total, 47 patients received CMSs for MDBOs (24 laser-cut type, 23 braided-type). The time to recurrent biliary obstruction (TRBO) was significantly longer in the braided-type CMSs (p=0.0008), and the median time to stent dysfunction or patient death was 141 and 265 days in the laser-cut-type CMSs and braided-type CMSs, respectively (p=0.0023). Stent migration was the major cause of stent dysfunction in both groups, which occurred in 37.5% of the laser-cut-type CMSs and 13.0% of the braided-type CMSs. There were no differences in the survival duration between the groups. Conclusions: The TRBO was significantly longer for the braided-type CMSs with an anti-migration system than for the laser-cut-type. Stent migration tended to be less frequent with the braided-type CMSs than with the laser-cut-type CMSs.

Prophylactic endoscopic transpapillary gallbladder stenting to prevent acute cholecystitis induced after metallic stent placement for malignant biliary strictures: a retrospective study in Japan

  • Fumisato Kozakai;Yoshihide Kanno;Shinsuke Koshita;Takahisa Ogawa;Hiroaki Kusunose;Toshitaka Sakai;Keisuke Yonamine;Kazuaki Miyamoto;Haruka Okano;Yuto Matsuoka;Kento Hosokawa;Hidehito Sumiya;Kei Ito
    • Clinical Endoscopy
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    • v.57 no.5
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    • pp.647-655
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    • 2024
  • Background/Aims: Endoscopic biliary drainage using self-expandable metallic stents (SEMSs) for malignant biliary strictures occasionally induces acute cholecystitis (AC). This study evaluated the efficacy of prophylactic gallbladder stents (GBS) during SEMS placement. Methods: Among 158 patients who underwent SEMS placement for malignant biliary strictures between January 2018 and March 2023, 30 patients who attempted to undergo prophylactic GBS placement before SEMS placement were included. Results: Technical success was achieved in 21 cases (70.0%). The mean diameter of the cystic duct was more significant in the successful cases (6.5 mm vs. 3.7 mm, p<0.05). Adverse events occurred for 7 patients (23.3%: acute pancreatitis in 7; non-obstructive cholangitis in 1; perforation of the cystic duct in 1 with an overlap), all of which improved with conservative treatment. No patients developed AC when the GBS placement was successful, whereas 25 of the 128 patients (19.5%) without a prophylactic GBS developed AC during the median follow-up period of 357 days (p=0.043). In the multivariable analysis, GBS placement was a significant factor in preventing AC (hazard ratio, 0.61; 95% confidence interval, 0.37-0.99; p=0.045). Conclusions: GBS may contribute to the prevention of AC after SEMS placement for malignant biliary strictures.

Timed barium esophagography to predict recurrent achalasia after peroral endoscopic myotomy: a retrospective study in Thailand

  • Tharathorn Suwatthanarak;Chainarong Phalanusitthepa;Chatbadin Thongchuam;Thawatchai Akaraviputh;Vitoon Chinswangwatanakul;Thikhamporn Tawantanakorn;Somchai Leelakusolvong;Monthira Maneerattanaporn;Piyaporn Apisarnthanarak;Jitladda Wasinrat
    • Clinical Endoscopy
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    • v.57 no.5
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    • pp.610-619
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    • 2024
  • Background/Aims: Achalasia is a rare esophageal motility disease, for which peroral endoscopic myotomy (POEM) has emerged as a promising treatment option; however, recurrence remains a challenge. Timed barium esophagography (TBE) is a useful diagnostic tool and potential outcome predictor of achalasia. This study aimed to determine predictive tools for recurrence after POEM. Methods: This retrospective study enrolled achalasia patients who underwent POEM between January 2015 and December 2021. Patients were categorized into two groups using the 1-month post-POEM Eckardt scores and TBE: the discordant group (Eckardt score improved >50%, TBE decreased <50%) and the concordant group (both Eckardt score and TBE improved >50%). Recurrence was defined as a reincrease in the Eckardt score to more than three during follow-up. Results: Complete medical records were available in 30 patients who underwent POEM. Seventeen patients (56.7%) were classified into the discordant group, while 13 patients (43.3%) were in the concordant group. The overall recurrence rate was 11.9% at 1-year, increasing to 23.8% during the extended follow-up. The discordant group had a 6.87 fold higher recurrence rate than the concordant group (52.9% vs. 7.7%, p=0.017). Conclusions: These results strongly suggest that combining the Eckardt score with TBE can effectively predict recurrent achalasia after POEM. Patients in the discordant group had an elevated risk.

