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.
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.
To evaluate the effectiveness of an anesthesia recovery management model based on the ORTCC framework in patients undergoing painless gastrointestinal endoscopy. In August 2023, our hospital implemented an anesthesia recovery management model structured around the ORTCC model-comprising five components: Objective, Rules, Training, Check, and Culture. After a one-month pilot period, a total of 1000 patients were enrolled using a pre-post quasi-experimental design. Five hundred patients who underwent endoscopy before the implementation formed the control group (conventional care), while 500 patients treated afterward constituted the intervention group, receiving care under the ORTCC-based recovery model. Recovery time, incidence of anesthesia-related complications, frequency of nursing adverse events, and patient satisfaction were measured and compared between groups. Compared to the control group, the intervention group demonstrated significantly shorter anesthesia recovery times, lower rates of anesthesia-related complications and nursing adverse events, and higher levels of patient satisfaction (P < 0.05). The implementation of an ORTCC-based anesthesia recovery management model in patients undergoing painless gastrointestinal endoscopy was associated with enhanced recovery efficiency, reduced complication rates, and improved care safety. By integrating structured objectives, standardized rules and workflows, targeted training, performance assessment, and a culture of quality, this model provides a replicable framework for improving perioperative nursing outcomes and patient-centered care in ambulatory surgical settings.
Introduction. Ingestion of a button battery constitutes an endoscopic emergency due to the risk of serious injury. Objective. To describe the clinical, endoscopic, and clinical course characteristics of patients who swallowed a button battery and required upper gastrointestinal endoscopy in the pediatric emergency department of a tertiary care center between 2014 and 2024. Population and methods. Observational, descriptive, and retrospective study. The study included patients younger than 15 years of age with a radiological diagnosis of button-cell battery ingestion who underwent upper gastrointestinal endoscopy. Results. A total of 106 patients (63 males) were included. The median age was 24 months (IQR 15-48); 35.8% of the patients were initially evaluated at another institution. In 51% of cases, the time since ingestion was unknown. At the time of consultation, 39/106 patients (36.5%) were asymptomatic. Among those with symptoms (67/106), the most common symptom was hypersalivation, present in 36/106 patients (33.9% of the total). Hypersalivation was significantly associated with severe lesions (OR 8.115; 95%CI 2.913-24.3; p <0.01). Lesions located in the upper esophagus also showed a significant association (OR 2.461; 95%CI 1.077-5.775; p = 0.029). Conclusion. Esophageal impaction was common and was associated with a high percentage of severe injuries. Hypersalivation was significantly associated with greater severity. Introducción. La ingesta de pila botón constituye una emergencia endoscópica por el riesgo de lesiones graves.Objetivo. Describir las características clínicas, endoscópicas y evolutivas de los pacientes con ingesta de pila botón que requirieron endoscopia digestiva alta en la guardia pediátrica de un centro de tercer nivel entre 2014 y 2024. Población y métodos. Estudio observacional, descriptivo y retrospectivo. Se incluyeron pacientes menores de 15 años con diagnóstico radiológico de ingestión de pila botón sometidos a endoscopia digestiva alta. Resultados. Se incluyeron 106 pacientes (63 varones). La mediana de edad fue 24 meses (RIC 15-48). El 35,8 % de los pacientes consultó inicialmente en otra institución. En el 51 % de los casos, se desconocía el tiempo de ingesta. Al momento de la consulta 39/106 pacientes (36,5 %) se encontraban asintomáticos. Entre los sintomáticos (67/106), el síntoma más frecuente fue la sialorrea, presente en 36/106 pacientes (33,9 % del total). La sialorrea se asoció significativamente con lesiones graves (OR 8,115; IC95% 2,913-24,3; p <0,01). La localización en esófago superior también mostró asociación significativa (OR 2,461; IC95% 1,077-5,775; p = 0,029). Conclusión. La impactación esofágica fue frecuente y se asoció con un alto porcentaje de lesiones graves. La sialorrea se asoció significativamente con mayor gravedad.
