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Upper gastrointestinal (UGI) cancers are among the most common cancers in the world, four of them being among the top eight causes of cancer related mortality. Included among UGI cancers are oesophageal, gastric, liver, biliary, pancreatic and small intestinal cancers. Despite more than half a century of well designed epidemiological (large cohort and case-control studies) and a limited number of experimental studies into the role of nutrition on UGI cancer, there is much inconsistency in the findings. Studies have reported significant associations of various food types and UGI cancers, but there are issues with reproducibility. Over the years, numerous meta-analyses have been conducted in an attempt to harmonize available data. On the whole, it is well accepted that fruit and vegetables reduce UGI cancer risk, while processed foods increase the risk. The role of antioxidants in protecting against UGI carcinogenesis is of great interest, but controversial. There is evidence that specific diets, such the Mediterranean or Okinawa, are associated with reduced cancer risk at a population level, but it is less clear if adopting them reduces risk in otherwise high-risk locations. In this review, I will discuss some of the available literature from selected original publications, systematic reviews and meta-analyses on the influence of diet on UGI cancers. I will also provide a brief overview of future directions that have the potential to provide specific evidence on how diet could be modified to reduce the growing global burden of UGI cancers.

Background Patients undergoing pancreaticoduodenectomy (PD) at low volume PD hospitals with high volume for other complex operations have comparable outcomes to high volume PD centers. We evaluated the impact of upper gastrointestinal operations (UGI) hospital volume on the outcomes of elderly, high risk patients undergoing PD. Methods Patients >65 years old who underwent PD for pancreatic adenocarcinoma were identified from SEER-Medicare (2008–2015). Four volume cohorts were created using PD tertiles and UGI median: low (1st tertile PD), mixed-low (2nd tertile PD, low UGI), mixed-high (2nd tertile PD, high UGI) and high (3rd tertile PD). Multivariable logistic and negative binomial regression assessed short-term complications. Results In total, 2717 patients were identified with a median age of 74.5 years. Patients treated at low, mixed-low and mixed-high volume hospitals, versus high volume, had higher risk of short-term complications, including major complications (low: OR 1.441, 95%CI 1.165–1.783; mixed-low: OR 1.374, 95%CI 1.085–1.740; mixed-high: OR 1.418, 95%CI 1.098–1.832) and 90-day mortality (low: OR 2.16, 95%CI 1.454–3.209; mixed-low: OR 2.068, 95%CI 1.347–3.175; mixed-high: OR 1.96, 95%CI 1.245–3.086). Discussion Patients with pancreatic adenocarcinoma who are older and more medically complex benefit from undergoing surgery at high volume PD centers, independent of the operative experience of that center.

Three hundred thirty-six Ross 308 male broiler chicks were used in a 21-d study to explore performance and gut function when treated with a proton pump inhibitor (PPI; 0 or 89 mg/kg) in a 2 × 2 factorial arrangement with a xylanase (Xyl; 0 or 0.1 g/kg) to determine if the beneficial activity of arabinoxylan (AX) depolymerisation, through arabinoxylo-oligosaccharides (AXOS) production, starts in the upper gastrointestinal tract. Treatment with the PPI started from d 14, and by d 21 animal performance had deteriorated (P

Please see the Editorial Comment by HaiThuy N. Nguyen discussing this article. Background: Use of upper gastrointestinal (UGI) series to diagnose UGI obstruction has raised concern in neonates and ...

Non-steroidal antiinflammatory drugs (NSAIDs) are currently one of the most widely used drugs. The use of NSAIDs is associated with gastrointestinal toxicity, affecting both upper gastrointestinal tract (peptic ulcer disease) and lower gastrointestinal tract (NSAID-induced enteropathy). NSAIDs use has been associated with an increased risk of clinical relapse in inflammatory bowel disease patients. In this article, we review the upper and lower gastrointestinal toxicity of NSAIDs, with a focus on the risks and specific data of these drugs in inflammatory bowel disease patients, giving recommendations for its appropriate use in the clinical practice. Although evidence is scarce, short-term use of NSAIDs appears to be safe, and the data available suggest that selective COX-2 inhibitors are the safer option. NSAIDs should be avoided as long-term treatment or with high doses, especially in patients with active inflammation.

Background and Aims Increasingly, gastroenterologists are being asked to assist in the closure of defects. Although there are several available tools that can be used for defect closure, there remains a need for devices that are easy to use, effective, and durable. The aim of this case series is to demonstrate the use of a novel helical tack system in the closure of upper GI defects. Methods Two cases of challenging upper GI defects were identified. One case involved a perforated duodenal ulcer, and the other involved a nonhealing marginal ulcer. In both cases, the helical tack system was used for defect closure. Results In both cases, defect closure was achieved using the helical tack system; however, 2 series of tacks were required in each case. There were no adverse events. Neither patient has required additional surgical or endoscopic interventions. Conclusions The helical tack system is a new device that may be useful for the closure of challenging upper GI defects. Additional comparative studies are needed to better understand the advantages and disadvantages of this system relative to other closure tools.

Незважаючи на багаторічний досвід міжнародної анестезіологічної спільноти, седація та анестезія під час ендоскопічних маніпуляцій на шлунково-кишковому тракті залишається фундаментальним аспектом вивчення. У статті наведено аналіз останніх досліджень та публікацій, присвячених особливостям анестезіологічного забезпечення ендоскопічних транспапілярних втручань. Також подані власні результати аналізу проведення тотальних внутрішньовенних анестезій з інтубацією трахеї у пацієнтів, які потребували виконання ендоскопічних маніпуляцій на верхніх відділах шлунково-кишкового тракту, та проаналізовано вплив способу застосованої анестезії на результати ендоскопічних втручань, якість роботи хірургів, задоволеність пацієнтів.

Objective: to create a model for predicting the risk of upper gastrointestinal diseases in children with bronchial asthma.Material and Methods. The study included 120 children with bronchial asthma, 78 of them had concomitant pathology of the upper gastrointestinal tract. All children underwent general clinical, laboratory and instrumental examination. Based on the analysis of primary medical records (patient’s medical card (F-003/o) and child’s records (F-112)), we have evaluated retrospectively the data of ante-, peri- and postnatal periods, clinical manifestations of atopy and concomitant somatic pathology.Results. In terms of the regression analysis, there were determined risk factors for chronic gastroduodenal pathology in children with bronchial asthma: child’s sex, disease duration, severity of asthma symptoms and level of their control, as well as duration of breastfeeding, food sensitization, H.pylori infection, the presence of digestive pathology in child’s parents. Several models for predicting the risk of chronic diseases of the upper gastrointestinal tract (including destructive ones) in this group of patients were developed, based on clinical and laboratory parameters. These prognostic models have a sufficient level of sensitivity, easy to use and can be recommended for primary care physicians.

