Search Results (54)

Background: Migrated foreign bodies in the prevertebral region represent a rare but potentially serious condition. This case underscores the importance of thorough visual and digital intraoperative exploration for successful foreign body retrieval and highlights the potential diagnostic and surgical challenges associated with migrated foreign bodies in the cervical region. Case report: A 77-year-old female patient presented with dysphagia following the intake of an Angiotensin-Converting Enzyme (ACE) inhibitor. Due to hemodynamic instability and laboratory findings that indicated multiple organ failure, a computed tomography (CT) scan was performed, which revealed a left-sided prevertebral abscess with gas collections. Because of persistently elevated and fluctuating inflammatory markers, multiple CT scans were performed, which showed an obliquely oriented, wire-like tubular structure approximately 30 mm in length, 5 mm in width and 1 mm in diameter in the prevertebral region of the previous abscess cavity. Eventually, after three surgical interventions—one transoral and two transcervical approaches—the foreign body could be identified and removed. Afterwards, the patient’s inflammatory markers decreased and her dysphagia resolved. Conclusions: This case demonstrates that early diagnosis and timely removal of foreign bodies in the cervical space are essential to prevent complications such as retropharyngeal abscess formation or mediastinitis. A combination of careful clinical examination, endoscopic evaluation, and cross-sectional imaging—particularly CT scan—is crucial for accurate localization. Finally, this report highlights the importance of maintaining a high index of suspicion for migrated foreign bodies in patients presenting with persistent symptoms or unexplained cervical infections following suspected foreign body ingestion. Full article

Background and Clinical Significance: Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally aggressive vascular tumor, classically affecting adolescent males. Diagnosis in adulthood is exceptionally uncommon and may mimic other vascular or malignant nasopharyngeal lesions. This patient also had chronic hypocalcemia with Fahr-like intracranial calcifications secondary to long-standing postoperative hypoparathyroidism after thyroid carcinoma treatment. To our knowledge, this coexistence has not been previously reported. Case Presentation: A 34-year-old Caucasian male with papillary thyroid carcinoma treated with total thyroidectomy developed postoperative hypoparathyroidism with chronic hypocalcemia and Fahr-like intracranial calcifications. During admission for acute respiratory insufficiency due to tracheostomy dysfunction, imaging revealed a 37 × 33 × 32 mm heterogeneous, hypervascular nasopharyngeal mass extending into the right pterygopalatine fossa (PPF) with bone remodeling and focal bony dehiscence. Digital subtraction angiography demonstrated a markedly hypervascular tumor, predominantly supplied by branches of the right internal maxillary artery (via the sphenopalatine artery). Endoscopic resection was performed, and histopathology confirmed JNA. Most JNA cases occur between 7 and 19 years of age; presentations in men older than 30 years are rare and often generate diagnostic uncertainty, particularly when differentiating from nasopharyngeal carcinoma or other lesions. In adults, magnetic resonance imaging/computed tomography for assessment of local extent and angiography for vascular mapping are key to minimizing hemorrhagic risk. The concurrent endocrine disorder emphasizes the need for multidisciplinary perioperative metabolic optimization, without implying a pathophysiological link. Conclusions: This report illustrates JNA diagnosed in adulthood in a male with Fahr-like intracranial calcifications secondary to chronic hypoparathyroidism. It highlights the necessity of considering JNA in the differential diagnosis of hypervascular nasopharyngeal masses in adults, especially in patients with complex comorbidities. Full article

A capsule endoscope (CE) provides noninvasive access to the gastrointestinal tract, offering diagnostic information that cannot be obtained through external imaging alone. However, during the examination inside the stomach, the CE’s posture may change rapidly as it moves within a dynamically deforming organ, making it difficult to determine its orientation using only the onboard camera feedback. To address this problem, this study proposes a method that employs an external array of Hall Effect Sensors (HES) to estimate the capsule’s position and orientation in real time, based on the magnetic field generated by a permanent magnet (PM) embedded inside the capsule, without the need for any additional internal sensors. This approach introduces a unified magnetic actuation and localization framework that enables real-time 5-degree-of-freedom posture estimation using only the internal PM of the capsule. Furthermore, the proposed system features an integrated architecture capable of simultaneous actuation and localization. To enhance system practicality, the sensor module and communication board were combined into a single unit that employs a digital serial communication scheme, eliminating the need for analog to digital conversion of sensing signals. By avoiding additional onboard sensors and employing a PM-based actuation system, the proposed system simplifies hardware configuration by preserving capsule miniaturization and by eliminating the high power consumption and thermal issues associated with electromagnet-based actuation, while maintaining accurate real-time tracking performance. Through an optimization process, the system achieved a position error of less than 2 mm and an angular error within 2° over a sensing range of up to 60 mm. Repeated experiments further validated the system’s effectiveness and reliability under realistic operating conditions, demonstrating its feasibility for compact and clinically applicable active capsule endoscopy systems. Full article

