Clinical usefulness of linked color imaging in identifying Helicobacter pylori infection:A systematic review and meta-analysis

BACKGROUND Accurate diagnosis of Helicobacter pylori(H.pylori)infection status is a crucial premise for eradication therapy,as well as evaluation of risk for gastric cancer.Recent progress on imaging enhancement endoscopy(IEE)made it possible to not only detect precancerous lesions and early gastrointestinal cancers but also to predict H.pylori infection in real time.As a novel IEE modality,linked color imaging(LCI)has exhibited its value on diagnosis of lesions of gastric mucosa through emphasizing minor differences of color tone.AIM To compare the efficacy of LCI for H.pylori active infection vs conventional white light imaging(WLI).METHODS PubMed,Embase,Embase and Cochrane Library were searched up to the end of April 11,2022.The random-effects model was adopted to calculate the diagnostic efficacy of LCI and WLI.The calculation of sensitivity,specificity,and likelihood ratios were performed;symmetric receiver operator characteristic(SROC)curves and the areas under the SROC curves were computed.Quality of the included studies was chosen to assess using the quality assessment of diagnostic accuracy studies-2 tool.RESULTS Seven original studies were included in this study.The pooled sensitivity,specificity,positive likelihood rate,and negative likelihood rate of LCI for the diagnosis of H.pylori infection of gastric mucosa were 0.85[95%confidence interval(CI):0.76-0.92],0.82(95%CI:0.78-0.85),4.71(95%CI:3.7-5.9),and 0.18(95%CI:0.10-0.31)respectively,with diagnostic odds ratio=26(95%CI:13-52),SROC=0.87(95%CI:0.84-0.90),which showed superiority of diagnostic efficacy compared to WLI.CONCLUSION Our results showed LCI can improve efficacy of diagnosis on H.pylori infection,which represents a useful endoscopic evaluation modality for clinical practice.

New hope for esophageal stricture prevention:A prospective singlecentertrial on acellular dermal matrix

BACKGROUNDGiven the high incidence of esophageal cancer in China,an increasing number ofpatients there are undergoing endoscopic mucosal dissection(ESD).Although the5-year survival rate after ESD can exceed 95%,esophageal stricture,the mostcommon and serious postoperative complication,affects the long-term prognosisof patients and the quality of life.Autologous mucosal grafts have proven to besuccessful in preventing stricture after ESD for early esophageal cancer.AIMTo examine the viability of acellular dermal matrix(ADM)as an alternative to autologous mucosa for the prevention of stricture after ESD.METHODSThis is a prospective,single-center,controlled study.Consecutive patients who underwent ESD surgery and werewilling to undergo autologous mucosal transplantation were recruited between January 1 and December 31,2017.Consecutive patients who underwent ESD surgery and were willing to undergo ADM transplantation wererecruited between January 1 to December 31,2019.A final three-year follow-up of patients who receivedtransplants was conducted.RESULTSBased on the current incidence of esophageal stricture,the sample size required for both the autologous mucosalgraft group and the ADM group was calculated to be 160 cases.Due to various factors,a total of 20 patients withautologous mucosal grafts and 25 with ADM grafts were recruited.Based on the inclusion exclusion andwithdrawal criteria,9 patients ultimately received autologous mucosal grafts and completed the follow-up,while11 patients received ADM grafts and completed the follow-up.Finally,there were 2 cases of stenosis in theautologous mucosal transplantation group with a stenosis rate of 22.22%and 2 cases of stenosis in the ADMtransplantation group with a stenosis rate of 18.18%,with no significant difference noted between the groups(P=0.94).CONCLUSIONIn this prospective,single-center,controlled trial,we compared the effectiveness of autologous mucosatransplantation and ADM for the prevention of esophageal stricture.Due to certain condition limitations,we wereunable to recruit sufficient subjects meeting our target requirements.However,we implemented strict inclusion,exclusion,and withdrawal criteria and successfully completed three years of follow-up,resulting in valuableclinical insights.Based on our findings,we hypothesize that ADM may be similarly effective to autologousmucosal transplantation in the prevention of esophageal stricture,offering a comparable and alternative approach.This study provides a new therapeutic idea and direction for the prevention of esophageal stricture.

Role of endoscopic ultrasound in idiopathic pancreatitis

Recurrent acute pancreatitis(RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. The initial evaluation fails to detect the cause of RAP in 10%-30% of patients, whose condition is classified as idiopathic RAP(IRAP). Idiopathic acute pancreatitis(IAP) is a diagnostic challenge for gastroenterologists. In view of associated morbidity and mortality, it is important to determine the aetiology of pancreatitis to provide early treatment and prevent recurrence. Endoscopic ultrasound(EUS) is an investigation of choice for imaging of pancreas and biliary tract. In view of high diagnostic accuracy and safety of EUS, a EUS based management strategy appears to be a reasonable approach for evaluation of patients with a single/recurrent idiopathic pancreatitis. The most common diagnoses by EUS in IAP is biliary tract disease. The present review aims to discuss the role of EUS in the clinical management and diagnosis of patients with IAP. It elaborates the diagnostic approach to IAP in relation to EUS and other different modalities. Controversial issues in IAP like when to perform EUS, whether to perform after first episode or recurrent episodes, comparison among different investigations and the latest evidence significance are detailed.