Application of artificial intelligence based on data enhancement and hybrid neural network to site identification during esophagogastroduodenoscopy / 中华消化内镜杂志

Objective:To evaluate artificial intelligence constructed by deep convolutional neural network (DCNN) for the site identification in upper gastrointestinal endoscopy.Methods:A total of 21 310 images of esophagogastroduodenoscopy from the Cancer Hospital of Chinese Academy of Medical Sciences from January 2019 to June 2021 were collected. A total of 19 191 images of them were used to construct site identification model, and the remaining 2 119 images were used for verification. The performance differences of two models constructed by DCCN in the identification of 30 sites of the upper digestive tract were compared. One model was the traditional ResNetV2 model constructed by Inception-ResNetV2 (ResNetV2), the other was a hybrid neural network RESENet model constructed by Inception-ResNetV2 and Squeeze-Excitation Networks (RESENet). The main indices were the accuracy, the sensitivity, the specificity, positive predictive value (PPV) and negative predictive value (NPV).Results:The accuracy, the sensitivity, the specificity, PPV and NPV of ResNetV2 model in the identification of 30 sites of the upper digestive tract were 94.62%-99.10%, 30.61%-100.00%, 96.07%-99.56%, 42.26%-86.44% and 97.13%-99.75%, respectively. The corresponding values of RESENet model were 98.08%-99.95%, 92.86%-100.00%, 98.51%-100.00%, 74.51%-100.00% and 98.85%-100.00%, respectively. The mean accuracy, mean sensitivity, mean specificity, mean PPV and mean NPV of ResNetV2 model were 97.60%, 75.58%, 98.75%, 63.44% and 98.76%, respectively. The corresponding values of RESENet model were 99.34% ( P<0.001), 99.57% ( P<0.001), 99.66% ( P<0.001), 90.20% ( P<0.001) and 99.66% ( P<0.001). Conclusion:Compared with the traditional ResNetV2 model, the artificial intelligence-assisted site identification model constructed by RESENNet, a hybrid neural network, shows significantly improved performance. This model can be used to monitor the integrity of the esophagogastroduodenoscopic procedures and is expected to become an important assistant for standardizing and improving quality of the procedures, as well as an significant tool for quality control of esophagogastroduodenoscopy.

A case of significant weight loss and severe malnutrition caused by achalasia

Achalasia is caused by chronic degeneration of ganglionic cells in the myenteric plexus that leads to failure of relaxation of the lower esophageal sphincter (LES). This leads to aperistalsis of the digital esophagus and eventually led to dilation of the lower esophagus. We present the case of a 37-year-old man who initially presented with dysphagia for solid food and then slowly developed dysphagia for liquid over the past 6 months. He had significant weight loss, and his esophagogastroduodenoscopy (EGD) showed esophagitis and gastritis. The imaging of computed tomography (CT) with oral contrast showed dilation of the distal esophagus and mild circumferential thickening at the gastroesophageal junction. After the failure of response to BoTox-infiltration in the LES, the patient was taken for Heller抯 myotomy. He showed immediate improvement in dysphagia after surgical intervention. This case study includes findings from CT scan, X-ray, and EGD with biopsies in this patient. This paper also summarizes the therapeutic options of BoTox-injection and surgical myotomy.

The rate of endoscopic observation of the major duodenal papilla can be increased by simple guideline

Background:Ampullary lesions are being detected with increased frequency with the growing use of esophagogastroduodenoscopy. However, it is uncertain how frequently endoscopists properly visualize the major papilla in routine clinical practice. This study was undertaken to determine the actual rate of observing the major papilla by endoscopists and if there is a room for improvement in visualizing the duodenal major papilla when performing esophagogastroduodenoscopy.Methods:This was a single-center, prospective, randomized study involving 3,088 consecutive patients referred for diagnostic esophagogastroduodenoscopy at tertiary-care referral center between September and November 2010. Six fellows-in-training in the study group attempted to visualize the major papillaup to three times, while six fellows-in-training in the control group performed endoscopy in a standard fashion.Results:The overall observation rate was significantly higher in study group (975 of 1070 [91.1%]) than in control group (624 of 1022 [61%], p<0.001). 揅omplete observation� was achieved in 68.2% of the cases in study group compared to 45.0% of the cases in control group (p<0.001). The total procedure time was slightly, but significantly longer in the study group (5.82�38 min versus5.52�11 min, p=0.003).Conclusions:The rate of observing the major papilla for endoscopists is not as high as expected in routine clinical practice; however, the rate of observing the major papilla might improve significantly through application of additional effort with but a modest increase in procedural time.

