Multimodal convolutional neural network-based algorithm for real-time detection and differentiation of malignant and inflammatory biliary strictures in cholangioscopy: a proof-of-concept study (with video).

Background And Aims: Deep learning algorithms gained attention for detection (computer-aided detection [CADe]) of biliary tract cancer in digital single-operator cholangioscopy (dSOC). We developed a multimodal convolutional neural network (CNN) for detection (CADe), characterization and discriminating (computer-aided diagnosis [CADx]) between malignant, inflammatory, and normal biliary tissue in raw dSOC videos. In addition, clinical metadata were included in the CNN algorithm to overcome limitations of image-only models.

Diagnostic Accuracy and Therapeutic Efficacy of Digital Single-Operator Cholangioscopy for Biliary Lesions and Stenosis.

Background/aims: Digital single-operator cholangioscopy (dSOC) has revolutionized bile duct visualization. Interventions like electrohydraulic or laser lithotripsy, inspection of suspicious areas, and targeted biopsies have become possible quick and easy. One main indication for dSOC remains the evaluation of indeterminate biliary strictures.

White-Light or Narrow-Band Imaging Colonoscopy in Surveillance of Ulcerative Colitis: A Prospective Multicenter Study.

Background & Aims: Early detection of neoplastic lesions is essential in patients with long-standing ulcerative colitis but the best technique of colonoscopy still is controversial.

Methods: We performed a prospective multicenter study in patients with long-standing ulcerative colitis. Two colonoscopies were performed in each patient within 3 weeks to 3 months.

Pre-study protocol MagPEP: a multicentre randomized controlled trial of magnesium sulphate in the prevention of post-ERCP pancreatitis.

Background: Acute pancreatitis is the most common complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In spite of continuing research, no pharmacologic agent capable of effectively reducing the incidence of ERCP-induced pancreatitis has found its way into clinical practise. A number of experimental studies suggest that intrapancreatic calcium concentrations play an important role in the initiation of intracellular protease activation, an initiating step in the course of acute pancreatitis.

Contrast-enhanced ultrasound improves real-time imaging of ablation region during radiofrequency ablation: preliminary results.

Purpose: To assess the added value of depicting tumour microvascularisation, using dynamic contrast enhanced (CEUS), during radiofrequency ablation, as a means of achieving a complete ablation (CA) of malignant liver lesions.

Material And Methods: 18 consecutive patients (2 female, 16 male, age range 52-79 years, mean 64.1 ± 9.

Causes of bolus impaction in the esophagus.

Background: Bolus impaction in the esophagus is a common indication for emergency endoscopy. The aim of this study was to determine the most common causes of esophageal bolus impaction.

Methods: In this retrospective study, data of 54 patients (41 male, 13 female) with bolus impaction in the esophagus were analyzed.

[69 year-old patient with chronic abdominal pain and anemia in neurofibromatosis].

The case of a patient with neurofibromatosis type 1 with chronic abdominal pain and iron deficiency anemia is described. Diagnostic procedures including esophagogastroduodenoscopy and ileocolonoscopy did not disclose a definitive cause. CT scan and MRI revealed multiple intraluminal tumors in the small bowel, especially in the ileum.

[Acute upper gastrointestinal bleeding after coronary intervention in acute myocardial infarction].

History And Admission Findings: A 73-year-old man with NSTEMI (non-ST segment elevation myocardial infarction) underwent coronary angiography and an in-stent restenosis and thrombosis in ramus circumflexus was found. A drug-eluting stent (DES) was implanted. 12 h after intervention during threefold platelet inhibition the patient presented a gastrointestinal bleeding with melena and the hemoglobin level dropped from 15.

Gastrointestinal manifestation of systemic sclerosis--thickening of the upper gastrointestinal wall detected by endoscopic ultrasound is a valid sign.

Objective: Gastrointestinal (GI) tract involvement has been observed in the majority of patients with SSc. This has been attributed to an accumulation of extracellular matrix within the GI walls. We visualized the walls of the oesophagus, stomach and duodenum with its layers and measured the thickness in SSc patients and control patients utilizing endoscopic ultrasound (EUS).

