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Artificial Intelligence (AI)-Guided vs Routine Colonoscopy for Colorectal Polyps: A Meta-Analysis of Recent Randomized Controlled Trials [Meeting Abstract]

Deliwala, S; Hamid, K; Barbarawi, M; Zayed, Y; Kandel, P; Lakshman, H; Malladi, S; Singh, A; Bachuwa, G; Gurvits, G; Chawla, S
INTRODUCTION: Colorectal cancer (CRC) remains a leading cause of cancer-related death in the United States. While colonoscopy based screening is the most effective of all CRC prevention strategies, it is operator dependent and can result in missed lesions, which may contribute to interval cancer. Incorporation of artificial intelligence (AI) to routine colonoscopy has been investigated in several small studies. In this meta-analysis, we attempt to collate evidence from recent randomized controlled trials (RCTs) to further define the role of AI in colonoscopy based CRC screening.
METHOD(S): A comprehensive search of MEDLINE, EMBASE, CENTRAL, and ClinicalTrials.gov from inception through May 2020 was completed. Pooled statistics using bivariate random-effects, odds ratio for binary outcomes, and standardized difference in means for continuous outcomes were used. Primary outcomes were Adenoma Detection Rate (ADR) and Polyp Detection Rate (PDR). Secondary outcomes were mean adenomas and polyps/procedure, withdrawal (WT) and cecal intubation times (CIT), and adequacy of bowel preparation. Post-hoc sensitivity analysis and subgroup analyses for adenomas and polyps was completed.
RESULT(S): 6 RCTs were included. Of 4996 patients, 2487 had AI-assisted, and 2509 had routine colonoscopies. Mean age was 51.99 +/- 4.43 years, 51% of males. AI had higher ADRs (P = 0.00) and PDRs (P = 0.00) [Figure 1]. Similar findings were noted for mean number of adenomas and polyps/procedure. Mean WTs favored AI when biopsy times were included. CIT and adequacy of bowel preparation were similar in both groups [Figure 2]. On subgroup analysis, AI systems had significantly better ADRs and PDRs in the transverse colon. AI had higher detection rates for adenomas < 5 mm (P = 0.00) and polyps < 10 mm (P = 0.00). However, routine colonoscopies outperformed AI in detecting pedunculated polyps (P = 0.00). PDRs had no differences based on shape. Sensitivity analysis remained unchanged for ADR, PDR, mean adenomas or polyps detected per procedure and WTs that included biopsies. Begg's funnel plots were relatively symmetrical for ADR (P - 0.25) and PDR (P - 0.20) [Figure 3].
CONCLUSION(S): The use of AI has the potential to improve the sensitivity of colonoscopy based screening. Colonoscopies using AI algorithms demonstrated significantly improved detection rates for adenomas and polyps. However, research and advancements are needed to refine the AI systems to detect pedunculated polyps and incorporate optical diagnosis into the algorithms
EMBASE:633657781
ISSN: 1572-0241
CID: 4720532

Black Esophagus Trends Across American College of Gastroenterology (ACG) Scientific Meetings over a Decade: 2010-2020 [Meeting Abstract]

Deliwala, S; Wiggins, B T; Ponnapalli, A; Hussain, M; Beere, T; Kunaprayoon, L; Lakshman, H; Obeid, M; Bala, A; Gurvits, G
INTRODUCTION: Acute Esophageal Necrosis (AEN) is a rare syndrome characterized by a diffuse necrotic black appearing mucosa preferentially affecting the distal esophagus with various proximal extensions and an abrupt demarcation at the GE junction. Its etiology is multifactorial, a combination of ischemic injury, massive reflux of gastric contents, and impaired esophageal mucosal defense systems. AEN incidence is 0.01-0.28% in selected studies, and population-based information regarding AEN is sparse. Presentation in literature is typically based on published reports, but scientific abstracts are often overlooked. We aim to present a systematic review of a large number of previously presented abstracts from 2010 to 2020 ACG annual meetings.
METHOD(S): We identified all ACG published abstracts over the past ten years using "acute esophageal necrosis" OR "black esophagus" OR "acute necrotizing esophagitis" across databases (Figure 1).
RESULT(S): Amongst 89 abstracts, 97 patients were identified. Mean age was 63.68 +/- 14 years, while 65% were males. Most common presenting features were hematemesis (34%), melena (22%), coffee-grounded emesis (16%), abdominal pain (11%), dysphagia (9%) and odynophagia (6%). Risk factors included diabetes mellitus (39%), CKD (33%), HTN (32%), cirrhosis (25%), alcohol use (23%), CAD (18%) and cancer (18%). Patients received an EGD within 3.41 +/- 10.34 days from symptom onset. Over 95% of cases were confirmed visually on endoscopy and remaining on autopsy. Affected segments were middle-distal (34%), pan-esophageal (28%), distal (20%), middle (5%), while proximal was seen in less than 1%. Histology findings uniformly confirmed necrosis, although biopsies were not performed in 54%. Majority received medical management with PPIs (80%), antibiotics (43%), and sucralfate (12%). Patients treated medically remained NPO for 5 +/- 2.52 days, with 9% receiving TPN. Follow-up endoscopies were seen in 32%, with a mean of 31.84 +/- 64.95 days. Majority demonstrated significant improvement, with complete resolution in 10%, as early as 3 days. Complications included perforation (18%), strictures (5%) and infections (4%), and a mortality rate of 23%.
CONCLUSION(S): AEN syndrome is increasingly being reported as awareness increases, with the majority of all ACG abstracts being published over the past decade. Patients with chronic diseases are more commonly afflicted. Endoscopy is diagnostic. Increased awareness of the disease may lead to a rise in prevalence
EMBASE:633657143
ISSN: 1572-0241
CID: 4720572