The correlation between lesions of the gastrointestinal tract (GIT) and allergic diseases is generally accepted. The action of allergic mediators, which cause an inflammation of the GIT, is known too. Objective: to study the state of the upper GIT to improve the quality of care for children with allergy diseases.Materials and Methods. 61 endoscopic investigations of children aged 6 months to 17 years with allergy were analyzed. The results were processed by methods of variation statistics.Results and Discussion. In the structure of allergic diseases: 43 % — children with combined allergic pathology, 31 % — with allergic rhinitis, 18 % — with bronchial asthma (BA), 8 % — with angioedema. Destructive changes of the GIT were detected in 23 % of patients. Destruction of all regions of the GIT was more common in patients with BA, of the duodenum — in 31 % of children with comorbidity. Erythematous changes of the sto­mach were identified in 91 % of patients with BA and 85 % of patients with combined allergic pathology. Erythematous lesions of the duodenum were detected in 82 % of patients with BA and 58 % — with concomitant allergy. Erythematous lesions of the esophagus were found in 27 % of patients with BA and 20 % of children with angioedema. 32.8 % of the surveyed subjects had lymphoid hyperplasia of various regions of the GIT. Duodenogastric reflux was diagnosed in 44.2 % of patients.Conclusions. 1. In children with allergic disease, the lesions of the digestive system are as follows: 15 % — of the esophagus, 67 % — of the stomach, 60 % — of the duodenum. 2. Destructive forms represented as an erosion account for 23 %. 3. The most unfavorable pathology in terms of GIT lesion is BA and its combinations. 4. 32.8 % of patients have lymphoid hyperplasia of the GIT. 5. Duodenogastric reflux was detected in 44.2 % of patients., Общепризнанной является взаимосвязь между поражениями желудочно-кишечного тракта (ЖКТ) и аллергическими заболеваниями. Известно и действие медиаторов аллергии, которые способствуют развитию воспаления ЖКТ. Цель исследования: изучить состояние верхних отделов ЖКТ для улучшения качества оказания медицинской помощи детям с аллергопатологией.Материалы и методы. Проанализировано 61 эндоскопическое исследование детей в возрасте от 6 мес. до 17 лет с аллергопатологией. Результаты обработаны методами вариационной статистики.Результаты и их обсуждение. В структуре аллергических заболеваний 43 % — дети с сочетанной аллергопатологией, 31 % — с аллергическим ринитом, 18 % — с бронхиальной астмой (БА), 8 % — с ангиоотеком. Деструктивные изменения ЖКТ выявлены у 23 % больных. Деструкция всех отделов ЖКТ чаще наблюдалась у больных БА, двенадцатиперстной кишки (ДПК) — у 31 % детей с сочетанной патологией. Эритематозные изменения желудка выявлены у 91 % больных БА и 85 % больных с сочетанной аллергопатологией. Эритематозные поражения ДПК отмечались у 82 % больных БА и у 58 % — с сочетанной аллергопатологией. Эритематозные поражения пищевода выявлены у 27 % больных БА и 20 % детей с ангиоотеком. У 32,8 % обследованных отмечалась лимфоидная гиперплазия различных отделов ЖКТ. Дуоденогастральный рефлюкс диагностирован у 44,2 % пациентов. Выводы. 1. У детей с аллергопатологией поражения органов пищеварения составляют: 15 % — пищевода, 67 % — желудка, 60 % — ДПК. 2. Деструктивные формы, представленные эрозиями, составляют 23 %. 3. Наиболее неблагоприятной патологией для развития поражения ЖКТ является БА и ее сочетания. 4. У 32,8 % больных отмечается лимфоидная гиперплазия ЖКТ. 5. Дуоденогастральный рефлюкс выявлен у 44,2 % обследованных., Загальновизнаним є взаємозв’язок між ураженнями шлунково-кишкового тракту (ШКТ) та алергічними захворюваннями. Відома й дія медіаторів алергії, що сприяють розвитку запалення ШКТ. Мета дослідження: вивчити стан верхніх відділів ШКТ для покращення якості надання медичної допомоги дітям з алергопатологією.Матеріали та методи. Проаналізовано 61 ендоскопічне дослідження дітей віком від 6 міс. до 17 років з алергопатологією. Результати опрацьовані методами варіаційної статистики.Результати та їх обговорення. У структурі алергічних захворювань 43 % — діти із сполученою алергічною патологією, 31 % — з алергічним ринітом, 18 % — із бронхіальною астмою (БА), 8 % — з ангіонабряком. Деструктивні зміни ШКТ виявлені в 23 % хворих. Деструкція всіх відділів ШКТ частіше спостерігалась у хворих на БА, дванадцятипалої кишки (ДПК) — у 31 % дітей із сполученою патологією. Еритематозні зміни шлунка виявлені в 91 % хворих на БА та в 85 % хворих із сполученою алергопатологією. Еритематозні ураження ДПК наявні в 82 % хворих на БА та в 58 % — із сполученою алергопатологією. Еритематозні ураження стравоходу виявлені в 27 % хворих на БА та в 20 % дітей з ангіонабряком. У 32,8 % обстежених відмічалася лімфоїдна гіперплазія різних відділів ШКТ. Дуоденогастральний рефлюкс діагностований у 44,2 % пацієнтів. Висновки. 1. У дітей з алергопатологією ураження органів травлення становить: 15 % — стравоходу, 67 % — шлунка, 60 % — ДПК. 2. Деструктивні форми, представлені ерозіями, становлять 23 %. 3. Найнесприятливішою патологією для розвитку ураження ШКТ є БА та її сполучення. 4. У 32,8 % хворих відмічається лімфоїдна гіперплазія різних відділів ШКТ. 5. Дуоденогастральний рефлюкс виявлений у 44,2 % обстежених.

It is well known that black and green tea extracts, particularly polyphenols, have antimicrobial activity against various pathogenic microbes including viruses. However, there is limited data on the antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), which emerged rapidly in China in late 2019 and which has been responsible for coronavirus disease 2019 (COVID‐19) pandemic globally. In this study, 20 compounds and three extracts were obtained from black and green tea and found that three tea extracts showed significant antiviral activity against SARS‐CoV‐2, whereby the viral titre decreased about 5 logs TCID50 per ml by 1·375 mg ml−1 black tea extract and two‐fold diluted tea bag infusion obtained from black tea when incubated at 25°C for 10 s. However, when concentrations of black and green tea extracts were equally adjusted to 344 µg ml−1, green tea extracts showed more antiviral activity against SARS‐CoV‐2. This simple and highly respected beverage may be a cheap and widely acceptable means to reduce SARS‐CoV‐2 viral burden in the mouth and upper gastrointestinal and respiratory tracts in developed as well as developing countries., Significance and Impact of the Study: Here, we show that black tea extract and tea bag infusion could reduce the viral titre of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in vitro by 5 logs TCID50 per ml within 10 s. Black and green teas are widely available and are relatively cheap to purchase in both developed and developing countries. In translational terms, drinking tea might contribute to the in vivo reduction in numbers of SARS‐CoV‐2 virus in saliva of infected persons, as well as lowering the viral burden in the mouth and upper gastrointestinal and respiratory tracts. A clinical trial is urgently needed to establish if drinking tea results in the prevention of transmission of SARS‐CoV‐2 virus between infected and non‐infected persons.

