Artificial intelligence (AI) has emerged as a transformative tool in gastrointestinal (GI) endoscopy, addressing challenges in detection, diagnosis, and decision-making. In upper GI endoscopy, AI supports blind spot monitoring, Helicobacter pylori diagnosis, and the identification of premalignant and malignant lesions, with high accuracy and reduced miss rates. In lower GI endoscopy, computer-aided detection improves adenoma detection, whereas computer-aided diagnosis supports "resect-and-discard" and "diagnose-and-leave" strategies. However, real-world benefits remain modest, with concerns regarding overdetection and variable performance across lesion types and colon segments. In inflammatory bowel disease, AI standardizes endoscopic and histologic scoring, reduces interobserver variability, and accelerates capsule endoscopy interpretation, including high diagnostic accuracy for Crohn's disease. Pancreatobiliary applications, including endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, and cholangioscopy, demonstrate strong performance in differentiating pancreatic masses and biliary strictures and in predicting postprocedural complications. Despite expert-level performance across multiple domains, most studies remain single-center or retrospective, and explainability, workflow integration, medicolegal responsibility, and cost-effectiveness continue to limit adoption. Emerging solutions, including explainable AI and AI-generated common data model-compatible reports, may bridge these gaps. With rigorous multicenter validation and real-world implementation, AI can evolve from an experimental adjunct into a core component of routine endoscopic practice.
Nasotracheal intubation is commonly used in maxillofacial surgeries but often causes complications, with epistaxis being the most frequent. Selecting the more patent nostril and appropriate tube size can help reduce bleeding. Flexible nasal endoscopy (FNE) is traditionally used for this assessment but is invasive. Virtual nasal endoscopy (VNE), a non-invasive imaging technique, may offer an alternative. This randomized controlled study aimed to compare the incidence of epistaxis during nasotracheal intubation when guided by VNE vs FNE. Sixty-four patients were enrolled. Preoperatively, VNE using OsiriX Lite software identified the more patent nostril and endotracheal tube (ETT) size. On surgery day, FNE was performed to assess the same. Patients were randomized into Group V (virtual) or Group E (endoscopy), with nostril side and Ring-Adair-Elwyn (RAE) tube size chosen accordingly. Incidence and severity of epistaxis during laryngoscopy and before throat packing, ease and time of insertion, manipulations, and number of attempts were recorded. The incidence and severity of epistaxis were significantly less in group V than group E at laryngoscopy (18.8% vs 59.4%, P < 0.001) and during throat packing (31.2% vs 84.4%, P < 0.001). The time taken for ETT insertion, tube impingement, and manipulations was also significantly reduced in group V. Our study showed that the incidence of epistaxis was significantly less in VNE than in FNE-guided intubation.
Although vedolizumab (VDZ) serves as a primary biologic for ulcerative colitis (UC), long-term data in Chinese biologic-naïve cohorts and cost-effective prognostic biomarkers remain lacking. We evaluated the 54-week clinical benefits of VDZ as a first-line biologic in a Chinese cohort and investigated the clinical utility of systemic immune-inflammation indices (SII, NLR, PLR) in reflecting long-term outcomes and systemic inflammatory clearance during treatment de-escalation. This multicenter retrospective study enrolled biologic-naïve UC patients receiving VDZ. The primary endpoint was week-54 clinical remission, primarily evaluated using the full analysis set (FAS) with last observation carried forward (LOCF), accompanied by non-responder imputation (NRI) as a supplemental extreme-scenario analysis. Baseline indices were evaluated for predictive value, alongside an exploratory longitudinal analysis for patients undergoing early treatment de-escalation. Among 41 patients in the FAS, the 54-week drug retention rate was 76.8%. Clinical remission was 73.2% (primary FAS-LOCF), with a conservative NRI estimate of 46.3%. In the paired endoscopy subgroup, 83.3% achieved endoscopic remission. While baseline SII and NLR correlated positively with C-reactive protein, they lacked robust predictive value for long-term remission. Instead, shorter disease duration was the sole independent predictor (OR = 0.84, P = 0.024). Notably, exploratory analysis revealed that declining SII trajectories coincided with successful treatment de-escalation. No unexpected safety signals emerged. Vedolizumab as a first-line biologic provides substantial clinical benefits and safety in bio-naive UC patients. While baseline inflammatory indices lack predictive power, their dynamic decline parallels clinical improvement. Due to the retrospective reliance on clinical symptoms and high rates of missing endoscopic data, these exploratory findings warrant cautious interpretation and prospective validation.
