Comparing Raman Spectroscopy-Based Artificial Intelligence to High-Definition White Light Endoscopy for Endoscopic Diagnosis of Gastric Neoplasia: A Feasibility Proof-of-Concept Study.

Background: Endoscopic assessment for the diagnosis of gastric cancer is limited by interoperator variability and lack of real-time capability. Recently, Raman spectroscopy-based artificial intelligence (AI) has been proposed as a solution to overcome these limitations.

Objective: To compare the performance of the AI-enabled Raman spectroscopy with that of high-definition white light endoscopy (HD-WLE) for the risk classification of gastric lesions.

Prospective single-arm trial on feasibility and safety of an endoscopic robotic system for colonic endoscopic submucosal dissection.

Background: The development of the EndoMaster "Endoluminal Access Surgical Efficacy" (EASE) system aims to enhance the safety and efficacy of colonic endoscopic submucosal dissection (ESD) through two flexible robotic arms. This is the first clinical trial to evaluate the performance of colorectal ESD using EndoMaster.

Method: Patients with early mucosal colorectal neoplasia that was not suitable for en bloc resection with snare-based techniques were recruited.

Partially covered versus uncovered pyloro-duodenal stents for unresectable malignant gastric outlet obstruction: Randomized controlled study.

Objectives: The aim of the current study was to compare the efficacy of partially covered duodenal stent (PCDS) vs. uncovered duodenal stent (UCDS) in patients suffering from unresectable primary malignant gastric outlet obstruction (GOO).

Methods: This was a prospective international randomized controlled study conducted in 10 high-volume institutions.

Impact of COVID-19 infection and vaccination in pancreatobiliary IgG4-related disease patients: An international multicenter study.

Background And Aim: Dedicated studies evaluating the impact of COVID-19 on outcomes of pancreatobiliary IgG4 related disease (IgG4-RD) patients are scarce. Whether COVID-19 infection or vaccination would trigger IgG4-RD exacerbation remains unknown.

Methods: Pancreatobiliary IgG4-RD patients ≥ 18 years old with active follow-up since January 2020 from nine referral centers in Asia, Europe, and North America were included in this multicenter retrospective study.

Beyond images: Emerging role of Raman spectroscopy-based artificial intelligence in diagnosis of gastric neoplasia.

White-light endoscopy with tissue biopsy is the gold standard interface for diagnosing gastric neoplastic lesions. However, misdiagnosis of lesions is a challenge because of operator variability and learning curve issues. These issues have not been resolved despite the introduction of advanced imaging technologies, including narrow band imaging, and confocal laser endomicroscopy.

Kyoto international consensus report on anatomy, pathophysiology and clinical significance of the gastro-oesophageal junction.

Objective: An international meeting was organised to develop consensus on (1) the landmarks to define the gastro-oesophageal junction (GOJ), (2) the occurrence and pathophysiological significance of the cardiac gland, (3) the definition of the gastro-oesophageal junctional zone (GOJZ) and (4) the causes of inflammation, metaplasia and neoplasia occurring in the GOJZ.

Design: Clinical questions relevant to the afore-mentioned major issues were drafted for which expert panels formulated relevant statements and textural explanations.A Delphi method using an anonymous system was employed to develop the consensus, the level of which was predefined as ≥80% of agreement.

Global variations in diagnostic guidelines for Barrett's esophagus.

Endoscopic diagnosis of gastroesophageal junction and Barrett's esophagus is essential for surveillance and early detection of esophageal adenocarcinoma and esophagogastric junction cancer. Despite its small size, the gastroesophageal junction has many inherent problems, including marked differences in diagnostic methods for Barrett's esophagus in international guidelines. To define Barrett's esophagus, gastroesophageal junction location should be clarified.

Is underwater endoscopic mucosal resection of colon polyps superior to conventional techniques? A network analysis of endoscopic mucosal resection and submucosal dissection.

Evidence from recent trials comparing conventional endoscopic mucosal resection (EMR) to underwater EMR (UEMR) have matured. However, studies comparing UEMR to endoscopic submucosal dissection (ESD) are lacking. Hence, we sought to conduct a comprehensive network meta-analysis to compare the efficacy of UEMR, ESD, and EMR.

Non-obese non-alcoholic fatty liver disease (NAFLD) in Asia: an international registry study.

Background: A significant proportion of the non-alcoholic fatty liver disease (NAFLD) population is non-obese. Prior studies reporting the severity of NAFLD amongst non-obese patients were heterogenous. Our study, using data from the largest biopsy-proven NAFLD international registry within Asia, aims to characterize the demographic, metabolic and histological differences between non-obese and obese NAFLD patients.

