Direct comparison of multiple computer-aided polyp detection systems

BACKGROUND AND STUDY AIMS

 Artificial intelligence (AI)-based systems for computer-aided detection (CADe) of polyps receive regular updates and occasionally offer customizable detection thresholds, both of which impact their performance, but little is known about these effects. This study aimed to compare the performance of different CADe systems on the same benchmark dataset.

METHODS

 101 colonoscopy videos were used as benchmark. Each video frame with a visible polyp was manually annotated with bounding boxes, resulting in 129 705 polyp images. The videos were then analyzed by three different CADe systems, representing five conditions: two versions of GI Genius, Endo-AID with detection Types A and B, and EndoMind, a freely available system. Evaluation included an analysis of sensitivity and false-positive rate, among other metrics.

RESULTS

 Endo-AID detection Type A, the earlier version of GI Genius, and EndoMind detected all 93 polyps. Both the later version of GI Genius and Endo-AID Type B missed 1 polyp. The mean per-frame sensitivities were 50.63 % and 67.85 %, respectively, for the earlier and later versions of GI Genius, 65.60 % and 52.95 %, respectively, for Endo-AID Types A and B, and 60.22 % for EndoMind.

CONCLUSIONS

 This study compares the performance of different CADe systems, different updates, and different configuration modes. This might help clinicians to select the most appropriate system for their specific needs.

Texture and color enhancement imaging versus high definition white-light endoscopy for detection of colorectal neoplasia: a randomized trial

BACKGROUND

 Texture and color enhancement imaging (TXI) was recently proposed as a substitute for standard high definition white-light imaging (WLI) to increase lesion detection during colonoscopy. This international, multicenter randomized trial assessed the efficacy of TXI in detection of colorectal neoplasia.

METHODS

 Consecutive patients aged ≥ 40 years undergoing screening, surveillance, or diagnostic colonoscopies at five centers (Italy, Germany, Japan) between September 2021 and May 2022 were enrolled. Patients were randomly assigned (1:1) to TXI or WLI. Primary outcome was adenoma detection rate (ADR). Secondary outcomes were adenomas per colonoscopy (APC) and withdrawal time. Relative risks (RRs) adjusted for age, sex, and colonoscopy indication were calculated.

RESULTS

 We enrolled 747 patients (mean age 62.3 [SD 9.5] years, 50.2 % male). ADR was significantly higher with TXI (221/375, 58.9 %) vs. WLI (159/372, 42.7 %; adjusted RR 1.38 [95 %CI 1.20-1.59]). This was significant for ≤ 5 mm (RR 1.42 [1.16-1.73]) and 6-9 mm (RR 1.36 [1.01-1.83]) adenomas. A higher proportion of polypoid (151/375 [40.3 %] vs. 104/372 [28.0 %]; RR 1.43 [1.17-1.75]) and nonpolypoid (136/375 [36.3 %] vs. 102/372 [27.4 %]; RR 1.30 [1.05-1.61]) adenomas, and proximal (143/375 [38.1 %] vs. 111/372 [29.8 %]; RR 1.28 [1.05-1.57]) and distal (144/375 [38.4 %] vs. 98/372 [26.3 %]; RR 1.46 [1.18-1.80]) lesions were found with TXI. APC was higher with TXI (1.36 [SD 1.79] vs. 0.89 [SD 1.35]; incident rate ratio 1.53 [1.25-1.88]).

CONCLUSIONS

 TXI increased ADR and APC among patients undergoing colonoscopy for various indications. TXI increased detection of polyps < 10 mm, both in the proximal and distal colon, and may help to improve colonoscopy quality indicators.

Mobile Apps for the Management of Gastrointestinal Diseases: Systematic Search and Evaluation Within App Stores

Background

Gastrointestinal diseases are associated with substantial cost in health care. In times of the COVID-19 pandemic and further digitalization of gastrointestinal tract health care, mobile health apps could complement routine health care. Many gastrointestinal health care apps are already available in the app stores, but the quality, data protection, and reliability often remain unclear.

Objective

This systematic review aimed to evaluate the quality characteristics as well as the privacy and security measures of mobile health apps for the management of gastrointestinal diseases.

Methods

A web crawler systematically searched for mobile health apps with a focus on gastrointestinal diseases. The identified mobile health apps were evaluated using the Mobile Application Rating Scale (MARS). Furthermore, app characteristics, data protection, and security measures were collected. Classic user star rating was correlated with overall mobile health app quality.

Results

The overall quality of the mobile health apps (N=109) was moderate (mean 2.90, SD 0.52; on a scale ranging from 1 to 5). The quality of the subscales ranged from low (mean 1.89, SD 0.66) to good (mean 4.08, SD 0.57). The security of data transfer was ensured only by 11 (10.1%) mobile health apps. None of the mobile health apps had an evidence base. The user star rating did not correlate with the MARS overall score or with the individual subdimensions of the MARS (all P>.05).

Conclusions

Mobile health apps might have a positive impact on diagnosis, therapy, and patient guidance in gastroenterology in the future. We conclude that, to date, data security and proof of efficacy are not yet given in currently available mobile health apps.