Hypoxemia is a common and serious complication during sedated gastrointestinal endoscopy for out- and in-patients. Though diagnostic and severity scoring systems of obstructive sleep apnea (OSA) and difficult airway assessment (DAA) are widely used to assess hypoxemia risk, there is no exclusively designed prediction model and convenient tool in real-world practice. We aimed to develop and validate a robust and accurate hypoxemia risk prediction model for pre-operative use in this context. Using data from out-patients undergoing gastrointestinal endoscopy between May 2020 and November 2023 across seven hospitals in China with diverse regional and ethnic backgrounds, we developed and independently validated a hypoxemia risk prediction model for sedated gastrointestinal endoscopy (HAPPY-12K). The model was developed to pre-operatively predict occurrence of hypoxemia during sedated gastrointestinal endoscopy, defined as SpO2 falling below 95% for a duration exceeding 10 s. HAPPY-12K was a logistic regression model incorporating eight predictors: body mass index, Mallampati grade, limited jaw protrusion, short thyromental distance, large tongue, history of snoring, short neck with large circumference and pre-operative mean arterial pressure. The model was constructed by a well-established 3-D modeling strategy composed of Double types of effects, Double steps of screening, and Double steps of modeling. The discriminative ability was evaluated using the area under the receiver operating characteristic curve (AUC). The model calibration was examined through calibration slope, expected-to-observed (E:O) ratio and Brier score. For clinical utility, decision curve analysis was performed to assess net benefit (NB) and net reduction (NR). Furthermore, we systematically compared HAPPY-12K with other newly developed models using scores or raw variables from questionaries of OSA and DAA using DeLong's test. This study is registered in the Chinese Clinical Trial Registry (ChiCTR2300074128). We included 11,957 patients, divided into a Training Set (n = 2,518, hypoxemia rate 10.37%), and five validation sets (n = 9,439, hypoxemia rate raining from 8.40% to 28.45%). HAPPY-12K was developed in a Han Chinese population and exhibited satisfactory discrimination ability with AUCs ranging from 0.818 to 0.895 in external populations of the same ethnicity, and an acceptable AUC of 0.771 in a Uygur Chinese population. Although its Brier scores were satisfactory across all ethnic populations, HAPPY-12K displayed acceptable calibration (calibration slope < 1.2) in external Han Chinese populations, and good calibration (E:O ratio = 0.962) in independent homogenous populations comparable to the training set. The average NB and NR were 45.2‰ and 59.5%, respectively. It was estimated that HAPPY-12K would identify over half a million patients with truly developing hypoxemia during sedated gastrointestinal endoscopy and could help avoid over six million unnecessary interventions annually in China. Meanwhile, a head-to-head comparison revealed that HAPPY-12K outperformed other models. HAPPY-12K has been implemented as an interactive online tool available at http://bigdata.njmu.edu.cn/HAPPY-12K/. HAPPY-12K could enable efficient and precise hypoxemia risk assessment before sedated gastrointestinal endoscopy, providing timely alerts for high-risk outpatients. National Natural Science Foundation of China; Noncommunicable Chronic Diseases-National Science and Technology Major Project; Science and Technology Project of Jiangsu Disease Control and Prevention Administration; Science and Technology Development Project of Nanjing Medical University; Priority Academic Program Development of Jiangsu Higher Education Institutions; and Outstanding Young Level Academic Leadership Training Program of Nanjing Medical University.
