The role of advanced endoscopy in the management of inflammatory digestive diseases (upper gastrointestinal tract)

A novel modified endoscopic method for treating patients with refractory gastro-esophageal disease and moderate hiatus hernia

BACKGROUND AND AIM

endoscopic anti-reflux mucosectomy (ARMS) is effective for patients with refractory gastroesophageal reflux disease (rGERD) with small hiatus hernia. However, evidence of its applicability in patients with larger hernia sac is lacking. This study aimed to evaluate the efficiency and safety of ARMS for patients with rGERD with moderate hiatus hernia (3-5 cm) and determine the appropriate resection range.

METHODS

thirty-six patients with rGERD with moderate hiatus hernia were enrolled. They were divided into 2/3 and 3/4 circumferential mucosal resection groups. The patients received modified ARMS. The gastroesophageal reflux disease questionnaire (GERD-Q) and DeMeester scores, endoscopy, 24-h pH monitoring results and lower esophageal sphincter (LES) resting pressure were compared pre- and post-procedure. Therapeutic effects and complications of the two mucosal resection ranges were analyzed.

RESULTS

thirty-six patients were enrolled in this study, all of whom had undergone ARMS surgery with at least six-month follow-up. In the 2/3 circumferential mucosal resection group, the GERD-Q score, acid exposure time (AET) and DeMeester score improved significantly compared with those before surgery (p < 0.001). In the 3/4 circumferential mucosal resection group, the GERD-Q score, AET and DeMeeter score worsened after six months (p < 0.001), but there was no difference between the two groups (p > 0.05). In both groups, there was no significant improvement in the ratio of esophagitis grade C/D and LES resting pressure after treatment compared with the baseline values (p > 0.05), and no postoperative bleeding or perforation was observed. The incidence of postoperative esophageal stenosis in the 2/3 circumferential mucosal resection group was lower than that in the 3/4 circumferential mucosal resection group (p = 0.041).

CONCLUSION

modified ARMS is effective for patients with rGERD with moderate hiatus hernia, but it cannot significantly increase the postoperative resting pressure of the LES. The 2/3 circumferential mucosal resection can reduce the incidence of postoperative esophageal stenosis.

Comparative Study of Helicobacter pylori-Infected Gastritis in Okinawa and Tokyo Based on the Kyoto Classification of Gastritis

The incidence of gastric cancer in Okinawa Prefecture is the lowest in Japan, which is attributed to differences in strains of Helicobacter pylori in Okinawa and other prefectures in Japan. Our aim was to compare the endoscopic findings of H. pylori-infected gastric mucosa in Okinawa and Tokyo. Patients who underwent upper gastrointestinal endoscopy (UGI) at Northern Okinawa Medical Center (Okinawa group) and Juntendo University Hospital (Tokyo group) from April 2019 to March 2020 were included. Patients diagnosed with H. pylori-infected gastric mucosa were retrospectively compared between the Okinawa and Tokyo groups according to the Kyoto Classification of Gastritis. The numbers of subjects (Okinawa/Tokyo) were 435/352, male/female ratio was 247:188/181:171, and age was 53.3 ± 14.7/64.6 ± 14.3 (mean ± standard deviation) years. Regarding the Kyoto Classification of Gastritis, the prevalence (Okinawa/Tokyo) of the closed type of atrophic gastritis was 73%/37% (p < 0.001), diffuse redness 80%/84% (p = 0.145), mucosal swelling 46%/46% (p = 0.991), enlarged fold 26%/32% (p = 0.048), spotty redness 77%/68% (p = 0.002), sticky mucus 17%/36% (p < 0.001), and intestinal metaplasia 32%/42% (p < 0.001). Age analysis also revealed that closed-type atrophy and spotty redness were more frequent in the Okinawa group than in the Tokyo group. There may be regional differences in endoscopic findings of H. pylori-infected gastric mucosa between Okinawa and Tokyo.

Gastrointestinal Tract Polyp Anomaly Segmentation on Colonoscopy Images Using Graft-U-Net

Computer-aided polyp segmentation is a crucial task that supports gastroenterologists in examining and resecting anomalous tissue in the gastrointestinal tract. The disease polyps grow mainly in the colorectal area of the gastrointestinal tract and in the mucous membrane, which has protrusions of micro-abnormal tissue that increase the risk of incurable diseases such as cancer. So, the early examination of polyps can decrease the chance of the polyps growing into cancer, such as adenomas, which can change into cancer. Deep learning-based diagnostic systems play a vital role in diagnosing diseases in the early stages. A deep learning method, Graft-U-Net, is proposed to segment polyps using colonoscopy frames. Graft-U-Net is a modified version of UNet, which comprises three stages, including the preprocessing, encoder, and decoder stages. The preprocessing technique is used to improve the contrast of the colonoscopy frames. Graft-U-Net comprises encoder and decoder blocks where the encoder analyzes features, while the decoder performs the features’ synthesizing processes. The Graft-U-Net model offers better segmentation results than existing deep learning models. The experiments were conducted using two open-access datasets, Kvasir-SEG and CVC-ClinicDB. The datasets were prepared from the large bowel of the gastrointestinal tract by performing a colonoscopy procedure. The anticipated model outperforms in terms of its mean Dice of 96.61% and mean Intersection over Union (mIoU) of 82.45% with the Kvasir-SEG dataset. Similarly, with the CVC-ClinicDB dataset, the method achieved a mean Dice of 89.95% and an mIoU of 81.38%.