Aims Endoscopic ultrasound (EUS) has emerged as a powerful diagnostic and therapeutic tool in gastroenterology, providing detailed images of the structure's layers, as well as nearby structures. However, EUS is operator-dependent and variability in operator proficiency results in discrepancies in diagnostic accuracy. Artificial intelligence (AI) can be trained to process and interpret EUS images in real-time, potentially mitigating the operator-dependent variability and improving diagnostic accuracy. Moreover, AI can analyze vast datasets offering a level of consistency and efficiency that is challenging for human operators to match. The aim of this study is to compare the diagnostic accuracy of an AI-based model (AIWorks-EUS, mdconsgroup, Guayaquil, Ecuador) against that of expert and nonexpert gastrointestinal endoscopists visual impression in the identification of normal anatomical structures during EUS procedures.
Abstract Background Pancreatic cancer (PC) remains a significant healthcare challenge due to its aggressive nature and poor prognosis. The current gold standard that combines imaging modalities, endoscopy, and biopsies has limited diagnostic efficacy due to various shortcomings. Methods We propose a feasibility study for the use of a bioimpedance biomarker to detect PC. The biomarker was evaluated in a double blind study on ex vivo pancreata of mice: 15 LSL-Kras G12D ; LSL-p53 R172H ; Pdx1-Cre, 2 LSL-Kras G12D , and 9 wild type controls (Study 1). To determine if the biomarker can distinguish between PC and acute pancreatitis (AP), we challenged it with 18 cerulein-induced AP and 6 saline-injected controls (Study 2). Results The results from Study 1 showed 100% specificity and 94% sensitivity against histopathology outcomes; for Study 2 all AP and saline-injected pancreases were diagnosed as non-cancerous. Regression analysis revealed a positive correlation between biomarker and pathologically analyzed cancer-induced fibrosis (r(24)= 0.73 ( p <0.001)). Conclusion These findings demonstrate the potential of this bioimpedance biomarker as a diagnostic tool for PC.
Malignant digestive-respiratory fistula (DRF) is associated with significant morbidity and mortality. In addition to the other recognized advantages of expandable stents, coated expandable stents can seal off DRF.Eight men and five women, mean age 52 yr, with endoscopically and radiographically proven DRF were treated with the coated Wallstent (Schneider). Eleven had dysphagia, 11 postprandial cough, and two required mechanical ventilation. The DRF was proximal in four, mid-esophageal in seven, and distal in two. Two had a normal esophagus and 11 had stricture.Stent placement and DRF obliteration were successful in all. During a median follow-up of 157 days (range 30-423), no recurrent DRF were noted. The median dysphagia score improved from 3.4 to 1.3. Respiratory symptoms were corrected in all. A gastrostomy tube was required in three. The only complications were transient chest pain and foreign body sensation in three patients and constant sensation of belching in one. There was no procedure-related mortality.In this small group of patients, the coated Wallstent demonstrated excellent palliation of DRF with minimal morbidity and no mortality.
