Emerging molecules,tools,technology,and future of surgical knife in gastroenterology

The 21^(st) century has started with several innovations in the medical sciences,with wide applications in health care management.This development has taken in the field of medicines(newer drugs/molecules),various tools and technology which has completely changed the patient management including abdominal surgery.Surgery for abdominal diseases has moved from maximally invasive to minimally invasive(laparoscopic and robotic)surgery.Some of the newer medicines have its impact on need for surgical intervention.This article focuses on the development of these emerging molecules,tools,and technology and their impact on present surgical form and its future effects on the surgical intervention in gastroenterological diseases.

Artificial intelligence:Applications in critical care gastroenterology

Gastrointestinal(GI)complications frequently necessitate intensive care unit(ICU)admission.Additionally,critically ill patients also develop GI complications requiring further diagnostic and therapeutic interventions.However,these patients form a vulnerable group,who are at risk for developing side effects and complications.Every effort must be made to reduce invasiveness and ensure safety of interventions in ICU patients.Artificial intelligence(AI)is a rapidly evolving technology with several potential applications in healthcare settings.ICUs produce a large amount of data,which may be employed for creation of AI algorithms,and provide a lucrative opportunity for application of AI.However,the current role of AI in these patients remains limited due to lack of large-scale trials comparing the efficacy of AI with the accepted standards of care.

Will artificial intelligence reach any limit in gastroenterology?

Endoscopy is the cornerstone in the management of digestive diseases.Over the last few decades,technology has played an important role in the development of this field,helping endoscopists in better detecting and characterizing luminal lesions.However,despite ongoing advancements in endoscopic technology,the incidence of missed pre-neoplastic and neoplastic lesions remains high due to the operator-dependent nature of endoscopy and the challenging learning curve associated with new technologies.Artificial intelligence(AI),an operator-independent field,could be an invaluable solution.AI can serve as a“second observer”,enhancing the performance of endoscopists in detecting and characterizing luminal lesions.By utilizing deep learning(DL),an innovation within machine learning,AI automatically extracts input features from targeted endoscopic images.DL encompasses both computer-aided detection and computer-aided diagnosis,assisting endoscopists in reducing missed detection rates and predicting the histology of luminal digestive lesions.AI applications in clinical gastrointestinal diseases are continuously expanding and evolving the entire digestive tract.In all published studies,real-time AI assists endoscopists in improving the performance of non-expert gastroenterologists,bringing it to a level comparable to that of experts.The development of DL may be affected by selection biases.Studies have utilized different AI-assisted models,which are heterogeneous.In the future,algorithms need validation through large,randomized trials.Theoretically,AI has no limit to assist endoscopists in increasing the accuracy and the quality of endoscopic exams.However,practically,we still have a long way to go before standardizing our AI models to be accepted and applied by all gastroenterologists.

Clinical Analysis of Common Irrational Gastroenterology Medication Problems in The Gastroenterology Department

Objective: To investigate and analyze the irrational problems of common gastroenterology medications applied to gastroenterology patients during treatment, and to develop and implement countermeasures. Methods: This study included 60 patients admitted to the Department of Gastroenterology from January 2021 to December 2023 who were randomly divided into a control group (conventional drug management) and an observation group (targeted drug treatment), of 30 cases each. After the implementation of different management methods, the occurrence of irrational drug use and the incidence of adverse reactions between both groups were compared and statistically analyzed. Results: The incidence of irrational medication in the observation group (13.33%) was lower than that in the control group (40.00%) (P < 0.05). The occurrence of adverse reactions in the observation group (10.00%) was lower than that of the control group (36.67%) after treatment (P < 0.05). The observation group had a higher level of satisfaction after treatment (90.00%) as compared to the control group (66.67%) (P < 0.05). Conclusion: Implementation of targeted drug treatment for gastroenterology patients reduced the incidence of irrational medication use, reduced adverse reactions, and improved patient satisfaction.

Challenges involved in the application of artificial intelligence in gastroenterology:The race is on!