Background/Objectives: Endoscopic endonasal transsphenoidal surgery (ETSS) has undergone substantial evolution driven by continuous technological innovations and is increasingly established as a minimally invasive and highly precise approach for the treatment of pituitary neuroendocrine tumors (PitNETs) and selected parasellar lesions. The objective of this review is to summarize the historical development of ETSS and to provide an integrated overview of recent advances shaping contemporary neuroendoscopic surgery. Methods: A narrative review of the literature was conducted focusing on key technological and conceptual developments in ETSS, including advances in endoscopic visualization systems, artificial intelligence (AI)-based image analysis, intraoperative navigation, educational support frameworks, and skull base reconstruction techniques. Representative clinical studies and review articles were examined to contextualize current applications and limitations. Results: Recent innovations have expanded the functional capabilities of ETSS beyond pituitary surgery alone. Progress in visualization, navigation, and reconstruction techniques has contributed to improved anatomical understanding, surgical safety, and outcome optimization. Furthermore, accumulating clinical evidence supports the selective extension of ETSS indications to complex midline skull base pathologies, including craniopharyngiomas, meningiomas, and chordomas, while emphasizing the importance of appropriate patient selection. Conclusions: ETSS has evolved from a single operative technique into an integrated surgical platform supported by technological convergence. Ongoing refinement of visualization, digital assistance, and reconstructive strategies is expected to further enhance safety and precision. This review highlights current trends in ETSS and outlines future directions for innovation and clinical application in neuroendoscopic skull base surgery. Full article

Background: Pediatric inflammatory bowel disease (IBD) is characterized by a heterogeneous and often aggressive disease course, requiring complex multimodal assessment and long-term monitoring. Artificial intelligence (AI) has emerged as a promising tool to support clinical decision-making by enabling an objective analysis of large, multidimensional datasets. Objectives: This narrative review aims to critically synthesize current evidence on the application of AI across the diagnosis, monitoring, and treatment of pediatric IBD. Methods: A narrative literature review was conducted using the PubMed (MEDLINE) and Cochrane Library databases, including publications available up to December 2025. Pediatric-focused studies were prioritized. However, due to the limited availability of pediatric-specific AI research, a considerable proportion of the evidence reviewed derives from adult or mixed cohorts, which were included when methodological frameworks or clinically relevant endpoints were applicable to pediatric IBD. Eligible publications included narrative and systematic reviews, observational studies, and clinical trials focusing on AI applications in endoscopy, histology, imaging, disease monitoring, and therapeutic response prediction. Results: AI-based models, particularly those using machine learning and deep learning, demonstrated promising performance in the automated analysis of endoscopic, histological, and imaging data, reducing interobserver variability and improving workflow efficiency. Multimodal approaches integrating imaging, clinical, and biomarker data consistently outperformed unimodal models. Emerging applications in patient-centered monitoring, digital biomarkers, and telemedicine enabled continuous disease assessment and early detection of flares, with particular relevance in pediatric settings where repeated, non-invasive monitoring is essential. AI-driven models also showed promising accuracy in predicting therapeutic response, supporting treatment stratification and precision medicine strategies. Conclusions: AI shows promising potential to complement clinical expertise in pediatric IBD by supporting diagnostic assessment, disease monitoring, and therapeutic optimization. However, translation into routine clinical practice remains constrained by methodological heterogeneity, limited pediatric-specific validation, and unresolved ethical and regulatory challenges. Future research should prioritize prospective multicenter pediatric studies, the development of transparent and explainable models, and the integration of AI-based tools into clinically meaningful and patient-centered care pathways. Full article