Improved team communication in endoscopic procedures by digital enhanced telecommunication during the COVID-19 pandemic

Background and study aims  Unbiased communication is crucial for excellent teamwork in high-quality endoscopy. Personal protective equipment (PPE) (FFP-masks and face-shields) worn by endoscopists that are ubiquitous in the current COVID-19 pandemic strikingly impair communication. Digital enhancement approaches to maintain team communication, especially during complex endoscopic procedures, are urgently warranted. Materials and methods  A prospective, two-armed interventional study was performed at an endoscopy unit at a tertiary center in Germany. Two hundred and three endoscopic procedures with PPE se according to pandemic risk level were randomly assigned (1:1) to a group performed by an endoscopy team equipped with digital enhanced cordless telecommunication (DECT) or one without digital-enhanced communication. The primary outcome was the team-reported number of communication-associated events (CAEs) defined as misunderstandings that impaired workflow during endoscopic examination. Secondary outcomes included perceived voice and headphone quality and overall comfort with DECT during endoscopic work. Results  The use of DECT was associated with a significant reduction in communication-associated events in endoscopic procedures and overall, was perceived positively. Conclusions  Digital enhancement of communication is a promising and easy-to- establish tool for improving team communication quality in endoscopy.

The "Twist-Needle" - a new concept for endoscopic ultrasound-guided fine needle-biopsy

Background and study aims  Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) represents a standard method for tissue acquisition of lesions adjacent to the gastrointestinal wall. Needles of 19 gauge acquire more tissue than needles with a smaller diameter, but are often unable to penetrate solid, rigid masses. In this study we evaluated a novel prototype that links forward movement of the needle to rotation of the needle tip. Materials and methods  Two needle-models that generate either a regular axial movement or a combination of axial movement with rotation of the needle tip were compared ex vivo for measurement of pressure needed to penetrate artificial tissue. Furthermore, a standard 19-gauge EUS-FNB needle was compared to a modified model ("Twist Needle") in an ex vivo model to measure the amount of tissue obtained. Results  Pressure measurements using the rotating needle revealed that significantly less pressure is needed for penetration compared to the regular axial movement (mean ± SEM; 3.7 ± 0.3 N vs. 5.5 ± 0.3 N). Using the modified 19-gauge "Twist Needle" did not diminish tissue acquisition measured by surface amount compared to a standard needle (37 ± 5 mm² vs. 35 ± 6 mm²). Conclusion  The method of rotation of an EUS-FNB needle tip upon forward movement requires less pressure for penetration but does not diminish tissue acquisition. Hence, the concept of our "Twist Needle" may potentially reduce some of the current limitations of standard EUS-FNB.

Thirty-eight-negative kinase 1 mediates trauma-induced intestinal injury and multi-organ failure

Dysregulated intestinal epithelial apoptosis initiates gut injury, alters the intestinal barrier, and can facilitate bacterial translocation leading to a systemic inflammatory response syndrome (SIRS) and/or multi-organ dysfunction syndrome (MODS). A variety of gastrointestinal disorders, including inflammatory bowel disease, have been linked to intestinal apoptosis. Similarly, intestinal hyperpermeability and gut failure occur in critically ill patients, putting the gut at the center of SIRS pathology. Regulation of apoptosis and immune-modulatory functions have been ascribed to Thirty-eight-negative kinase 1 (TNK1), whose activity is regulated merely by expression. We investigated the effect of TNK1 on intestinal integrity and its role in MODS. TNK1 expression induced crypt-specific apoptosis, leading to bacterial translocation, subsequent septic shock, and early death. Mechanistically, TNK1 expression in vivo resulted in STAT3 phosphorylation, nuclear translocation of p65, and release of IL-6 and TNF-α. A TNF-α neutralizing antibody partially blocked development of intestinal damage. Conversely, gut-specific deletion of TNK1 protected the intestinal mucosa from experimental colitis and prevented cytokine release in the gut. Finally, TNK1 was found to be deregulated in the gut in murine and porcine trauma models and human inflammatory bowel disease. Thus, TNK1 might be a target during MODS to prevent damage in several organs, notably the gut.

A 3D-printed cap with sideoptics for colonoscopy: a randomized ex vivo study

Background Adequate polyp detection is crucial to colonoscopy; however, detection can be impaired. In particular, flat polyps located behind folds or near the colonic flexures appear to be a problem. We present a cheap and easily adjustable 3D-printed tool to enhance the view of a standard colonoscope using additional commercially available sideoptics. Materials and methods A cap adjustable to a standard endoscope was printed by a 3 D printer and had two microcameras fixed to offer two additional views. Fourteen endoscopists performed one standard and one sideoptic-enhanced colonoscopy in a randomized order. Flat lesions were simulated in an endoscopy training model. Time for withdrawal was measured, along with the number of flat lesions detected. Results Withdrawal time did not differ significantly between standard and sideoptic-enhanced colonoscopy (329 vs. 389 seconds). The median number of detected flat lesions per endoscopic examination was significantly higher using the sideoptic tool (8 vs. 6.5; P = 0.001). Conclusions A 3D-printed sideoptic-enhanced cap including two microcameras may be a cheap, easy, and feasible add-on to improve adenoma detection rates in routine colonoscopy.