Antioxidant Activity and Protective Effects of Extracts from Helianthus tuberosus L. Leaves on t-BHP Induced Oxidative Stress in Chang Cells (돼지감자잎 추출물의 항산화 활성 및 간세포 보호 효과)

  • Kim, Yon-Suk;Lee, Seung-Jae;Hwang, Jin-Woo;Kim, Ee-Hwa;Park, Pyo-Jam;Jeon, Byung-Tae
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.40 no.11
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    • pp.1525-1531
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    • 2011
  • Antioxidant activity and protective effects of extracts from Helianthus tuberosus L. leaves (HTL) on t-BHP-induced oxidative stress in human liver Chang cells were investigated. The total polyphenol and flavonoid content of the water and ethanolic extracts from HTL were 89.6${\pm}$1.96, 94${\pm}$2.03 mg gallic acid equivalent/g extract, and 65.1${\pm}$2.84, 54.6${\pm}$1.87 mg catechin equivalent/g extract, respectively. In addition, $IC_{50}$ values for 1,1-diphenyl-2-picrydrazyl (DPPH), alkyl, and hydroxyl radical scavenging activity of the water extracts were 0.010${\pm}$0.003 mg/mL, 0.014${\pm}$0.002 mg/mL, and 0.989${\pm}$0.003 mg/mL, respectively. Antioxidant activities of the extracts were also determined by ferric reducing antioxidant power (FRAP), 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical scavenging activity and reducing power. The HTL extracts showed a strongly inhibitory effect on lipid peroxidation by measuring ferric thiocyanate (FTC) and thiobarbituric acid (TBA) values. In an MTT assay on the Chang cells, the extracts showed a protective effect by increasing cell viability and decreasing ROS on t-BHP-induced oxidative stress in Chang cells. These results indicate that the HTL extracts possess an antioxidant activity.