Endoscopes are widely used in medicine, making objective evaluation of imaging performance essential for device development and quality assurance. Image resolution is commonly characterized by the modulation transfer function (MTF); however, its interpretation depends critically on how spatial frequency is defined and reported. Because spatial frequency is directly tied to sampling, it can be expressed in different units across the imaging chain, including the object plane, image sensor plane, and digital image domain. Inconsistent conversion between these spaces and domains can mislead comparisons and even alter the apparent ranking of regions of interest (ROIs) or imaging systems. This work presents a systematic analysis of spatial-frequency relationships along the endoscopic imaging chain and provides a practical conversion and interpretation workflow for MTF analysis. The framework accounts for sensor sampling, in-camera processing, resampling or scaling, and geometric distortion. Because geometric distortion introduces position-dependent sampling across the field of view, ROI-specific local-magnification measurements are incorporated to convert measured MTFs to a consistent object space spatial-frequency axis. Two case studies illustrate the implications. First, an off-axis ROI may appear to outperform the image center when MTF is expressed in digital image domain cycles per pixel, but this conclusion reverses after conversion to object space cycles per millimeter using local magnification. Second, resampled image outputs can yield inflated MTF curves unless scaling differences between formats are explicitly incorporated into the spatial-frequency axis. Overall, the proposed conversion and reporting workflow enables consistent and physically meaningful MTF comparison across devices, ROIs, and acquisition configurations when geometric distortion, sampling, or resampling differs, clarifying how optics, sensor characteristics, and image processing jointly determine reported MTF results. Full article

Pancreaticobiliary endoscopy, encompassing endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), and digital single-operator cholangioscopy (DSOC), is essential for diagnosing and managing pancreatic and biliary diseases. However, these procedures are limited by operator dependency, variable diagnostic accuracy, and technical complexity. Artificial intelligence (AI), particularly through machine learning (ML) and deep learning (DL), has emerged as a promising tool to address these challenges. Early studies show that AI can enhance lesion detection, improve differentiation of pancreatic masses, classify cystic lesions, and aid in diagnosing malignant biliary strictures. AI has also been used to predict post-ERCP pancreatitis risk and reduce radiation exposure during ERCP. Despite this promise, current AI models are largely experimental—limited by small, single-center datasets, lack of external validation, and no FDA-approved systems for these indications. Major barriers include inconsistent data acquisition, limited interoperability across hardware platforms, and integration into real-time workflows. Future progress depends on multicenter data sharing, standardized imaging protocols, interpretable AI design, and regulatory pathways for model deployment and updates. AI can be developed as a valuable partner to endoscopists, enhancing diagnostic accuracy, reducing complications, and supporting more efficient, personalized care in pancreaticobiliary endoscopy. Full article

Background: The miniaturization of ureterorenoscopes increasingly enables atraumatic primary ureteroscopy, without ureteral dilation or presenting. This study aims to evaluate the feasibility and safety of primary ureteroscopy using the HU30M (6.3 Fr, HugeMed, Shenzhen HugeMed Medical Technical Development Co., Ltd., Shenzhen, China), the smallest currently available ureteroscope. Methods: We analyzed consecutive patients in whom primary ureteroscopy using the HU30M was performed or attempted, using prospectively collected in-hospital and 30-day follow-up data for retrospective evaluation. The primary outcome was the success rate of primary ostial intubation. Secondary outcomes included the stone-free rate (SFR) in patients with urolithiasis, incidence of in-hospital complications (Clavien–Dindo classification) and 30-day emergency readmission. Additionally, we conducted a propensity score-matched comparative analysis of the HU30M versus a contemporary 7.5 Fr digital single-use ureteroscope (PUSEN PU3033AH, Zhuhai Pusen Medical Technology Co., Ltd., Jinhua, China). Results: Between January and April 2025, primary ureteroscopy using the HU30M was performed or attempted in 34 patients, including four bilateral procedures. Primary ureteroscopy was defined as ureteroscopic access without prior stenting or dilation. Indications were diagnostic evaluation in 15 patients (44%), uretreroscopic stone treatment in 10 patients (29%) and endoscopic combined intrarenal surgery (ECIRS) in 9 patients (27%). Successful primary ostial intubation was achieved in 36 of 38 renal units (95%). Among urolithiasis cases, SFR was 17/19 (90%) in-hospital complications were limited to postoperative fever in two patients (6%) and no procedure-related 30-day emergency readmission occurred. In matched analyses, HU30M demonstrated significantly shorter operative times compared with the 7.5 Fr ureteroscope, while postoperative hemoglobin drop, inflammatory parameters and renal function were comparable. Conclusions: Primary ureteroscopy with HU30M is feasible and safe across diverse indications, achieving high success of atraumatic ostial access. Comparative analyses suggest procedural efficiency advantages and overall safety comparable to the current digital single-use ureteroscope standard. Full article