A Prospective Study to Improve the Yield of Esophagogastroduodenoscopy at a Tertiary Hospital in India

Background: Esophagogastroduodenoscopy (EGD)is an efficient tool for diagnosis, screening and therapy. However, it must be used efficiently, to maximize value for costs and reduce complications. Many centers have adopted an open-access referral policy, resulting in increased costs, waiting times and clinical workload. When EGD is used for screening of common symptoms like dyspepsia by medical and paramedical personnel, the yield is less than 50%.We planned a study to differentiate disease from non-diseased findings and improve the diagnostic yield of EGD. Methods: The clinical history and examination of 150 patients of a tertiary care hospital in north India over 2 years wasrecorded. EGD when indicated by any clinician or desired by a patient was performed by a consultant, using topical anaesthesia.The outcome of the endoscopy was categorized as positive, if there was significant finding. Less severe and equivocal findings such as gastritis, duodenitis were not considered positive for the purpose of this study. Logistic regression (forward LR score) was used; the coefficient of regressionwas used to assign a score for each symptom. Results: Pain was the most common symptom; in 110 patients (77.3%) the endoscopy showed no significant findings. Significant findings were seen in 34 patients giving a diagnostic yield of 22.7%. Clinical features like weight loss, hematemesis, melena, dysphagia, anemia, abdominal distention, ascites, and abdominal lump significantly discriminated and pointed towards a positive endoscopic finding. Pain was not a good discriminating factor; dysphagia, presence of ascites and the presence of abdominal lump independently predict significant endoscopic findings. At a total score of 4 or less endoscopy could be avoided in 75 (50%) of the patients. A score of 5 yielded a sensitivity of 82% and specificity of 71%. For picking up a positive finding. All 11 patients with malignancy had a score >5. Conclusions: Our findings suggest selection of patients for EGD can be improved based on a scoring system. It also provides a basis for prospective studies which can lead to better use of resources in future.

Cohortes de premedicación en endoscopia alta con simeticona, N-acetilcisteína, Hedera helix y validación de la escala visual / Cohorts of premedication for endoscopy of the upper gastrointestinal tract with simethicone, N-acetylcysteine, Hedera helix and visual scale validation

