The NICE classification is an international endoscopic classification of colorectal neoplasia through a narrowband spectrum that on the basis of lesion colors, vascular pattern, and structure of the ...surface of the mucous membrane classifies colorectal neoplasms in three categories: type 1 as hyperplastic lesions, type 2 as adenomas, and type 3 as invasive tumors. The aim of this study was to verify diagnostic accuracy of the NICE classification system compared to the reference standard: histopathological analysis. This retrospective study was conducted by ten physicians on a sequential sample of 418 patients and 735 polyps. The total diagnostic accuracy of the NICE classification system is found to be 76.7%. Optical recognition is significantly better with larger polyps, high-risk lesions (HGIEN), and neoplastic lesions. This research has shown that the NICE classification system is at the moment inferior to histopathological analysis. However, it is noticed that some physicians achieve significantly better results, with the accuracy of diagnosis ranging from 59.5% to 84.2%. These results show that with proper training of physicians and the use of endoscope enhancements to improve image quality, the NICE classification system could in the future potentially replace the histopathological diagnosis process.
The aims of this study were to evaluate diagnostic value of endoscopic ultrasound strain ratio elastography in patients with focal pancreatic masses and to determine the cutoff value between the ...pancreatic malignancies and inflammatory pancreatic masses using reference areas different than those used by other investigators.
In a prospective single-center study, strain ratio was measured in patients with pancreatic masses. After the diagnosis was established, statistical analysis was used to compare the group with pancreatic malignancies to the one with inflammatory masses.
Strain ratio cutoff of 7.59 provided 100% sensitivity, 95% specificity, and 97% overall accuracy for differentiation of patients with pancreatic malignancies from those with inflammatory masses.
Our data show high sensitivity and specificity for the calculated strain ratio. Adjacent normal pancreatic tissue is adequate as a reference area based on the inclusion criteria. Diverse cutoff values and standardization of methods in the studies published so far require further investigations, before the implementation of the method in a routine clinical practice becomes possible.
AIM: To investigate the accuracy of the strain histogram endoscopic ultrasound(EUS)-based method for the diagnostic differentiation of patients with pancreatic masses. METHODS: In a prospective ...single center study, 149 patients were analyzed, 105 with pancreatic masses and 44 controls. Elastography images were recorded using commercially available ultrasound equipment in combination with EUS linear probes. Strain histograms(SHs) were calculated by machine integrated software in regions of interest and mean values of the strain histograms were expressed as Mode 1(over the mass) and Mode 2(over an adjacent part of pancreatic tissue, representing the reference area). The ratio between Mode 2 and Mode 1 was calculated later, representing a new variable, the strain histogram ratio. After the final diagnosis was established, two groups of patients were formed: a pancreatic cancer group with positive cytology achieved by fine needle aspiration puncture or histology after surgery(58 patients), and a massforming pancreatitis group with negative cytology and follow-up after 3 and 6 mo(47 patients). All statistical analyses were conducted in SPSS 14.0(SPSS Inc., Chicago, IL, United States).RESULTS: Results were obtained with software for strain histograms with reversed hue scale(0 represents the hardest tissue structure and 255 the softest). Based on the receiver operating characteristics(ROC) curve coordinates, the cut-off point for Mode 1 was set at the value of 86. Values under the cut-off point indicated the presence of pancreatic malignancy. Mode 1 reached 100% sensitivity and 45% specificity with overall accuracy of 66%(95%CI: 61%-66%) in detection of pancreatic malignant tumors among the patients with pancreatic masses. The positive and negative predictive values were 54% and 100%, respectively. The cut-off for the new calculated variable, the SH ratio, was set at the value 1.153 based on the ROC curve coordinates. Values equal or above the cut-off value were indicative of pancreatic malignancy. The SH ratio reached 98% sensitivity, 50% specificity and an overall accuracy of 69%(95%CI: 63%-70%). The positive and negative predictive values were 92% and 100%, respectively.CONCLUSION: SH showed high sensitivity in pancreatic malignant tumor detection but disappointingly low specificity. Slight improvements in specificity and accuracy were achieved using the SH ratio.
