Background:Endoscopic ultrasonography (EUS) is the most sensitive modality for accurately establishing a tissue diagnosis in patients with solid pancreatic masses. However, small lesions can be challenging to detect, particularly for less experienced endosonographers. Therefore, outcomes of EUS are operator dependent. We validated the performance of novel artificial intelligence (AI)-enhanced EUS for detection of solid pancreatic lesions. Methods:In this single-center, prospective, nonrandomized, comparative study, high-risk patients aged ≥18 years referred for pancreatic cancer screening or with suspected (solid and cystic) pancreatic lesions owing to symptoms, radiological, or laboratory findings were evaluated in real time using AI-EUS software. The model included 32 713 EUS frames (training/testing phases) of normal, solid, and >10-mm cystic pancreatic lesions from 202 patients. Clinical validation was conducted prospectively when EUS findings were evaluated concurrently in real time by two independent expert examiners, one using conventional EUS and another with AI-EUS, both blinded to the alternative assessments. The primary outcome was detection of solid pancreatic masses. Results:308 patients were evaluated (January–July 2024). AI-EUS performance was not significantly different to that of conventional EUS performed by experts (97.1% vs. 100%; risk difference 2.9%, 95%CI –1.2 to 6.8; P = 0.25). Final pathology of 105 pancreatic solid masses revealed neoplasia in 93 (88.6%) and benign lesions in 12 (11.4%). Conclusion:The performance of AI-EUS was not significantly different to that of experienced endosonographers for detection and segmentation of solid pancreatic masses. By standardizing performance, AI-EUS may have the potential to optimize clinical outcomes in pancreatic cancer.

NdxY1-xFeO3 polycrystalline samples with ‘x’ value ranging from 0.0 to 1.0 in steps of 0.2 are synthesized using sol–gel auto combustion method. The structural and magnetic properties of Neodymium (Nd) doped YFeO3 are presented in the present work. Experimental techniques like X-ray diffraction (XRD) and Raman spectroscopic studies are used for structural characterization of the prepared compounds. From XRD measurements, unit cell parameters and cell volume are calculated. XRD graphs indicate the presence of secondary phases in the studied samples. The Fe–O–Fe bond angles from XRD show no significant change with substitution. Magnetic measurements indicate the presence of weak ferromagnetic component for all the samples. Isomer shift value from 57Fe Mossbauer measurements indicate that iron ion is in Fe3+ionic state. Hyperfine field (Bhf) values increase with the increase in the Nd doping concentration. The important observation of the present work is the increase in electrical leakage current with Nd substitution.

Glasses of the composition xBaO-(30-x)TeO2-10TiO2-59.5B2O3-0.5Fe2O3 were synthesized using the melt-quenching process and investigated using differential scanning calorimeter (DSC), optical characterization techniques. The DSC spectra of the prepared glass samples attest to their glassy nature. Archimedes' principle was used to determine the density (ρ) of the glass samples. The progressive replacement of BaO with TeO2 leads to the structural compactness of the vitreous network and improves the glass stability. Optical absorption spectra have also been employed to examine the optical transitions and electronic band structure. From the edges of UV absorption, the Eopt and Urbach energies have been determined. All the glasses' physical properties have been examined in relation to BaO mol%.

The multiferroic materials, specifically Gd-doped LaFeO3, were synthesized using sol–gel processes and characterized using various techniques. The phase purity of the samples was confirmed using both X-ray diffraction (XRD) and Raman spectroscopy with orthorhombic crystal structure and Pbnm space group determined through Rietveld refinement using Fullproof software. SEM analysis was conducted to investigate the surface morphology of the samples, revealing non-uniformly distributed grains. Furthermore, P-E loops were measured to obtain polarization results, providing insights into the ferroelectric properties of the materials. The combination of XRD, Raman spectroscopy, SEM, and P-E loop measurements allowed for a comprehensive characterization of the Gd-doped LaFeO3 samples. These findings contribute to a better understanding of the structural, morphological, and ferroelectric properties of the multiferroic materials, significant implications for the potential applications of these materials in advanced functional devices.

