Sclerosing angiomatoid nodular transformation of spleen: an uncommon benign lesion of spleen

SANT (sclerosing angiomatoid nodular transformation) is a rare benign vascular tumour of spleen. SANT can mimic benign and malignant conditions of spleen. There are no definite radiological features. It has characteristic histopathology and immunohistochemistry findings which help us to differentiate it from other angiomatoid and tumor-like lesions. Splenectomy is the treatment of choice as it is diagnostic and therapeutic at the same time. We present a case of 22 years female with left upper quadrant pain since, 2 months. Magnetic Resonance Imaging revealed well-defined hypodense mass measuring 6.3×6.1×5.8cm in the spleen, with provisional diagnosis of hemangioma. Laproscopic splenectomy was done and a diagnosis of SANT was made on histology and immunohistochemistry. This case shows us that SANT should be considered in the differential diagnosis of splenic solid lesions

Advanced Therapeutic Gastrointestinal Endoscopy in Children – Today and Tomorrow

Gastrointestinal (GI) endoscopy plays an indispensable role in the diagnosis and management of various pediatric GI disorders. While the pace of development of pediatric GI endoscopy has increased over the years, it remains sluggish compared to the advancements in GI endoscopic interventions available in adults. The predominant reasons that explain this observation include lack of formal training courses in advanced pediatric GI interventions, economic constraints in establishing a pediatric endoscopy unit, and unavailability of pediatric-specific devices and accessories. However, the situation is changing and more pediatric GI specialists are now performing complex GI procedures such as endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography for various pancreatico-biliary diseases and more recently, per-oral endoscopic myotomy for achalasia cardia. Endoscopic procedures are associated with reduced morbidity and mortality compared to open surgery for GI disorders. Notable examples include chronic pancreatitis, pancreatic fluid collections, various biliary diseases, and achalasia cardia for which previously open surgery was the treatment modality of choice. A solid body of evidence supports the safety and efficacy of endoscopic management in adults. However, additions continue to be made to literature describing the pediatric population. An important consideration in children includes size of children, which in turn determines the selection of endoscopes and type of sedation that can be used for the procedure

Gastroenterology training in private hospitals: India vs South Africa

In South Africa, nurses and doctors are emigrating in significant numbers. Job satisfaction, safety and ensuring career progression are important in retaining doctors to make a career in Republic of South Africa (RSA). Due to budgetary constraints many hospitals have not been upgraded. Coming home after overseas training seems difficult. In RSA it takes a minimum of 13 years for a young specialist to become registered and 15 years for subspecialists. Career progression, creating more specialist trainees in public and private hospitals and shortening the period of professional training are potential solutions to the problem. India, which has a population of more than 1 billion people, is struggling with similar problems. For the past 10-15 years, private hospitals have assisted in manpower development for medical specialist and subspecialist careers. Currently their private sector trains 60% of their recognised (sub)specialities fellows. A national task force for specialist training in RSA should be instituted. It should discuss, based on the current status and projected specialist and subspecialist personnel requirements, the future structure and logistics of training needs. This is required in all subspecialities including gastroenterology, as has been done in India. It is hoped that as a consequence well-trained doctors, similar to those in India, might move to provincial hospitals in rural areas, upgrading the medical services and keeping medical power in South Africa. South Africa should become a model for Sub-Saharan Africa, as India already is for South-East Asia

Effect of COVID-19 Vaccination on the Levels of SARS-CoV-2 Neutralizing Antibodies in COVID-19 Naive, Hybrid, and Breakthrough SARS-CoV-2 Recovered Indian Individuals

Introduction Vaccination has shown to be protective against severe coronavirus disease 2019 by various studies. However, the vaccine efficacy was demonstrated to be less against the emerging variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Both vaccine- and infection-induced immunity against SARS-CoV-2 may prevent reinfection and severity. Our study aims to assess and compare the humoral response in heterogeneous population based on infection and vaccination status along with hybrid immunity

Carbon dioxide insufflation is superior to air insufflation during endoscopic retrograde cholangiopancreatography: A randomized trial