Resumen Los parámetros de calidad para endoscopia digestiva alta han introducido indicadores intraprocedimiento, dentro de los cuales la adecuada visibilidad de la mucosa, libre de saliva, moco o burbujas, puede aumentar la posibilidad de detección de lesiones en fase temprana. Sin embargo, el uso de mucolíticos y antiburbujas ha mostrado gran variabilidad de eficiencia según las soluciones, concentraciones, tiempos de exposición y escala de visibilidad aplicados. Objetivos: determinar la efectividad de diferentes soluciones de premedicación para la limpieza de la mucosa digestiva; validar, mediante una prueba de concordancia interobservador, una nueva escala de adecuada visualización de la mucosa (TVMS) para el esófago, estómago y duodeno; y reportar eventos adversos o complicaciones relacionadas con las soluciones utilizadas y los procedimientos realizados. Material y métodos: estudio de cohortes prospectivas comparativas. Se incluyeron 412 pacientes adultos, ASA I y ASA II, para endoscopia diagnóstica bajo sedación consciente, distribuidos en 6 cohortes similares, divididas en dos grupos: no premedicación, 2 cohortes C1 (ayuno de 6 a 8 horas)y C2 (agua 100 mL); premedicación, 4 cohortes C3 a C6 (C3: agua 100 m L + simeticona 1000 mg; C4: agua 100 mL + simeticona 200 mg + N-acetilcisteína 600 mg; C5: agua 100 mL + simeticona 200 mg + N-acetilcisteína 1000 mg; C6: agua 100 mL + simeticona 200 mg + Hedera helix 70 mg). Se ingirió la solución 15 a 30 minutos antes del paso por cricofaríngeo. Se realizó la prueba de Kappa para medir la concordancia interobservador de la escala TVMS. Resultados: De 412 pacientes, 58% fueron de sexo femenino; 23% (136) fue de cohortes C1 y C2 y 67% (276) fue de cohortes C3 a C6. El tiempo medio de exposición a cada solución fue de 24,4 minutos. El volumen de lavado para lograr una adecuada visualización fue significativamente diferente entre ambos grupos: en los pacientes con premedicación se utilizaron 75,6 mL, mientras que en los pacientes sin premedicación se utilizaron 124 mL (p = 0,000), con una calidad de TVMS excelente de 88,7% frente al 41,4%, respectivamente. La cohorte C4 (agua 100 mL + simeticona 200 mg + N-acetilcisteína 600 mg) mostró ser la más efectiva con una diferencia significativa (p = 0,001) frente a C1 (ayuno) y C2 (placebo con agua 100 mL), y también tuvo una eficiencia superior frente a C3, C5 y C6 en su orden. No se presentaron eventos adversos o complicaciones en relación con la endoscopia, la sedación y los productos usados en la premedicación. Conclusiones: la solución más efectiva como premedicación para lograr una excelente visibilidad de la mucosa digestiva correspondió a la cohorte C4 (SIM 200 + NAC 600 + H2O 100 mL). La escala TVMS propuesta es una herramienta muy completa y fácil de aplicar por más de un observador. La premedicación ingerida, con antiburbuja, mucolítico y agua hasta 100 mL, entre 15 y 30 minutos previos a endoscopia, es segura en las condiciones descritas en este estudio.

Abstract Quality parameters for upper gastrointestinal endoscopy have introduced intraprocedural indicators, including adequate mucosal visualization free of saliva, mucus, or bubbles, which may increase the possibility of early-stage injury detection. The use of mucolytics and anti-foaming agents has shown great efficiency variability depending on the type of solution, concentrations, exposure times and visibility scale applied. Objectives: To determine the effectiveness of different premedication solutions for cleaning the digestive mucosa; to validate, by means of an interobserver concordance test, a new scale for the adequate visualization of the mucosa (TVMS) for the esophagus, stomach, and duodenum; and to report adverse events or complications associated with the solutions used and the procedures performed. Material and methods: Prospective, comparative cohort study. 412 adult patients, ASA I and ASA II, were included for diagnostic endoscopy under conscious sedation. They were distributed in 6 similar cohorts and divided into two groups: non-premedication, 2 in C1 (fasting 6 to 8 hours) and C2 (water 100 mL) cohorts; premedication, 4 C3 to C6 cohorts (C3: water 100 mL + simethicone 1000 mg; C4: water 100 ml + simethicone 200 mg + N-acetylcysteine 600 mg; C5: water 100 ml + simethicone 200 mg + N-acetylcysteine 1000 mg; C6: water 100 ml + simethicone 200 mg + Hedera helix 70 mg). The solution was swallowed 15 to 30 minutes passing through the cricopharyngeus muscle. The Kappa test was performed to measure interobserver concordance of the TVMS scale. Results: Of 412 patients, 58% were female; 23% (136) were included in the C1 and C2 cohorts; and 67% (276) were in the C3 to C6 cohorts. The average exposure time to each solution was 24.4 minutes. The wash volume for proper visualization was significantly different between the two groups. In premedicated patients, 75.6 mL of solution were used, while in patients without premedication, 124 mL were used (p = 0.000), with an excellent quality of TVMS of 88.7% versus 41.4%, respectively. The C4 cohort (water 100 mL + simethicone 200 mg + N-acetylcysteine 600 mg) was the most effective with a significant difference (p= 0.001) compared with the C1 (fasting) and C2 (placebo with water 100 mL) cohorts. It also had better efficiency compared to the C3, C5 and C6 cohorts in that order. There were no adverse events or complications associated with endoscopy, sedation, or premedication products. Conclusions: The most effective solution as a premedication to achieve excellent visibility of the digestive mucosa was that used in the C4 cohort (SIM 200 + NAC 600 + H2OR 100 mL). The proposed TVMS scale is a very complete and easy tool to apply by more than one observer. Premedication ingested, with anti-foam, mucolytic and water up to 100 mL, between 15 and 30 minutes before endoscopy, is safe under the conditions described in this study.

