Abstract AI (artificial intelligence) including ML (machine learning), DL (deep learning) and NLP(Natural language processing) is rapidly entering gastroenterology. Colonoscopy Real-Time Polyp Detection (CADe), Colonoscopy Real-Time Polyp Characterization (CADx), AI-assisted IBD (inflammatory bowel disease) scoring, radiomics for liver disease, and Large language models (LLMs) for documentation are moving toward deployment. This review focuses on (1) luminal endoscopy and IBD, where evidence is most developed, and (2) cross-cutting issues of validation, regulation, workflow, economics and medico-legal considerations. A narrative review (Pub Med, Scopus, Web of Science; Jan 2010–Aug 2025) using predefined terms related to AI, ML, DL and gastroenterology was done. Data extracted included algorithm type, clinical setting, performance metrics, and patient-related outcomes. AI demonstrated high diagnostic performance across multiple domains. Deep learning–based polyp detection systems achieved pooled sensitivities of 92–98% and specificities of 85–93% for real-time colonoscopy. Algorithms for Barrett’s esophagus dysplasia detection reported accuracies up to 94%, while hepatocellular carcinoma prediction models integrating imaging and laboratory parameters reached AUCs of 0.86–0.93. NLP tools improved risk stratification accuracy in endoscopy and pathology reporting by 18–24% compared with manual review. Clinical decision-support systems for IBD and chronic liver disease enhanced treatment selection accuracy by 15–20% in prospective pilot studies. AI is transitioning to early clinical use, but most tools remain developmental, biased and poorly validated. Clear governance, external validation, health-economic assessment, and a pragmatic framework for “when to turn AI on” is needed.
Abstract Gastrointestinal (GI) vascular interventions have undergone transformative evolution from the advent of radiological portocaval shunts in the 1960s to modern endoscopic ultrasound (EUS)-guided therapies. This is a narrative review which summarizes current evidence and clinical experience regarding EUS-guided management of gastric varices, visceral artery pseudoaneurysms (PsA), and other GI vascular pathologies. The review highlights the expanding role of EUS in achieving precise vascular access and real-time Doppler-guided delivery of hemostatic agents such as cyanoacrylate, thrombin, embolization coils, and gelatin sponge. Combination therapy using coils and cyanoacrylate demonstrates superior obliteration rates and reduced rebleeding compared with monotherapy. EUS-guided thrombin injection is an effective alternative for PsA not amenable to angiographic embolization. Emerging applications include management of ectopic varices, refractory upper GI bleeding, and partial splenic artery embolization. Reported technical success exceeds 95%, with major adverse events being rare and manageable. EUS-guided vascular therapy represents a pivotal convergence of endoscopy and interventional radiology, providing minimally invasive, image-directed, and highly effective management for complex GI vascular disorders.
Abstract Introduction: Duodenal tumors, both benign and malignant, present unique surgical challenges due to the complex anatomy and proximity to major structures. Pancreaticoduodenectomy is often performed to avoid technically demanding resections and tenuous anastomoses. However, a thorough understanding of duodenal anatomy may allow pancreas-preserving segmental resections, even for malignant lesions, provided adequate margins are achieved. This study reviews our experience with duodenal tumors over 3 years and explores surgical alternatives to pancreaticoduodenectomy. Methods: We retrospectively analyzed patients who underwent segmental duodenal resections in a single surgical unit at a tertiary care center between October 2017 and September 2020. Data were obtained from a prospectively maintained database, including demographics, clinical presentation, imaging, endoscopic findings, surgical details, and outcomes. Follow-up was conducted telephonically. Results: A total of eight patients were operated for duodenal tumors over the study period (2017–2020). Of these, five patients underwent segmental duodenal resections, and three patients underwent pancreaticoduodenectomy. Two patients underwent D1 resections, one D3-D4 resection, one D4 and proximal jejunal resection, and one DJ resection. There was no mortality or major perioperative morbidity. After a median follow-up of 62 (28–78) months, there was one death due to disease in a patient who had liver metastases at presentation. Conclusions: Segmental duodenal resections offer a safe and feasible surgical strategy for the management of both benign and malignant localized duodenal tumors.