BackgroundDistinguishing benign from malignant gastric outlet obstruction (GOO) remains a major clinical challenge. Despite comprehensive preoperative evaluation, occult malignancy and advanced fibrosis may be overlooked, complicating treatment selection, particularly in the era of minimally invasive and endoscopic bypass techniques. This study aimed to evaluate the clinical and pathological characteristics of clinically benign GOO, focusing on the prognostic significance of intraoperative duodenal wall thickening.MethodsThis observational study included adult patients who underwent surgical treatment for clinically benign GOO between September 2023 and December 2025, identified from a prospective institutional gastrectomy database. Preoperative assessment included endoscopy with biopsy, contrast-enhanced computed tomography, tumor markers, and nutritional evaluation. All patients underwent distal subtotal gastrectomy with Roux-en-Y reconstruction using a laparoscopic-first approach. Intraoperative duodenal wall thickening was prospectively recorded, and its association with postoperative outcomes was analyzed.ResultsTwenty-two patients were included (median age 58.5 years; 59.1% male). All demonstrated gastric dilatation and normal tumor markers. Helicobacter pylori infection was present in 95.5%, and 54.5% had prior balloon dilatation. Conversion occurred in 27.3%, stump leakage in 13.6%, and 30-day mortality in 9.1%. Occult carcinoma was identified in 4.5%. Duodenal wall thickening was significantly associated with conversion (P < 0.001), major complications (P = 0.002), and stump leakage (P = 0.036). All survivors had durable symptom resolution.ConclusionIn clinically benign GOO, intraoperative duodenal wall thickening is a clinically actionable marker associated with increased surgical complexity, morbidity, and possible occult malignancy, supporting its role in guiding intraoperative decision-making, including conversion, operative caution, and selection between resection and non-resectional strategies.
Airway management during upper gastrointestinal endoscopic procedures and other transesophageal instrumentation remains challenging because the airway and procedural device share the upper aerodigestive tract. Endoscopy-specific dual-channel supraglottic airways (dc-SGAs), including the LMA® Gastro™ Airway and the Jcerity Endoscoper™ Airway, are designed to maintain ventilation while permitting passage of an endoscope or transesophageal probe through a separate procedural channel. Nevertheless, their comparative efficacy and safety remain uncertain across heterogeneous procedures and comparator strategies. We conducted a systematic review and meta-analysis of randomized controlled trials comparing endoscopy-specific dc-SGAs with endotracheal tubes, other placed airway or access devices, or non-invasive oxygen therapy during upper gastrointestinal endoscopic or transesophageal instrumentation procedures. Observational studies were summarized narratively but were not included in pooled analyses. Fifteen studies were included, including 13 randomized controlled trials involving 2,481 participants in the quantitative synthesis and 2 observational studies summarized narratively. Endoscopy-specific dc-SGAs showed comparable first-attempt airway device and endoscope/probe insertion success to comparator strategies and shortened airway device insertion time. Effects on endoscope/probe insertion time and endoscopist satisfaction were inconsistent and varied across comparator types. dc-SGAs reduced intraoperative hypoxemia, mainly in comparisons with non-invasive oxygen therapy. Postoperative sore throat showed a comparator-dependent pattern, with fewer events compared with endotracheal tubes but more events compared with non-invasive oxygen therapy. Endoscopy-specific dc-SGAs may represent a feasible intermediate airway strategy for selected patients undergoing upper gastrointestinal endoscopic and transesophageal instrumentation procedures. They may improve airway placement efficiency and, compared with non-invasive oxygen therapy, reduce hypoxemia; however, these potential benefits should be interpreted in light of comparator-dependent throat discomfort, procedure heterogeneity, and the low-to-moderate certainty of evidence. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251182546, identifier [CRD420251182546].