Endoscopic Study of Dyspepsia with Special Reference to Helicobacter pylori

Introduction: In our day to day practice we encountermany patients who present with dyspepsia. Approximately50% of world’s population is estimated to be infected withHelicobacter pylori. The prevalence of this bacterium ishigher in developing countries when compared to developedcountries. The aim of this study was to look at the uppergastrointestinal (GI) tract endoscopic findings in patientspresenting with dyspepsia and the presence of H.pyloriinfection in those patients.Material and methods: It was a prospective study involving107 patients over a period of 10 months visiting the outpatientdepartment of Assam Medical College and Hospital fordyspepsia and meeting the inclusion criteria. Patientsunderwent upper GI endoscopy and tissue sampling fordetection of urease enzyme production by H.pylori.Results: 74 males and 33 females participated in the studywith mean age of 39.6 years (SD ± 12.10). 74% of studypopulation tested positive for H.pylori infection by detectionof urease enzyme produced by H.pylori. 77.5% of the studypopulation had ulcer in stomach or duodenum as detected byupper GI endoscopy.Conclusion: This study shows that H.pylori infection isdetected in a significant number of patients presenting withdyspepsia with no other specific risk factors for acid pepticdisease (eg: alcohol, smoking, usage of NSAID).

A case of formic acid poisoning: prompting for a different line of management

Formic acid is an easily available substance and can thus be consumed voluntarily or accidentally. Here is a case who presented to our center 5 days post accidental ingestion of formic acid. He had developed acute renal failure requiring hemodialysis. Post admission he had altered sensorium probably alcohol withdrawal and later aspiration pneumonia and ARDS. He developed a late onset GI bleed on day 8 of ingestion with significant hemoglobin drop. An emergency endoscopy was done which showed a normal esophagus but extensive corrosive damage and active bleeding from gastric area. He continued to have drop in hemoglobin in-spite of aggressive volume and blood product transfusions. He was taken up for an emergency subtotal gastrectomy and viable tissue was demarcated with intraoperative endoscopy and a subtotal gastrectomy was performed. He stabilized initially but worsened again 2 days later with worsening lactic acidosis and succumbed to his illness. The fact that esophagus was completely spared with extensive involvement of stomach could possibly indicate a need for review of initial management of corrosive/organic acid poisoning.

Endoscopic findings in uninvestigated dyspepsia patients

Background: Dyspepsia is a frequent syndrome in our country where there are limitations for endoscopy and there is high burden of H. pylori infection. It is important to establish the causes of dyspepsia hence therapeutic approach will be easier. Aim of the study was to find out the common endoscopic findings in a patient with dyspepsia symptoms large tertiary care hospital.Methods: A cross-sectional study was conducted on 184 patients either admitted or seen on outpatient basis at the Basaveswara medical college and research institute, Chitradurga with the upper GI symptom dyspepsia and the data was analysed using appropriate statistical methods.Results: Out of 184 patients who underwent Esophagogastroduodenoscopy (EGD scopy) 62% were male and 61% were 31-59year old. The common pathological findings in dyspeptic patients were gastritis and esophagitis.Conclusions: The following insights/observations were made during the course of this study? dyspepsia is usually caused by H. pylori gastritis, eradication of which relieves the symptom in this observation. Many a times dyspepsia found to have normal study. Hence wise referral for endoscopy is a key in resource limited setup.

Swallowed Oro-esophageal Tube: A Case Report / 대한연하장애학회지

Tube feeding is used to provide nutritional support to patients who have difficulty taking food orally. A nasogastric tube is commonly used for these patients but there are some complications. Therefore, the oro-esophageal tube feeding method was developed to avoid these disadvantages. A 33-year-old male with a history of right basal ganglia intracranial hemorrhage was admitted to the rehabilitation department for the treatment of dysphagia caused by a new onset left basal ganglia intracranial hemorrhage. After the videofluoroscopic swallowing study, the nasogastric tube feeding was changed to intermittent feeding via an oro-esophageal tube. Unfortunately, the patient swallowed the tube during insertion. Hence, an emergent endoscopy was performed for tube removal. This article reports a rare case of a patient who underwent oro-esophageal tube removal with an esophagogastroduodenoscopy after tube swallowing during insertion. The insertion of an oro-esophageal tube requires a careful approach after considering the cognitive function, muscle strength, and family education.

