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Background:  The medical consortium is an intensive and disease-specific association that integrates tertiary public hospitals and medical examination centers in China. We aimed to evaluate the feasibility of the medical consortium for screening upper gastrointestinal (GI) cancers (MCSC) by magnetically controlled capsule gastroscopy (MCCG).Methods:  6627 asymptomatic subjects underwent MCCG as part of health check-ups in the MCSC between March and November 2018. Relevant clinical data were collected and analyzed.Results:  The MCSC detected 32 patients with upper GI cancer (0.48 %) confirmed by pathology. The detection rate of early gastric cancer was 16.67 % (4 /24). Gastric polyps, ulcers, and submucosal tumors were found in 15.54 %, 3.76 %, and 3.17 % of subjects, respectively. The whole GI preparation and operation process were well tolerated.Conclusions:  The MCSC was a feasible model for upper GI cancer screening, especially for asymptomatic subjects. Further prospective studies with better operational quality control are warranted. [ABSTRACT FROM AUTHOR]

Background and Study Aims: Ideal bowel preparation for colonoscopy requires complete removal of fluid and foam from the colon. Polyethylene glycol (PEG) is widely used for bowel preparation, with antifoaming agents such as simethicone commonly used in combination with PEG. Data on the effect of simethicone on the adenoma detection rate (ADR) were limited. This study therefore aimed to investigate whether preprocedure simethicone could increase the ADR.Patients and Methods: This was a prospective, multicenter, endoscopist-blinded randomized controlled trial involving consecutive patients who underwent colonoscopy in six centers in China. Patients were randomly assigned to one of two groups: PEG plus simethicone or PEG alone. The primary outcome was ADR; secondary outcomes were quality of bowel preparation, measured by the Boston bowel preparation scale (BBPS) and bubble scores.Results: 583 patients were included. More adenomas were detected in the PEG plus simethicone group than in the PEG alone group (ADR 21.0 % vs. 14.3 %, P = 0.04; advanced ADR 9.0 % vs. 7.0 %, P = 0.38). The mean number of adenomas detected was 2.20 ± 1.36 vs. 1.63 ± 0.89 (P = 0.02). Patients in the PEG plus simethicone group showed better bowel cleansing efficacy: BBPS ≥ 6 in 88.3 % vs. 75.2 % (P < 0.001) and bubble scores of 1.00 ± 1.26 vs. 3.98 ± 2.50 (P < 0.001). Abdominal bloating was reported less frequently in the PEG plus simethicone group (7.8 % vs. 19.7 %, P < 0.001) than in the PEG alone group.Conclusion: Combined use of PEG and simethicone is associated with a significantly increased ADR in a Chinese population. [ABSTRACT FROM AUTHOR]

Background and study aims Interval colorectal cancers detected after screening colonoscopy are more likely to be associated with missed lesions in the proximal colon. The aim of this study was to determine whether segmental re-examination of the proximal colon could increase the proximal adenoma detection rate (ADR) and to evaluate the time-effectiveness of this approach. Patients and methods Patients undergoing colonoscopy were recruited into the prospective randomized controlled study. They were randomly assigned to the segmental re-examination group, in which the proximal colon was examined twice segmentally, and a control group in which the withdrawal time was extended (EWT). Detection rates were calculated and compared for all polyps and adenomas in both the proximal colon and the whole colon. Withdrawal times were recorded and compared. Results A total of 360 patients were included in the study (re-examination 178 vs. EWT 182). The proximal ADR in the re-examination group was higher than that in the EWT group (33.1 % vs. 23.6 %; P = 0.045). More proximal adenomas were detected per patient in the re-examination group (0.54 vs. 0.36; P = 0.048). The ADR of the whole colon was similar in the two groups. Proximal withdrawal time was also similar (re-examination 4.29 ± 1.23 minutes vs. EWT 4.34 ± 1.36 minutes; P = 0.74). In addition, there was no statistically significant difference in the total duration of the colonoscopy between the two groups. Conclusions Segmental re-examination of the proximal colon increased the proximal ADR and the number of proximal adenomas detected, and was accomplished easily and safely without increasing the overall examination time.Trial Registration: ClinicalTrials.gov (NCT02581475). [ABSTRACT FROM AUTHOR]