Anastomotic stricture after esophagectomy with cervical reconstruction remains a clinically significant complication, yet effective preventive strategies are limited. This study aimed to clarify the clinical significance of endoscopic findings on postoperative day 14 for predicting subsequent anastomotic stricture. This retrospective single-center cohort study included 106 patients with esophageal cancer who underwent transthoracic esophagectomy with cervical reconstruction between April 2021 and December 2023. Cervical esophagogastric anastomosis was performed using a triangulating stapling technique with a linear stapler. Endoscopy was performed on postoperative day (POD) 14. Anastomotic stricture was defined as luminal narrowing requiring endoscopic balloon dilation within 1 year. Associations between POD 14 endoscopic findings and subsequent stricture were assessed using multivariable analysis. Exploratory analyses evaluated factors associated with ulcer formation. Anastomotic stricture occurred in 16 patients (15%). Ulcer formation and esophageal edema on POD 14 were independent risk factors for stricture (both P = 0.03). Greater circumferential ulcer extent was significantly associated with higher stricture risk (P = 0.001). Exploratory analyses showed that elevated C-reactive protein on POD 7 (P = 0.004) and an anastomosis located across the thoracic inlet (P = 0.08) were associated with ulcer formation. Ulceration observed on POD 14 endoscopy is a significant predictor of subsequent anastomotic stricture after esophagectomy. Early postoperative endoscopic assessment may help identify patients at increased risk of subsequent anastomotic stricture and support risk stratification during postoperative follow-up.
Endobiliary radiofrequency ablation (EB-RFA) is an adjunctive local therapy performed during endoscopic biliary drainage for malignant biliary obstruction. EB-RFA was originally introduced to reduce the intraductal tumor burden and maintain biliary drainage, and has been investigated for its potential survival benefits, especially for patients with extrahepatic cholangiocarcinoma (eCCA). However, the available evidence shows heterogeneity, and recent large trials have reported neutral results. This review summarizes the current evidence regarding the clinical benefits and limitations of EB-RFA, focusing on its effects on survival and stent patency. Existing data suggest that the survival benefit associated with EB-RFA is greater in patients with eCCA without distant metastasis than in those with metastatic disease. Evidence of its efficacy in improving stent patency is inconsistent based on the findings of randomized trials. However, observational studies, particularly those involving uncovered self-expandable metal stents, have reported its benefits. EB-RFA may also be considered for reintervention in cases involving metal stents occluded due to tumor ingrowth; however, clinical success may be suboptimal due to imperfect tissue contact and technical factors. Future studies with standardized protocols and predefined subgroup analyses are required to define optimal candidates and clinically meaningful endpoints, especially in the context of evolving systemic therapy.
Endoscopy has evolved to include the assessment of gastrointestinal function, an approach known as functional endoscopy. In this review, we summarize the current evidence on the endoscopic pressure-integrated system (EPSIS) as a representative modality in this field. Initial studies demonstrated the diagnostic utility of the EPSIS for gastroesophageal reflux disease by revealing significant associations between EPSIS parameters and 24-hour pH monitoring, as well as endoscopic findings such as erosive esophagitis and Barrett's esophagus. The usefulness of the EPSIS was also demonstrated in diagnosing achalasia and in the evaluation of treatment efficacy following antireflux mucosal interventions and peroral endoscopic myotomy. Dynamic changes in the gastric cardia during EPSIS were observed as the intragastric pressure increased. These changes were categorized into three sequential phases, referred to as the phase concept. In healthy individuals, all three phases function appropriately, whereas in patients with acid reflux, dysfunction is observed in one or more phases. Despite these promising findings, several aspects of the EPSIS remain to be clarified, and most previous studies have been conducted at a single center. Future multicenter prospective studies are warranted to accumulate robust evidence and further establish the clinical utility of the EPSIS.
Abdominal midline defects, like diastasis recti (DR), primary and incisional ventral hernias, significantly impair function and quality of life. Minimally invasive abdominal wall reconstruction is increasingly shifting toward extraperitoneal approaches. This study aimed to evaluate the safety, efficacy, and long-term outcomes of Totally Endoscopic Sublay Anterior Repair (TESAR), an anterior completely extraperitoneal technique, through a retrospective observational analysis. Consecutive adult patients undergoing TESAR for DR and/or primary and/or incisional midline ventral hernias between January 2018 and March 2025 were included. The primary endpoint was the 30-day postoperative complication rate. Secondary endpoints included length of stay, recurrence, and quality of life (QoL), assessed by EuraHS-QoL and Carolinas Comfort Scale (CCS) up to 12 months. Recurrence was assessed clinically at scheduled visits or via telemedicine and by imaging (ultrasound or CT). The impact of technical refinements, including subcutaneous quilting suture, was analyzed. A total of 120 patients were analyzed, with a median follow-up of 31 months. Indications included DR with umbilical hernia in 83 patients (69.2%), incisional hernias in 39 patients (32.5%), and other primary hernias in 15 patients (12.5%). No intraoperative complications occurred. Median follow-up was 31 months (range 12-81, IQR 18-54.5). Postoperative morbidity was 6.7% (seroma 5%, hematoma 1.6%), with no surgical site infections. No recurrences were clinically detected during follow-up. Quilting suture reduced clinically relevant seromas to 0%. Median hospital stay was 3 days. EuraHS-QoL scores improved from a median of 57 preoperatively to 0 at 12 months, and CCS scores from 35.5 to 0. TESAR appears to be a safe and effective minimally invasive technique for selected patients, associated with low morbidity and significant improvement in QoL. However, given the retrospective, observational and non-comparative design, these findings should be interpreted cautiously. Further prospective comparative studies are warranted.