Iatrogenic atrio-esophageal fistula following a video-assisted thoracoscopic maze procedure: Is esophageal instrumentation justified even when the diagnosis is equivocal?

A 74-year-old female underwent an uneventful bilateral thoracoscopic maze procedure for persistent atrial fibrillation with continuous transesophageal echocardiographic (TEE) guidance. She presented six weeks later with persistent fever and focal neurological signs. Computed tomography of the thorax revealed air in the posterior LA, raising suspicion for an abscess versus an atrioesophageal fistula (AEF). Before undergoing an exploratory median sternotomy, an esophagogastroduodenoscopy (EGD) was performed by the surgeon to check for any esophageal pathology. This however, resulted in sudden hemodynamic compromise that required intensive treatment with vasopressors and inotropes. In this case-report, we review the various intraoperative risk factors associated with the development of AEF during cardiac ablation procedures as well as the potential hazards of esophageal instrumentation with TEE, naso- or oro- gastric devices, and/or an EGD when an AEF is suspected.

Upper gastrointestinal endoscopy applied in pediatrics: endoscopic and histological findings, including Helicobacter pylori / Endoscopia digestiva alta aplicada em pediatria: hallazgos endoscópicos e histológicos incluyendo al Helicobacter pylory

Objective: To present and discuss the endoscopic and histological results, as well as the incidence of Helicobacter pylori and other diseases, indications and characteristics of upper digestive endoscopies performed in children. Material and methods: Twenty-five endoscopies were performed in children aged six months to 11 years (mean 7.69 years), from February 2013 to January 2016. In 200 patients, endoscopies were diagnostic and serial biopsies were performed (esophagus, stomach and duodenum), in 120 of them. Results: The indication of endoscopy was diagnosed in 88.89% of the patients, and in 26 patients, a therapeutic procedure was performed. The most frequent endoscopic findings were esophagitis in 49 patients, gastritis in 84 and duodenitis in 16 patients. Four duodenal ulcers were diagnosed. In the therapeutic endoscopies, six gastrostomies were performed, 14 foreign body withdrawals, five nasoenteral tube passages and esophageal dilatation. The H. pylori survey was performed by anatomopathological method and was positive in 26 (13%) of the 200 patients in whom it was searched. Conclusion: pediatric endoscopy is an important niche of the digestive endoscopy, where it is important to emphasize the relevance of the institutional structure that performs these procedures, in order to conduct them safely, being able to treat possible and feasible complications

Objetivo: Presentar y discutir los hallazgos endoscópicos e histológicos, así como la incidencia de Helicobacter pylori y otras enfermedades, indicaciones y características de endoscopia digestiva alta realizada en niños. Material y métodos: Fueron realizadas 225 endoscopias en niños de seis meses a 11 años (media de 7,69 años) a partir de febrero de 2013 hasta enero de 2016. En 200 pacientes, en las endoscopias diagnósticas se llevan a cabo biopsias seriadas (esófago, estómago y duodeno) en 120 de ellos. Resultados: La indicación de endoscopia fue diagnóstica en el 88,89% de los pacientes y en 26 pacientes se realizaron un procedimiento terapéutico. Los hallazgos endoscópicos más frecuentes fueron esofagitis en 49 pacientes, gastritis y duodenitis 84 y en 16 pacientes se diagnosticaron cuatro úlceras duodenales. En endoscopias terapéuticas fueron realizadas seis gastrostomías, catorce extracciones de cuerpos extraños, cinco pasajes de sonda nasogástrica y una dilatación esofágica. El estudio de H. pylori se realizó por el método histopatológico y fué positivo en 26 (13%) de 200 pacientes en los que se han buscado. Conclusión: La endoscopía pediátrica es un nicho importante de la endoscopía digestiva donde es importante enfatizar la relevancia de la estructura institucional que realiza estos procedimientos para conducirlos con seguridad y ser capaces de tratar las complicaciones posibles