The causes of postprandial hyperinsulinemic hypoglycemia (PHH) in patients who have under-gone an upper gastrointestinal tract surgery are still a matter of debate in the scientific community. Low postoperative body mass index, high postprandial beta-cell activity before the surgery, and younger age are all have been associated with higher PHH risk. It is hypothesized that the insulin-like growth factor-1 increases the tissue sensitivity to insulin and indirectly promotes the development of hypoglycemia. An increase in postprandial secretion of enteropancreatic hormones is still considered to be the main reason for PHH manifestation; however, a particular contribution has been ascribed to glycentin, which could be used as a marker of PHH risk in the future. At present, there are no clinical guidelines for the diagnosis of PHH. Undoubtedly, the first step in this direction should be the collection of the disease history. The provocative tests have been proposed for the detection of PHH. Today, the 72-hour fast test is still the gold standard in the diagnosis of hypoglycemia. However, most post-bariatric patients do not have fasting hypoglycemia, and insulinoma is extremely rare in this patient category. The use of a prolonged oral glucose tolerance test as the main method is associated with a risk of a false diagnosis, because about 12% of healthy individuals may have their glycemic levels at below 2.8 mmol/l. The mixed meal test has not been validated yet. The best results in the assessment of glucose variability have been obtained with “real time” continuous glucose monitoring the interstitial fluid for several days. The goal of PHH treatment is to reduce the stimulated insulin secretion. First of all, patients are advised to eat small meals consisting of carbohydrates with a low glycemic index in combination with proteins and lipids, with high fiber content. Should the nutritional modification be ineffective, it is possible to prescribe medical treatment, such as acarbose or somatostatin analogs. Diazoxide and slow calcium channel blockers can be used as the third line of therapy. A recent study has suggested that exogenous agonists of glucagon-like peptide-1 (GLP-1) receptors by stronger bonds with receptors, compared to those with endogenous GLP-1, could enhance glucagon response to hypoglycemia, thereby stabilizing glucose levels. In severe refractory PHH, reconstructive surgery and gastric banding are to be considered. If the expected decrease in insulin hypersecretion by reconstructive surgery is not achieved, partial or complete pancreatectomy remains the only possible approach to prevent hypoglycemia. However, due to the small number and short duration of the studies, effectiveness and safety of these techniques for PHH treatment have not yet been proven.

Background Foreign body(FB) ingestion in the upper digestive tract is a common emergency that lacks sufficient attention in adult population. Improper management may bring additional injuries and financial burdens to patients. This review was performed to determine the clinical characteristics of upper gastrointestinal FBs, including the demographic of adult patients, the type and location of FBs, underlying diseases of patients and other risk factors, and outcomes. Methods We searched PubMed, MEDLINE, EMBASE and Cochrane databases with the terms “foreign body AND upper gastrointestinal NOT child”. Finally, we got 7 articles between 2001 and 2020 and extracted the information. Results A total of 1391 patients were included. 736 (52.9%) patients were males and 655 (47.1%) were females. Fish bone was the most common type of FBs. Esophagus accounts for the most location in the upper digestive tract. 18.2% (235/1291) patients had the underlying diseases, and 11.7% (58/494) had other risk factors. The overall complication rate was 4.5% (63/1391).

Background Endoscopic ultrasonography (EUS) is useful for the differential diagnosis of subepithelial lesions (SELs); however, not all of them are easy to distinguish. Gastrointestinal stromal tumors (GISTs) are the commonest SELs, are considered potentially malignant, and differentiating them from benign SELs is important. Artificial intelligence (AI) using deep learning has developed remarkably in the medical field. This study aimed to investigate the efficacy of an AI system for classifying SELs on EUS images. Methods EUS images of pathologically confirmed upper gastrointestinal SELs (GIST, leiomyoma, schwannoma, neuroendocrine tumor [NET], and ectopic pancreas) were collected from 12 hospitals. These images were divided into development and test datasets in the ratio of 4:1 using random sampling; the development dataset was divided into training and validation datasets. The same test dataset was diagnosed by two experts and two non-experts. Results A total of 16,110 images were collected from 631 cases for the development and test datasets. The accuracy of the AI system for the five-category classification (GIST, leiomyoma, schwannoma, NET, and ectopic pancreas) was 86.1%, which was significantly higher than that of all endoscopists. The sensitivity, specificity, and accuracy of the AI system for differentiating GISTs from non-GISTs were 98.8%, 67.6%, and 89.3%, respectively. Its sensitivity and accuracy were significantly higher than those of all the endoscopists. Conclusion The AI system, classifying SELs, showed higher diagnostic performance than that of the experts and may assist in improving the diagnosis of SELs in clinical practice.

Background Upper gastrointestinal cancers are aggressive malignancies with poor prognosis, even following multimodality therapy. As such, they require timely and accurate diagnostic and surveillance strategies; however, such radiological workflows necessitate considerable expertise and resource to maintain. In order to lessen the workload upon already stretched health systems, there has been increasing focus on the development and use of artificial intelligence (AI)-centred diagnostic systems. This systematic review summarizes the clinical applicability and diagnostic performance of AI-centred systems in the diagnosis and surveillance of esophagogastric cancers. Methods A systematic review was performed using the MEDLINE, EMBASE, Cochrane Review, and Scopus databases. Articles on the use of AI and radiomics for the diagnosis and surveillance of patients with esophageal cancer were evaluated, and quality assessment of studies was performed using the QUADAS-2 tool. A meta-analysis was performed to assess the diagnostic accuracy of sequencing methodologies. Results Thirty-six studies that described the use of AI were included in the qualitative synthesis and six studies involving 1352 patients were included in the quantitative analysis. Of these six studies, four studies assessed the utility of AI in gastric cancer diagnosis, one study assessed its utility for diagnosing esophageal cancer, and one study assessed its utility for surveillance. The pooled sensitivity and specificity were 73.4% (64.6–80.7) and 89.7% (82.7–94.1), respectively. Conclusions AI systems have shown promise in diagnosing and monitoring esophageal and gastric cancer, particularly when combined with existing diagnostic methods. Further work is needed to further develop systems of greater accuracy and greater consideration of the clinical workflows that they aim to integrate within.