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].
Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder characterized by venous malformations involving the skin and gastrointestinal (GI) tract. GI involvement may lead to chronic bleeding and iron deficiency anemia, most commonly presenting in younger individuals. We report the case of an 83-year-old male presenting with progressive fatigue and severe anemia (hemoglobin 5 g/dL), requiring multiple blood transfusions. His medical history was significant for recurrent anemia and prior gastrointestinal bleeding. Upper endoscopy was unremarkable; however, colonoscopy revealed multiple bluish, compressible venous malformations scattered throughout the ascending and transverse colon, consistent with BRBNS. Capsule endoscopy excluded small bowel involvement. Given the diffuse distribution and number of lesions, endoscopic or surgical intervention was not feasible. The patient was managed conservatively with blood transfusions and close outpatient follow-up. BRBNS is typically diagnosed in childhood, and adult presentation, particularly in the elderly, is uncommon. Gastrointestinal lesions are more prone to bleeding than cutaneous lesions and may lead to chronic transfusion-dependent anemia. Diagnosis requires a high index of suspicion, especially in patients with recurrent unexplained anemia and negative initial investigations. Management remains challenging and depends on disease extent, ranging from conservative measures to endoscopic, surgical, or pharmacologic therapies. This case highlights an unusual late presentation of BRBNS with isolated colonic involvement and emphasizes the importance of considering vascular malformations in the differential diagnosis of obscure gastrointestinal bleeding in elderly patients.
Sedation and anesthesia practices in gastrointestinal endoscopy units play a critical role in enhancing patient comfort, improving procedural tolerance, and ensuring procedural success. However, increasing procedural complexity and the growing burden of patient comorbidities have heightened the importance of patient safety, particularly with respect to the cardiorespiratory risks associated with deep sedation. This review provides a comprehensive overview of current sedation and anesthesia practices in endoscopy units, with a focus on patient selection, risk stratification, pharmacological agents, monitoring standards, and complication management. Emphasis is placed on patient-centered and individualized sedation strategies that account for patient age, comorbidities, American Society of Anesthesiologists physical status classification, and procedural characteristics. Propofol remains the cornerstone of endoscopic sedation because of its rapid onset and favorable recovery profile. Nevertheless, newer agents such as remimazolam, ciprofol, and esketamine have emerged as promising alternatives either as primary sedative agents or as adjuvant drugs, offering improved pharmacokinetic predictability, greater hemodynamic stability, and potentially enhanced cardiorespiratory safety. Adjunctive agents, including opioids and ketamine, may further optimize analgesia and sedation quality when used appropriately. Standard monitoring modalities, including pulse oximetry, noninvasive blood pressure, and electrocardiography, are essential, whereas capnography offers significant advantages for the early detection of respiratory compromise. Effective complication management relies on early recognition, timely intervention, and adherence to structured safety protocols. Validated recovery and discharge scoring systems further contribute to safe postprocedural care. In conclusion, safe and effective sedation in gastrointestinal endoscopy units requires a multidisciplinary, protocoldriven approach that integrates individualized pharmacological strategies, appropriate monitoring, and experienced clinical teams.
Pediatric gastrointestinal scintigraphy provides physiologic, quantitative, and clinically useful information for children with suspected motility disorders, feeding intolerance, reflux or aspiration, refractory constipation, and complex postsurgical anatomy. This review summarizes the role of esophageal transit scintigraphy, gastric emptying and gastroesophageal reflux scintigraphy, and small-bowel and colonic transit scintigraphy in children. These studies complement anatomic imaging, endoscopy, pH-impedance testing, and manometry by directly evaluating the movement of radiolabeled meals or boluses under relatively physiologic conditions. For each application, the review emphasizes practical patient preparation, meal and radiopharmaceutical selection, acquisition methods, quantitative analysis, interpretation patterns, reporting elements, and common pitfalls. Suggested pediatric protocols are provided in three tables, and representative examples are illustrated as figures. Because pediatric normative data are limited for several gastrointestinal transit applications, results should be interpreted in the context of patient age, symptoms, meal type, position, medication status, prior surgery, and institutional methodology. A structured and clinically oriented approach can improve the diagnostic value of pediatric gastrointestinal scintigraphy and help guide multidisciplinary management.
