Validation of a clinical scoring model and proposal of a classification system to guide endoscopic resection strategies for cardial submucosal tumors.

Background And Aims: A scoring model was proposed to support endoscopic decision-making for cardial submucosal tumors (SMTs). The aim of this study is to perform a multicenter validation of the clinical scoring model and to introduce a new clinical classification system for cardial SMTs.

Methods: A multicenter analysis of endoscopic decision-making for cardial submucosal tumors (SMTs) was conducted.

Expert-AI Collaborative Training for Novice Endoscopists: A Path to Enhanced Efficiency.

Background: Esophagogastroduodenoscopy (EGD) is essential for diagnosing upper gastrointestinal disorders. Traditional training for novice endoscopists is often inefficient and inconsistent. This study evaluates the effectiveness of an AI-assisted system (EndoAdd) in improving EGD training.

Association of Increased Epstein-Barr Virus Reactivation With Imbalanced Immunity and Myenteric Neuron Loss in Achalasia.

Background And Aim: Viral infection has been postulated as a potential etiology of achalasia, yet the definitive role of viral involvement remains elusive. This study aims to elucidate virus infections and to analyze their relationships with clinical characteristics, immunological alterations, and neuron loss.

Methods: We investigated viral infections in achalasia patients (n = 288) and controls (n = 71).

Scoring system supporting suture decision-making for duodenal submucosal tumors.

Background: In recent years, endoscopic resection (ER) has been employed for the excision of submucosal tumors (SMTs). Nonetheless, ER in the duodenum is linked to elevated risks of both immediate and delayed hemorrhagic complications and perforations. Satisfactory suturing is crucial for reducing the occurrence of complications.

An Automated Video Analysis System for Retrospective Assessment and Real-Time Monitoring of Endoscopic Procedures (with Video).

Background And Aims: Accurate recognition of endoscopic instruments facilitates quantitative evaluation and quality control of endoscopic procedures. However, no relevant research has been reported. In this study, we aimed to develop a computer-assisted system, EndoAdd, for automated endoscopic surgical video analysis based on our dataset of endoscopic instrument images.

A scoring system to predict the technical difficulty of endoscopic resection for cardial submucosal tumors.

Background And Aim: Endoscopic resection has been successfully used for the removal of digestive submucosal tumors (SMTs). However, the cardia has been considered a challenging location for endoscopic resection due to its narrow lumen and sharp angle. The objective of this study was to establish a clinical scoring model to grade the technical difficulty of endoscopic resection for cardial SMTs.

Endoscopic features and treatments of gastric cystica profunda.

Background: Gastric cystica profunda (GCP) represents a rare condition characterized by cystic dilation of gastric glands within the mucosal and/or submucosal layers. GCP is often linked to, or may progress into, early gastric cancer (EGC).

Aim: To provide a comprehensive evaluation of the endoscopic features of GCP while assessing the efficacy of endoscopic treatment, thereby offering guidance for diagnosis and treatment.

Endoscopic resection for calcifying fibrous tumors of the gastrointestinal tract.

Background: Calcifying fibrous tumors (CFTs) are rare mesenchymal lesions that can occur in various sites throughout the body, including the tubular gastrointestinal (GI) tract.

Aim: To analyze the clinical findings of 36 patients with GI tract CFTs to provide guidance for diagnosis and treatment.

Methods: This retrospective study included 36 patients diagnosed with CFTs of the GI tract.

YY1: a key regulator inhibits gastric cancer ferroptosis and mediating apatinib-resistance.

Objective: Gastric cancer (GC) stands as a prevalent and deadly global malignancy. Despite its role as a preoperative neoadjuvant therapy, Apatinib's effectiveness is curtailed among GC patients exhibiting elevated YY1 expression. YY1's connection to adverse prognosis, drug resistance, and GC metastasis is established, yet the precise underlying mechanisms remain elusive.

Risk factors for complications and incomplete resection after endoscopic resection for duodenal submucosal tumors.

Background And Aim: Endoscopic resection (ER) has been used to remove submucosal tumors (SMTs) in recent years; however, duodenal ER is associated with high rates of immediate or delayed bleeding and perforation. Whether ER can be recommended for the treatment of duodenal SMTs remains controversial. Therefore, we aimed to investigate the clinical outcomes associated with the ER of duodenal SMTs and to assess possible predictive factors for complications and incomplete resection.

The role of type II esophageal microbiota in achalasia: Activation of macrophages and degeneration of myenteric neurons.

Objective: The gut microbiota plays a critical role in the appropriate development and maintenance of the enteric nervous system (ENS). Esophageal achalasia (EA) is a rare motility disorder characterized by the selective degeneration of inhibitory neurons in the esophageal myenteric plexus. This study aimed to evaluate the composition of the esophageal microbiota in achalasia and explore the potential microbial mechanisms involved in its pathogenesis.