SummaryThe oncological community witnessed several practice-changing clinical reports in this years’ annual congress of the American Society of Clinical Oncology (ASCO). Many immunotherapeutic agents were shown to be beneficial for upper gastrointestinal tumors. For advanced squamous cell carcinoma, immunotherapy and chemotherapy combinations revealed by the CheckMate 648 and ESCORT-1st trials have been implemented into the clinical practice. The updates on the CheckMate 649 and CheckMate 577 trials again underlined the significant clinical contribution of nivolumab in advanced and localized gastroesophageal cancer, respectively. However, this effect seems to be dependent to PD-L1 expression. Not only immunotherapy trials, but also targeted therapy studies such as the FIGHT trial investigating the anti-FGFR2b monoclonal antibody bemarituzumab attracted huge interest, not only due to extension of survival in experimental group, but also due to the innovative design of this trial. This review summarizes the highlights regarding gastroesophageal tumors at the ASCO 2021 congress.

BACKGROUND A single state-wide upper gastrointestinal (GI) cancer video-linked multidisciplinary team (MDT) meeting guides management and evidence-based care for all newly diagnosed upper GI cancer patients in South Australia. This study determined the patterns of care and outcomes for patients diagnosed with gastric and gastro-oesophageal junction (GOJ) cancers. METHODS Patients diagnosed with gastric cancer and GOJ (Siewert III) cancer between June 2012 and June 2016 were included. Patient demographics, cancer stage, histology, diagnostic modalities and treatment data was analysed from a prospective database. Stage-specific survival outcomes were determined and analysed for each treatment modality. RESULTS The study included 218 patients and at diagnosis 132 (61%) patients had stage I-III and 86 (39%) patients had stage IV disease. One hundred and ninety-five (89%) patients had gastric cancer and 23 (11%) had GOJ cancer (Siewert III). One hundred and nine (50%) patients underwent surgery, with 92% R0 resection rate. Forty-six patients received perioperative chemotherapy and 111 (51%) patients received palliative intent treatment. Median overall survival for stage II, III and IV cancers was 57.6 (95% CI 57.6-NR), 22.8 (95% CI 20.4-43.2), and 6.0 months (95% CI 4.8-8.4) respectively (p

Background: Early nasogastric tube (NGT) removal is a component of enhanced recovery after surgery (ERAS) protocol for esophagectomy. The aim of this study is to assess a protocol-driven application of UGI contrast study to facilitate early NGT removal and direct a standardized therapeutic response in patients with evidence for delayed gastric conduit emptying (DGCE). Methods: All patients undergoing esophagectomy between January 2017 and October 2019 were prospectively enrolled. Esophageal resections were performed through different surgical approaches involving gastric conduit reconstruction. A standardized clinical protocol (SCP) was systematically applied, which targeted a UGI contrast study on POD 2–3 to allow immediate NGT removal or initiate DGCE protocols. Results: This study enrolled 50 patients undergoing open Ivor Lewis (42%), left thoracoabdominal (46%), and three-field procedure (12%) with gastric conduit reconstruction and either upper thoracic (66%) or cervical (34%) anastomosis. Jejunostomy was routinely placed while pyloric procedures were not performed. Patients achieving targeted contrast study (86%) demonstrated significantly earlier NGT removal (p-value 0.010), oral protocol initiation (0.001), and decreased length of hospital stay (6 vs 10days, 0.024). Four patients (8%) presented with radiology signs of DCGE and underwent protocoled treatment, eventually achieving discharge similar to the overall study population (7 vs 8.5days). Conclusions: Protocol-driven UGI contrast study can effectively provide objective data facilitating early NGT removal and discharge. Patients with DGCE can successfully undergo intervention to improve conduit emptying and adhere to ERAS discharge goals.

The most common clinical manifestations of coronavirus SARS-CoV-2 (COVID-19) include fever, cough, dyspnea, sore throat, muscle or bone aches, chills, and headache. Nevertheless, gastrointestinal infections have been reported, with symptoms such as diarrhea, nausea, vomiting, abdominal pain, and lack of appetite. Although is not clear the mechanisms responsible for the development of diarrhea in COVID-19, the current hypothesis is that the direct viral infection on the intestinal tissue and local immune response to the virus may be involved. Additionally, after gastrointestinal SARS-CoV-2 infection some patients may develop alterations in the gastrointestinal microbiota. In this review we outlined the important GI manifestations of COVID-19 and discussed the possible mechanisms and aspects relating to their diagnosis and management.

Aims: The aim of this study is to analyze the endoscopy and pathology results of patients who underwent endoscopy in Yozgat region, to determine the frequency of Helicobacter pylori (H. pylori) positivity and to compare the results with the data in the literature. Material and Method: Among the patients who applied to our clinic for any reason between 01/01/2019 and 31/12/2019, 772 patients who underwent upper gastrointestinal system endoscopy were included in the study and analyzed retrospectively. Results: The mean age of the patients was 50±16.78 (16–89). 61.3% (n=473) of the patients were female; 38.7% (n=299) were male. When gastroscopic diagnoses were evaluated, the rate of patients reported as "normal upper gastrointestinal endoscopy" was found to be 5.2% (n= 40). The most frequently reported diagnosis was “nonerosive gastritis” with a rate of 59.2% (n=457). Biopsy was obtained in 646 of 772 patients. The most common diagnosis was reported as “chronic active gastritis” with 90.6% (n=585). 626 of the patients had H. pylori pathological evaluation results. While 18.7% (n=117) of the patients were found to be H. pylori negative, 81.3% (n=509) were found to be H. pylori positive. Stomach cancer was found to be 1.3% (n=9) and esophageal cancer was found to be 0.1% (n=1). Conclusion: In the Yozgat region, the frequency of H. pylori positivity was found to be 81.3%, and it is often mildly (+) positive. In addition, the frequency of H. pylori positivity was similar between men and women, consistent with the literature. The most common diagnosis was reported as "chronic active gastritis". While stomach cancer was detected at a rate of 1.3%, esophageal cancer was found at a rate of 0.1%.

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PURPOSE OF REVIEW To provide a review of current evidence evaluating endoscopic simulators as teaching platforms in gastroenterology training, with emphasis on upper gastrointestinal anatomy. RECENT FINDINGS Endoscopic simulators have leveraged mechanical, virtual reality and ex-vivo or live animal platforms to deliver training in both general and therapeutic endoscopy. Simulators have demonstrated their greatest utility in training novice endoscopists. Intermediate and expert endoscopists may additionally benefit from simulator exposure when learning advanced therapeutic techniques including large tissue resection or natural orifice transluminal endoscopic surgery. SUMMARY Simulator-based learning offers promise to complement conventional endoscopic training modalities for novice trainees. Nevertheless, additional evidence demonstrating a clear benefit is required for simulators to become an integral part of gastroenterology training. As novel advanced endoscopic therapies are developed, endoscopic simulators may assume a larger role in training prior to clinical practice.