Hemangioma of the small intestine is a rare vascular malformation which mostly presents as occult gastrointestinal bleeding and iron-deficiency anemia. Patients are often asymptomatic except of ...fatigue due to anemia. Hemangiomas can arise anywhere in the luminal gastrointestinal tract, with jejunum as the most commonly involved site. They are very hard to recognize mostly due to their localization. Video capsule endoscopy and balloon-assisted enteroscopy have very much improved preoperative diagnostics and made major contribution to establishing the diagnosis - which was very difficult in the past and almost all cases were diagnosed during or after the operation. Surgical resection is still the conventional treatment modality, although with the improvement of endoscopic therapeutic interventions (endoscopic mucosal resection, argon-plasma coagulation) there are more therapeutic possibilities.
AIM： To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy. METHODS： In this prospective study, conducted over a period of three years, ...1,104 patients referred for a same day GI endoscopy procedure were analyzed. All patients were given a propofol bolus （0.5-1.5 mg/kg）. Arterial blood pressure （BP） was monitored at 3 rain intervals and heart rate and oxygen saturation （SpO2） were recorded continuously by pulse oximetry. Analyzed data acquisition was carried out before, during, and after the procedure. RESULTS： A statistically significant reduction in mean arterial pressure was demonstrated （P〈0.001） when compared to pre-intervention values, but severe hypotension, defined as a systolic blood pressure below 60mmHg, was noted in only 5 patients （0.5%）. Oxygen saturation decreased from 96.5% to 94.4 % （P〈0.001）. A critical decrease in oxygen saturation （〈90%） was documented in 27 patients （2.4%）. CONCLUSION： Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant hemodynamic side effelts if carefully titrated. All the patients （and especially ASA Ⅲ group） require monitoring and care of an anesthesiologist.
Uz endoskopske i radiološke metode, osovinu dijagnostike funkcijskih poremećaja jednjaka čini manometrija. Radi se o tradicionalnoj metodi kojom se ispituje funkcijska sposobnost gornjeg i donjeg ...sfinktera te tijela jednjaka. Prateći razvoj informatičke tehnologije, konvencionalna se manometrija tijekom proteklih desetljeća transformirala u manometriju visoke rezolucije. Tehnika visoke rezolucije omogućuje bolju prostornu razlučivost svih segmenata jednjaka, znatno je olakšana inicijalna orijentacija prema svim strukturnim podjedinicama jednjaka te je kraće vrijeme pretrage, što bolesniku uvelike olakšava podnošljivost procedure. Manometrija visoke rezolucije koristi dvije vrste katetera – čvrsti i vodom-perfundirani (silikonski), u koje su ugrađeni multipli senzori koji imaju mogućnost radijalne detekcije signala iz bliskih dijelova tkiva. Današnja tehnologija omogućuje i inkorporaciju impedancijskih senzora u kateter, koji temeljem promjena otpora u tkivu jednjaka detektiraju suptilne promjene u tranzitu bolusa hrane ili tekućine. Funkcijski, odnosno poremećaji motiliteta jednjaka prema definiranim parametrima Chicago klasifikacije kategoriziraju se hijerarhijski u poremećaje s opstrukcijom na razini ezofago-gastričnog spoja, velike poremećaje te male poremećaje peristaltike. Uvođenje ove metode, kao i redovito ažuriranje Chicago klasifikacije, omogućuje značajan napredak u dijagnostici, posljedično i liječenju sve češćih funkcijskih poremećaja jednjaka.
Područje gastrointestinalne endoskopije kod bolesnika na antiagregacijskoj terapiji karakteriziraju dva klinička scenarija. Zbog ulceriformnog potencijala acetilsalicilne kiseline postoji povećan ...rizik od nastanka gastrointestinalnog krvarenja, osobito u bolesnika starije životne dobi. U ovom kontekstu uloga liječnika obiteljske medicine očituje se u prepoznavanju populacije s čimbenicima rizika od nastupa krvarenja te poduzimanju prikladnih mjera prevencije. Drugi scenarij uključuje pripremu bolesnika na antiagregacijskoj terapiji za intervencijske gastrointestinalne zahvate. Odluka o prekidu antiagregacijske terapije ovisi o ravnoteži rizika od nastanka tromboembolijskog incidenta s jedne strane te rizika od nastanka postproceduralnog krvarenja s druge strane. Liječnik obiteljske medicine treba biti upoznat s navedenim čimbenicima rizika radi adekvatne pripreme bolesnika za endoskopsku proceduru. Ipak, bolesnici s visokim rizikom od nastanka tromboembolijskog incidenta u kojih se planira zahvat s visokim rizikom od nastanka postproceduralnog krvarenja zaslužuju zajedničku odluku gastroenterologa i kardiologa, i to za svakog bolesnika individualno.
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