Spirocerca lupi is a parasitic nematode responsible for spirocercosis, a potentially severe disease in domestic dogs. Clinical manifestations are variable and nonspecific, often leading to confusion with other gastrointestinal, respiratory, or neoplastic disorders and making diagnosis challenging. Although canine spirocercosis has previously been reported on Reunion Island, the molecular epidemiology and data on its occurrence remain limited. This study aimed to investigate the circulation of S. lupi on Reunion Island, using endoscopy, coproscopy, and molecular assays. Over a 75-day period, 88 dogs were recruited on Reunion Island from a veterinary clinic (n = 54) and a municipal shelter (n = 34), regardless of their clinical status. Clinical data and fecal samples were collected from all animals. Fecal samples were processed using coproscopic flotation and preserved in ethanol-containing Eppendorf tubes and FTA cards for subsequent molecular analyses. Overall, 20 dogs (22.7%) were identified as positive for S. lupi using at least one diagnostic method. Since not all animals were subjected to every diagnostic test, results were analyzed per modality: endoscopy, performed on 31 dogs, showed a positivity rate of 48.4% (15/31). In contrast, coproscopic examination, performed on 40 dogs, yielded a lower detection rate of 15.0% (6/40), consistent with the limitations of intermittent egg shedding. Molecular analysis of all 88 dogs revealed no amplification with semi-nested PCR targeting cox1 gene, whereas ITS1 qPCR detected infection in 6.8% of dogs (6/88), including one positive sample preserved on an FTA card. Under the conditions of the present study, the ITS1 qPCR assay successfully detected S. lupi DNA, whereas no amplification was obtained with the semi-nested cox1 PCR. The present study provides evidence of the active circulation of S. lupi in Reunion Island. Substantial discordance was observed between diagnostic approaches, emphasizing that no single method is sufficient for reliable diagnosis of canine spirocercosis. The findings support the continued use of endoscopy as the reference diagnostic tool, complemented by molecular and coprological approaches in epidemiological investigations.
Endoscopic flexor hallucis longus (FHL) tendon transfer is a minimally invasive surgical technique that shows promise for treating chronic Achilles tendon ruptures and tendinopathies. The procedure involves transferring the FHL tendon to the plantar foot for the calcaneus. Studies have demonstrated positive outcomes with improved American Orthopedic Foot and Ankle Society scores and patient-reported results along with low complication rates. However, for optimal results in highly active individuals, simultaneous reconstruction of the gastrocnemius-soleus complex may be necessary, particularly if significant elongation is present. This study provides a detailed surgical technique for this procedure.
Map-like redness (MLR) is a characteristic feature of gastritis after Helicobacter pylori (H. pylori) eradication and independent risk factor of gastric cancer after H. pylori eradication. The present study investigated the endoscopic manifestations and histopathological features of MLR to further investigate the relationship between MLR and gastric cancer after Helicobacter pylori eradication. We enrolled 56 consecutive MLR patients between January 2023 and July 2023. Endoscopic signs and histopathological characteristics were compared among the reddish area, transition zone, and background mucosa (areas R, T, and B, respectively). The histopathological analysis showed significantly greater atrophy, gastric intestinal metaplasia (GIM), and dysplasia in area R compared to other areas (p < 0.05). Incomplete GIM predominated in area R, while complete GIM predominated in areas T and B. Area R had a higher microvascular density compared to areas T and B. Intervening parts width for area T was greater than that for area B, which was greater than that for area R (p < 0.05). Crypt opening sizes in area R were greater than those in area T, which were greater than those in area B (p < 0.05). Gastric MLR, particularly the central reddish area, was associated with localized high-risk mucosal changes, including advanced atrophy, GIM, incomplete GIM, increased microvessel density, and dysplasia in some cases. MLR may serve as an endoscopic marker of high-risk mucosal changes after successful H. pylori eradication.