While brachytherapy applications are not widely used for cancer diagnoses in the upper GI tract (including the esophagus, liver, stomach, and pancreas), they have a clear role in palliation and symptom management and occasionally definitive locoregional treatment. With the increasing use of image-guided techniques, the incidence of side effects and complications has shown to be lower than many other alternative treatment modalities, making brachytherapy approaches a preferred treatment option. This review examines procedural complications and acute and chronic adverse effects from radiation associated with esophageal, hepatobiliary, and pancreatic brachytherapy and their management.

Background Perforation and anastomotic leakage of the upper gastrointestinal tract (UGI) has a high mortality and morbidity rate. Recently, UGI leaks have been treated with endoscopic vacuum therapy (EVT). However, this technique traditionally requires multiple EVT changes and a prolonged and uncomfortable nasoenteric intubation. We describe our experience using EVT through a novel pharyngostomy access to manage UGI leaks. Methods We describe our development and implementation of EVT via a novel pharyngostomy access to treat a variety of UGI defects. Preoperative, perioperative, and postoperative data were analyzed. Results Six patients with UGI perforations or anastomotic leaks were treated with an EVT using a pharyngostomy access. The median age was 69 years (IQR 53-71). Four patients leaked after an Ivor Lewis esophagectomy, one after a robotic para-esophageal hernia repair, and another after a Roux en Y esophagojejunostomy. Defects were detected on a median of 11.5 days (IQR 3-21). Median values for the duration of the EVT therapy and the number of EVT changes were 19.5 days (IQR 14-31) and 7 (IQR 6.5-9), respectively. Four of the patients were discharged with an EVT in place and were successfully managed as outpatients. At a median follow-up of 8 months, two patients developed strictures. None of the patients required any surgical re-intervention, they tolerated oral intake, and all leakages were confirmed closed by imaging and endoscopy. Discussion Endoscopic vacuum therapy can be successfully managed through a pharyngostomy access, as described. This access is easy, comfortable, and reliable and allows for a transition to outpatient management.

BACKGROUND Crohn's disease (CD) with upper gastrointestinal involvement (UGI) may have a more aggressive and refractory course. However, evidence on this phenotype of patients is scarce. AIMS To identify the clinical characteristics, therapeutic requirements and complications associated with UGI in CD METHODS: Nationwide study of cases (UGI, UGI plus ileal/ileocolonic involvement) paired with controls (ileal/ileocolonic involvement) from the ENEIDA registry. Cases were matched to 2 controls by year of diagnosis ± 2.5 years. Patients with exclusive/predominant colonic location or complex perianal fistula were excluded. RESULTS Of 24 738 patients with CD in the ENEIDA registry, we identified 4058 with UGI (16% of the total CD cohort). Finally, 854 cases and 1708 controls were included. Cases were independently associated to extensive involvement (OR 2.7 [2.2-3.3], P

BACKGROUND Functional dyspepsia (FD) is a chronic disorder of the upper gastrointestinal tract that currently lacks substantially effective therapy options. AIMS To evaluate the feasibility and potential impact on FD symptoms and well-being of a fully automated gut-directed hypnosis intervention delivered via audio recordings. METHODS FD patients were enrolled at a single medical center and given access to a password-protected website where they completed 7 bi-weekly audio-recorded hypnosis sessions over a 3-month period. Study questionnaires including the Patient assessment of upper gastrointestinal symptom severity index, Short-Form Nepean Dyspepsia Index, the Visceral Sensitivity Index, and the Brief Symptom Inventory (BSI-18) were completed online pre-treatment, mid-treatment, post-treatment and at 3-month follow-up. RESULTS Of 23 enrolled patients (18 females; mean age = 38 years), 96% completed the entire treatment program and 3-month follow-up. Intention-to-treat analyses showed significant improvement at both end of treatment and 3-month follow-up in dyspepsia severity and quality of life, as well as in gut-specific anxiety and psychological distress. 68% of treatment completers reported that their FD symptoms were improved. Improvement in FD severity was significantly positively correlated with baseline PAGI-SYM total scores and BSI Global Severity Index scores. CONCLUSIONS The fully automated hypnosis audio treatment program, which requires no therapist or clinician involvement, demonstrated excellent feasibility and resulted in significant improvement in FD symptoms, quality of life and emotional well-being. The results indicate that the intervention has high potential as adjunctive therapy for FD and warrants further investigation in a randomized controlled trial.

There is wide variation in the recommendations for photodocumentation at colonoscopy. The British Society of Gastroenterology (BSG) quality assurance standard suggests ‘photographic proof of ileocaecal valve, terminal ileum, anastomosis or appendix orifice [is] required in all cases’.1 Like the American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology (ACG) guidelines,2 documentation of any other part of the colon is not currently mandated. Although caecal photographs serve to confirm that the colonoscope has been passed the full length of the colon, they do not document whether the colonic mucosa has been adequately visualised. Photodocumentation is a relatively simple ‘push button’ process, and most endoscopists now have access to reporting systems that can automatically integrate multiple images in real time. A pertinent question therefore is, should we perform more comprehensive photodocumentation and will this lead to improvements in the quality and reliability of the examination? One approach to overcoming the limitations of static photodocumentation would be to video record the entire procedure, and with improvements in data storage, this is now technically possible. Video-recording has been found to increase mean inspection time by 49% and quality of mucosal inspection technique (measured by blinded assessment) by up to 30%.3 However, there are still significant data storage costs and issues arise around sharing of information with colleagues and manipulation of large data files. Given that endoscopists are familiar with photodocumentation and files are smaller and easy to embed in current software records, enhancing current practice with specific emphasis on quality and training in photodocumentation may be a more acceptable and realistic way of enhancing quality. An example of where enhanced photodocumentation has been recommended is the BSG standards for upper gastrointestinal (GI) endoscopy.4 Eight photos of anatomical landmarks are now advised. The impetus for this approach was a recognition that …

Background: There have been several reports of seasonal variations in the incidence of esophageal variceal bleeding but the data available from this part of the world is scanty. Aims and Objective: We aimed to study whether monthly and seasonal climatic changes during the year have an influence on the incidence of variceal bleeding in our setting and whether a particular time in the year can be defined as a high-risk period for variceal bleed. Materials and Methods: Data of all the patients with diagnosis of acute variceal upper gastrointestinal bleed who presented to our endoscopy centre from January 2010 to December 2019 was retrieved and analysed. The demographic data, clinical presentations and seasonal and monthly variation was analysed. Results: Out of a total of 10200 patients presenting with upper gastrointestinal bleed during the study time period, 530 patients had a diagnosis of variceal bleed after esophagogastroduodenoscopy (EGD). The majority of variceal bleed patients (48.5%) were seen between May to August months of the year. Conclusions: Contrary to the most of the literature which shows increased frequency of variceal bleed during winters, our patients bleed more during the months of May and August. This could be explained on the basis of unique socio-cultural and demographic pattern of this part of the world.