Background ESGE recommends colonic stenting for relief of malignant left sided colonic obstruction. In view of limited data, these recommendations are not inferred for malignant obstruction of the proximal colon (MOPC), Herein, we highlight our experience in stenting for MOPC. Methodology This was a single centre, retrospective review of patients in a teaching hospital referred for endoscopic stenting of MOPC from 2013–2021. Data was retrieved from endoscopy database (Unisoft) and electronic medical notes. MOPC was defined as obstruction proximal to the splenic flexure. Technical success was defined as satisfactory placement of a metal stent across a malignant stricture as seen on fluoroscopy. Data on demographics, technical success, complications, and outcomes were collected. Results 29 patients underwent stenting for MOPC. Median age was 76 (Range 51–91 years). All cases were inpatients performed by 4 endoscopists using through the scope technique under fluoroscopic guidance. Mean procedure time was 37 minutes. 93% (n=27) cases were performed for strictures caused by colonic cancer, 7% (n=2) were done for extramural compression from metastatic disease (stomach & breast). 72% (n=21) of cases were done with palliative intent, 28% (n=8) were performed as a bridge to surgery. Technical & clinical success rates were 100%. 30-day mortality rate post-stent was 14% (n=4), none of these deaths were related to stent insertion, and all cases were in the palliative cohort. The complication rate was 3.5% (n=1) which was recorded as a post-procedural perforation presenting 14 days post-stent in a patient with extramural colonic compression from palliative stomach cancer. This was managed conservatively and she died 3 weeks later following discharge. In the palliative group, mean survival following stent insertion was 163 days, median 111 days. In the bridge to surgery group, 50% (n=4) are still alive at the time of data collection, 1 patient (T3N0R0 at staging) recurred at 3 years with a solitary liver met, this was managed with surgery and remains in remission. of the bridge to surgery patients that have now died (n=4); 1 patient recurred at 9 months (T3N0M0 at staging), 1 patient was found to have liver metastases on further evaluation, 1 patient passed away 6 months later relating to frailty, and 1 patient passed away 8 years post stent insertion due to COVID. Conclusion In our experience, stenting for MOPC is an efficacious option for palliation and as a bridge to surgery. Technical & clinical success rates were 100% with good outcomes seen in both groups. Larger studies and RCTs would need to be undertaken to determine if outcomes of colonic stenting are better than emergency surgery for such patients.

Introduction Endoscopic mucosal resection (EMR) is now the accepted first-line resection technique for large non-ampullary duodenal adenomas and are associated with significant adverse events. Aim of this series is to analyse EMR of duodenal adenomas in a tertiary centre. Methods Retrospective data was collected from October 2015 to August 2021 for patients who underwent duodenal EMR at a tertiary care centre. Patient's demographics, polyp morphology, procedural details, outcomes and histological data were analysed. Results Forty-five lesions required EMR in 35 patients (60% female). The mean adenoma size was 28.2 ± 20.3 mm (range 8–80 mm). Paris class IIa was noted in 68.89% (31/45); IIb in 15.56% (7/45),Is or Ip in 15.56% (7/45) procedures. Thirty-eight (84.45%) were laterally spreading tumours (LSTs) with 60.53% (23/38) non-granular and 39.47% (15/38) granular type tumours. Eleven patients (31.42%) had Familial Adenomatosis Polyposis (FAP) whilst the rest were sporadic. Piece-meal EMR was performed in 60% (27/45) and the remaining en-bloc. Argon plasma coagulation for tissue destruction at the edges of resection margins was used in 20% (9/45). Prophylactic haemostatic clips for closure of mucosal defect after EMR were deployed in 82.22% (37/45). Out of these, complete closure of the resection defect was successful in 27 (72.97%) procedures and in 10 (27.02%) with wide resection margins, haemoclips were deployed to reduce the size of the defect. Two (4.4%) post procedural bleeding occurred; one patient requiring surgical intervention and the other treated with endotherapy. At the median follow up of 23 months (range 3–58 months) recurrence was identified in 7.5% of cases. These patients achieved clinical success after a mean of 3.33 attempts (median 2, range 2–6). Risk factors for recurrence include size greater than 25 mm (p= 0.002), Paris IIa morphology (p=0.019), tubulovillous morphology(p=0.04) and piecemeal resection (p=0.02). Technical success was achieved in all procedures and clinical success in 34/35 (97.14%) patients with one patient referred for pancreas preserving total duodenectomy. Conclusion Endoscopic mucosal resection is a safe and effective primary treatment option for non-ampullary duodenal adenomas. Pre-emptive clip placement may protect against post procedural bleeding. Recurrent adenomas can be treated with further endotherapy.