Contrast-enhanced ultrasound in diagnosing liver malignancy.

Purpose: The use of contrast enhancers has widened the possibilities of sonographic imaging, and allows the differentiation of characteristic enhancement patterns leading to diagnosis in focal liver lesions. The aim of our study was to evaluate contrast ultrasound signs in diagnosing malignant liver lesions.

Methods: 86 patients with 100 solid liver lesions were enrolled.

Visual characteristics of the papilla to estimate cannulation of the common bile duct - a pilot study.

Objectives: Performance of endoscopic retrograde cholangiography (ERC) depends mainly on the skills of the examiner, but also on anatomical variants. The aim of the study was to investigate patient- and papilla-related factors for the successful selective cannulation of the common bile duct (CBD).

Patients And Methods: 50 patients with a papilla with no prior sphincterotomy needing an ERC were enrolled.

[Impaction of a "sausage bread" in the esophagus--first manifestation of an eosinophilic esophagitis in a 17-year-old patient].

A 17-year-old patient was transferred to the emergency room with an impacted food bolus by colleagues from the Department of Otorhinolaryngology. The examination of ear, nose and throat revealed significant amounts of saliva in both recessus piriformis, a radiologic examination of the esophagus showed a foreign body with a diameter of 1.6 cm in the region of the transitional zone of esophagus and stomach with a support level of the contrast medium.

Complicated wireless capsule enteroscopy in a patient with Crohn's disease.

An 18-year-old male experienced a first episode of Crohn's disease with inflammation of the colon, stenosis of small intestine and a fistula of the anal sphincter. After resection of the fistula and 30 cm of proximal ileum the patient remained free of symptoms under medication with azathioprine and mesalazine for 6 years. Then, blood in the stool occurred.

A new grading system to evaluate the risk of endoscopic retrograde cholangiopancreatography.

Background: The aim of our study was to develop a system to grade the risk of the procedures summarized under the term endoscopic retrograde cholangiopancreatography (ERCP).

Methods: In a controlled prospective study, we evaluated the early complications of ERCP in 526 consecutive patients at a single endoscopy center in a defined period. The relation between endoscopic procedures and related complications was analyzed for significance.

Continuous non-invasive arterial pressure technique improves patient monitoring during interventional endoscopy.

Introduction: Close monitoring of arterial blood pressure (BP) is a central part of cardiovascular surveillance of patients at risk for hypotension. Therefore, patients undergoing diagnostic and therapeutic procedures with the use of sedating agents are monitored by discontinuous non-invasive BP measurement (NIBP). Continuous non-invasive BP monitoring based on vascular unloading technique (CNAP, CN Systems, Graz) may improve patient safety in those settings.

Trimming of a Broken Migrated Biliary Metal Stent with the Nd:YAG Laser.

Biliary metal stents are a permanent solution for bile duct stenosis. Complications can arise when the stent migrates, breaks or is overgrown by tumour. The following case demonstrates how a Nd:YAG laser can be used to solve these problems.

Microcirculation and perfusion with contrast enhanced ultrasound (CEUS) in Crohn's disease: first results with linear contrast harmonic imaging (CHI).

Aim: To evaluate a newly introduced high resolution linear transducer for vascularization and mural perfusion assessment using contrast harmonic imaging (CHI) with quantitative time intensity curve analysis (TIC) in patients with active Crohn's disease (CD).

Material And Methods: We prospectively evaluated 14 consecutive patients (7 women, 7 males, age range 19-42 years, median 28 years) with histologically proven CD having an acute episode of the disease applying contrast enhanced MRI and high resolution ultrasound. For the ultrasound we used a newly introduced high resolution linear multi-frequency transducer (6-9 MHz, Logiq 9, GE).

Endoscopic retrograde cholangiography of a hepaticojejunostomy using double balloon enteroscopy.

Examination of a biliodigestive anastomosis presents a diagnostic and therapeutic challenge. Visualization of biliodigestive anastomosis and endoscopic retrograde cholangiography with intervention is possible with a double balloon enteroscope.