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.
The "weekend effect"-worse outcomes among patients admitted on Saturdays or Sundays-has been reported in upper gastrointestinal bleeding (UGIB) and attributed to delayed endoscopy and reduced after-hours resources. We examined whether weekend admission is associated with worse outcomes within a contemporary integrated health system with continuous endoscopy availability. We performed a retrospective cohort study of adults (18-89 years) admitted to Northwell Health hospitals with a primary or secondary diagnosis of UGIB between January 2019 and January 2024. Weekend admission was defined as arrival on a Saturday or Sunday. The primary outcome was in-hospital mortality; secondary outcomes were intensive care unit (ICU) admission, length of stay (LOS), and 30-day readmission. Groups were compared using chi-square and Wilcoxon rank-sum tests. A multivariable logistic regression model for mortality included weekend admission (forced entry), age, liver cirrhosis, and shock. Of 7,640 patients, 1,927 (25.2%) were admitted on a weekend. Baseline characteristics were broadly similar, although liver cirrhosis was modestly more frequent among weekend admissions (8.0% vs 6.5%, P = 0.03). Overall in-hospital mortality was 5.5% and did not differ by admission timing (adjusted odds ratio [aOR] 1.06, 95% CI 0.83-1.35, P = 0.67). Independent predictors of mortality were shock (aOR 19.08, 95% CI 15.33-23.76), liver cirrhosis (aOR 1.81, 95% CI 1.23-2.67), and age (aOR 1.04 per year, 95% CI 1.03-1.05). ICU admission (23.3% vs. 21.9%, P = 0.21), median LOS (4.49 vs. 4.66 days, P = 0.43), and 30-day readmission (1.8% vs. 2.3%, P = 0.18) did not differ significantly. The null association persisted in sensitivity analyses using an off-hours exposure window (aOR 1.02) and holiday reclassification (aOR 1.04), after adjustment for AIMS65 severity (aOR 1.08), and in a prespecified clinically informed model (aOR 1.06). In a large multicenter cohort within an integrated health system, weekend admission was not associated with worse outcomes in UGIB, and this null association was robust across alternative off-hours and holiday exposure definitions, severity adjustment, and a prespecified clinically informed model. Disease severity, particularly shock and cirrhosis, was the dominant determinant of mortality. These findings are consistent with standardized, continuously available GI bleed care pathways mitigating temporal disparities in UGIB outcomes.
Hemosuccus pancreaticus is an uncommon but potentially life-threatening cause of upper gastrointestinal bleeding. We report the case of a 47-year-old man with a history of alcohol use disorder and alcohol use disorder and a previous episode of alcohol-induced acute pancreatitis who presented with melena, severe microcytic anemia, and recurrent epigastric pain. Upper endoscopy demonstrated blood emerging from the major papilla alternating with bile, raising suspicion for hemosuccus pancreaticus. Contrast-enhanced computed tomography revealed a large pseudoaneurysm of the pancreatoduodenal artery within the pancreatic head, likely secondary to chronic inflammatory changes. The patient underwent successful endovascular coil embolization, resulting in complete cessation of bleeding and an uneventful recovery. This case highlights the role of upper endoscopy in early recognition of hemosuccus pancreaticus and underscores the effectiveness of endovascular therapy in managing pseudoaneurysm-related hemorrhage. O hemosuccus pancreaticus é uma causa rara, mas potencialmente fatal, de hemorragia digestiva alta. Apresenta-se o caso de um homem de 47 anos, com antecedentes de perturbação do uso de álcool e um episódio de pancreatite aguda induzida por álcool, que recorreu ao serviço de urgência por melenas, dor epigástrica recorrente e anemia microcítica grave. A endoscopia digestiva alta evidenciou saída intermitente de sangue pela papila major, alternando com saída de bílis, achado sugestivo de hemosuccus pancreaticus. A tomografia computorizada revelou um pseudoaneurisma da artéria pancreatoduodenal, localizado na cabeça do pâncreas, provavelmente secundário a alterações inflamatórias crónicas. O doente foi submetido com sucesso a embolização endovascular com coils, não se tendo verificado recidiva hemorrágica nem outras complicações. Este caso destaca o papel da endoscopia alta no reconhecimento precoce do hemosuccus pancreaticus, bem como a eficácia da abordagem endovascular no seu tratamento.
