No abstract

Artificial intelligence (AI) based on deep learning boosted medical research in the past years and is expected to enormously change the style of health care in many aspects in the foreseeable future. Nowadays, there are exploding volumes of healthcare‐related data being generated daily. Because of its time‐sensitive characteristics, being able to process large amounts of data in real‐time fashion is crucial in healthcare settings. In gastroenterology practice, AI can manage and interpret the sheer amount of data with different formats coming from a myriad of sources, including currently used endoscopic or imaging devices, digital record systems, and electronic health records, or from other sources such as governmental databases, social media, or wearable devices over a long period. Traditional gastroenterology is nowadays beginning to transform to a new personalized, predictive, and preventive paradigm. Evidence‐based practices and recent studies are coming out every day, and big data‐based approaches and the progress in basic sciences and its emerging applications are now becoming the indispensable part of precision medicine. In gastroenterology, AI can be applied in disease diagnosis, treatment guidance, outcome prediction, and reducing workload of the healthcare staff. As the healthcare community begins to embrace AI technology, how to seamlessly construct an interoperable platform to accommodate data with high variety and veracity with high velocity and implement AI in the clinical workflow would be the future challenges.

Adequate bowel preparation is an essential part of a high-quality colonoscopy. Recent studies showed that the small-volume bowel cleansing agent Bowklean performs better in terms of tolerability and acceptability. However, its split-dose regimen is sometimes confusing to the patient. To promote Bowklean in Fu Jen Catholic University Hospital, dedicated staff for patient education on bowel preparation were provided by Universal Integrated Corporation (Taiwan), but not in every period because of the clinic room availability and manpower capacity. This provided us an opportunity to compare the quality of colonoscopy between those with and without the dedicated patient education. This study aimed to compare various quality indices between the two groups. We set bowel preparation quality as the primary endpoint, assessed by modified Aronchick scale, and other quality indices including procedure time and adenoma detection rate as the secondary endpoints. We performed a single institution retrospective study. All patients who received colonoscopy from an outpatient setting with Bowklean as the bowel cleansing agent from October 2020 to November 2020 were reviewed. Primary and secondary endpoints were then compared between the conventional group and the dedicated staff group, with StataSE 14 by Wilcoxon rank sum test or logistic regression. Four hundred ten patients were recruited, including 217 patients with dedicated patient education and 193 without. The proportion of bowel preparation quality “Excellent + Good + Fair” was significantly higher in dedicated staff group than conventional group (97.7% vs 93.3%, P = .03; logistic regression coefficient = 1.12). The cecal intubation time was significantly shorter in the dedicated staff group (3.68 ± 2.02 minutes vs 4.52 ± 3.25 minutes, P < .01). After excluding those with polypectomy or biopsy, the total procedure time tended to be shorter in the dedicated staff group (10.2 ± 3.35 minutes vs 9.40 ± 2.43 minutes, P = .06). There was no significant difference regarding adenoma detection rate between the two groups. Our study shows that patient education by dedicated staff can improve bowel preparation quality and has the potential to decrease procedure time. Further large-scale prospective trials are still needed to evaluate if it can also achieve a better adenoma detection rate.

Background and Aim Vonoprazan as a new acid blocker has more potency and longer lasting acid suppression than proton pump inhibitors. Whether the efficacy of vonoprazan‐based triple therapy is comparable with or even better than that of currently recommended first‐line therapies is still unknown. Our study aims to compare the eradication rate and major adverse effects between 7‐day vonoprazan‐based triple therapy with high‐dose amoxicillin and 14‐day extended sequential therapy. Methods We performed a retrospective analysis from the database of 13 C‐urea breath test at Fu Jen Catholic University Hospital. All patients with a definite diagnosis of Helicobacter pylori infection by rapid urease test, urea breath test, stool antigen test, or pathology report were recruited. Patients receiving first‐line regimens with vonoprazan‐based triple therapy or extended sequential therapy were included. The respective eradication rate determined by 13 C‐urea breath test and major adverse effects were demonstrated. Results Totally, 106 patients were recruited in the vonoprazan‐based triple therapy group and 357 in the extended sequential therapy group. There was no significant difference in eradication rate between vonoprazan‐based triple therapy with high‐dose amoxicillin and extended sequential therapy (83.0 vs 88.8%, P = 0.12). Major adverse effects occurred in 13 of the extended sequential therapy group but none in the other group (0% vs 3.6%, P = 0.046). Conclusions Seven‐day vonoprazan‐based triple therapy with high‐dose amoxicillin is a potential first‐line anti‐ Helicobacter pylori regimen alternative to current standard treatment, with the advantages of simplicity, short treatment duration, low pill burden, and fewer major adverse effects.

In contrast to the “one‐size‐fits‐all” approach, precision medicine focuses on providing health care tailored to individual variabilities. Implementing precision medicine in endoscopy practice involves selecting the appropriate procedures among the endoscopic armamentarium in the diagnosis and management of patients in a logical sequence, jointly considering the pretest probabilities of possible diagnoses, patients' comorbidities and preference, and risk–benefit ratio of the individual procedures given the clinical scenario. The aim of this review is to summarize evidence‐supported strategies and measures that may enhance precision medicine in general endoscopy practice.