INTRODUCTION: Adequate bowel preparation is key to a successful colonoscopy, which is necessary for detecting adenomas and preventing colorectal cancer. We developed an artificial intelligence (AI) platform using a convolutional neural network (CNN) model (AI-CNN model) to evaluate the quality of bowel preparation before colonoscopy. METHODS:This was a colonoscopist-blinded, randomized study. Enrolled patients were randomized into an experimental group, in which our AI-CNN model was used to evaluate the quality of bowel preparation (AI-CNN group), or a control group, which performed self-evaluation per routine practice (control group). The primary outcome was the consistency (homogeneity) between the results of the 2 methods. The secondary outcomes included the quality of bowel preparation according to the Boston Bowel Preparation Scale (BBPS), polyp detection rate, and adenoma detection rate. RESULTS:A total of 1,434 patients were enrolled (AI-CNN, n 5 730; control, n 5 704). No significant difference was observed between the evaluation results ("pass" or "not pass") of the groups in the adequacy of bowel preparation as represented by BBPS scores. The mean BBPS scores, polyp detection rate, and adenoma detection rate were similar between the groups. These results indicated that the AI-CNN model and routine practice were generally consistent in the evaluation of bowel preparation quality. However, the mean BBPS score of patients with "pass" results were significantly higher in the AI-CNN group than in the control group, indicating that the AI-CNN model may further improve the quality of bowel preparation in patients exhibiting adequate bowel preparation.

Background and Aim Biliary tract infection (BTI) is an inflammatory disease and commonly associated with bacteremia. Delays in diagnosis or treatment of BTI cause high morbidity and mortality. However, an early diagnosis depends on appropriate clinical investigations. Appropriate biomarkers are urgently needed to improve the BTI diagnostic rate. We hypothesized that intestinal fatty acid‐binding protein (I‐FABP) might be a potential biomarker for BTI diagnosis. Methods We examined data from subjects aged ≥18 years diagnosed with BTI, including cholangitis and cholecystitis, whose blood samples were adequate for I‐FABP and zonulin assessment. We also collected blood samples from healthy volunteers as the control group. We excluded subjects in both groups who received steroids, antibiotics, or probiotics within 1 month before hospital admission (BTI cohort) or participation in this research (controls). The main study endpoint was to compare the diagnostic ability of I‐FABP to detect BTI in comparison with high‐sensitivity C‐reactive protein (hs‐CRP) and zonulin. Results The study collected the data of 51 patients with BTI and 35 healthy subjects. The receiver operating characteristic (ROC) area under the curve (AUC) for I‐FABP was 0.884 (95% confidence interval [CI]: 0.814–0.954), numerically higher than that for hs‐CRP (0.880; 0.785–0.976) and zonulin (0.570; 0.444–0.697). We estimated that the optimal cutoff value of I‐FABP was 2.1 ng/mL (sensitivity: 0.804; specificity: 0.829) for the diagnosis of BTI. Conclusions In summary, this study suggests that I‐FABP may be a potential alternative biomarker to hs‐CRP for diagnosing BTI. Further research should verify the use of I‐FABP as a marker for BTI diagnosis, but also for other inflammatory diseases.

Background and Aim A pyogenic liver abscess (PLA) is an infectious disease with high in‐hospital mortality. It has no specific symptoms and is difficult to be diagnosed early in the emergency department. Ultrasound is commonly used to detect PLA lesions of PLA, but its sensitivity can be affected by lesion size, location, and clinician experience. Therefore, early diagnosis and prompt treatment (especially abscess drainage) are crucial for better patient outcomes and should be prioritized by clinical physicians. Methods We conducted a retrospective study to compare the effect of early and late (i.e., receiving CT scanning within 48 h and >48 h after admission) adoption of nonenhanced computed tomography (CT) scanning regarding the hospitalization days and interval between admission and drainage of patients with PLA. Results This study included 76 hospitalized patients with PLA in the Department of Digestive Disease of Xiamen Chang Gung Hospital in China who underwent CT examinations from 2014 to 2021. We conducted CT scans on 56 patients within 48 h of admission and on 20 patients more than 48 h after admission. The early CT group had a significantly shorter hospitalization length compared with the late CT group (15.0 days vs. 20.5 days; P = 0.035). Besides, the median time to initiate drainage after admission was also significantly shorter in the early CT group than in the late CT group (1.0 days vs. 4.5 days; P < 0.001). Conclusion Early CT scanning within 48 h of admission may aid in early PLA diagnosis and benefit disease recovery, as revealed by our findings.