Introduction Once mainstay of therapy, surgery has now been replaced by endoscopic ampullectomy, as the primary therapeutic modality for non-invasive ampullary adenomas. The present study aims to analyse endoscopic ampullectomy as a therapeutic approach in a large single-centre series. Methods This is a retrospective study of fifty consecutive patients who underwent endoscopic ampullectomy over an eleven-year period (January 2011 to December 2021) for ampullary adenomas. The analysis includes demographical features, diagnostic findings, technique of intervention (sedation choices, pre-intervention protocols, interventions), histology, technical, clinical success and adverse events. Results Fifty consecutive patients who underwent endoscopic ampullectomy during this period; with 27(54%) females and a mean age 67.62(+/- 12.13) years were included. Out of these, 44(88%) were sporadic and 6(12%) were Familial adenomatous polyposis (FAP) cases. Forty-two (84%) patients underwent pre-ampullectomy endoscopic ultrasound (EUS) evaluation. Pancreatic divisum was found in 6(12%) patients. Laterally spreading adenomas were seen in 15(30%) patients. In total, 35(70%) patients underwent ampullectomy under general anaesthesia, whereas in 15(30%) patients conscious sedation was used. Mean size of ampullary adenoma was 20.5mm (+/- 12.09mm, range 10–90mm). Single piece snare ampullectomy was performed in 33(66%) patients while remaining 17(34%) patients underwent piecemeal resection. Pancreatic stent placement as a prophylaxis against pancreatitis was achieved in 42(84%) patients and rectal Diclofenac was administered in 31(62%) patients. Bile duct stent placement was required in 21(42%) patients to prevent post-procedure cholangitis. Overall, in 20(40%) patients prophylactic haemoclip application to prevent post-procedure bleed was performed. Three patients were referred to surgery post ampullectomy for T2 adenocarcinoma, intraductal extension and high-grade dysplasia respectively. Overall, technical success was achieved in 46 (92%) patients while clinical success in 45(90%) patients. After a mean follow up was 20.84(+/-15.21) months (1–63 months), recurrence occurred in 4(8%) cases. All recurrences were treated endoscopically to eradication. Adverse events were noted in five (10%) patients; two (4%) each of pancreatitis and bleeding whilst one perforation occurred, requiring endoscopic clip closure. Conclusion Endoscopic ampullectomy is a safe and effective first line therapy for ampullary adenomas confined to mucosa. Meticulous patient selection through a multidisciplinary team approach, strict protocol-based management including endoscopic surveillance are essential for optimal outcomes.

The present work reports the study of cation distribution in Ni substituted polycrystalline Ba0.5Sr1.5Co2Fe12O22 (Co2Y-BSCFO) hexaferrite samples using complimentary experimental methods viz., in-field F57e Mössbauer and Raman spectroscopy. Combining the analysis of in-field F57e Mo¨ssbauer and Raman spectroscopy measurements it is shown that the substituted Ni in Co2Y-BSCFO preferentially occupies the octahedral site with spin-down configuration i.e., 6cVI. The obtained cation distribution data is found to qualitatively match the magnetization values as obtained from bulk magnetic measurements. Temperature dependent dielectric data reveals a significant dispersion in dielectric constant associated with loss peaks and the conduction-hopping mechanism explains such behavior.