In jungster Vergangenheit konnten die Tumoren des oberen Gastrointestinaltraktes (osophageales Plattenepithelkarzinom [ESCC], osophageales Adenokarzinom [EAC], gastrales Adenokarzinom) zunehmend molekulargenetisch charakterisiert werden. Die resultierenden Subtypen bieten hierbei gemas ihren biologischen Eigenschaften mogliche Angriffspunkte fur zielgerichtete Therapien. Es wird eine Ubersicht uber den aktuellen Stand der molekularen Subtypen aller drei Tumorentitaten vermittelt und hiervon abgeleitete individualisierte Therapiestrategien diskutiert. Es wurde eine selektive Literaturrecherche insbesondere hinsichtlich der bestehenden molekularen Subtypisierung, der derzeitig bestehenden „targeted therapies“ und der Auswirkung auf die onkologischen Therapiekonzepte durchgefuhrt. Dabei wurden Datenbanken wie PubMed genutzt. Anhand der molekularen Charakteristika wird das ESCC in drei Subtypen kategorisiert. Genetisch ahnelt hierbei zumindest eine Subgruppe eher den Oropharynxkarzinomen als denjenigen des oberen Gastrointestinal(GI)-Traktes. Das EAC zeichnet sich dagegen durch seine hohe Tumorlast und die grose chromosomale Instabilitat aus. Beim Magenkarzinom werden zudem vier Subtypen unterschieden: 1. Epstein-Barr-Virus(EBV)-positive, 2. mikrosatelliteninstabile (MSI), 3. genomisch stabile (GS) und 4. chromosomal instabile (CIN) Tumoren. Bisher konnten anhand der genetischen Charakterisierung nur wenige zielgerichtete Therapieoptionen fur die drei Tumorentitaten in die tagliche Routine uberfuhrt werden. Hierzu gehoren die selektive ERBB2-Inhibition, die Immuntherapie mittels PD-L1-Inhibition oder kombinierte Blockade von ERBB2/VEGF.

Recent advancement in endoscopic closure techniques have revolutionized the treatment of gastrointestinal perforations, leaks and fistulas. Traditionally, these have been managed surgically. The treatment strategy depends on the size and location of the defect, degree of contamination, presence of healthy surrounding tissues, patients' condition and the availability of expertise. One of the basic principles of management includes providing a barricade to the flow of luminal contents across the defect. This can be achieved with a wide range of endoscopic techniques. These include endoclips, stenting, suturing, tissue adhesives and glue, and endoscopic vacuum therapy. Each method has their distinct indications and shortcomings. Often, a combination of these techniques is required. Apart from endoscopic closure, drainage procedures by the interventional radiologist and surgical management also play an important role. In this review article, the outcomes of each of these endoscopic closure techniques in the literature is provided in tables, and practical management algorithms are being proposed.

Background/purpose We developed EUS-guided double-balloon occluded gastrojejunostomy (EPASS) for gastric drainage tract obstruction. The success of EPASS depends on the proximity of the stomach and the gastrointestinal (GI) tract near the ligament of Treitz. The aim of this study is to clarify the GI anatomy near the ligament of Treitz. Methods One thousand and sixteen cases imaged upper GI radiography using barium were retrospectively evaluated. Morphologically, the GI tract running near the ligament of Treitz was divided in three types: Type I: The 4th portion of the duodenum (D4) approaches the stomach; Type II: D4 does not approach the stomach; Type III: D4 forms a loop to the jejunum. The minimum distance between the stomach and the GI tract near the ligament of Treitz was measured. Results Based on the morphological classification, 74.6% in the study group was classified in Type I, 22.0% in Type II, and 3.3% in Type III, respectively. The median minimum distance in Type II/III group were significantly longer, compared with the Type I (P Conclusions The GI anatomy near the ligament of Treitz was clarified using upper GI radiography. It is divided into three patterns, and one-fourth of cases may have difficulty in EUS-guided gastrojejunostomy.

Aim: Mucosal melanomas are highly malignant tumors that are of great interest for their aggressive behaviour and unfavourable prognosis, which could be the result of many reasons. In this paper, we describe a retrospective study performed to investigate the characteristics and prognoses of gastrointestinal mucosal melanomas in a Chinese population to help future clinicians recognize the prognosis of this disease. Methods: We retrospectively studied 49 patients diagnosed with gastrointestinal mucosal melanomas. Multivariate analysis of prognosis and overall survival (OS) was performed using the Cox proportional hazards model. Results: The multivariate analysis showed that the condition of the primary or metastatic tumor and tumor location were independent factors that affected the prognosis of patients with gastrointestinal mucosal melanomas. Patients with metastatic tumors had a better prognosis than patients with primary tumors, and tumors that occurred in the lower gastrointestinal tract had a better prognosis than those that occurred in the upper gastrointestinal tract. Conclusion: Tumor location and the condition of the primary or metastatic tumor may be independent factors that affect the prognosis of patients with gastrointestinal mucosal melanomas.

Aortoesophageal fistula in children is a very uncommon disease, which in most cases leads to death during the first days from the moment it occurs. Its high mortality is due to the lack of knowledge among doctors about the similarity of the disease in children and the lack of experience treating it. This paper presents the case history of a 1.5-year-old child who was admitted with bleeding from the upper gastrointestinal tract and died 36 hours after admission due to continued massive bleeding at the diagnostic measure stages. An autopsy revealed an aortic aneurysm with a diameter of 1.5 cm, which penetrated the esophageal lumen and formed an aortoesophageal fistula. This article analyzes the treatment results of 17 cases of successfully treating children with aortoesophageal fistula, which we found in the literature. It describes the leading causes and mechanisms of the development of this pathology in children. Also, the article describes the diagnostic and treatment methods for children with aortoesophageal fistula.

Acetals and ketals and their nitrogen and sulfur homologues are often considered to be unconventional and potentially problematic scaffolding elements or pharmacophores for the design of orally bioavailable drugs. This opinion is largely a function of the perception that such motifs might be chemically unstable under the acidic conditions of the stomach and upper gastrointestinal tract. However, even simple acetals and ketals, including acyclic molecules, can be sufficiently robust under acidic conditions to be fashioned into orally bioavailable drugs, and these structural elements are embedded in many effective therapeutic agents. The chemical stability of molecules incorporating geminal diheteroatomic motifs can be modulated by physicochemical design principles that include the judicious deployment of proximal electron-withdrawing substituents and conformational restriction. In this Perspective, we exemplify geminal diheteroatomic motifs that have been utilized in the discovery of orally bioavailable drugs or drug candidates against the backdrop of understanding their potential for chemical lability.