Methods A cross-sectional study of all eligible LT recipients from 2008 to 2020 in a leading transplant centre in Singapore was conducted to determine the vaccine response in HBV-naïve subjects. A standardised workflow was devised to identify barriers in vaccination and response monitoring. Transplant coordinators and pharmacists assisted physicians to identify and prescribe CDC-recommended vaccinations using a template, which include Engerix 40mcg of three doses, followed by rechecking anti-HBs titre one month after. A second 3-dose Engerix regimen was given if anti-HBs remains <10 mIU/mL. Non-responder is defined as failure to achieve protective anti-HBs titre after completing two cycles. Results Of the 279 LT recipients, we excluded patients not on follow-up and patients with anti-HBc positivity. 75 patients were included. Prior to vaccination implementation, 9/75 (12%) were not checked for anti-HBs. Of the 66 checked, 40 required vaccination. 29/40 (72.5%) were started on the first cycle, and 21/40 (52.5%) completed. 11/20 (55%) patients were initiated on the second cycle. Post workflow implementation, 40 needed vaccination. 34/40 (85%) were started on the first cycle and 24/40 (60%) completed. 18/23 (78.3%) were started on a second cycle. 3/4 (75%) were non-responders (IDDF2021-ABS-0190 Figure 1). Our implementation coincided with the COVID-19 pandemic where more teleconsultation was used. COVID-19 vaccination was also prioritised over HBV vaccination. We postulate that these results would be further improved once physical consultations resumed. Conclusions The development of a standardised workflow can lead to improvement in anti-HBs testing and compliance to vaccination post-LT. These findings may be useful for other patients who are on long-term immunosuppression. Continual efforts from the multidisciplinary team are required to ensure the sustainability of effect.

Background/aims Given the increased incidence of obstructive sleep apnea (OSA) among patients with nonalcoholic fatty liver disease (NAFLD), noninvasive screening methods are urgently needed to screen for OSA risk in these patients when conducting an office-based assessment of hepatic steatosis. Therefore, we investigated the controlled attenuation parameter (CAP) and hepatic steatosis index (HSI) in patients with and without OSA and developed screening models to detect OSA. Methods We retrospectively reviewed the medical records of all adult snorers with suspected NAFLD undergoing liver sonography between June 2017 and June 2020. Records encompassed CAP and HSI data as well as data collected during in-hospital full-night polysomnography. The multivariate logistic regression models were constructed to explore the predictors of OSA risk. Furthermore, model validation was performed based on the medical records corresponding to the July 2020–June 2021 period. Results A total of 59 patients were included: 81.4% (48/59) were men, and the mean body mass index (BMI) was 26.4 kg/m2. Among the patients, 62.7% (37/59) and 74.6% (44/59) (detected by the HSI and CAP, respectively) had NAFLD, and 78% (46/59) were diagnosed with OSA on the basis of polysomnography. Three screening models based on multivariate analysis were established. The model combining male sex, a BMI of > 24.8, and an HSI of > 38.3 screened for OSA risk the most accurately, with an area under the receiver operating characteristic curve of 0.81 (sensitivity: 78%; specificity: 85%; and positive and negative predictive values: 95% and 52%, respectively) in the modeling cohort. An accuracy of 70.0% was achieved in the validation group. Conclusions The combination screening models proposed herein provide a convenient, noninvasive, and rapid screening tool for OSA risk and can be employed while patients receive routine hepatic check-ups. These models can assist physicians in identifying at-risk OSA patients and thus facilitate earlier detection and timely treatment initiation.