Abstract Context: Postoperative ileus is the most common complication of ileostomy reversal. Aim: The aim is to evaluate the effect of reinfusion of proximal loop effluent into the distal loop of stoma in bowel function recovery in patients with ileostomy. Settings and Design: A prospective nonrandomized interventional study was undertaken in the surgery department of UCMS and GTB hospital, Delhi, from September, 2022, to February, 2024. Materials and Methods: 62 patients were divided into two groups, where the intervention group ( n = 31) received proximal bowel effluent refeeding into the distal loop of stoma daily for 7 days before ileostomy reversal, while the control group ( n = 31) received no refeeding. Postoperative return of bowel function was compared between the two groups. Independent sample “ t ” test was used for continuous data and Chi-squared test for categorical data. Results: Interval to first passage of stool after stoma reversal was significantly shorter in the intervention group as compared to controls (44.6 ± 21.45 h vs. 69.85 ± 37.16 h; P < 0.01). The mean duration of return of bowel sound (17.03 ± 30.21 h vs. 38.6 ± 20.71 h), return of appetite (21.29 ± 24.86 h vs. 40.4 ± 21.41 h; P < 0.01), first passage of flatus (30.38 ± 22.43 h vs. 59.08 ± 28.85 h; P < 0.01) and length of hospital stay (6.1 ± 1.67 days vs. 7.8 ± 1.62 days; P < 0.01) were also significantly shorter in the intervention group. Conclusions: Distal bowel stimulation by ileostomy effluent is beneficial in early recovery of bowel function, return of appetite, and thus leads to shorter hospital stay in patients undergoing ileostomy reversal. Further randomized controlled trials with a larger sample size are required to establish chyme reinfusion as a standard treatment before ileostomy closure.
Abstract Background: Inflammatory bowel disease (IBD), which is mainly categorized into Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic immune-mediated condition that affects the gastrointestinal tract. Malnutrition is common among patients with IBD and is linked to an increased risk of unfavorable clinical outcomes. Early identification of patients at risk of malnutrition enables timely referral for thorough dietary evaluation and management to prevent related complications. Hence, this study aimed to evaluate the risk of malnutrition and its associated factors among individuals with IBD. Materials and Methods: A hospital-based, cross-sectional study was conducted at Tikur Anbessa Specialized Hospital and Adera Medical and Surgical Centre, Addis Ababa, Ethiopia, in 2024. A total of 252 patients with IBD were selected using a consecutive recruitment technique. Data were collected through interviews and medical record reviews using structured questionnaires. Malnutrition risk was assessed using the Malnutrition Universal Screening Tool. Bivariate logistic regression was employed, followed by multivariable logistic regression analysis, to examine the association between the outcome and predictor variables by selecting variables with P ≤ 0.25. Finally, P < 0.05 was used to declare statistical significance. Results: Two hundred and forty-two individuals participated, yielding a response rate of 96.03%. The majority of IBD cases were CD patients (190; 78.51%). The prevalence of malnutrition risk among patients with IBD was 34.30% (95% confidence interval: 28.56–40.53), with no difference between CD and UC (34.2% vs. 34.6%; P = 0.957). Older age was associated with a lower risk of malnutrition (adjusted odds ratio [AOR] = 0.96, P = 0.035), whereas elevated C-reactive protein levels (AOR = 1.96, P = 0.030) and, most notably, active disease (AOR = 3.03, P = 0.030) were associated with an increased risk of malnutrition. Conclusion: One in three patients with IBD were at risk for malnutrition. Age, elevated inflammatory markers, and disease activity are found to be significant predictors for risk of malnutrition. Targeted interventions to address nutritional, clinical, and socioeconomic determinants of IBD outcomes should be implemented.