Abstract Background Symptomatic pancreatic pseudocysts or walled off necrosis following pancreatitis can be drained via a stoma from the collection to the GI tract, this is typically facilitated by endoscopic stents. These stents are left in-situ until the area has drained, this can take several months. The stent is then ideally removed endoscopically. Little is known about the consequences of failed endoscopic stent removal or factors contributing to this failure. Methods Retrospective analysis of prospective data at LUHFT between 1st January 2018 and 31st December 2019 of patients receiving at least one Hot Axios stent for management of pancreatic collection. Normally distributed data were compared using Student’s two tailed T test, with non-parametric data compared using Mann-Witney U test, categorical data were analysed using Chi2 test Results 131 patients were included in analysis, of which 74 were male with a median age of 56 years (IQR 46-66.5). Failure of endoscopic removal (14 patients) was associated with a longer time to removal; 101 days (IQR 78-121) to first attempt vs. 49 days (IQR 19-104) to first endoscopic attempt where the stent was successfully retrieved endoscopically (p < 0.01). Surgical removal was undertaken in 6 patients, with significant morbidity in 2 of 6 patients. Overall 90-day mortality in patients undergoing Hot Axios stent placement was 8 of 131 (6%). Conclusions Endoscopic stent removal fails more frequently in patients where the stent has remained in situ for a long time before removal is attempted. Surgical removal of Hot Axios Stents is associated with significant morbidity, and this should be balanced against the as yet unknown consequences of leaving Hot Axios stent in-situ permanently.

The COVID-19 pandemic has had a substantial impact on endoscopy training worldwide, due to various factors such as significant decreased case volume and training opportunities. Moreover, the British Society of Gastroenterology had advised on operational considerations during the pandemic such as restricting number of staff in procedure rooms. Aim: We describe a novel training method employed at a single tertiary hospital in the United Kingdom to circumvent such restrictions to minimize disruption to advanced endoscopy training.

Objectives:. To assess both individual patient and institutional costs as well as outcomes in patients with pancreatic necrosis who underwent either endoscopic, minimal access or open pancreatic necrosectomy. These data can be used to evaluate clinical effectiveness with a view to informing local healthcare providers. Background:. Intervention for infected pancreatic necrosis is associated with a high morbidity, mortality, and long hospital stays. Minimal access surgical step-up approaches have been the gold standard of care; however, endoscopic approaches are now offered preferentially. Methods:. All patients undergoing endoscopic (EN), minimal access retroperitoneal (MARPN), and open (OPN) necrosectomy at a single institution from April 2015 to March 2017 were included. Patients were selected for intervention based on morphology and position of the necrosis and on clinical factors. Patient-level costing systems were used to determine inpatient and outpatient costs. Results:. Eighty-six patients were included: 38 underwent EN, 35 MARPN, and 13 OPN. Preoperative APACHEII was 6 versus 9 versus 9 (P = 0.017) and CRP 107 versus 204 versus 278 (P = 0.012), respectively. Postoperative stay was 19 days for EN versus 41 for MARPN versus 42 for OPN (P = 0.007). Complications occurred in 68.4%, 68.6%, and 46.2% (P = 0.298), whereas mortality was 10.5%, 22.9%, and 15.4% (P = 0.379), respectively. Mean total cost was £31,364 for EN, £52,770 for MARPN (P = 0.008), and £60,346 for OPN. Ward and critical care costs for EN were lower than for MARPN (ward: £9430 vs £14,033, P = 0.024; critical care: £5317 vs £16,648, P = 0.056). Conclusions:. EN was at least as safe and effective as MARPN and OPN and was associated with markedly reduced hospital stay and cost, although some markers of disease severity were higher in patients undergoing MARPN and OPN. These results support EN as the preferred approach to necrosectomy, but hybrid utilization of all available techniques remains integral to optimal outcomes.

The present work reports the preparation and study of multiferroic Nd doped BiFeO3 (BFO) polycrystalline samples. The samples are prepared with sol-gel method. The x-ray diffraction measurements confirm the orthorhombic structure with Pnma space-group. Small amount of secondary phase is also observed. SEM and EDX have been used to study the surface morphology and weight percentage of the elements. The room temperature leakage current density (J-E) measurements indicate grain boundary limited conduction and Ohmic conduction mechanisms under lower and higher field regions, respectively. Ferroelectric (P-E& PUND) and Mössbauer spectroscopy measurements are also carried out and are discussed in the present paper.