In human medicine, computer-aided diagnosis (CAD) is increasingly employed for screening, identifying, and monitoring early endoscopic signs of various diseases. However, its potential—despite proven benefits in human healthcare—remains largely underexplored in equine veterinary medicine. This study aimed to quantify endoscopic signs of pharyngeal lymphoid hyperplasia (PLH) as digital data and to assess their effectiveness in CAD of PLH in comparison and in combination with clinical data reflecting respiratory tract disease. Endoscopic images of the pharynx were collected from 70 horses clinically assessed as either healthy or affected by PLH. Digital data were extracted using an object detection-based processing technique and first-order statistics (FOS). The data were transformed using linear discriminant analysis (LDA) and classified with the random forest (RF) algorithm. Classification metrics were then calculated. When considering digital and clinical data, high classification performance was achieved (0.76 accuracy, 0.83 precision, 0.78 recall, and 0.76 F1 score), with the highest importance assigned to selected FOS features: Number of Objects and Neighbors, and Tracheal Auscultation. The proposed protocol of digitizing standard respiratory tract diagnostic methods provides effective discrimination of PLH grades, supporting the clinical value of CAD in veterinary medicine and paving the way for further research in digital medical diagnostics. Full article

Background/Objectives: Esophageal and esophagogastric junction adenocarcinoma (EADC-EGJA), which mainly develops from Barrett’s esophagus (BE), low-grade dysplasia (LGD), and high-grade dysplasia (HGD), has a poor prognosis and several unmet clinical needs, among which is the detection of minimal residual disease (MRD) after endoscopic/surgical resection. Long interspersed nuclear element-1 (LINE-1), a surrogate marker of global methylation, is considered an emerging biomarker for MRD monitoring. The aim of this study was to determine, by LINE-1 methylation analysis, at which carcinogenesis step global methylation is affected and whether this biomarker could be followed in longitudinal to monitor the disease behavior post-surgery. Methods: Cell-free DNA of 90 patients with non-dysplastic Barrett’s esophagus (NDBE), HGD/early EADC-EGJA, or locally advanced/advanced EADC-EGJA were analyzed for LINE-1 methylation, by Methylation-Sensitive Restriction Enzyme droplet digital PCR (MSRE-ddPCR). Twenty-six patients were longitudinally studied by repetitive blood sampling. Results: Global hypomethylation increased during carcinogenesis, with significant difference between locally advanced/advanced EADC-EGJA and NDBE patients (p = 0.028). Longitudinal cases confirmed the rareness of hypomethylation in NDBE cases. The majority of HGD/early EADC-EGJA and locally advanced/advanced EADC-EGJA patients showed methylation changes after resection according to clinical status. Conclusions: This study suggests that global hypomethylation occurs just prior to cancer invasiveness and that it is a promising biomarker to monitor MRD. Full article

This study investigates the potential of a novel sleep endoscope, NasoLens, to eliminate the need for anesthesia in sleep endoscopy. We assess NasoLens’ safety, maneuverability, and ability to allow sleep without sedatives, aiming to improve the overall patient experience and reduce risks associated with anesthesia. Sleep endoscopy is commonly performed under anesthesia, which introduces risks, increases costs, and can limit accessibility. NasoLens’ design aims to address these challenges by improving patient comfort and enhancing maneuverability, eliminating the need for anesthesia. This could provide a safer, more cost-effective alternative for patients, particularly those at higher risk for anesthesia-related complications. NasoLens distinguishes itself with its smaller size, teardrop-shaped head, specialized camera angle for better visualization, and an integrated microphone for real-time auditory monitoring. These features enable NasoLens to offer improved maneuverability and comfort, compared to traditional nasopharyngoscopes, while enhancing diagnostic accuracy. These design innovations could revolutionize clinical practice by minimizing anesthesia-related risks, reducing procedural costs, and improving both procedural efficiency and patient satisfaction. With its ability to allow natural sleep without sedation, NasoLens has the potential to improve patient satisfaction, procedural outcomes, and expand the feasibility of sleep endoscopy into more accessible clinical settings, making it a promising alternative to traditional models. Full article

Background: The accurate measurement of the distances within the airways during bronchoscopy is necessary for diagnostic purposes; however, a reliable and simple device does not exist. Methods: The LJ system, consisting of a probe, a box with a display, an encoder, and a microcontroller, has been developed, and its prototype has been tested in vitro and validated in clinical practice in suitable procedures of interventional bronchoscopy. Results: In vitro, the device measurements showed a good correlation with the control performed with a digital caliper. Subsequently, ten patients were included in a pilot study evaluating this novel prototype of a measurement device. The device was used on four patients with tracheal stenosis indicated for Y-stent placement, four patients indicated for open surgery, and two cases of tracheoesophageal fistula. The measurements have been validated using computed tomography imaging or by direct inspection and measurement during open surgical procedures. Conclusions: The first experience and pilot study evaluating this novel instrument for distance measurements during interventional bronchology procedures showed that the LJ device can provide precise readings of the distance from the vocal cords, the lengths of tracheal stenoses, or the size of tumorous and other lesions. Its use might be widened to other endoscopic indications. Full article