Gastroenterology is a particularly data-rich field,generating vast repositories of data that are a fruitful ground for artificial intelligence(AI)and machine learning(ML)applications.In this opinion review,we initially elaborate on the current status of the application of AI/ML-based software in gastroenterology.Currently,AI/ML-based models have been developed in the following applications:Models integrated into the clinical setting following real-time patient data flagging patients at high risk for developing a gastrointestinal disease,models employing non-invasive parameters that provide accurate diagnoses aiming to either replace,minimize,or refine the indications of endoscopy,models utilizing genomic data to diagnose various gastrointestinal diseases,computer-aided diagnosis systems facilitating the interpretation of endoscopy images,models to facilitate treatment allocation and predict the response to treatment,and finally,models in prognosis predicting complications,recurrence following treatment,and overall survival.Then,we elaborate on several challenges and how they may negatively impact the widespread application of AI in healthcare and gastroenterology.Specifically,we elaborate on concerns regarding accuracy,cost-effectiveness,cybersecurity,interpretability,oversight,and liability.While AI is unlikely to replace physicians,it will transform the skillset demanded by future physicians to practice.Thus,physicians are expected to engage with AI to avoid becoming obsolete.

Application of artificial intelligence in gastroenterology

Artificial intelligence(AI) using deep-learning(DL) has emerged as a breakthrough computer technology. By the era of big data, the accumulation of an enormous number of digital images and medical records drove the need for the utilization of AI to efficiently deal with these data, which have become fundamental resources for a machine to learn by itself. Among several DL models, the convolutional neural network showed outstanding performance in image analysis. In the field of gastroenterology, physicians handle large amounts of clinical data and various kinds of image devices such as endoscopy and ultrasound. AI has been applied in gastroenterology in terms of diagnosis,prognosis, and image analysis. However, potential inherent selection bias cannot be excluded in the form of retrospective study. Because overfitting and spectrum bias(class imbalance) have the possibility of overestimating the accuracy,external validation using unused datasets for model development, collected in a way that minimizes the spectrum bias, is mandatory. For robust verification,prospective studies with adequate inclusion/exclusion criteria, which represent the target populations, are needed. DL has its own lack of interpretability.Because interpretability is important in that it can provide safety measures, help to detect bias, and create social acceptance, further investigations should be performed.

Current status of gene therapy in gastroenterology

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This year's Nobel Prize to gastroenterology:Robin Warren and Barry Marshall awarded for their discovery of Helicobacter pylori as pathogen in the gastrointestinal tract

TO THE EDITORPeptic ulcer disease is a major health care concern in the society today, in view of personal suffering as well as economical health care costs.

Magnifying endoscopy in upper gastroenterology for assessing lesions before completing endoscopic removal

Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at diagnosis.Endoscopic submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as curative treatments for many early-stage GI lesions in recent years.The technologies have been widely accepted in many Asian countries because they are minimally invasive and supply thorough histopathologic evaluation of the specimens.However,before engaging in endoscopic therapy,an accurate diagnosis is a precondition to effecting the complete cure of the underlying malignancy or carcinoma in situ.For the past few years,many new types of endoscopic techniques,including magnifying endoscopy with narrow-band imaging (MENBI),have emerged in many countries because these methods provide a strong indication of early lesions and are very useful in determining treatment options before ESD or EMR.However,to date,there is no comparable classification equivalent to "Kudo's Pit Pattern Classification in the colon",for the upper GI,there is still no clear internationally accepted classification system of magnifying endoscopy.Therefore,in order to help unify some viewpoints,here we will review the defining optical imaging characteristics and the current representative classifications of microvascular and microsurface patterns in the upper GI tract under ME-NBI,describe the accurate relationship between them and the pathological diagnosis,and their clinical applications prior to ESD or en bloc EMR.We will also discuss assessing the differentiation and depth of invasion,defying the lateral spread of involvement and targeting biopsy in real time.