Polycrystalline YFe1−xMnxO3 (x = 0, 0.1, 0.2, 0.3, 0.4 and 0.5) samples are prepared via sol-gel method. Structural characterization of these samples is done by x-ray diffraction (XRD) technique and Raman spectroscopic method. Intense peaks in XRD graphs show that the sample is crystalline in nature and Reitveld refined XRD data shows that the samples are formed in single phase. Raman spectroscopic study confirms the structure and phase purity of the samples. Room temperature 57Fe Mossbauer studies confirm that Fe ion exists in ferric state. The hyperfine field (Bhf) values are found to decrease with increase in manganese (Mn) concentration. This decrease in Bhf value indicates the increase in antiferromagnetic nature of the samples, which arises due to the weakening of magnetic interactions between the Fe ions. From room temperature leakage current density (J-E) measurements, it is observed that leakage current density increases with increase in Mn doping. Scanning electron micrographs explain the reason of increase in leakage current density based on the micro structure of the samples. The samples are found to exhibit Ohmic conduction mechanism in entire electric field range.

OBJECTIVES: Intraductal papillary mucinous neoplasms (IPMNs) are associated with risk of pancreatic ductal adenocarcinoma (PDAC). It is unclear if an IPMN in individuals at high risk of PDAC should be considered as a positive screening result or as an incidental finding. Stratified familial pancreatic cancer (FPC) populations were used to determine if IPMN risk is linked to familial risk of PDAC. METHODS: This is a cohort study of 321 individuals from 258 kindreds suspected of being FPC and undergoing secondary screening for PDAC through the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer (EUROPAC). Computerised tomography, endoscopic ultrasound of the pancreas and magnetic resonance imaging were used. The risk of being a carrier of a dominant mutation predisposing to pancreatic cancer was stratified into three even categories (low, medium and high) based on: Mendelian probability, the number of PDAC cases and the number of people at risk in a kindred. RESULTS: There was a median (interquartile range (IQR)) follow-up of 2 (0-5) years and a median (IQR) number of investigations per participant of 4 (2-6). One PDAC, two low-grade neuroendocrine tumours and 41 cystic lesions were identified, including 23 IPMN (22 branch-duct (BD)). The PDAC case occurred in the top 10% of risk, and the BD-IPMN cases were evenly distributed amongst risk categories: low (6/107), medium (10/107) and high (6/107) (P = 0.63). CONCLUSIONS: The risk of finding BD-IPMN was independent of genetic predisposition and so they should be managed according to guidelines for incidental finding of IPMN.

Introduction The use of fully covered metal stents (FCSEMS) and specifically designed lumen apposing metal stents (LAMS) for transmural drainage of peri-pancreatic fluid collections has become widespread. A systematic review published in 20151 did not support the routine use of metal stents for drainage of pancreatic fluid collections. However, recent studies have shown conflicting data; therefore a systematic review and meta-analysis was performed. Method We conducted a Pubmed search for English language original comparative studies between plastic and metal stents from January 2014 to January 2017. The random effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Outcomes analysed were clinical success, defined as near complete or complete resolution of the pseudocyst on imaging, adverse events and requirement of further intervention. Results The search identified 183 studies, 6 studies2-7 with 592 (284 metal, 308 plastic) patients met inclusion criteria and were included in the meta-analysis. Clinical success was achieved in 96.1% vs 87.5%, in the metal and plastic groups respectively, RR 1.08 [95% CI 1.01–1.15], I2=38.1%. The rate of adverse events was 10.7% for metal stents vs 26.6% for plastic, RR 0.43 [95% CI 0.21–0.88], I2=53.5%. Further intervention was required in 18.2% of patients in the metal stent group vs 27.3% RR 0.61 [95% CI 0.22–1.71], I2= 73.6%. Conclusion Metal stent usage for drainage of peripancreatic fluid collections improves clinical outcomes and reduces adverse events. References . Bang J, et al. Dig Endosc2015;27(4):486–98. . Lee B, et al. Endoscopy2014;46(12):1078–84. . Mukai S, et al. Endoscopy2015;47(1):47–55. . Bang J, et al. Dig Endosc2017;29(1):83–90. . Bapaye A, et al. Dig Endosc2017;29(1):104–110. . Ang T, et al. Endosc Ultrasound2016;(5): 320–7. . Sharaiha R, et al. Gastrointest Endosc2015;82(5):822–7. Disclosure of Interest None Declared