ATHEROSCLEROSIS, CHOLESTEROL AND EGG - REVIEW -

  • Paik, I.K.;Blair, R.
    • Asian-Australasian Journal of Animal Sciences
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    • v.9 no.1
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    • pp.1-25
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    • 1996
  • The pathogenesis of atherosclerosis can not be summarized as a single process. Lipid infiltration hypothesis and endothelial injury hypothesis have been proposed and investigated. Recent developments show that there are many points of potential interactions between them and that they can actually be regarded as two phases of a single, unifying hypothesis. Among the many risk factors of atherosclerosis, plasma homocysteine and lipoprotein(a) draw a considerable interest because they are independent indicators of atherogenicity. Triglyceride (TG)-rich lipoproteins (chylomicron and VLDL) are not considered to be atherogenic but they are related to the metabolism of HDL cholesterol and indirectly related to coronary heart disease (CHD). LDL can of itself be atherogenic but the oxidative products of this lipoprotein are more detrimental. HDL cholesterol has been considered to be a favorable cholesterol. The so-called 'causalist view' claims that HDL traps excess cholesterol from cellular membranes and transfers it to TG-rich lipoproteins that are subsequently removed by hepatic receptors. In the so-called 'noncausalist view', HDL does not interfere directly with cholesterol deposition in the arterial wall but instead reflects he metabolism of TG-rich lipoproteins and their conversion to atherogenic remnants. Approximately 70-80% of the human population shows an effective feedback control mechanism in cholesterol homeostasis. Type of dietary fat has a significant effect on the lipoprotein cholesterol metabolism and atherosclerosis. Generally, saturated fatty acids elevate and PUFA lower serum cholesterol, whereas MUFA have no specific effect. EPA and DHA inhibit the synthesis of TG, VLDL and LDL, and may have favourable effects on some of the risk factors. Phospholipids, particularly lecithin, have an antiatherosclerotic effect. Essential phospholipids (EPL) may enhance the formation of polyunsaturated cholesteryl ester (CE) which is less sclerotic and more easily dispersed via enhanced hydrolysis of CE in the arterial wall. Also, neutral fecal steroid elimination may be enhanced and cholesterol absorption reduced following EPL treatment. Antioxidants protect lipoproteins from oxidation, and cells from the injury of toxic, oxidized LDL. The rationale for lowering of serum cholesterol is the strong association between elevation of plasma or serum cholesterol and CHD. Cholesterol-lowing, especially LDL cholesterol, to the target level could be achieved using diet and combination of drug therapy. Information on the link between cholesterol and CHD has decreased egg consumption by 16-25%. Some clinical studies have indicated that dietary cholesterol and egg have a significant hypercholesterolemic effect, while others have indicated no effect. These studies differed in the use of purified cholesterol or cholesterol in eggs, in the range of baseline and challenge cholesterol levels, in the quality and quantity of concomitant dietary fat, in the study population demographics and initial serum cholesterol levels, and clinical settings. Cholesterol content of eggs varies to a certain extent depending on the age, breed and diet of hens. However, egg yolk cholesterol level is very resistant to change because of the particular mechanism involved in yolk formation. Egg yolk contains a factor of factors responsible for accelerated cholesterol metabolism and excretion compared with crystalline cholesterol. One of these factors could be egg lecithin. Egg lecithin may not be as effective as soybean lecithin in lowering serum cholesterol level due probably to the differences of fatty acid composition. However, egg lecithin may have positive effects in hypercholesterolemia by increasing serum HDL level and excretion of fecal cholesterol. The association of serum cholesterol with egg consumption has been widely studied. When the basal or control diet contained little or no cholesterol, consumption of 1 or 2 eggs daily increased the concentration of plasma cholesterol, whereas that of the normolipemic persons on a normal diet was not significantly influenced by consuming 2 to 3 eggs daily. At higher levels of egg consumption, the concentration of HDL tends to increase as well as LDL. There exist hyper-and hypo-responders to dietary (egg) cholesterol. Identifying individuals in both categories would be useful from the point of view of nutrition guidelines. Dietary modification of fatty acid composition has been pursued as a viable method of modifying fat composition of eggs and adding value to eggs. In many cases beneficial effects of PUFA enriched eggs have been demonstrated. Generally, consumption of n-3 fatty acids enriched eggs lowered the concentration of plasma TG and total cholesterol compared to the consumption of regular eggs. Due to the highly oxidative nature of PUFA, stability of this fat is essential. The implication of hepatic lipid accumulation which was observed in hens fed on fish oils should be explored. Nutritional manipulations, such as supplementation with iodine, inhibitors of cholesterol biosynthesis, garlic products, amino acids and high fibre ingredients, have met a limited success in lowering egg cholesterol.

Review of Copper Trihydroxychloride, a Green Pigment Composed of Copper and Chlorine (구리와 염소 주성분 녹색 안료 코퍼 트리하이드록시클로라이드(Copper Trihydroxychloride)에 대한 고찰)

