Striving for quality improvement: can artificial intelligence help?

Artificial intelligence (AI) is of keen interest for global health development as potential support for current human shortcomings. Gastrointestinal (GI) endoscopy is an excellent substrate for AI, since it holds the genuine potential to improve quality in GI endoscopy and overall patient care by improving detection and diagnosis guiding the endoscopists in performing endoscopy to the highest quality standards. The possibility of large data acquisitioning to refine algorithms makes implementation of AI into daily practice a potential reality. With the start of a new era adopting deep learning, large amounts of data can easily be processed, resulting in better diagnostic performances. In the upper gastrointestinal tract, research currently focusses on the detection and characterization of neoplasia, including Barrett's, squamous cell and gastric carcinoma, with an increasing amount of AI studies demonstrating the potential and benefit of AI-augmented endoscopy. Deep learning applied to small bowel video capsule endoscopy also appears to enhance pathology detection and reduce capsule reading time. In the colon, multiple prospective trials including five randomized trials, showed a consistent improvement in polyp and adenoma detection rates, one of the main quality indicators in endoscopy. There are however potential additional roles for AI to assist in quality improvement of endoscopic procedures, training and therapeutic decision making. Further large-scale, multicenter validation trials are required before AI-augmented diagnostic gastrointestinal endoscopy can be integrated into our routine clinical practice.

Prevalence of gastrointestinal malignancy in iron deficiency without anaemia: A systematic review and meta-analysis

BACKGROUND

Iron deficiency anaemia is associated with gastrointestinal (GI) malignancy and is an indication for GI investigations. However, the relevance of iron deficiency without anaemia (IDWA) and the underlying risks of GI malignancy are uncertain. Therefore, the aim of this study was to estimate the prevalence of GI malignancy in patients with IDWA overall and in clinically relevant subgroups.

METHODS

We searched MEDLINE and EMBASE for studies that reported on the prevalence or risk of GI malignancy in patients with confirmed IDWA. We performed a random effects meta-analysis of proportions and assessed statistical heterogeneity using the I² statistic.

RESULTS

A total of 1923 citations were screened and 5 studies (4 retrospective cohorts, 1 prospective cohort) comprising 3329 participants with IDWA were included in the meta-analysis. Overall pooled random-effects estimates for prevalence of GI malignancy in those with IDWA were low (0.38%, 95% CI 0.00%-1.84%, I2 = 87.7%). Older patients (2.58%, 95% CI 0.00%-8.77%); non-screening populations (2.45%, 95% CI 0.16%-6.39%) and men and post-menopausal women (0.90%, 95% CI 0.11%-3.23%) with IDWA were at increased risk of GI malignancy compared to younger patients (0.00%, 95% CI 0.00%-0.21%); screened populations (0.24%, 95% CI 0.00%-1.10%) and pre-menopausal women (0.00%, 95% CI 0.00%-1.05%).

CONCLUSION

Overall, IDWA is associated with a low risk of GI malignancy. Older patients and non-screening populations are at elevated risk and require GI investigations. Those not in these subgroups have a lower risk of GI malignancy and may wish to be monitored following discussion of the risk and potential benefits of GI investigations.

Lupus Gastrointestinal Tract Vasculopathy: Lupus "Enteritis" Involving the Entire Gastrointestinal Tract from Esophagus to Rectum

Gastrointestinal symptoms are very common in systemic lupus erythematosus (SLE). Lupus "enteritis" is very responsive to treatment but can have devastating consequences if not detected. Most descriptions of enteritis involve the small and large bowel. This is the first report of lupus "enteritis" involving the entire gastrointestinal tract from the esophagus and stomach to the rectum. Lupus "enteritis" is another cause of upper gastrointestinal involvement in SLE (involving even the esophagus and stomach) in addition to involvement of the lower intestinal tract.