Endoscopic sleeve gastroplasty (ESG) is a promising bariatric endoluminal procedure. Restriction and shortening of the stomach are obtained by means of non-resorbable full-thickness sutures, thus inducing the formation of several endoluminal pouches in which food can stagnate. The effect of ESG on the upper gastrointestinal tract has never been investigated.This study objectively evaluates endoscopic macroscopic and histopathologic changes within 12-month follow-up (FU) in patients who underwent ESG.Retrospective study on a prospective database of patients who underwent ESG at our tertiary referral center between October 2016 and March 2019.All consecutive patients undergoing upper endoscopy (EGD) preoperatively and 6 and 12 months after ESG were included. The upper gastrointestinal tract was evaluated for mucosal abnormalities and biopsies were systematically taken.Eighty-six patients were included. EGD results were as follows: esophagitis decreased from 14% preoperatively to 3.6% and 1.2% at 6- and 12-month FU, respectively (P = .001); 19.8% of patients presented preoperatively a type I hiatal hernia4 cm and showed no size increment or de novo hiatal hernia at 6- and 12-months. The rate of preoperative hyperemic (23.2%) and erosive (3.5%) gastropathy decreased to 9.5% and 1.2% at 6 months and 17.4% and 1.2% at 12 months, respectively. Gastric ulcer (4.7%), duodenal hyperemic mucosa (1.2%) and duodenal micro-ulcerations (2.3%) detected preoperatively were not present at 6- and 12-month EGD. The rate of histopathological disease, which was 68.1% preoperatively, dropped to 29.2% at 12 months, chronic gastritis decreased from 40.3% to 26.4%, acute gastritis from 9.7% to 0%, and acute inflammation on chronic gastritis from 18% to 2.8% (P.001).ESG is a safe procedure that does not promote the new onset of macroscopic and histopathologic abnormalities within 1-year follow-up.

Background: Upper GI endoscopy is an established procedure for investigating a wide range of upper GI conditions especially inflammatory and malignant diseases of stomach and esophagus. A good correlation in diagnosis can be achieved by complementing endoscopic findings with histopathology of biopsy specimens. Methods: Both retrospective and prospective study of upper GI endoscopic biopsy was carried out at department of pathology, KIMS, Hubli during January 2016 to December 2018. Samples were received in 10% formalin; routine processing was followed with H & E staining. Special stain like Giemsa was done for detection of H. Pylori. 396 endoscopic mucosal biopsies were analyzed and evaluated. Result: Out of 396 cases, 250 cases were esophageal biopsies, 104 cases were gastric biopsies & 42 cases were duodenal biopsies. The male: female ratio was 1:9:1. The highest number of cases was seen between 61 to 70 years. Dyspepsia was the common symptom seen in 61.3%. The most common lesions encountered in the esophagus were carcinomas (67%) followed by esophagitis (16%). The commonly encountered gastric lesion was chronic gastritis in 54.8% with H. pylori gastritis being positive in 38.18%. Among the duodenal biopsies, non-neoplastic lesions were most common (59.5%) followed by neoplastic lesions (26%). Conclusion: Upper GI endoscopy is an effective and appropriate preliminary investigation to assess patients with dysphagia, dyspepsia, vomiting. Endoscopy without biopsy is incomplete and that the combination of methods offers a strong diagnostic tool for better patient care.

Ulcerative colitis (UC) is a chronic, nonspecific, relapsing inflammatory bowel disease. The colorectum is considered the chief target organ of UC, whereas upper gastrointestinal (UGI) tract manifestations are infrequent. Recently, emerging evidence has suggested that UC presents complications in esophageal, stomachic, and duodenal mucosal injuries. However, UC-related UGI tract manifestations are varied and frequently silenced or concealed. Moreover, the endoscopic and microscopic characteristics of UGI tract complicated with UC are nonspecific. Therefore, UGI involvement may be ignored by many clinicians. In addition, no standard criteria have been established for patients with UC who should undergo fibrogastroduodenoscopy. Furthermore, specific treatment recommendations may be needed for patients with UC-associated UGI lesions. Herein, we review the esophageal, gastric, and duodenal mucosal lesions of the UC-associated UGI tract, as well as the potential pathogenesis and therapy.

Obstruction of the upper gastrointestinal tract, caused by blocked passage in the oesophagus, stomach or duodenum, is an important clinical and diagnostic problem in gastroenterological practice. The typical symptoms are dysphagia, postprandial vomiting, epigastric pain and weight loss. Post-inflammatory oesophageal lesions associated with reflux oesophagitis are the most common cause of obstruction. Other common causes include foreign bodies, neoplasms, chemical burns of the oesophagus and radiation-induced stenosis. In more than 2/3 cases, foreign bodies are localised in the proximal part of the oesophagus, but anatomical abnormalities, such as a Schatzki ring or post-inflammatory stenosis, increase the risk of food bolus impaction in the distal part of the oesophagus. Radiotherapy of head and neck tumours may cause stenosis, which affects more than 7% of patients treated this way. For the stomach and duodenum, 50–80% of obstruction cases are associated with neoplastic processes, with gastric cancer and pancreatic adenocarcinoma accounting for 35% and 15–25% of these cases, respectively. Mild causes of peripyloric obstruction include gastric and duodenal peptic ulcer, peritoneal adhesions, gastric polyps and Crohn’s disease. Symptoms of temporary pylorus obstruction can be caused by large, gastric hyperplastic pedunculated polyps. Therapeutic endoscopy is the most commonly used method for upper gastrointestinal tract obstruction. Depending on the cause, it involves foreign body removal, balloon enteroscopy, stenting with self-expanding metallic stents, and, in the case of treatment failure, surgical resection or palliative gastrojejunostomy.

The syndrome of the mesenteric clamp or Wilkies syndrome is defined by a compression of the third duodenum between the superior mesenteric artery, and the aorta . The symptoms are variable and non specific. Management is based first on medical treatment with recourse most often to surgery if failure. We report a review of the literature by reporting an observation of a case. Observation: This is a 27-year-old patient with a history of intermittent chronic vomiting since the age of 16, unexplored, who for the past 1 year has been worsening vomiting becoming persistent with epigastralgia. gravity, evolving in a context of deterioration of the general state and slimming. A high gastrointestinal endoscopy that showed significant gastric stasis, injected abdominal CT found a disparity in caliber against D3. An upper gastrointestinal fluoroscopy showed gastric stasis with a stomach reaching the pelvis. The management consisted in a surgical treatment after failure of the medical treatment with good evolution. The mesenteric forceps syndrome is a rare and benign condition. Positive diagnosis is hard on the scanner. The treatment is medical in the first place but the use of surgery is common.