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Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease in which elimination diets represent an effective therapeutic option. Although six-food elimination diets (6-FED) achieve high remission rates, their complexity often compromises adherence. Dairy-free diet (DFD) has emerged as a simpler alternative, yet evidence in adult populations remains limited. To evaluate the clinical, endoscopic, and histological outcomes of a 12-week DFD in adult patients with EoE and to explore potential predictors of histological remission and dietary adherence. We conducted a prospective, multicenter, open label, single-arm interventional study across five Italian referral centers, enrolling 31 adults with active EoE. Participants followed a 12-week DFD, after which clinical symptoms (EEsAI), disease severity (I-SEE), endoscopic findings (EREFS), quality of life (EoE-QOL-A), and adherence (VAS scale) were assessed. Twenty-eight patients completed the 12-week protocol. Histological remission was achieved in 53.6% of patients (intention-to-treat: 48.4%); among these, 86.7% also reached clinical remission. The median EEsAI improved from 35 to 18.5 (p = 0.009) and the median I-SEE score from 6.5 to 4 (p < 0.0001). Quality of life improved (median EoE-QoL-A from 36.5 to 52, p = 0.02), and adherence was high (median VAS 8 [IQR 7-9.5]). Predictors of lower histological response included previous esophageal dilations and higher baseline exudate and eosinophil counts. Male sex and higher BMI predicted lower adherence. In this exploratory multicenter prospective study, DFD induced histological remission in more than half of patients and clinically meaningful improvements in symptoms, disease severity, endoscopy, and quality of life.
Robot-assisted distal pancreatectomy is increasingly recognized as an important minimally invasive option for lesions of the pancreatic body and tail. Given the technical complexity inherent to distal pancreatectomy, including deep operative planes, vascular dissection, splenic vessel management, and the persistent risk of postoperative pancreatic fistula, robotic systems may offer specific advantages in selected settings. However, although the number of relevant publications has continued to rise, the overall research landscape and thematic development of this field remain insufficiently and unsystematically characterized. The present study was designed to assess the global research status, knowledge structure, and evolving hotspots in the field of robot-assisted distal pancreatectomy through bibliometric and visualization analysis. A total of 254 eligible publications indexed in the Web of Science Core Collection between January 1, 2007 and December 31, 2025, including 210 articles and 44 reviews, were analyzed using Bibliometrix, VOSviewer, CiteSpace, and Scimago Graphica. The yearly publication output demonstrated a general increasing pattern, with more marked growth from the mid-2010s onward and the highest output recorded in 2025. Italy together with the United States remained the principal contributors across much of the study period, while China showed sustained growth in recent years. The United States ranked first in citation impact. Several institutions, including the University of Amsterdam, University of Verona, and University of Pisa, emerged as major contributors. Among the leading publication venues were Surgical Endoscopy and Other Interventional Techniques, Annals of Surgical Oncology, and Journal of Robotic Surgery. Citation and co-citation analyses showed that the intellectual structure of the field has been shaped mainly by studies focusing on surgical technique, perioperative outcomes, and comparisons with laparoscopic distal pancreatectomy. Keyword analysis indicated that spleen preservation, pancreatic fistula, laparoscopic comparison, learning curve, clinical outcomes, and multicenter evaluation are among the main research themes, with recent attention increasingly directed toward preservation strategies, outcome assessment, and more refined clinical application. In conclusion, research on robot-assisted distal pancreatectomy has expanded steadily and is moving from early feasibility-focused exploration toward a more specialized and clinically oriented stage. Future progress in this field will likely depend on stronger multicenter collaboration, more indication-specific evaluation, and more standardized evidence generation.