Sedation in Pediatric Esophagogastroduodenoscopy

Pediatric esophagogastroduodenoscopy (EGD) has become an established diagnostic and therapeutic modality in pediatric gastroenterology. Effective sedation strategies have been adopted to improve patient tolerance during pediatric EGD. For children, safety is a fundamental consideration during this procedure as they are at a higher risk of severe adverse events from procedural sedation compared to adults. Therefore, a detailed risk evaluation is required prior to the procedure, and practitioners should be aware of the benefits and risks associated with sedation regimens during pediatric EGD. In addition, pediatric advanced life support by endoscopists or immediate intervention by anesthesiologists should be available in the event that severe adverse events occur during pediatric EGD.

Difference in F-18 FDG Uptake After Esophagogastroduodenoscopy and Colonoscopy in Healthy Sedated Subjects / 대한핵의학회잡지

PURPOSE: We aimed to evaluate the difference in fluorodeoxyglucose (FDG) uptake in sedated healthy subjects after they underwent esophagogastroduodenoscopy (EGD) and colonoscopy procedures.METHODS: The endoscopy group (n = 29) included healthy subjects who underwent screening via F-18 FDG positron emission tomography/computed tomography (PET/CT) after an EGD and/or colonoscopy under sedation on the same day. The control group (n = 35) included healthy subjects who underwent screening via PET/CT only. FDG uptake in the tongue, uvula, epiglottis, vocal cords, esophagus, stomach, duodenum, liver, cecum, colon, anus, and muscle were compared between the two groups.RESULTS: Maximum standardized uptake value (SUVmax) in the tongue, pharynx, larynx, and esophagus did not significantly differ between the endoscopy and control groups. In contrast, mean SUVmax in the whole stomach was 18 % higher in the endoscopy group than in the control group (SUVmax: 2.96 vs. 2.51, P = 0.010). In the lower gastrointestinal track, SUVmax from the cecum to the rectum was not significantly different between the two groups, whereas SUVmax in the anus was 20% higher in the endoscopy group than in the control group (SUVmax: 4.21 vs. 3.50, P = 0.002). SUVmax in the liver and muscle was not significantly different between the two groups. Mean volume of the stomach and mean cross section of the colon was significantly higher in the endoscopy group than in the control group (stomach: 313.28 cm³ vs. 209.93 cm³, P < 0.001, colon: 8.82 cm² vs. 5.98 cm², P = 0.001).CONCLUSIONS: EGD and colonoscopy under sedation does not lead to significant differences in SUVmax in most parts of the body. Only gastric FDG uptake in the EGD subjects and anal FDG uptake in the colonoscopy subjects was higher than uptake in those regions in the control subjects.

Investigation of Efficacy of Lidocaine Spray for Sedated Esophagogastroduodenoscopy in Children / 대한소아소화기영양학회지

PURPOSE: Our aim in this study is to investigate efficacy of topical lidocaine spray for sedated esophagogastroduodenoscopy (EGD) in children. METHODS: The endoscopy of children aged between 3-18 years who underwent EGD in our endoscopy unit. Intravenous (IV) midazolam and ketamine were used for sedation. Prior to sedation, endoscopy nurse applied topical lidocaine 10% with pump spray at 1 mg/kg dose in group 1, and distilled water via identically scaled pump spray in group 2, in a double blinded fashion. RESULTS: Sedation was not applied in 24.1% of the cases in topical lidocaine spray group (LS group) and in 5.7% of the cases in distilled water spray group (DS group). Gag reflex was observed in 6.5% of cases in LS group and 33.3% of cases in DS group (p=0.024), increased oral secretion was observed in 9.3% of cases in LS group and 51.7% of cases in DS group (p=0.038), sore throat was observed in 3.7% of cases in LS group and 35.6% of cases in DS group (p=0.019) and the difference was statistically significant. CONCLUSION: The study showed that topical pharyngeal lidocaine reduces both requirement and amount of IV sedation before EGD in children and sore throat, gag reflex and decreased oral secretion increase.