Artificial intelligence in gastroenterology: A state-of-the-art review

The development of artificial intelligence(AI)has increased dramatically in the last 20 years,with clinical applications progressively being explored for most of the medical specialties.The field of gastroenterology and hepatology,substantially reliant on vast amounts of imaging studies,is not an exception.The clinical applications of AI systems in this field include the identification of premalignant or malignant lesions(e.g.,identification of dysplasia or esophageal adenocarcinoma in Barrett’s esophagus,pancreatic malignancies),detection of lesions(e.g.,polyp identification and classification,small-bowel bleeding lesion on capsule endoscopy,pancreatic cystic lesions),development of objective scoring systems for risk stratification,predicting disease prognosis or treatment response[e.g.,determining survival in patients post-resection of hepatocellular carcinoma),determining which patients with inflammatory bowel disease(IBD)will benefit from biologic therapy],or evaluation of metrics such as bowel preparation score or quality of endoscopic examination.The objective of this comprehensive review is to analyze the available AI-related studies pertaining to the entirety of the gastrointestinal tract,including the upper,middle and lower tracts;IBD;the hepatobiliary system;and the pancreas,discussing the findings and clinical applications,as well as outlining the current limitations and future directions in this field.

Endoscopic ultrasound in gastroenterology:From diagnosis to therapeutic implications

Since its advent in 1980,the scope of endoscopic ultrasound(EUS)has grown to include a wide range of indications,and it is now being incorporated as an integral part of everyday practice in the field of gastroenterology.Its use is extending from an adjuvant imaging aid to utilization as a therapeutic tool for various gastrointestinal disorders.EUS was first used to visualize remote organs,such as the pancreas and abdominal lymph nodes.When fine needle aspiration was introduced,the indications for EUS expanded to include tissue sampling for diagnostic purposes.At the same time,the needle can be used to convey a potential therapy to the internal organs,allowing access to remote sites.In this review,we aim to highlight the expanding spectrum of EUS indications and uses in the field of gastroenterology.

Challenges and opportunities in the application of artificial intelligence in gastroenterology and hepatology

Artificial intelligence(AI)is an umbrella term used to describe a cluster of interrelated fields.Machine learning(ML)refers to a model that learns from past data to predict future data.Medicine and particularly gastroenterology and hepatology,are data-rich fields with extensive data repositories,and therefore fruitful ground for AI/ML-based software applications.In this study,we comprehensively review the current applications of AI/ML-based models in these fields and the opportunities that arise from their application.Specifically,we refer to the applications of AI/ML-based models in prevention,diagnosis,management,and prognosis of gastrointestinal bleeding,inflammatory bowel diseases,gastrointestinal premalignant and malignant lesions,other nonmalignant gastrointestinal lesions and diseases,hepatitis B and C infection,chronic liver diseases,hepatocellular carcinoma,cholangiocarcinoma,and primary sclerosing cholangitis.At the same time,we identify the major challenges that restrain the widespread use of these models in healthcare in an effort to explore ways to overcome them.Notably,we elaborate on the concerns regarding intrinsic biases,data protection,cybersecurity,intellectual property,liability,ethical challenges,and transparency.Even at a slower pace than anticipated,AI is infiltrating the healthcare industry.AI in healthcare will become a reality,and every physician will have to engage with it by necessity.

Current status of basic and clinical research studies in the field of gastroenterology in China

his article involves the major scientific advances in the field of gastroenterology in China, in which some investingations into the mechanism of diseases, new clues and new approaches to treatment are included.

Gastroenterology service in a teaching hospital in rural New Zealand, 1991-2003

AIM: To retrospectively collect inpatient and outpatient data and to assess the use of endoscopic procedures during the years 1991, 1997 and 2003 to analyse for trends. METHODS: This retrospective survey was conducted in a University-associated Gastroenterology Unit offering secondary and tertiary health care services for a population of approximately 182 000 people in Southern New Zealand. Data collected included patient contacts (inand outpatients), gastroscopic and colonoscopic investigations. RESULTS: We observed a significant increase in the absolute numbers of patient contacts over the years (1991: 2308 vs 1997: 2022 vs 2003: 2783, P < 0.0001) with inflammatory bowel disease, other diseases of the colon, anus and rectum and iron studies related disorders decreasing significantly but liver disease and constipation increasing linearly over time. The use of endoscopy services remained relatively stable but colonoscopic investigations for a positive family history of colorectal cancer increased significantly while more gastroscopies were performed for unexplained anaemia. CONCLUSION: The whole spectrum of gastroenterology contacts was studied. A substantial proportion of colonoscopies and outpatient consultations were undertaken to screen for colorectal cancer. This proportion is likely to grow further. Our fi ndings have implications for the recruitment and training of the next generation of gastroenterologists.