The aim of this study was to determine the association between intestinal elastography and laboratory, clinical, ultrasound, endoscopic, and histopathological parameters in dogs with chronic inflammatory enteropathy (CIE). Twelve dogs were assessed and divided into two groups: six dogs with CIE (EG) and six healthy dogs (CG). Strain ratio (SR) values for the duodenum in the EG ranged from 1.01 to 3.3, with a mean of 2.105 ± 1.016, while in the CG, they ranged from 0.2 to 0.96, with a mean of 0.5667 ± 0.3133. For the jejunum, the values in the EG ranged from 1.19 to 2.76, with an average of 1.867 ± 0.5711, and in the CG, they ranged from 0.15 to 0.72, with an average of 0.4667 ± 0.2439. The results showed that the EG dogs had higher values in the elastography parameters than the CG, with significant differences in the SR of the duodenum (p = 0.0053) and jejunum (p = 0.0003). There was no significant correlation between intestinal elasticity and the variables weight and age of the dogs, either in the EG or in the CG. For the clinical, laboratory, and ultrasound parameters, there were weak negative and positive correlations between the variables analyzed, except for a strong, negative, and statistically significant correlation (r = -0.886, p = 0.033) between jejunal SR and serum albumin. Digestive endoscopy and histopathological analysis showed varied lesions, with no significant correlation with elastography values. It is concluded that strain elastography is a viable technique for assessing the intestines of dogs with CIE, showing higher intestinal stiffness values compared to healthy dogs. It was not possible to infer that increased SR suggests intestinal fibrosis and that mucosal hardness is associated with greater clinical alterations and complementary tests. Despite this, we suggest that the results found be applied in further studies with a larger number of animals, measuring more specific biological markers for the canine gastrointestinal tract and making better use of the samples obtained from intestinal biopsy and histopathology.
Endoscopic remission is a key therapeutic goal in ulcerative colitis (UC); however, conventional indices focus on peak severity without accounting for the spatial extent of inflammation. We developed a deep learning-based score, Quantitative Ulcerative Colitis Assessment using Deep Learning (QUAD), and evaluated whether incorporating inflammatory extent improves relapse prediction in patients with UC in clinical remission. To our knowledge, no studies have examined whether artificial intelligence (AI)-derived assessment of inflammatory extent predicts clinical relapse. This prospective cohort study evaluated relapse prediction over 24 months in patients with UC in clinical remission. The QUAD model assigns a score of 0-3 to each image quadrant, yielding a total score of 0-12. The model was trained on 84 743 images from 998 patients with UC across three centers. Still image-based validation and automated full-length video analysis were conducted to assess the impact of inflammatory extent on relapse prediction. Clinical relapse occurred in 19.4% of patients with QUAD ≥ 4 compared with 5.2% of those with QUAD < 4 (P = .01), with an area under the curve (AUC) of 0.67 (95% confidence interval [CI]: 0.57-0.76). Notably, automated video-based analysis showed that distal inflammatory burden yielded the highest predictive performance, with analysis of the distal 10% segment achieving an AUC of 0.73 (95% CI: 0.62-0.85), compared with whole-colon assessment (AUC, 0.62; 95% CI: 0.48-0.76) and still image-based evaluation. AI-augmented assessment integrating inflammatory severity and extent may provide complementary prognostic information beyond severity-based evaluation.