Is a Preoperative Gastrointestinal Endoscopy for Second Primary Cancer Detection in Head and Neck Cancer Necessary? Ten-year Registry Data / 대한소화기학회지

BACKGROUND/AIMS: In head and neck squamous cell carcinoma, second primary gastrointestinal tumors are not uncommon. However, it is unclear whether a screening endoscopy is needed for detecting gastrointestinal neoplasm in patients with head and neck cancer. Therefore, we analyzed the prevalence and independent risk factors for second primary gastrointestinal neoplasm in head and neck squamous cell carcinoma. METHODS: A consecutive series of 328 patients with primary head and neck squamous cell carcinoma that underwent esophagogastroduodenoscopy or colonoscopy were included using our registry. An age- and sex-matched group of 328 control subjects was enrolled. We assessed risk factors of synchronous gastrointestinal cancer. RESULTS: The prevalence of esophageal cancer with head and neck squamous cell carcinoma was significantly higher than that of the control group (1.5% vs. 0.0%, p=0.011). An age of 54 years or more (OR, 1.033; 95% CI, 1.008-1.059; p=0.009) and male gender (OR, 4.974; 95% CI, 1.648-15.013; p=0.004) were risk factors for concomitant colorectal cancer or adenomas in the head and neck squamous cell carcinoma patients. CONCLUSIONS: Preoperative colonoscopy can be recommended for detecting synchronous second primary colorectal lesions in head and neck squamous cell carcinoma patients with male sex regardless of age, and esophagogastroduodenoscopy is necessary in all head and neck squamous cell carcinoma patients for detecting esophageal cancer.

Clinical Risk Factors for Upper Gastrointestinal Bleeding after Percutaneous Coronary Intervention: A Single-Center Study

BACKGROUND/AIMS: Percutaneous coronary intervention (PCI) is often performed therapeutically, and antithrombotic treatment is required for at least 12 months after stent implantation. However, the development of post-PCI upper gastrointestinal bleeding (UGIB) increases morbidity and mortality. We investigated the incidence and risk factors for UGIB in Korean patients within 1 year after PCI. METHODS: The medical records of 3,541 patients who had undergone PCI between January 2006 and June 2012 were retrospectively reviewed. We identified 40 cases of UGIB. We analyzed the incidence and clinical risk factors associated with UGIB occurring within 1 year after PCI by comparing the results for each case to matched controls. The propensity score matching method using age and sex was utilized. RESULTS: UGIB occurred in 40 patients (1.1%). Two independent risk factors for UGIB were a history of peptic ulcer disease (odds ratio [OR], 12.68; 95% confidence interval [CI], 2.70 to 59.66; p=0.001) and the use of anticoagulants (OR, 7.76; 95% CI, 2.10 to 28.66; p=0.002). CONCLUSIONS: UGIB after PCI occurred at a rate of 1.1% in the study population. Clinicians must remain vigilant for the possibility of UGIB after PCI and should consider performing timely endoscopy in patients who have undergone PCI and are suspected of having an UGIB.

Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy

BACKGROUND/AIMS: This study was performed to investigate the clinical role of urgent esophagogastroduodenoscopy (EGD) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) performed by experienced endoscopists after hours. METHODS: A retrospective analysis was performed for consecutively collected data of patients with ANVUGIB between January 2009 and December 2010. RESULTS: A total of 158 patients visited the emergency unit for ANVUGIB after hours. Among them, 60 underwent urgent EGD (within 8 hours) and 98 underwent early EGD (8 to 24 hours) by experienced endoscopists. The frequencies of hemodynamic instability, fresh blood aspirate on the nasogastric tube, and high-risk endoscopic findings were significantly higher in the urgent EGD group. Primary hemostasis was achieved in all except two patients. There were nine cases of recurrent bleeding, and 30-day mortality occurred in three patients. There were no significant differences between the two groups in primary hemostasis, recurrent bleeding, and 30-day mortality. In a multiple linear regression analysis, urgent EGD significantly reduced the hospital stay compared with early EGD. In patients with a high clinical Rockall score (more than 3), urgent EGD tended to decrease the hospital stay, although this was not statistically significant (7.7 days vs. 12.0 days, p > 0.05). CONCLUSIONS: Urgent EGD after hours by experienced endoscopists had an excellent endoscopic success rate. However, clinical outcomes were not significantly different between the urgent and early EGD groups.