Abstract Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) with a rising prevalence in developing countries, including India. While most studies on risk factors of UC originate from Western populations, limited data exist for the Indian population, particularly in Rajasthan. This study aimed to identify key dietary, lifestyle, and environmental risk factors associated with UC in Central Rajasthan and to compare their distribution between urban and rural populations. Materials and Methods: A hospital-based case–control study was conducted at Jawaharlal Nehru Hospital, Ajmer, including 85 patients with UC and 85 age- and sex-matched healthy controls without gastrointestinal disorders. Data were collected using a structured questionnaire assessing demographic, dietary, lifestyle, and environmental parameters. Associations between risk factors and UC were analyzed using Chi-square tests and logistic regression. Variables with P < 0.10 in univariate analysis were entered into multivariate logistic regression to determine independent predictors. Results: Nonvegetarian diet (adjusted odds ratio [aOR] 3.95, 95% confidence interval [CI] 1.85–8.42, P = 0.001), family history of IBD (aOR 3.21, 95% CI 1.10–9.34, P = 0.032), and migration from rural to urban areas (aOR 4.10, 95% CI 1.95–8.62, P < 0.001) were independent risk factors for UC. High fiber intake (aOR 0.46, P = 0.018) and smoking (aOR 0.29, P = 0.005) were protective. The proportion of urban and rural residents did not differ significantly between cases and controls. Conclusion: Key risk factors for UC in Central Rajasthan include a nonvegetarian diet, low fiber intake, family history of IBD, and migration from rural to urban settings. The findings underscore the impact of dietary transition and environmental change on the pathogenesis of UC. Targeted public-health strategies promoting fiber-rich diets and lifestyle awareness may aid in disease prevention.
Abstract Up to one-third of patients who undergo radiation therapy for pelvic malignancies can suffer from radiation proctopathy. Acute radiation proctopathy develops during or within 3 months and is usually self-limiting. The treatment of chronic radiation proctopathy is challenging. Patients presenting with rectal discomfort with minor rectal bleeding without anemia do not require treatment. Medical therapy mainly includes sucralfate enema, oral metronidazole, and hyperbaric oxygen therapy. Endoscopic therapies include argon plasma coagulation (APC), transcolonoscopic formalin spray/instillation, bipolar electrocoagulation, heater probe, and radiofrequency ablation. The success rate of APC treatment ranges from 80% to 100%. The surgical or endovascular therapy is warranted in case of failure of other treatment modalities. Here, we discuss a complete understanding of radiation proctopathy and present a simplified practical approach for the management of the radiation proctopathy.
Abstract Intentional ingestion of drug packets and small cell phones is described in drug traffickers and prison inmates. A lithium battery in cell phones can leak into the gastric lumen and potentially cause serious complications. A few instances of successful endoscopic retrieval of mobile phones are described. Here, we describe the technique of endoscopic retrieval of a cellphone. Surgical removal is an alternative treatment.
Abstract Context: Delayed gastric emptying (DGE) is a frequent postoperative complication following pancreaticoduodenectomy (PD), leading to delayed recovery, prolonged hospital stays, and increased morbidity. Aims: To determine the incidence and clinical profile of DGE in patients undergoing PD at a tertiary care center. Subjects and Methods: This retrospective case series included 30 patients who underwent PD between January 2022 and December 2023. Patient demographics, operative details, postoperative outcomes, and DGE grading based on International Study Group of Pancreatic Surgery criteria were analyzed. Statistical Analysis: Descriptive statistics were expressed as frequencies, percentages, and mean ± standard deviation. Associations were assessed using the Chi-square or Fisher’s exact test, with P < 0.05 considered statistically significant. Results: DGE occurred in 8 patients (26.7%). Grades A, B, and C DGE were observed in 3 (10%), 4 (13.3%), and 1 (3.3%) patients, respectively. The retrocolic route of reconstruction showed a significant association with DGE ( P < 0.01). Patients with DGE required longer nasogastric decompression and delayed oral intake (median postoperative day 9 vs. 5) and had significantly prolonged hospital stay (mean 14.5 vs. 9.8 days; P < 0.05). Postoperative complications such as pancreatic fistula and intra-abdominal infection were present in 75% of patients with DGE. Conclusions: DGE remains a common complication after PD. Surgical reconstruction technique and postoperative complications appear to influence its occurrence. Early identification of risk factors may help improve postoperative recovery and outcomes.