Changing perspectives in the training of endoscopic ultrasonography in Asia.

Training of endoscopic ultrasound (EUS) in Asia faces challenges of the ever-increasing demand for skills to handle a growing range of both diagnostic and interventional EUS procedures, and a continual shortage of EUS training programs. To keep up with the pace of development in EUS, more short-term EUS programs have been conducted across Asia in recent years. In this aspect, the Asian EUS Group (AEG) has taken the lead to fast-track the dissemination of EUS knowledge and skills across Asia through its multinational network of training centers.

Endoscopic submucosal dissection endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis.

Background: Endoscopic submucosal dissection (ESD) has shown to be effective in management of colorectal neoplasm in the Asian countries, while its implementation in Western countries where endoscopic mucosal resection (EMR) is preferred is still debatable.

Aim: To compare the surgical, histological, and oncological outcomes between ESD and EMR in the treatment of colorectal polyps, with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world.

Methods: Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing , complete resection, margin involvement, resection time, need for additional surgery, complications, and recurrence rate of ESD with EMR.

Severity of gastric intestinal metaplasia predicts the risk of gastric cancer: a prospective multicentre cohort study (GCEP).

Objective: To investigate the incidence of gastric cancer (GC) attributed to gastric intestinal metaplasia (IM), and validate the Operative Link on Gastric Intestinal Metaplasia (OLGIM) for targeted endoscopic surveillance in regions with low-intermediate incidence of GC.

Methods: A prospective, longitudinal and multicentre study was carried out in Singapore. The study participants comprised 2980 patients undergoing screening gastroscopy with standardised gastric mucosal sampling, from January 2004 and December 2010, with scheduled surveillance endoscopies at year 3 and 5.

Multinational survey on the preferred approach to management of Barrett's esophagus in the Asia-Pacific region.

Background: Major societies provide differing guidance on management of Barrett's esophagus (BE), making standardization challenging.

Aim: To evaluate the preferred diagnosis and management practices of BE among Asian endoscopists.

Methods: Endoscopists from across Asia were invited to participate in an online questionnaire comprising eleven questions regarding diagnosis, surveillance and management of BE.

Two Magnetic Sensor Based Real-Time Tracking of Magnetically Inflated Swallowable Intragastric Balloon.

This paper presents a two magnetic sensor based tracking method for a magnetically inflated intragastric balloon capsule (MIBC) which is used for obesity treatment. After the MIBC is swallowed, it is designed to be inflated inside the stomach by approaching a permanent magnet (PM) externally near the abdomen. However, if the balloon inflation is accidentally triggered while the MIBC is still in the esophagus, the esophagus will be damaged.

Artificial intelligence in upper GI endoscopy - current status, challenges and future promise.

White-light endoscopy with biopsy is the current gold standard modality for detecting and diagnosing upper gastrointestinal (GI) pathology. However, missed lesions remain a challenge. To overcome interobserver variability and learning curve issues, artificial intelligence (AI) has recently been introduced to assist endoscopists in the detection and diagnosis of upper GI neoplasia.

Extraction of intra-biliary hepatocellular carcinoma by endoscopic retrograde cholangiopancreatography.

Background: Hepatocellular carcinoma with biliary ductal invasion is rare and associated with a significantly lower survival rate.

Case Presentation: We present an unusual case of a patient with hepatocellular carcinoma and biliary invasion, who had his diagnosis confirmed by histological analysis from tissue extracted by endoscopic retrograde cholangiopancreatography. An 87-year-old male presented with a 1-day history of right upper quadrant pain and jaundice.

EndoPil: A Magnetically Actuated Swallowable Capsule for Weight Management: Development and Trials.

Intragastric balloons (IGBs), by occupying the stomach space and prolonging satiety, is a promising method to treat obesity and consequently improves its associated comorbidities, e.g. coronary heart disease, diabetes, and cancer.

Clinical adoption of robotics in endoscopy: Challenges and solutions.

The endoscope was traditionally used as a diagnostic instrument. In past decades, it has increasingly been adapted for therapeutic intents. Subsequently, the master-slave robotic concept was introduced into the field of endoscopy to potentially reduce the difficulty and complication rates of endoscopic therapeutic procedures.

Colonic endoscopic submucosal dissection using a novel robotic system (with video).

Background And Aims: One of the difficulties in performing endoscopic submucosal dissection (ESD) is the lack of retraction during submucosal dissection. The development of the EndoMaster EASE System (EndoMaster Pte Ltd, Singapore) aims to enhance the safety and efficacy of ESD through 2 flexible robotic arms for tissue retraction and dissection. This is a preclinical animal study to evaluate the performance of colorectal ESD using the latest version of the EndoMaster EASE System.