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Real-time prediction of histologic features of small colorectal polyps may prevent resection or pathologic evaluation and therefore decrease colonoscopy costs. This prospective, single-group study at 6 U.S. sites assessed the diagnostic performance of histologic predictions by general endoscopists before and after assistance from computer-aided diagnosis in a real-life setting. Visual Abstract. Artificial Intelligence for Real-Time Prediction of the Histology of Colorectal Polyps by General Endoscopists: Real-time prediction of histologic features of small colorectal polyps may prevent resection or pathologic evaluation and therefore decrease colonoscopy costs. This prospective, single-group study at 6 U.S. sites assessed the diagnostic performance of histologic predictions by general endoscopists before and after assistance from computer-aided diagnosis in a real-life setting. Background: Real-time prediction of histologic features of small colorectal polyps may prevent resection and/or pathologic evaluation and therefore decrease colonoscopy costs. Previous studies showed that computer-aided diagnosis (CADx) was highly accurate, though it did not outperform expert endoscopists. Objective: To assess the diagnostic performance of histologic predictions by general endoscopists before and after assistance from CADx in a real-life setting. Design: Prospective, multicenter, single-group study. (ClinicalTrials.gov: NCT04437615) Setting: 6 centers across the United States. Participants: 1252 consecutive patients undergoing colonoscopy and 49 general endoscopists with variable experience in real-time prediction of polyp histologic features. Intervention: Real-time use of CADx during routine colonoscopy. Measurements: The primary end points were the sensitivity and specificity of CADx-unassisted and CADx-assisted histologic predictions for adenomas measuring 5 mm or less. For clinical purposes, additional estimates according to location and confidence level were provided. Results: The CADx device made a diagnosis for 2695 polyps measuring 5 mm or less (96%) in 1252 patients. There was no difference in sensitivity between the unassisted and assisted groups (90.7% vs. 90.8%; P = 0.52). Specificity was higher in the CADx-assisted group (59.5% vs. 64.7%; P < 0.001). Among all 2695 polyps measuring 5 mm or less, 88.2% and 86.1% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be resected and discarded without pathologic evaluation. Among 743 rectosigmoid polyps measuring 5 mm or less, 49.5% and 47.9% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be left in situ without resection. Limitation: Decision making based on CADx might differ outside a clinical trial. Conclusion: CADx assistance did not result in increased sensitivity of optical diagnosis. Despite a slight increase, the specificity of CADx-assisted diagnosis remained suboptimal. Primary Funding Source: Olympus America Corporation served as the clinical study sponsor. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Quality metrics for inpatient cirrhosis management have been created to improve processes of care. We aimed to improve adherence to quality metrics by creating a novel clinical decision support (CDS) tool in the electronic health record (EHR). METHODS: We developed and piloted an alert system in the EHR that directs providers to a cirrhosis order set for patients who have a known diagnosis of cirrhosis or are likely to have cirrhosis. Adherence to process measures and outcomes when the CDS was used were compared with baseline performance before the implementation of the CDS. RESULTS: The use of the order set resulted in a significant increase in adherence to process measures such as diagnostic paracentesis (29.6%–51.1%), low-sodium diet (34.3%–77.8%), and social work involvement (36.6%–88.9%) (P < 0.001 for all). There were also significant decreases in both intensive care and hospital lengths of stay (P < 0.001) as well as in-hospital development of infection (P = 0.002). There was no difference in hospital readmissions at 30 or 90 days between the groups (P = 0.897, P = 0.640). DISCUSSION: The use of CDS in EHR-based interventions improves adherence to quality metrics for patients with cirrhosis and could easily be shared by institutions through EHR platforms. Further studies and larger sample sizes are needed to better understand its impact on additional outcome measures. [ABSTRACT FROM AUTHOR]

Background: Blue light imaging (BLI) has been shown to improve the characterization of colorectal polyps among the endoscopy experts. We aimed to determine if this technology could be taught to endoscopy trainees while maintaining high accuracy and interobserver agreement. Methods: Twenty‐one gastroenterology trainees (fellows) from two academic institutions participated in this prospective study. Each trainee completed a web‐based learning comprising four modules: pre‐test, didactic videos explaining the BLI Adenoma Serrated International Classification (BASIC), interactive examples, and post‐test assessment. The pre‐ and post‐test modules consisted of reviewing video images of colon polyps in high definition white light imaging and BLI and then applying the BASIC classification to determine if the polyps were likely to be adenomatous. Confidence in adenoma identification (rated '1' to '5'), accuracy in polyp (adenoma vs. non‐adenoma) identification, and agreement in characterization per BASIC criteria were derived. Results: Trainee accuracy in the adenoma diagnosis improved from 74.7% (pre‐test) to 85.4% (post‐test) (P < 0.01). There was a trend towards higher accuracy in polyp characterization with subsequent years of training (1st year fellows 77.4%, 2nd year 88.5%, and final year 94.0%) with consistent improvements after the e‐learning across years of trainees. Overall, trainees were able to identify adenoma with a high sensitivity of 86.9%, specificity 83.9%, positive predictive value of 84.4%, and negative predictive value of 86.5%. However, their interobserver agreement in adenoma diagnosis was moderate (k = 0.52). Conclusion: The novel BLI classification can be easily taught to gastroenterology trainees using an online module and accuracy improves with years of training reaching >90% for colorectal polyp characterization. [ABSTRACT FROM AUTHOR]

Acetaminophen (APAP) overdose is the most common cause of acute liver failure (ALF) in the United States. Liver transplantation (LT) is potentially lifesaving for patients with ALF, but its feasibility in clinical practice is limited. Liver assist devices, such as the Molecular Adsorbent Recirculating System (MARS), are used in some centers as a "bridge" to liver transplantation or as a means of liver recovery, but their role in the treatment of ALF is not well-defined. We present the case of a 44-year-old man with APAP-associated ALF who experienced hepatic recovery after treatment with MARS., (© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)