Abstract Colonoscopy is a widely performed and generally safe procedure with a low complication rate. However, acute cholecystitis following colonoscopy is a rare complication, with only 21 cases reported in the literature to date. We present the case of a 66-year-old male who underwent an elective screening colonoscopy and subsequently developed acute abdominal pain 48 h postprocedure. Diagnostic investigations, including a computed tomography scan, suggested acute cholecystitis with associated cholelithiasis. This report discusses our case in detail, reviews previously documented cases, and explores potential mechanisms underlying this unusual association between colonoscopy and acute cholecystitis.
Abstract Trichobezoar is a rare condition consisting of a hairball in the proximal gastrointestinal tract. A 3-year-old girl presented with a history of epigastric pain and vomiting. Esophagogastroduodenoscopy revealed a large trichobezoar extending from the gastric body to the duodenum (D2). Endoscopic removal of the trichobezoar (18 cm × 7 cm in size) was done using a hot snare and argon plasma coagulation. The procedure was done in multiple sessions to avoid mucosal injury and complications of prolonged anesthesia. Endoscopic removal of large trichobezoar is feasible without major complications. Surgery is the definitive treatment option.
Abstract Esophageal ectopic sebaceous glands are a rare benign developmental anomaly first described in 1962. These lesions arise from ectodermal tissue unusually located within the endodermal-derived esophagus, making them exceptionally rare. We report a 42-year-old male patient presenting with epigastric burning and globus sensation refractory to proton-pump inhibitor therapy. Esophagogastroduodenoscopy revealed multiple yellowish subepithelial nodules in the middle to distal esophagus with characteristic petal-like morphology. Histopathological examination confirmed ectopic sebaceous glands within the lamina propria. The pathogenesis remains uncertain, with embryologic misplacement being the most accepted theory. Differential diagnosis includes glycogenic acanthosis, xanthomas, and granular cell tumors. Conservative management is recommended for asymptomatic patients.
Abstract Metastatic carcinoma to the liver can exhibit striking histomorphological similarity to benign hepatic pathology, leading to diagnostic pitfalls. Distinguishing such entities is critical for accurate patient management. We report the case of a 53-year-old woman presenting with a 3-month history of abdominal pain and fullness. Imaging revealed a suspected gastric malignancy with hepatic, skeletal, and nodal metastases. Liver biopsy was performed to evaluate hepatic lesions. Histopathological examination demonstrated cords of cells closely resembling steatotic hepatocytic cell plates with pericellular fibrosis in one biopsy core. However, this focus was devoid of portal tracts. Immunohistochemistry (IHC) revealed strong cytokeratin (CK) 7 positivity, along with positivity for BerEp4 and MOC31, and negativity for CK20, CDX2, and HepPar1. This immunoprofile confirmed metastatic adenocarcinoma of probable gastric origin. Notably, extensive extramedullary hematopoiesis was observed within hepatic sinusoids, implicating a compensatory hematopoietic response secondary to bone marrow involvement by the malignancy. This case highlights the critical need for careful histopathological evaluation of liver biopsies, corroborated by IHC in patients with known or suspected malignancy. Metastatic adenocarcinoma can closely mimic benign hepatic steatosis on routine histology, emphasizing the crucial role of an appropriate IHC panel in picking up such “stealthy metastasis.” Awareness of this pitfall ensures prompt and accurate diagnosis, directly influencing patient management.