Landscape of Psychological Profiles in Patients With Esophageal Achalasia.

Introduction: Esophageal achalasia (EA) is a chronic esophageal dysmotility disease, of which psychological distress was poorly understood. This study aims to assess the status of psychosocial characteristics in EA and to determine the relationship between psychological distress and EA.

Methods: Seventy pairs of age and gender-matched patients with EA and healthy control individuals were prospectively enrolled from December 2019 to April 2020 at our hospital.

Muscular injury as an independent risk factor for esophageal stenosis after endoscopic submucosal dissection of esophageal squamous cell cancer.

Background And Aims: Stenosis after esophageal endoscopic submucosal dissection (ESD) has a high incidence, and muscular injury is an important risk factor for esophageal stenosis. Hence, this study aimed to classify muscular injury degrees and investigate their association with postoperative stenosis.

Methods: This retrospective study included 1033 patients with esophageal mucosal lesions treated with ESD between August 2015 and March 2021.

Improving bowel preparation for colonoscopy with a smartphone application driven by artificial intelligence.

Optimal bowel preparation is a prerequisite for a successful colonoscopy; however, the rate of inadequate bowel preparation remains relatively high. In this study, we establish a smartphone app that assesses patient bowel preparation using an artificial intelligence (AI)-based prediction system trained on labeled photographs of feces in the toilet and evaluate its impact on bowel preparation quality in colonoscopy outpatients. We conduct a prospective, single-masked, multicenter randomized clinical trial, enrolling outpatients who own a smartphone and are scheduled for a colonoscopy.

A prediction model and nomogram for technical difficulty of peroral endoscopic myotomy.

Background And Aims: Peroral endoscopic myotomy (POEM) is a promising endoscopic technique for achalasia. We aimed to establish a regression model and develop a simple nomogram to predict the technical difficulty of POEM in a single center with large volume cases.

Methods: 3385 achalasia patients treated with POEM were included, and the technical difficulty was systemically evaluated.

Submucosal Tunneling Techniques for Tumor Resection.

The concept of third space endoscopy is based on the principle that the deeper layers of the gastrointestinal tract can be accessed by tunneling in the submucosal space and maintaining the integrity of the overlying mucosa. The mucosal flap safety valve enabled endoscopists to use submucosal space securely. The era of third space endoscopy started with peroral endoscopic myotomy for treatment of achalasia and has expanded to treat various other gastrointestinal disorders, such as mucosal lesions, submucosal tumors, extraluminal tumors, and refractory gastroparesis, Zenker diverticulum, and restoration of the completely obstructed esophageal lumen.

Two-step artificial intelligence system for endoscopic gastric biopsy improves the diagnostic accuracy of pathologists.

Background: Endoscopic biopsy is the pivotal procedure for the diagnosis of gastric cancer. In this study, we applied whole-slide images (WSIs) of endoscopic gastric biopsy specimens to develop an endoscopic gastric biopsy assistant system (EGBAS).

Methods: The EGBAS was trained using 2373 WSIs expertly annotated and internally validated on 245 WSIs.

Erratum: A scoring system to support surgical decision-making for cardial submucosal tumors.

[This corrects the article DOI: 10.1055/a-1775-7976.].

Enteric Nervous System: The Bridge Between the Gut Microbiota and Neurological Disorders.

The gastrointestinal (GI) tract plays an essential role in food digestion, absorption, and the mucosal immune system; it is also inhabited by a huge range of microbes. The GI tract is densely innervated by a network of 200-600 million neurons that comprise the enteric nervous system (ENS). This system cooperates with intestinal microbes, the intestinal immune system, and endocrine systems; it forms a complex network that is required to maintain a stable intestinal microenvironment.

A scoring system to support surgical decision-making for cardial submucosal tumors.

Submucosal tunneling endoscopic resection (STER) and non-tunneling techniques are two alternative options for the treatment of cardial submucosal tumors (SMTs). We aimed to establish a regression model and develop a simple scoring system (Zhongshan Tunnel Score) to help clinicians make surgical decisions for cardial submucosal tumors. A total of 246 patients who suffered cardial SMTs and received endoscopic resection were included in this study.

Endoscopic submucosal dissection for giant esophageal lipomatous tumors.

Background And Aim: Thoracotomy is the foremost choice of giant esophageal lipomatous tumors in previous studies, but it is highly traumatic and possibly diminishes the quality of patients' lives. To minimize such impacts, a minimally invasive method without loss of curability is desirable for giant lipomatous tumors of the esophagus. With recent progress in endoscopic techniques and devices, endoscopic submucosal dissection (ESD) has been successfully used to remove esophageal or gastric submucosal tumors.