Acute Esophageal Necrosis (Gurvits Syndrome) Presenting as Globus and Altered Phonation

Deliwala, Smit S; Bala, Areeg; Haykal, Tarek; Elbedawi, Mamoon M; Bachuwa, Ghassan; Gurvits, Grigoriy E
BACKGROUND Acute esophageal necrosis (AEN), also known as black esophagus or Gurvits syndrome, is an infrequently seen clinical condition distinguishable by a visually striking endoscopic appearance of necrotic esophageal mucosa that involves the distal esophagus with proximal extensions ending at the gastroesophageal junction. Since its early recognition pathologically in the 1960s and endoscopically in the 1990s, AEN, despite its rarity, is being increasingly recognized as a demonstratable cause of upper gastrointestinal bleeding. Cases of pan-esophageal necrosis are sparsely reported, leaving management guidance to isolated case reports. CASE REPORT An 80-year-old female smoker with advanced chronic obstructive pulmonary disease presented with signs and symptoms of acute pharyngitis and globus sensation that had been evolving over the preceding weeks. An esophagogastroduodenoscopy revealed circumferential necrotic mucosa encircling the entire lumen of the esophagus. The patient was made nil-per-os and started on high-dose anti-reflux therapy with adequate hemodynamic resuscitation. CONCLUSIONS AEN is multifactorial but primarily a combination of decreased tissue perfusion and a massive influx of gastric contents in settings of impaired local defense barriers. Despite its dramatic presentation, the majority of cases resolve with conservative medical management, foregoing surgical interventions.
PMID: 32881843
ISSN: 1941-5923
CID: 4583462

Nuances in diagnosis and management of acute esophageal necrosis

Gurvits, Grigoriy E
PMCID:7315703
PMID: 32624671
ISSN: 1108-7471
CID: 4518112

Black Esophagus in the Setting of Alcohol Abuse after External Beam Radiation [Case Report]

Deliwala, Smit S; Lakshman, Harini; Congdon, Douglas D; Elbedawi, Mamoon M; Bachuwa, Ghassan; Gurvits, Grigoriy E
Acute esophageal necrosis (AEN), black esophagus, or Gurvits syndrome is a rare clinical disorder characterized by a striking endoscopic appearance of necrotic esophageal mucosa, universally affecting the distal esophagus and ending abruptly at the gastroesophageal junction. It has been gaining traction as a demonstrable cause of upper gastrointestinal bleeding in the 21st century. Its pathophysiology is multifactorial affecting men and the elderly disproportionally, with a mortality rate nearing 36%. AEN has been associated with numerous conditions in the past, and we aim to present an unusual case of AEN on the setting of chronic alcohol use.
PMCID:7506255
PMID: 32999646
ISSN: 1662-0631
CID: 4615852

Important points on black oesophagus

Gurvits, Grigoriy E
PMID: 32299287
ISSN: 1758-1133
CID: 4383762

When gastroenterology meets radiology: air under right diaphragm

Gurvits, Grigoriy E
PMCID:7043082
PMID: 32133121
ISSN: 2041-4137
CID: 4339802

Metastatic Cutaneous Squamous Cell Carcinoma of the Colon Presenting as Transfusion-Dependent Hematochezia [Case Report]

Dornblaser, David; Hajdu, Cristina; Rosenberg, Jonathan; Gurvits, Grigoriy
Squamous cell carcinoma (SCC) of the colon is an exceedingly rare clinical diagnosis with few cases reported in the literature. We report a case of a 61-year-old man with a medical history of cutaneous SCC of the penis who presented with hematochezia and was found to have metastatic SCC to the distal transverse colon. To our knowledge, this is the first case of colonic SCC presenting as a metastatic disease from a primary penile site.
PMCID:7145165
PMID: 32309497
ISSN: 2326-3253
CID: 4402062

The Use of Cannabinoids in Colitis: Hyperemesis Syndrome

Fradkov, Elena; Gurvits, Grigoriy E
PMID: 29912339
ISSN: 1536-4844
CID: 3158032

Acute Esophageal Necrosis Following Orthotopic Liver Transplantation [Case Report]

Planchard, Jeffrey A; Dikstein, Anna F; Koveleskie, Joseph; Cohen, Ari; Gurvits, Grigoriy E
Acute esophageal necrosis (AEN) is a rare syndrome characterized by circumferential blackening of the esophageal mucosa extending from the gastroesophageal (GE) junction and affecting variable length of the organ. Its etiology is largely multifactorial including ischemic compromise, massive reflux of gastric secretions, and decreased mucosal defense. Endoscopy is diagnostic. Clinical management requires treatment of underlying condition, nil-per-os restriction, and anti-acids. Esophageal stricture or stenosis may be seen as late complication, managed symptomatically with dilatation. Mortality is high and related to associated medical conditions. We present the first case of AEN following orthotopic liver transplantation.
PMCID:6472871
PMID: 31032150
ISSN: 2168-8184
CID: 3854302