Baishideng’s Reference Citation Analysis database announces the first Journal Article Influence Index of 101 core journals and a list of high-quality academic journals in gastroenterology and hepatology

After three rounds of rigorous evaluation of core journals in gastroenterology andhepatology conducted by the Reference Citation Analysis (RCA) editorial team ofBaishideng Publishing Group (Baishideng), the RCA database of Baishidengofficially released the 2022 Journal Article Influence Index (2022 JAII) of 101 corejournals in gastroenterology and hepatology, for the first time. The list of 101 corejournals can be found at: https://www.referencecitationanalysis.com/Search-Journal. Among them, the highest 2022 JAII is 48.014 and the lowest is 3.900. Thisarticle highlights the top 20 journals, describes the calculation method for the 2022JAII, the evaluation process, and the inclusion principles for journals in the RCA.These steps are the underpinning of the RCA’s empirical journal academicevaluation service by which the digital platform addresses the needs of authors toselect reliable journals for submission, readers to select high-quality literature forreading, and editors to track their own journal citation performance. As such, theRCA core journal list will serve as a useful Find-a-Journal tool. Any interestedparty is welcome to use this journal list and recommend it to their peers.

Do probiotics have a therapeutic role in gastroenterology?

Several hundred species of bacteria inhabit the gut, and affect its cell biology, morphology and homeostasis. Many bacteria are however potential pathogens, especially if the integrity of the epithelial barrier is physically or functionally breached. Conversely, the interaction between host and commensal microbes can confer important health benefits. This has led to commercial and public interest in ＇probiotics＇, live microbes principally taken as food supplements. Might probiotics also be used in disease therapy？ Experimental evidence that probiotics modulate gut physiology, particularly barrier integrity and immunological function, underpins exciting new gastroenterological research. We discuss below the scientific basis for probiotic effects and present a critical perspective for their use in relation to gastrointestinal disease.

Improved citation status of World Journal Gastroenterologym 2004: Analysis of all reference citations by WJG and citations of WJG articles by other SCI journals during 1998-2004

AIM: To determine the citation status in 2004 and the citation trend of WJG by analyzing all articles cited by WJG and all WJG articles cited by SCI journals during 1998-2004.METHODS: The total number of published articles and reference citations in WJG, authors' self-citations, WJG's self-citations, citations of WJG articles by SCI journals and inappropriate citations in WJG during 1998-2004 were statistically analyzed. Data on self-citations of the articles published between 1998 and August 2004 (Issues 1-16)were from ISI SCI-E, and data on self-citations of articles published after August 2004 (Issues 17-24) were from the WJG Editorial Office. Data on citations of WJG articles by other journals between 1998 and August 2004 were from ISI SCI-E.RESULTS: Annual number of published articles: WJG published 179, 144, 211, 174, 236, 634 and 830 articles,respectively, in 1998, 1999, 2000, 2001, 2002, 2003 and 2004. The number in 2004 increased by 594, compared to that in 2002, giving an increased rate of 251.7%. Annual references cited by WJG were 2 123, 2 125, 6 244,8 883, 11 442, 23 218 and 25 971, respectively, in 1998-2004.The average number was 31.3 per WJG article in 2004,which was less than that (48.5) in 2002, giving a reduction rate of 35.5%. Authors of WJG cited 125, 126, 343, 210,354, 310 and 470 of their own published articles,respectively, in 1998-2004. The average number of authors'self-citations was 0.57 per WJG article in 2004, which was decreased by 0.93 or 62.0%, compared with that in 2002.Annual numbers of journal's self-citations: Authors of WJG articles cited 5, 7, 373, 733, 1474, 1947 and 1412 of WJG articles, respectively, in 1998-2004. The average number of journal's self-citations was 1.70 per WJG article in 2004,which decreased by 4.55 or 72.8%. No WJG article was cited in 1998 by other SCI journals. However, the number of citations steadily increased afterwards, with 16, 18, 39,85, 372 and 580, respectively, in 1999-2004. The average number of citations by other SCI journals was 0.11, 0.09,0.22, 0.36, 0.59 and 1.06 per WJG article, respectively,1999-2004 (January-August). There was an increase by 582%, when comparing the citation numbers between 2004and 2002. Annual WJG self-citation rates and citation rates of WJG articles by other SCI journals: WJG self-citation rates were 30.43%, 95.40%, 95.07%, 94.55%, 83.96%and 67.47%, respectively, in 1999-2004 (January-August).Compared with 2002, the self-citation rate in 2004decreased by 26.87%. The citation rates of WJG articles by other SCI journals were 69.57%, 4.60%, 4.93%, 5.45%,16.04%, and 32.53%, respectively, in 1999-2004 (January-August). Compared with 2002, the citation rate in 2004decreased by 26.87%. There were 8, 19, 218, 274, 461,698 and 574 inappropriate citations, respectively, in 1998-2004.The average inappropriate citation in 2004 was 0.69 per article, which represents a decrease of 1.26, compared with that in 2002. Inappropriate citations were mostly those with the differences between the two sides of the hyphens of 5-9, and the proportions of inappropriate citations within the three subsections of the differences between the two sides of the hyphens (5-9, 10-19, and ＞=20) were approximately 7:2:1. In addition, inappropriate citations mostly occurred with frequencies of 1-3 in the articles,and the proportion of inappropriate citations within the two frequency subsections (1-3 and ＞3) have been approximately 4:1 since 1999.CONCLUSIONS: In 2004, the average number of reference citations, authors' self-citations and journal's self-citations were 31.3, 0.57 and 1.70 per article, respectively, which represents a decrease in the numbers by 35.5%. 62.0%,and 72.8% respectively compared to the corresponding numbers in 2002. WJG self-citation rate was 67.47% in 2004 (January-August), which was a decrease by26.87%,compared with 2002. The citation rate of WJG articles by other SCI journals was 32.53% in 2004 (January-August),an increase of 26.87%, compared to 2002. There were 574inappropriate citations in 2004, with an average of 0.69per article, which represents a decrease of 1.26, compared with that in 2002. These figures demonstrate that the overall citation status of WJG is improving.