Background: The diagnostic yield of current techniques for gastric subepithelial tumors (SETs) is suboptimal. This prospective study aimed to develop diagnostic criteria for needle-based confocal laser endomicroscopy (nCLE) of gastric SETs, and to evaluate the diagnostic efficacy, feasibility, and safety of endoscopic ultrasound-guided nCLE (EUS-nCLE).Methods: Eligible patients were prospectively recruited to undergo EUS-nCLE. Four unblinded investigators evaluated nCLE videos and corresponding histopathology to develop the nCLE criteria. The recorded nCLE videos were reviewed off-line by one endoscopist 3 months later. Image quality (five-point scale, 1 = poor and 5 = very good) and the interobserver agreements were assessed.Results: All 33 patients underwent successful EUS-nCLE procedures. The nCLE criteria for gastric SETs were established. Overall accuracy of off-line nCLE was significantly higher than that of EUS alone (87.9 % vs. 63.6 %; P = 0.02). The mean image quality score was 3.9. The kappa values of the interobserver agreements were 0.66 for gastrointestinal stromal tumor, 0.89 for ectopic pancreas, 0.58 for leiomyoma, and 0.72 for carcinoma.Conclusions: EUS-nCLE was feasible and safe to accurately diagnose gastric SETs. [ABSTRACT FROM AUTHOR]

Background and study aims Owing to the indistinctive endoscopic appearance of gastric intestinal metaplasia (GIM), gastric intraepithelial neoplasia (GIN), and early gastric cancer (EGC), a significant number of such lesions may be missed during surveillance endoscopy. The aim of this clinical trial was to assess the value of combined computed virtual chromoendoscopy (flexible spectral imaging color enhancement [FICE]) and probe-based confocal laser endomicroscopy (pCLE) for in vivo detection of GIM, GIN, and EGC. Patients and methods This was a multicenter, randomized controlled trial performed in 238 patients at four tertiary centers. Patients were randomized to FICE-guided pCLE with targeted biopsies (group A) or FICE with standard biopsies (group B). The diagnostic yield of GIM, GIN, or EGC was compared between the two groups. Results On a per-patient assessment, the diagnostic yield for GIM/GIN/EGC was 73.3 % (88/120) in group A and 63.6 % (75/118) in group B (P = 0.09). On a per-biopsy analysis, FICE-guided pCLE with targeted biopsies significantly increased the diagnostic yield of GIM/GIN/EGC vs. FICE with standard biopsies, from 31.5 % (252/800) to 75.1 % (313/417) (P < 0.001). In addition, pCLE-guided targeted biopsies led to a significant 48.5 % decrease in the number of biopsies per patient vs. FICE with standard biopsies (P < 0.001). Conclusions Real-time pCLE and targeted biopsies after FICE improved the diagnostic yield for the detection of GIM, GIN, and EGC, and only required about half the number of biopsies vs. FICE with standard biopsies. This may allow a better regimen for endoscopic surveillance and subsequent treatment of patients with premalignant and malignant gastric abnormalities.Trial registered at ClinicalTrials.gov (NCT02515721). [ABSTRACT FROM AUTHOR]

Background and study aims: Gastric intestinal metaplasia (GIM) is associated with a risk for development of intestinal-type gastric cancer. This study aimed to compare the diagnostic yield of GIM from confocal laser endomicroscopy (CLE) and white light endoscopy (WLE). Patients and methods: In a prospective, doubleblind, randomized study, patients were randomly assigned to receive either CLE with targeted biopsies (group A) or WLEwith a standard biopsy protocol (group B). Results: A total of 168 patients were finally analyzed (group A 85, group B 83). On a per-patient analysis, the diagnostic yields of GIM (including GIM with gastric intraepithelial neoplasia [GIN]) for groups A and B were 44.71% and 31.33%, respectively (P=0.074). On a per-biopsy analysis, CLE-targeted biopsy gave a significantly higher diagnostic yield of GIM compared with WLE and standard biopsy, at 65.70% (113/172 biopsies) versus 15.73% (81/515 biopsies) (P<0.001). Moreover, the diagnostic yield of the operative link on gastric intestinal metaplasia (OLGIM) assessment stages III and IV was higher at 20.93% (36/172 biopsies) in group A versus 4.08% (21 / 515 biopsies) in group B (P<0.001). In addition, use of CLE-guided biopsy significantly decreased by 68% (P<0.001) the mean number of biopsies required per patient. Conclusions: CLE with targeted biopsies is superior to WLE with standard biopsies for the detection and surveillance of GIM. The number of biopsies needed to confirm GIM is about one third of that needed with WLE with standard biopsies. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 28-year-old woman with chronic anemia symptoms, repeated bouts of incomplete small-intestine obstruction and circular ulcers in the small intestine, who was diagnosed with cryptogenic multifocal ulcerous stenosing enteritis using single-balloon enteroscopy.

The article presents a case study of a 50-year-old woman with a history of nonprogressive dysphagia, weight loss and aversion to greasy food was test using the virtual gastroscopy. The patient's physical examination shows a scar on her right thorax. It also outlines that computed tomography (CT)-based virtual gastroendoscopy as alternative approach for gastrointestianal tract examination.