Baldwin Po Man Yeung

Background and aims: Colonoscopy remains as an invaluable diagnostic and therapeutic tool used for the screening and evaluation of colonic pathologies. Periodic endoscopic screening allowing for early detection and removal of pre-malignant lesions, resulting in significant overall decreased incidence and mortality from colorectal cancer. Despite its added costs, artificial intelligence (AI) has been increasingly utilized in the field of endoscopy, boasting benefits of improving adenoma detection rates while reducing endoscopists’ mental fatigue intra-procedurally. As such, further evaluation of the financial impact of such AI-usage in screening colonoscopies was performed to assess if routine use of AI-guidance in screening colonoscopies was justifiable. Methods: This study conducted a cost effectiveness analysis of the GI Genius™ CADx Intelligent Endoscopy Module (US-DG-2000309, 2021 Medtronic) system in our local Singaporean tertiary public healthcare institution. A decision tree model was used to calculate Incremental Cost Effectiveness Ratio (ICER), comparing cancer-related costs for patients who underwent conventional colonoscopy versus colonoscopy with AI guidance. Results: With a calculated ICER value of 0.72, our study suggests that AI-assisted colonoscopy was indeed cost effective. Quality-Adjusted Life Years (QALY) values derived for each subgroup of patients further demonstrated overall improved quality of life reported by patients who underwent AI-assisted colonoscopy, as compared to conventional colonoscopy. Conclusion: Our study supports the incorporation of AI guidance into routine colonoscopic evaluation in view of increased cost effectiveness and improved overall quality of life achieved. However, further studies and analysis must be undertaken before reliably determining the cost-effectiveness of AI on regional or international scales.

Background/Aims: Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population.Methods: From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion.Results: Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining 10 patients, nine did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the 1st week and a soft diet in the 2nd week. One patient was allowed clear oral feeds on the 8th day after DPT insertion.Conclusions: Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.

Aim: Weight-based stigmatization is prevalent. They have been reported in schools, work and healthcare settings. However, almost all the literature on such weight-based stereotypes were from Western countries. The study aims to evaluate the prevalence of weight-based stigmatization in an Asian population. Methods: An anonymized questionnaire-based cross-sectional study was conducted. Respondents were asked about their socioeconomic status, followed by questions on perceived weight-based stigmatization across 4 domains (self, social, healthcare, work and education). A subsequent subgroup analysis was performed to evaluate the impact of different obesity classes on perceived stigmatization across these domains. Results: A total of 101 respondents replied. Respondents with higher BMI were middle-aged (p = 0.040), Malays (p = 0.018), low-income (p = 0.041) and had lower educational qualifications (p = 0.038). Total prevalence of perceived weight-based stigmatization was 65.6%. Class III obesity respondents were more stigmatized at work (Prevalence Rate Ratio (PRR) 5.73, 95% Confidence Interval (CI): 1.16–28.47), and resort to increased consumption of unhealthy food or partake in lesser exercise due to stigma (PRR 24.94, 95% CI: 3.61-172.41). Conclusion: Obesity stigmatization is equally prevalent in Asian societies. Individuals with higher BMI were more likely to report perceived stigmatization in the workplace, as well as maladaptive dietary and exercise behaviours in response to stigmatization, regardless of socioeconomic status.

Background: Laparoscopic sleeve gastrectomy (LSG) is one of the commonest bariatric procedures. However, it is associated with postoperative gastroesophageal reflux disease (GERD) and erosive esophagitis (EE). This study aims to assess the impact of various preoperative clinical and endoscopic characteristics on the development of postoperative GERD and EE. Methods: A single institution retrospective cohort study involving all patients who underwent LSG. A univariate and multivariate analysis was performed to identify preoperative parameters that were significantly associated with the development of postoperative GERD and EE, at up to 1-year follow-up. Results:At up to 1-year follow-up, out of 127 patients, only preoperative endoscopic presence of a hiatal hernia noted on axial length (p=0.024), and the Hill’s classification of the gastroesophageal junction (p<0.001), were significantly associated with the development of postoperative GERD. Similarly, at 1-year follow-up endoscopy, the presence of a hiatal hernia (p=0.041) and the Hill’s classification (p=0.001) were associated with postoperative EE. On the multivariate analysis, compared to patients with a Hill’s I flap valve, Hill’s II patients were more likely to develop postoperative GERD (OR 7.13, 95% CI: 1.69-29.98, p=0.007), and Hill’s III patients were more likely to develop postoperative GERD (OR 20.84, 95% CI: 3.98-109.13, p<0.001) and EE (OR 34.49, 95% CI: 1.08-1105.36, p=0.045). All patients with Hill’s IV developed postoperative GERD and EE in this study. Conclusion: Postoperative GERD and EE remains an important limitation following LSG. Proper preoperative assessment using the Hill’s classification can help to accurately predict patients at risk of postoperative GERD and EE.

Stem cell therapy enhances healing of NSAID-related peptic ulcer through reducing inflammation and stimulating cell proliferation and angiogenesis.