Does Sedation Affect Examination of Esophagogastric Junction during Upper Endoscopy?

PURPOSE: During sedated esophagogastroduodenoscopy (EGD), patients may not be able to perform inspiration, which is necessary to examine the esophagogastric junction. Therefore sedation may affect diagnosis of gastroesophageal reflux-related findings. The aim of our study was to investigate the effect of sedation on diagnosis of gastroesophageal reflux-related findings during EGD. MATERIALS AND METHODS: This retrospective study evaluated 28914 patients older than 20 years who underwent EGD at our institution between January 2011 and December 2011. Ultimately, 1546 patients indicated for EGD for health check-up and symptom evaluation were included. RESULTS: There were 18546 patients who had diagnostic EGD: 10471 patients (56%) by non-sedated EGD and 8075 patients (43%) by sedated EGD. After statistical adjustment for age, sex, and body mass index, minimal change esophagitis, and hiatal hernia were significantly less frequently observed in the sedated EGD group [odds ratio (OR), 0.651; 95% confidence interval (CI), 0.586 to 0.722 and OR, 0.699; 95% CI, 0.564 to 0.866]. Nevertheless, there was no significant difference in other findings at the gastroesophageal junction, such as reflux esophagitis with Los Angeles classification A, B, C, and D or Barrett's esophagus, between the two groups. Similarly, there were no differences in early gastric cancer, advanced gastric cancer, and gastric ulcer occurrence. CONCLUSION: Sedation can impede the detection of minimal change esophagitis and hiatal hernia, but does not influence detection of reflux esophagitis of definite severity and Barrett's esophagus.

Early Detection of Anterior Cervical Osteophytes Causing Dysphagia by Esophagogastroduodenoscopy

Anterior cervical osteophytes affecting the cervical spine are a rare cause of dysphagia. They may affect the patient's life by compressing the larynx. A 66-year-old male patient complained of dysphagia during swallowing that started five months earlier. During esophagogastroduodenoscopy, the endoscopist felt outside pressure and severe resistance, and a protruded lesion at the posterior wall of the hypopharynx was found. A cervical spine x-ray showed prominent anterior osteophytes at the C-spine 2-5 level. In addition, computed tomography showed esophageal luminal narrowing related to prominent anterior cervical osteophytes at the C-spine 3-4 level. Due to the absence of any effective medical therapy and rapid progression of dysphagia, surgery was recommended to relieve the symptoms. Clinical improvement occurred after surgical resection of the osteophytes through an anterior cervical approach. So we report here on a rare case of anterior cervical osteophytes with dysphagia with review of the relevant literature.

Early Postoperative Cognitive Dysfunction after Sedation for Esophagogastroduodenoscopy / 胃肠病学

Background:It is commonly recommended that patients should refrain from driving for 24 hours after sedation for endoscopy,however,this recommendation has been queried recently. Aims:To investigate the effect of sedation on early postoperative cognitive function in patients undergoing endoscopy. Methods:One hundred adult patients undergoing sedative esophagogastroduodenoscopy ( EGD ) were randomly recruited, and another 100 adult patients undergoing conventional EGD were served as controls. All patients had an education level more than 9 years. Cognitive function was assessed by number connection test-A( NCT-A),number cancellation test and digit symbol test( DST)before propofol sedation or the beginning of endoscopic procedure and was reassessed when the discharge criteria were met. If the results obtained were inferior to those before EGD,a third assessment was taken 30 minutes later until the results recovered or being superior to the baseline levels. Results:All patients completed the first and second assessment,and 124 patients had taken the third assessment. When the discharge criteria were met,result of number cancellation test was inferior to that before EGD in sedation group( P =0. 000 ). Furthermore,the results were analyzed by grouping with age,number cancellation test in young patients and NCT-A in elderly patients were inferior to that before EGD,respectively(P=0. 000 and P =0. 025 ). In control group,none of the results were inferior to those before EGD. The results of the third assessment recovered or being superior to the baseline levels. Conclusions:Early postoperative cognitive dysfunction at discharge is common in patients undergoing endoscopy using propofol sedation,but the impairment will recover by a prolonged staying calm before discharge. The optimal time for discharge and resuming driving remains to be further studied.