Fluidized bed reactors (FBRs) are integral to various industries due to their exceptional capability in facilitating efficient gas–solid interactions, resulting in superior mixing and heat and mass transfer. This research delves into the impact of temperature on fluidization dynamics, particularly focusing on the collisional properties of particles within the bed. The investigation builds upon foundational research, notably Geldart’s classification of fluidization regimes and recent advancements in high-temperature experimental techniques, such as High-Temperature Endoscopic-Laser particle image velocimetry/digital image analysis. To explore these temperature effects, a coupled Discrete Element Method and Computational Fluid Dynamics (cfd–dem) model was employed. This approach enables a detailed examination of gas–particle and particle–particle interactions under varying temperature conditions. The simulations in this study explore the friction coefficient, as well as changes in both tangential and normal restitution coefficients, which affect the fluidization behavior. These changes were systematically analyzed to determine their influence on minimum fluidization velocity and bubble formation. The numerical results are compared with experimental data from high-temperature fluidization studies, highlighting the necessity of incorporating inter-particle forces to fully capture the observed phenomena. The findings underscore the critical role of particle collisional properties in high-temperature fluidization and suggest the potential increasing role of inter-particle forces. Overall, this paper provides new insights into the complex dynamics of fluidized beds at elevated temperatures, emphasizing the need for further experimental–numerical research to enhance the reliability and understanding of these systems in industrial applications. Full article

Background: Several artificial intelligence systems based on large language models (LLMs) have been commercially developed, with recent interest in integrating them for clinical questions. Recent versions now include image analysis capacity, but their performance in gastroenterology remains untested. This study assesses ChatGPT-4’s performance in interpreting gastroenterology images. Methods: A total of 740 images from five procedures—capsule endoscopy (CE), device-assisted enteroscopy (DAE), endoscopic ultrasound (EUS), digital single-operator cholangioscopy (DSOC), and high-resolution anoscopy (HRA)—were included and analyzed by ChatGPT-4 using a predefined prompt for each. ChatGPT-4 predictions were compared to gold standard diagnoses. Statistical analyses included accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC). Results: For CE, ChatGPT-4 demonstrated accuracies ranging from 50.0% to 90.0%, with AUCs of 0.50–0.90. For DAE, the model demonstrated an accuracy of 67.0% (AUC 0.670). For EUS, the system showed AUCs of 0.488 and 0.550 for the differentiation between pancreatic cystic and solid lesions, respectively. The LLM differentiated benign from malignant biliary strictures with an AUC of 0.550. For HRA, ChatGPT-4 showed an overall accuracy between 47.5% and 67.5%. Conclusions: ChatGPT-4 demonstrated suboptimal diagnostic accuracies for image interpretation across several gastroenterology techniques, highlighting the need for continuous improvement before clinical adoption. Full article

Background: Diet significantly impacts the onset and progression of inflammatory bowel disease (IBD), and diet offers unique opportunities for treatment and preventative purposes. However, despite growing interest, no diet has been conclusively associated with improved long-term clinical and endoscopic outcomes in IBD, and evidence-based dietary guidelines for IBD remain scarce. This narrative review critically examines dietary assessment methods tailored to the unique needs of IBD, highlighting opportunities for precision and inclusivity. Methods: We conducted a comprehensive literature review using search terms related to diet, diet assessment, nutrition, food, sex, gender, equity, and IBD. Results: The identified dietary assessment tools evaluated nutritional quality, dietary patterns, food processing, lifestyle interactions, inflammatory potential, and effects of specific nutrients. Advanced methods, including biomarkers, multi-omics approaches, and digital tools, were highlighted as being complementary to traditional approaches, offering enhanced precision and real-time monitoring. Women remain under-represented in dietary research but face unique nutritional needs due to hormonal cycles, pregnancy, and higher malnutrition risks in IBD. Discussion: Traditional diet assessment methods remain valuable but are often limited by misreporting biases. Advanced approaches may provide greater precision, enabling real-time monitoring and personalised dietary tracking. Incorporating considerations of sex, gender, age, ethnicity, socioeconomic, and sustainability enhances the relevance and applicability of these methods. Addressing these multifaceted aspects of dietary assessment in IBD can facilitate robust interventional trials. Conclusions: Diet assessment tools are essential for developing personalised dietary interventions in IBD, informing evidence-based guidelines, and improving health outcomes and quality of life in IBD. Full article