Upper gastrointestinal (GI) cancers are the leading cause of cancer-related deaths worldwide. Early identification of precancerous lesions has been shown to minimize the incidence of GI cancers and substantiate the vital role of screening endoscopy. However, unlike GI cancers, precancerous lesions in the upper GI tract can be subtle and difficult to detect. Artificial intelligence techniques, especially deep learning algorithms with convolutional neural networks, might help endoscopists identify the precancerous lesions and reduce interobserver variability. In this review, a systematic literature search was undertaken of the Web of Science, PubMed, Cochrane Library and Embase, with an emphasis on the deep learning-based diagnosis of precancerous lesions in the upper GI tract. The status of deep learning algorithms in upper GI precancerous lesions has been systematically summarized. The challenges and recommendations targeting this field are comprehensively analyzed for future research.

BACKGROUND AND AIM Gastrointestinal submucosal tumors (SMTs) can be removed by submucosal tunneling endoscopic resection (STER). However, limited studies have evaluated STER for the removal of multiple upper gastrointestinal SMTs. The aim of this study was to evaluate the feasibility and outcomes of STER in the treatment of multiple upper gastrointestinal SMTs. METHODS From January 2011 to April 2020, the cases of patients with multiple upper gastrointestinal SMTs undergoing STER were retrospectively analyzed. Variables of clinicopathological characteristics, major adverse events (mAEs), and follow up were collected and analyzed. RESULTS Submucosal tunneling endoscopic resection was performed in 54 patients (48 male and 6 female patients) with 120 SMTs. Forty-four patients had two tumors, eight patients had three tumors, and two patients had four tumors. The median size of each patient was 1.8 cm (range 0.7 to 3.5 cm). Forty-five patients had tumors removed by one tunnel, and nine patients by two tunnels. The median procedure time was 50 min (range 14 to 120 min), and the mAE rate was 16.7% (9/54). No significant differences were found between patients with two tumors and those with > 2 tumors in terms of tunnel length, hospital stay, procedure time, and mAEs (all P > 0.05). In addition, patients with two tunnels had procedure time, hospital stay, and mAE rates comparable with those with one tunnel (all P > 0.05). No local recurrence or distant metastasis occurred during a median follow up of 64 months. CONCLUSIONS Submucosal tunneling endoscopic resection is a safe and effective technique for the resection of multiple upper gastrointestinal SMTs.

In view of the rare occurrence, the small spectrum of clinical manifestations and the non-specificity of changes in instrumental and laboratory data, the diagnosis of ganglioneuroma at the moment is a very difficult task for the routine of a doctor. Ganglioneuromas have a slow growth, which leads to a long asymptomatic course and, as a result, complicates its early diagnosis. In most cases, ganglioneuroma is random. Complaints in these patients are non-specific and are directly dependent on localization.One of the available methods for imaging retroperitoneal tumors is ultrasound (ultrasound)., which makes preventive and regular ultrasound an indispensable method for early detection of extraorgan formations. This article describes the clinical case of ganglioneroma in a young man with the pathology of the upper gastrointestinal tract.

Objective In an effort to reduce mortality from gastric cancer, endoscopic screening was introduced in 2016 as a nationwide screening program in Japan. Recent developments in high-definition endoscopic imaging and diagnostic strategies have enabled the simultaneous detection of other upper gastrointestinal (U-GI) malignancies. Therefore, we conducted a study to evaluate the feasibility of endoscopic screening for U-GI malignancy in a comprehensive health checkup. Methods We retrospectively reviewed the data of 13,120 participants who had received a comprehensive health checkup in a single institution between April 2012 and March 2018. Participants were divided into two groups [gastrointestinal endoscopy (GIE) group (n=9,142) and gastrointestinal X-ray (X-ray) group (n=3,978)] and compared with regards to the screening results, adverse events, and detection rate of U-GI malignancies (gastric cancer or other) using a propensity-score matched analysis. Results The gastric cancer detection rate was significantly higher in the GIE group [34/9,142 (0.48%)] than in the X-ray group [3/3,978 (0.08%)] (p=0.003). Other U-GI malignancies were found only in the GIE group and comprised two hypopharyngeal cancers, five esophageal cancers, two duodenal cancers, and one duodenal gastrointestinal stromal tumor. Adverse events occurred in 6/9,142 (0.07%) participants in the GIE group and 18/3,978 (0.45%) participants in the X-ray group (p

We sought to construct and validate a model of cancer surgeon approaches to patient-centered decision-making (PCDM) and compare applications of that model relative to surgical specialties. Ten PCDM strategies were assessed using a cross-sectional survey administered online to 295 board-certified cancer surgeons. Structural equation modeling was used to empirically validate and compare approaches to PCDM. Within the full sample, 7 strategies comprised a latent construct labeled, “physical & emotional accessibility,” associated with surgeon approaches to PCDM (β = 0.37, p

Background and Aims Esophagogastroduodenoscopy (EGD) observation time is associated with detection rate of premalignant or neoplastic lesions in the upper gastrointestinal (UGI) tract. The aim of this study was to evaluate of an institutional policy of EGD observation time on the detection rate of UGI neoplasms. Methods From July 2017 to March 2019, all endoscopists were requested to adhere to our institutional policy of spending more than 3 minutes of observation time in every screening EGD. Observation time was defined as the time from when the endoscope reached the duodenum to when it was withdrawn. We obtained neoplasm detection rate (NDR) during this period, which was compared with that of baseline period from 2009 to 2015. Results During the study period, 30,506 EGDs were performed. The age of subjects was 49.9 ± 10.5 years, and 56.5% were male. All endoscopists achieved the average EGD observation time more than 3 minutes during this period. Mean observation time was 3:35 ± 0:50, which was significantly longer than that of baseline (2:38 ± 0:21, P Conclusions This study provides evidence that implementing a protocol of a prolonged observation time could increase NDR. Observation time should be an important quality indicator of EGD examination.

Hemobilia, or hemorrhage within the biliary system, is an uncommon form of upper gastrointestinal (GI) bleeding that presents unique diagnostic and therapeutic challenges. Most cases are the result of iatrogenic trauma, although accidental trauma and a variety of inflammatory, infectious, and neoplastic processes have also been implicated. Timely diagnosis can often be difficult, as the classic triad of upper GI hemorrhage, biliary colic, and jaundice is present in a minority of cases, and there may be considerable delay in the onset of bleeding after the initial injury. Therefore, the radiologist must maintain a high index of suspicion for this condition and be attuned to its imaging characteristics across a variety of modalities. CT is the first-line diagnostic modality in evaluation of hemobilia, while catheter angiography and endoscopy play vital and complementary roles in both diagnosis and treatment. The authors review the clinical manifestations and multimodality imaging features of hemobilia, describe the wide variety of underlying causes, and highlight key management considerations.©RSNA, 2021.