  • Oh, Joonsuk;Lee, Saerom;Hwang, Minyoung
    • Korean Journal of Heritage: History & Science
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    • v.53 no.2
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    • pp.64-87
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    • 2020
  • Copper trihydroxychloride (atacamite, botallackite, paratacamite, etc.), the first green pigment used in Mogao Grotto's mural paintings of China, has been known as "copper green", "green salt", and "salt green", etc. and has been used as an important green pigment with malachite. At first, the natural mineral atacamite was employed, but after the Five Dynasties (907~960 CE), synthetic copper trihydroxychloride was primarily used. In Chinese literature, copper green, green salt, and salt green are recorded as being made via reaction with copper powder, Gwangmyeongyeom (natural sodium chloride), and Yosa (natural ammonium chloride), and the prepared material was analyzed to be copper trihydroxychloride. Copper trihydroxychloride pigment was not found in paintings prior to the Joseon Dynasty (1392~1910 CE) in Korea. In analysis of the green pigments used in paintings and the architectural paintworks in the Joseon Dynasty, copper trihydroxychloride was also shown to have been used as an important green pigment with malachite (Seokrok). In particular, the proportion of copper trihydroxychloride use was high in Buddhist paintings, shamanic paintings, and dancheongs (decorative coloring on wooden buildings). Some of these turned out to be synthetic copper trihydroxychloride, but it is unclear whether the rest of them are synthetic or natural pigments due to a lack of analyzed data. From literature and painting analyses, the pigment name of copper trihydroxychloride in the Joseon Dynasty turns out to be Hayeob, a dark green pigment. It is believed to have first been prepared by learning from China in the early Joseon period (early 15th century) and its use continued until the late 19th century with imported Chinese pigment. Round or oval particles with a dark core of copper trihydroxychloride which were used in Chinese literature were similar to the synthetic copper trihydroxychloride pigments used in the Joseon Dynasty and Chinese paintings. Therefore, the synthetic copper trihydroxychloride pigments of Korea and China are believed to have been prepared in a similar way.

Characteristics and Significance of the Huirang Daesa Sculpture at Haeinsa Temple in Hapcheon (합천(陜川) 해인사(海印寺) 희랑대사상(希朗大師像)의 특징과 제작 의미)

  • Jeong, Eunwoo
    • MISULJARYO - National Museum of Korea Art Journal
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    • v.98
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    • pp.54-77
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    • 2020
  • Produced during the Goryeo period (718-1392), the statue of the monk Huirang Daesa at Haeinsa Temple in Hapcheon is almost life-size, with a height of 82.4 cm, a width of 66.6 cm at the knees, and a maximum width of 44 cm at the torso (front and back). Notably, it is the only known example of an East Asian Buddhist sculpture made from wood and dry lacquer that was formed by joining the front and back halves. However, a similar technique was used on a dry lacquer statue of the Medicine Buddha at Cheongnyangsa Temple in Bonghwa, which is estimated to date from the late Goryeo or early Joseon period. As such, this technique is thought to represent this particular time period. In an eighteenth-century travelogue about a trip to Mt. Gayasan, the author describes a sculpture that is believed to be the statue of Huirang Daesa at Haeinsa Temple, based on various unique features that closely correspond to the sculpture's current appearance. For example, the sculpture is said to have a hole in the chest and rough, knobby tendons and bones, two features that can still be seen today. Another sculpture of a Buddhist monk who was active in the western regions during the third and fourth century also has a hole in the chest, which is said to be a symbol of spiritual strength. The travelogue also states that the statue was lacquered black at the time, which means that it must have been painted with its present colors some time in the nineteenth century. Over time, the sculpture has been enshrined in various halls of Haeinsa Temple, including Haehaengdang, Jinsangjeon, and later Josajeon (Hall of the Patriarchs), and Bojangjeon. Records show that images of Buddhist monks, or "seungsang," were produced in Korea as early as the Three Kingdoms period (18 BCE-660 CE), but few of these works have survived. At present, only four such sculptures are extant, including the images of Huirang Daesa from the Goryeo period, and those of Monk Naong and Uisang Daesa from the Joseon period. Of these, the sculpture of Huirang Daesa has special significance for its early production date (i.e., CE. tenth century), outstanding production techniques, and superb artistic quality, realistically capturing both the external appearance and internal character of the subject. The tradition of producing, sanctifying, and worshipping statues of monks was prevalent not only in Korea, but also in China and Japan. However, each country developed its own preferred materials and techniques for producing these unique images. For example, while China has a large number of mummified Buddhist images (yuksinbul), Japan produced diverse images with various materials (e.g., dry lacquer, wood, clay) according to period. But despite the differences in materials and techniques, the three nations shared the same fundamental purpose of expressing and honoring the inherent spirituality of the monks.