Dedicated service for Barrett's oesophagus (BO) surveillance may be more effective than conventional service, according to some single centre studies. To determine whether the surveillance of BO through a dedicated service can improve key performance indicators (KPIs), and dysplasia detection rate (DDR) compared with conventional service in a multi centre study. A retrospective cohort study was conducted across 6 NHS-hospitals, capturing BO surveillance data over 8 years. Factors associated with DDR were assessed by logistic regression. There were 1037 dedicated and 976 conventional surveillance procedures (N = 2013), male: female ratio = 2.2:1; mean age = 64.4 (SD ± 12.2) years; mean maximum length of BO = 4.1 cm (range: 0-18 cm). All the KPIs and DDR were significantly higher in the dedicated service (DDR = 6.9%) than in the conventional service (DDR = 2.8%), p < 0.001. The use of narrow band imaging (NBI) and acetic acid chromoendoscopy (AAC) and sedation were high, and the complication rate was significantly lower in the dedicated service. The lesion recognition was significantly associated with DDR (OR = 6.9). Surprisingly, Seattle biopsy protocol adherence showed no correlation with DDR (OR = 0.47). The dedicated service provides higher quality endoscopy, and a higher yield of early neoplasia. It uses more sedation, advanced imaging, and detects more lesions than conventional services. Thus, the dedicated surveillance could potentially replace time and cost consuming Seattle biopsies with targeted biopsies of visible lesions. In future, this may become easier with the use of artificial intelligence for lesion detection (CADe).
Evaluating clinical practices in the management of non-esophageal eosinophilic gastrointestinal disorders (non-EoE EGIDs) among pediatric gastroenterologists in Latin America. A cross-sectional descriptive study was conducted using a survey distributed via the REDCap platform. A total of 309 pediatric gastroenterologists and trainees from 17 Latin American countries (excluding Nicaragua and Bolivia) participated in the study. Data collection took place between March and May 2024. Sixty-five percent of respondents reported seeing fewer than five cases per year. Only 17.8% consistently collaborate with allergists. While 92.2% perform biopsies in all segments during endoscopy, just 80.9% send specimens in separate containers. Systematic endoscopic monitoring is carried out by 48.9% of practitioners. Ancillary tests such as fecal calprotectin (10.0%) and peripheral eosinophilia (19.4%) are infrequently used. The most common treatment strategies were proton pump inhibitors (44.4%) and elimination diets (40.1%), with systemic corticosteroids (17.4%), viscous budesonide (16.4%), and biologics (11.1%) being less frequently employed. There is considerable variability in clinical practice regarding non-EoE EGIDs across Latin America. These findings underscore the urgent need for consensus-based diagnostic and therapeutic guidelines and highlight the importance of ongoing medical education to improve patient care in this emerging field of pediatric gastroenterology.
Ascariasis is a helminthic infection caused by the nematode Ascaris lumbricoides and remains the most prevalent helminth infection worldwide. Although typically asymptomatic or limited to intestinal symptoms, intestinal ascariasis can present unusually as demonstrated in these two cases. The first case involves a 73-year-old male who was being treated for non-steroidal anti-inflammatory drug (NSAID) - induced upper gastrointestinal bleeding (UGIB) and was incidentally found to harbor Ascaris worms in the duodenum during endoscopy. The second case describes a 63-year-old male with decompensated liver cirrhosis who began vomiting and passing large quantities of Ascaris worms while hospitalized. Both patients responded excellently to anthelminthic therapy. The first case highlights the need to consider ascariasis in the differential diagnosis of upper gastrointestinal bleeding, either as a primary cause or in conjunction with other causes of upper GI bleeding. The second case underscores the importance of considering biliary ascariasis or ascariasis co-infection in patients with liver cirrhosis. Ascariasis continues to pose a significant public health challenge. Effective preventive strategies such as improved sanitation, enhanced personal hygiene, and routine deworming programs are crucial for reducing the disease burden and averting potentially severe complications.