Abstract Background: Optimal duration of percutaneous catheter drainage (PCD) in uncomplicated amebic liver abscess (ALA) is unclear. Methods: We retrospectively studied 75 adults with uncomplicated ALA undergoing PCD (2024–2025), analyzing daily drain output, catheter duration, complications, and imaging. Results: Drain output peaked early and plateaued after 72 h despite residual cavities. Median catheter duration was 8 days. Complications were more frequent with drainage >7 days. Residual cavities persisted in most patients without the need for reintervention. Conclusion: Most pus evacuation in ALA occurs within 72 h; residual cavities alone should not mandate prolonged catheter retention. Prospective multicenter trials are needed to define evidence-based removal criteria.
Abstract Amebic liver abscess (ALA) remains the most common extraintestinal manifestation of Entamoeba histolytica infection and continues to impose substantial morbidity and mortality, particularly in tropical regions. This review provides a narrative synthesis of current evidence on epidemiology, pathogenesis, clinical features, diagnosis, and management of ALA, with a focus on sex-specific differences, alcohol-associated risk, immune mechanisms, and evolving diagnostic and therapeutic strategies. A comprehensive literature search of PubMed, Scopus, and Google Scholar was performed using the terms “amoebic liver abscess,” “ Entamoeba histolytica ,” “diagnosis,” “management,” “immunity,” and “complications.” Additional studies were identified from reference lists. Relevant clinical and experimental studies were screened, and data were narratively synthesized to provide a state-of-the-art overview. ALA shows a striking male predominance, with alcohol use, hormonal influences, and immunological differences contributing to susceptibility. Clinical presentation ranges from mild subacute disease to severe illness complicated by rupture, vascular thrombosis, biliary involvement, and sepsis. Ultrasonography remains the initial diagnostic modality, while serology and molecular tests significantly enhance etiologic confirmation, particularly in nonendemic settings. Metronidazole continues as the cornerstone of therapy; however, optimal drainage strategies, catheter size, timing, and duration remain incompletely defined. Novel biomarkers, molecular assays, and point-of-care tests are rapidly improving diagnostic accuracy, particularly in resource-limited settings. Despite therapeutic advances, delayed diagnosis, large abscesses, and complications such as rupture, thrombosis, and biliary communication continue to determine outcomes. Future priorities include standardization of interventional protocols, improved access to diagnostics, and deeper understanding of host–parasite interactions to guide targeted therapies.
Abstract Background and Objectives: Acute pancreatitis (AP) is a pancreatic inflammatory disorder that may present as a mild, self-limiting illness or progress to severe systemic disease. Early recognition of severe forms is essential to reduce morbidity and mortality. This study evaluated the performance of serum interleukin-6 (IL-6), procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), and D-dimer in predicting disease severity and compared these biomarkers with established clinical scoring systems. Materials and Methods: In this prospective and observational study, 164 patients with AP were enrolled within 48 h of hospital admission. Biomarker levels were measured on admission and disease severity was classified according to the Revised Atlanta Classification. Ranson’s score, Acute Physiology and Chronic Health Evaluation II (APACHE II), bedside index for severity in AP (BISAP), and modified computed tomography severity index (MCTSI) were calculated. Receiver operating characteristic (ROC) curves were used to assess predictive performance. Results: All four biomarkers and scoring systems demonstrated excellent accuracy in predicting moderately severe AP (SAP) and SAP. IL-6 had the highest biomarker performance (area under the ROC curve [AUC] 0.986), closely matching MCTSI (AUC 0.993), the best-performing scoring system. D-dimer (AUC 0.955) and hs-CRP (AUC 0.971) outperformed BISAP (AUC 0.908) and APACHE II (AUC 0.940), while PCT (AUC 0.932) achieved perfect specificity (100%). Overall, IL-6 provided the most balanced accuracy. Conclusions: Serum IL-6, PCT, hs-CRP, and D-dimer, particularly IL-6, can accurately predict severe disease early in the course of AP and perform comparably to standard scoring systems. Integrating these biomarkers into early evaluation protocols could improve risk stratification in clinical practice.