Behavioral gastroenterology: An emerging system and new frontier of action

Behavioral gastroenterology is a new interdisciplinary science that explores the influence of unhealthy lifestyles and psychological factors on the digestive system and addresses the prevention,diagnosis,treatment,and rehabilitation of digestive diseases. Moreover,the concept of whole-course intervention with a focus on disease prevention and a new model of integrated therapy based on alterations of lifestyle and psychology are being gradually established. This paradigm may substantively impact the prevention and treatment of digestive diseases.

Artificial intelligence in gastroenterology and hepatology:Status and challenges

Originally proposed by John McCarthy in 1955,artificial intelligence(AI)has achieved a breakthrough and revolutionized the processing methods of clinical medicine with the increasing workloads of medical records and digital images.Doctors are paying attention to AI technologies for various diseases in the fields of gastroenterology and hepatology.This review will illustrate AI technology procedures for medical image analysis,including data processing,model establishment,and model validation.Furthermore,we will summarize AI applications in endoscopy,radiology,and pathology,such as detecting and evaluating lesions,facilitating treatment,and predicting treatment response and prognosis with excellent model performance.The current challenges for AI in clinical application include potential inherent bias in retrospective studies that requires larger samples for validation,ethics and legal concerns,and the incomprehensibility of the output results.Therefore,doctors and researchers should cooperate to address the current challenges and carry out further investigations to develop more accurate AI tools for improved clinical applications.

Single port laparoscopy in gastroenterology and hepatology: A fine step forward

Single incision laparoscopy(SIL) has become an emerging technology aiming at a further reduction of abdominal wall trauma in minimally invasive surgery. Available data is encouraging for the safe application of standardized SIL in a wide range of procedures in gastroenterology and hepatology. Compared to technically simple SIL procedures, the merit of SIL in advanced surgeries, such as liver or colorectal interventions, compared to conventional laparsocopy is self-evident without any doubt. SIL has already passed the learning curve and is routinely utilized in expert centers. This minimized approach has allowed to enter a new era of surgical management that can not be acceded without a fruitful combination of prudent training, consistent day-to-day work and enthusiastic motivation for technical innovations. Both, basic and novel technical specifics as well as particular procedures are described herein. The focus is on the most important surgical interventions in gastroenterology and aims at reviewingthe current literature and shares our experience in a high volume center.