Complicated jejunal diverticulosis - a rare but important diagnosis to consider in abdominal pain: a report of three cases

Jejunal diverticulosis, a form of acquired false diverticula, is considered to be a rare clinical entity, which is mostly asymptomatic. But, in case of complications, jejunal diverticulosis can present as acute abdominal distress. Due to its rarity in clinical manifestation, jejunal diverticulosis may lead to a diagnostic and therapeutic delay. We report on 3 interdisciplinary cases of complicated jejunal diverticulosis by diverticulitis, diverticular bleeding, and perforation. We want to highlight the fact that complicated jejunal diverticulosis should be considered as a differential diagnosis in cases of unclear abdominal pain.

Gastrointestinal stromal tumor as entry port for S. intermedius causing bacteremia and multiple liver abscesses. Case report and review of literature

We report a case of a previously healthy 52-year-old man who presented with fever and liver lesions suspicious for metastatic disease, which proved subsequently to be abscesses. Further workup revealed a gastrointestinal stromal tumor (GIST) in the gastric corpus as entry port to Streptococcus intermedius-associated bacteremia and liver abscesses. After antibiotic treatment and surgical resection of the tumor, the patient recovered well. This unusual case indicates that gastrointestinal stromal tumors can remain undetected until they cause a life threatening infection. A review of recent literature pertaining to GIST and liver abscesses follows.

Immunostimulatory effect of dietary oregano etheric oils on lymphocytes from growth-retarded, low-weight growing-finishing pigs and productivity

The present study was designed to evaluate the possible effect of dietary oregano etheric oils as non-specific immunostimulating agents in growth-retarded, low-weight growing-finishing pigs. Forty-nine growth-retarded (> 10% under average weight in a group) growing-finishing pigs of the same age were assigned to two groups and treated as follows: Group 1 (n = 25): the animals weighed 58.2 +/- 2.4 kg and were fed until slaughter ad libitum with a commercial fattening diet supplemented with 3000 ppm commercial oregano feed additive (Oregpig Pecs, Hungary). Oregpig is dried leaf and flower of Origanum vulgare, enriched with 500 g/kg cold-pressed essential oils of the leaf and flower of Origanum vulgare. Analysis of Oregpig: 60 g carvacrol and 55 g thymol/kilogram. Group 2 (n = 24): the animals weighed 57.9 +/- 2.6 kg and were fed until slaughter with the same diet without Oregpig supplementation. Oregpig-receiving pigs showed a significantly (P < 0.05) better average daily gain and feed conversion rate than the non-treated animals (Oregpig group 788.1 +/- 31.3 g, control animals 709.3 +/- 42.2 g; 2.96, vs. 3.08, respectively). Mortality was significantly (P < 0.001) higher in the non-treated animals (Oregpig group, 1 animal = 4%; control, 8 animals = 33.3%). The proportion of CD4, CD8, MHC class II antigen, and non-T/non-B cells in peripheral blood lymphocytes was significantly higher in the Oregpig-receiving pigs than in the control animals. The proportion of CD4+ CD8+ double-positive T lymphocytes in peripheral blood and mesenteric lymph nodes was higher in the Oregpig-receiving pigs than in the control animals.

IMPLICATION

Dietary oregano improves growth in growth-retarded growing-finishing pigs and has non-specific immunostimulatory effects on porcine immune cells.

Home care aide retention: building team spirit to avoid employee walkouts

While home care agencies work to increase productivity and decrease costs, it is easy to lose sight of the value of employees. Because home care aides are seldom in the office, their value to the organization may get overlooked. In this article, one home care agency shares ways to build team spirit among the home care aides and empower them to be better employees. The result has been increased productivity, improved morale, and a more stable workforce.

Recollective experience, normal aging, and frontal dysfunction

This study examined the nature of verbal recognition memory in young and old subjects. Following presentation of a word list, subjects undertook a yes-no recognition test and indicated whether their decision was based on explicit recollection or assessment of familiarity. Explicit recollection declined with age, and familiarity-based recognition increased. Furthermore, the extent to which older subjects relied on familiarity-based recognition correlated with neuropsychological indices of frontal lobe dysfunction. A further experiment indicated that the change from explicit recollection to familiarity-based responding was unrelated to changes in older subjects' confidence about their memory. The data indicate the central role of frontal dysfunction in understanding age-related memory loss.

Recollective experience, normal aging, and frontal dysfunction

This study examined the nature of verbal recognition memory in young and old subjects. Following presentation of a word list, subjects undertook a yes-no recognition test and indicated whether their decision was based on explicit recollection or assessment of familiarity. Explicit recollection declined with age, and familiarity-based recognition increased. Furthermore, the extent to which older subjects relied on familiarity-based recognition correlated with neuropsychological indices of frontal lobe dysfunction. A further experiment indicated that the change from explicit recollection to familiarity-based responding was unrelated to changes in older subjects' confidence about their memory. The data indicate the central role of frontal dysfunction in understanding age-related memory loss.