The complex and heterogeneous physiological barriers of the gastrointestinal (GI) tract severely limit the efficacy of therapeutic agents for local diseases. This review comprehensively examines strategies for translating targeted drug delivery "from bench to bowel" within the GI tract. We detail the unique biological barriers across GI segments (oral cavity, esophagus, stomach, small intestine, colon) and analyze core challenges in designing effective delivery systems: payload stability, precise targeting/retention, controlled release, mucosal/epithelial penetration, and biocompatibility. The article critically evaluates recent advancements in key delivery platforms, including nanocarriers (liposomes, polymeric NPs, dendrimers, inorganic NPs), hydrogels, and microscale systems (microspheres, microneedles, microrobots), categorizing them by their targeting mechanisms: passive (e.g., the classical EPR effect in solid tumors and EPR-like permeability/retention phenomena in inflamed GI lesions), passive (e.g., EPR effect), active (ligand-mediated), and stimuli-responsive (pH, enzymes, redox, etc.). Furthermore, we highlight the transformative applications of these targeted systems in treating major GI diseases such as inflammatory bowel disease (IBD), GI cancers, and peptic ulcer disease, emphasizing their potential to enhance local efficacy while minimizing systemic toxicity. This work bridges fundamental principles with translational progress to provide a roadmap for developing clinically viable targeted therapies for GI diseases.
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Imatinib is the standard first-line therapy for chronic myeloid leukemia (CML) and is generally well tolerated. Gastrointestinal adverse effects are common; however, gastric antral vascular ectasia (GAVE) is an extremely rare complication. We report a 77-year-old woman with chronic-phase CML who developed severe upper gastrointestinal bleeding 1 month after the initiation of imatinib therapy. Endoscopy revealed classic features of GAVE, and no alternative etiology was identified. Discontinuation of imatinib resulted in complete clinical and endoscopic resolution. Clinicians should consider this rare complication in patients receiving imatinib who present with unexplained anemia or gastrointestinal bleeding.
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.
Mitochondrial diseases are rare genetic disorders that affect the body's ability to produce energy at the cellular level. Because many organs rely heavily on mitochondrial function, these diseases can cause a wide range of symptoms involving the nervous system, muscles, heart, and gastrointestinal tract. Gastrointestinal complications are common and may include difficulty swallowing, gastroparesis, and intestinal motility disorders. Although pyloric stenosis has rarely been reported, mitochondrial dysfunction affecting gastrointestinal smooth muscle and enteric neuronal function provides a plausible mechanism for the development of gastric outlet obstruction and pyloric dysfunction, leading to severely limited nutritional intake, weight loss, and malnutrition. We present the case of a young woman with a mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) variant who developed severe pyloric stenosis resulting in chronic gastric outlet obstruction and profound malnutrition. Her condition progressed to complete dependence on total parenteral nutrition (TPN) and was complicated by recurrent septicemia related to central line-associated bloodstream infections (CLABSI). After failing conservative treatment, she underwent laparoscopic hand-assisted pyloromyotomy with intraoperative esophagogastroduodenoscopy. Following surgery, her gastric emptying improved significantly, allowing her to regain weight and discontinue TPN. With her nutritional status and strength restored, she was able to resume normal activities and successfully complete her college education. This case demonstrates the significant gastrointestinal complications that can occur in mitochondrial disease and highlights the potential benefit of surgical intervention in selected patients with severe pyloric dysfunction.