Abstract Upper gastrointestinal bleeding (UGIB) is commonly caused by gastric varices, gastric and duodenal ulcers, gastroesophageal reflux disease, and malignancies. Gastric arterial collaterals secondary to splenic artery thrombosis or hypoplasia are exceedingly rare causes of upper gastrointestinal hemorrhage. We present two cases of life-threatening UGIB due to arterial collaterals originating from the posterior gastric wall supplying the spleen, caused by splenic artery thrombosis or hypoplasia. Both patients underwent laparoscopic splenectomy with posterior gastric vessel dissection. Postoperative recovery was uneventful, and long-term follow-up showed no recurrence of symptoms. Gastric arterial collaterals should be considered in cases of recurrent UGIB without evidence of portal hypertension or venous varices. Laparoscopic splenectomy provides definitive treatment with excellent outcomes.
Abstract Amoebiasis, caused by Entamoeba histolytica , is a major health concern in tropical regions and commonly affects the colon and liver. Although extraintestinal spread occurs in a minority of symptomatic cases, rare sites such as the gallbladder are seldom recognized – especially without hepatic involvement. A 71-year-old woman presented with right hypochondrial pain suggestive of acute cholecystitis. She underwent cholecystectomy, converted to open surgery due to adhesions. Histopathology revealed E. histolytica trophozoites within the gallbladder wall, confirming amoebic cholecystitis. No hepatic abnormalities were seen on preoperative imaging. This case represents an unusual instance of isolated amoebic cholecystitis, a rarely reported extraintestinal manifestation. Although the liver is involved in most extraintestinal cases, atypical sites such as the pleura, brain, and gallbladder can be affected. Accurate diagnosis requires histopathological confirmation, as imaging may not reliably distinguish parasitic causes of cholecystitis. In endemic settings, clinicians should maintain a high index of suspicion for rare extraintestinal manifestations of amoebiasis. Histopathology remains crucial for definitive diagnosis and guiding appropriate antiparasitic therapy.
Abstract This case report highlights the diagnostic journey of a young migraine sufferer presenting with severe abdominal pain. A clinical diagnosis of acute pancreatitis was considered, but ultrasonography was normal with normal serum amylase and lipase levels. In view of high clinical suspicion, a contrast-enhanced computed tomography abdomen was done, which clinched the diagnosis of acute pancreatitis. Pain had a temporal association with ingestion of sumatriptan prior to abdominal pain, with a history of similar episodes in the past. Although pancreatitis due to sumatriptan is rare, its potent vasoconstrictive properties could cause pancreatic ischemia, triggering inflammation. Our patient presented with mild pancreatitis, normal enzyme levels, and subsequently full recovery with conservative management. This case emphasises the importance of considering drug-induced pancreatitis in cases where no discernible cause for the same could be identified.
Abstract Amyand hernia is an uncommon type of inguinal hernia where the vermiform appendix is found within the hernia sac. It represents 0.19%–1.7% of all inguinal hernia cases. Due to its rarity, Amyand hernia poses a diagnostic challenge, particularly in the preoperative phase. We present the case of a 70-year-old male who was diagnosed with a right-sided Amyand hernia during an open mesh hernioplasty performed under spinal anesthesia. Intraoperatively, the appendix was discovered within the hernia sac, appearing grossly normal without any signs of inflammation or adhesions. The contents of the hernia were reduced, and the hernia was repaired using mesh, without the need for an appendectomy. Amyand hernia is often incidentally diagnosed during surgery due to its nonspecific clinical presentation. The management of this condition can vary, particularly in deciding whether to perform an appendectomy when the appendix is not inflamed. In this case, considering the normal appearance of the appendix and absence of inflammation, the patient was managed with mesh repair alone, aligning with the Losanoff and Basson classification. Given its rarity and diagnostic challenges, Amyand hernia requires a high index of suspicion, especially in atypical presentations of inguinal hernias. Surgical management should be tailored to the condition of the appendix, with appendectomy reserved for cases where the appendix shows signs of inflammation or other pathology.