Background: Carbon dioxide (CO2) insufflation has been shown to be superior to air insufflation in colonoscopy, and double balloon enteroscopy. However, the value of CO2 insufflation in endoscopic retrograde cholangiopancreatography (ERCP) is not established. This study aims to assess the efficacy and safety of CO2 insufflation during ERCP. Materials and Methods: Consecutive patients referred for ERCP at a single center were randomized to either air or CO2 insufflation during ERCP. The primary objectives were a post-ERCP abdominal pain (measured by 10 cm visual analog scale [VAS] 30 and 90 min, and 3 h and 24 h after ERCP). Secondary objectives included end-tidal CO2 (ETCO2) values and procedural complications. Results: We randomized 298 patients; 149 into air group and 149 into CO2 group. The VAS score for pain was higher in the air group compared to the CO2 group at 30 min, with a median of 1 (interquartile range 1–0) versus median of 1 (interquartile range 1–0); P = 0.031 and 90 min after the procedure with a median of 0 (interquartile range 1–0) versus median of 0 (interquartile range 0–0); P = 0.006. There were no serious adverse events, and the ETCO2 was within normal limits in both groups. Conclusions: CO2 insufflation is superior to air insufflation during ERCP with regard to patient pain and discomfort and warrants wide adoption. Clinical Trials.gov registration number NCT 01321203

Real-World Experience of AI-Assisted Endocytoscopy Using EndoBRAIN—An Observational Study from a Tertiary Care Center

Background and Aims Precise optical diagnosis of colorectal polyps could improve the cost-effectiveness of colonoscopy and reduce polypectomy-related complications. We conducted this study to estimate the diagnostic performance of visual inspection alone (WLI + NBI) and of EndoBRAIN (endocytoscopy-computer-aided diagnosis [EC-CAD]) in identifying a lesion as neoplastic or nonneoplastic using EC in real-world scenario. Methods In this observational, prospective, pilot study, a total of 55 polyps were studied in the patients aged more than or equal to 18 years. EndoBRAIN is an artificial intelligence (AI)-based system that analyzes cell nuclei, crypt structure, and vessel pattern in differentiating neoplastic and nonneoplastic lesion in real-time. Endoscopist assessed polyps using white light imaging (WLI), narrow band imaging (NBI) initially followed by assessment using EC with NBI and EC with methylene blue staining. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of endoscopist and EndoBRAIN in identifying the neoplastic from nonneoplastic polyp was compared using histopathology as gold-standard. Results A total of 55 polyps were studied, in which most of them were diminutive (36/55) and located in rectum (21/55). The image acquisition rate was 78% (43/55) and histopathology of the majority was identified to be hyperplastic (20/43) and low-grade adenoma (16/43). EndoBRAIN identified colonic polyps with 100% sensitivity, 81.82% specificity (95% confidence interval [CI], 59.7–94.8%), 90.7% accuracy (95% CI, 77.86–97.41%), 84% positive predictive value (95% CI, 68.4–92.72%), and 100% negative predictive value. The sensitivity and negative predictive value were significantly greater than visual inspection of endoscopist. The diagnostic accuracy seems to be superior; however, it did not reach statistical significance. Specificity and positive predictive value were similar in both groups. Conclusion Optical diagnosis using EC and EC-CAD has a potential role in predicting the histopathological diagnosis. The diagnostic performance of CAD seems to be better than endoscopist using EC for predicting neoplastic lesions

Recommendations for the Operation of Endoscopy Centers in the setting of the COVID-19 pandemic – World Endoscopy Organization guidance document

7 páginasSevere Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) is the etiologic agent causing the disease Corona Virus Disease 19 (COVID-19), resulting in a worldwide pandemic. Non-emergent endoscopy services have been disrupted as incidence and hospitalizations were rising. It is anticipated that the peak incidence may be leveling off in many parts of the world, but there is a concern for resurgence of the virus activity. Thus, it is important for endoscopy units to have plans in place during peak times of the epidemic and when resuming endoscopic services as the pandemic wanes. The global endoscopy community is faced with the challenge of providing care during this time. The WEO-COVID guidance task force has provided this resource document based on the current evidence and consensus opinion. These World Endoscopy Organization (WEO) recommendations are meant to guide endoscopists worldwide, should be interpreted in light of specific clinical conditions and resource availability and may not apply in all situations. This guidance document does not supersede the need to check for all local regulations and legislations