Eosinophilic Esophagitis (EoE) is a chronic inflammatory disorder with variable macroscopic and microscopic findings and clinical presentations, complicating management. This study examines esophageal sampling practices, segmental disease patterns, and longitudinal treatment trends and outcomes in pediatric EoE. We retrospectively reviewed charts of 138 pediatric EoE patients diagnosed between 2009 and 2023. EoE was defined as compatible symptoms and ≥ 15 eosinophils per high-power-field without alternative explanation. Diagnostic endoscopy was defined as the first endoscopy performed for evaluation of symptoms showing ≥ 15 eosinophils. Data included demographics, symptoms, macroscopic/microscopic findings, sampling methods, and treatments. Mean age at diagnosis was 8.33 ± 5.37 years, 75% male. Most common presenting symptoms were vomiting (39.28%), dysphagia (32.14%) and food impaction (28.57%). Among 112 diagnostic endoscopies, macroscopic abnormalities were most frequent in the lower esophagus (85.71%), with furrows (69.64%) and exudates (55.36%) predominating. Multi-level sampling in patients with ≥ 15 eosinophils in one field, revealed < 15 eosinophils in 21.11% of upper, 7.14% of middle, and 14.14% of lower esophageal samples. Microscopic findings despite normal endoscopic appearance were most common in the upper (26.4%, p < 0.001), and less frequently in the lower (9.8% p = 0.002) esophagus. Remission following first-line therapy was achieved in 44 patients (48.35%). Biologic therapy was initiated after multiple prior treatment failures and resulted in histologic remission in all treated patients (n = 9).  Findings indicate greater disease severity distally and underscore the need for multi-regional sampling, even in normal-appearing areas. Therapeutic responses are heterogenous and limited, and biologic therapies show promise but require validation in larger studies. • Pediatric eosinophilic esophagitis (EoE) is a chronic immune-mediated disease with variable endoscopic findings, requiring both compatible clinical features and histologic evidence of ≥15 eosinophils per high-power field. • Empiric elimination diets and proton pump inhibitors are considered first-line treatments, with variable remission rates. • Pan-esophageal multi-level biopsies, including from normal-appearing mucosa, improve diagnostic accuracy. • While first-line therapies show mild success rates, real-world data demonstrate complete histologic remission with biologic therapy, supporting its promise for pediatric EoE.
d-amino acids (D-AAs), the enantiomers of proteinogenic l-amino acids, are detectable in mammals, yet their biological roles in cancer immunity remain largely unexplored. Whether specific D-AAs modulate tumour progression or influence responsiveness to immunotherapy in gastrointestinal cancer is unknown. We aimed to determine how D-AAs, particularly d-serine (D-ser), shape the tumour immune microenvironment and affect clinical outcomes in gastrointestinal cancers. Mechanistic studies were conducted using murine MC38 tumours and orthotopic gastric cancer (GC) organoid allografts with or without D-AAs supplementation. Immune landscape alterations were assessed using single-cell RNA sequencing of tumour-infiltrating immune cells, flow cytometry, ex vivo macrophage-T cell co-culture assays, and microbiome manipulation experiments. D-AAs concentrations in plasma, urine, and stool were quantified in healthy controls (HCs; n = 87) and patients with GC across three cohorts (Cohort 1, n = 14; Cohort 2, n = 108; Cohort 3, n = 28). Associations between plasma D-ser levels, disease stage, immune cell infiltration, and clinical outcomes following anti-PD-1 antibody therapy were analysed. D-ser promoted tumour progression by suppressing CD8+ T cell immunity and enhancing SPP1-associated immunosuppressive macrophage signalling in murine model. Across all clinical cohorts, the plasma, urine, and stool levels of several D-AAs, most prominently D-ser, were significantly elevated in patients with GC compared to HCs. Plasma concentration of D-ser strongly correlated with disease stage (I-IV). Elevated plasma D-ser is associated with an immunosuppressive tumour microenvironment and poor response to anti-PD-1 monotherapy in patients with advanced gastric cancer. This study identifies D-ser as a previously unrecognised immunosuppressive metabolite that promotes tumour immune evasion by increased macrophages and reduced CD8+ T cell effector function, thereby shifting the tumour microenvironment toward an immunosuppressive phenotype. Clinically, D-ser is a potential metabolite to predict cancer progression and immunotherapy resistance. This work was supported by The Japan Science and Technology Agency (JST) Fusion Oriented Research for Disruptive Science and Technology (FOREST)[JPMJFR210P], Grants-in-Aid from the Japanese Society for the Promotion of Science (JSPS) (25K10430, 21K18272, 23H02899, 23K27590, 25K22627), KGRI challenge grant, Sakaguchi Memorial Foundation, Japan Agency for Medical Research and Development (CREST 21gm1510002h0001), and Miyarisan Pharmaceutical Grant.