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Article: Assessment of

Glover, Ben / Teare, Julian / Patel, Nisha

BMJ open gastroenterology

2021 Volume 8, Issue 1

Abstract: Objectives: Helicobacter pylori: Design: Patients undergoing high-definition upper gastrointestinal (GI) endoscopy without magnification were recruited prospectively. During the endoscopy, the presence or absence of specific endoscopic findings was ... ...

Abstract	Objectives: Helicobacter pylori Design: Patients undergoing high-definition upper gastrointestinal (GI) endoscopy without magnification were recruited prospectively. During the endoscopy, the presence or absence of specific endoscopic findings was noted. Sydney protocol biopsies were used as the diagnostic reference standard, and urease test if taken. The results informed a logistic regression model used to produce a simple diagnostic approach. This model was subsequently validated using a further cohort of 30 patients. Results: 153 patients were recruited and completed the study protocol. The prevalence of active Conclusion: A simple endoscopic model may be accurate for predicting Trial registration number: The study was registered with ClinicalTrials.gov, No. NCT02385045.
MeSH term(s)	Gastric Mucosa ; Gastroscopy ; Helicobacter Infections/diagnosis ; Helicobacter pylori ; Humans ; Prospective Studies
Language	English
Publishing date	2021-08-05
Publishing country	England
Document type	Journal Article
ISSN	2054-4774
ISSN	2054-4774
DOI	10.1136/bmjgast-2021-000608
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Article: A systematic review of the role of non-magnified endoscopy for the assessment of

Glover, Ben / Teare, Julian / Patel, Nisha

Endoscopy international open

2020 Volume 8, Issue 2, Page(s) E105–E114

Abstract: Background and study ... ...

Abstract	Background and study aims
Language	English
Publishing date	2020-01-22
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2761052-4
ISSN	2196-9736 ; 2364-3722
ISSN (online)	2196-9736
ISSN	2364-3722
DOI	10.1055/a-0999-5252
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Article ; Online: The endoscopic predictors of

Glover, Ben / Teare, Julian / Ashrafian, Hutan / Patel, Nisha

Therapeutic advances in gastrointestinal endoscopy

2020 Volume 13, Page(s) 2631774520950840

Abstract: Objective: The endoscopic findings associated with : Data sources: The databases of MEDLINE and Embase, clinicalTrials.gov and the Cochrane Library were systematically searched for relevant studies from October 1999 to October 2019.: Methods: A ... ...

Abstract	Objective: The endoscopic findings associated with Data sources: The databases of MEDLINE and Embase, clinicalTrials.gov and the Cochrane Library were systematically searched for relevant studies from October 1999 to October 2019. Methods: A bivariate random effects model was used to produce pooled diagnostic accuracy calculations for each of the studied endoscopic findings. Diagnostic odds ratios and sensitivity and specificity characteristics were calculated to identify significant predictors of Results: Meta-analysis included 4380 patients in 15 studies. The most significant predictor of an Conclusion: The regular arrangement of collecting venules, mucosal oedema, diffuse redness and map-like redness are important endoscopic findings for determining
Language	English
Publishing date	2020-10-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	3011635-1
ISSN	2631-7745 ; 2631-7745
ISSN (online)	2631-7745
ISSN	2631-7745
DOI	10.1177/2631774520950840
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Article ; Online: The Status of Advanced Imaging Techniques for Optical Biopsy of Colonic Polyps.

Glover, Ben / Teare, Julian / Patel, Nisha

Clinical and translational gastroenterology

2020 Volume 11, Issue 3, Page(s) e00130

Abstract: The progressive miniaturization of photonic components presents the opportunity to obtain unprecedented microscopic images of colonic polyps in real time during endoscopy. This information has the potential to act as "optical biopsy" to aid clinical ... ...

Abstract	The progressive miniaturization of photonic components presents the opportunity to obtain unprecedented microscopic images of colonic polyps in real time during endoscopy. This information has the potential to act as "optical biopsy" to aid clinical decision-making, including the possibility of adopting new paradigms such as a "resect and discard" approach for low-risk lesions. The technologies discussed in this review include confocal laser endomicroscopy, optical coherence tomography, multiphoton microscopy, Raman spectroscopy, and hyperspectral imaging. These are in different stages of development and clinical readiness, but all show the potential to produce reliable in vivo discrimination of different tissue types. A structured literature search of the imaging techniques for colorectal polyps has been conducted. The significant developments in endoscopic imaging were identified for each modality, and the status of current development was discussed. Of the advanced imaging techniques discussed, confocal laser endomicroscopy is in clinical use and, under optimal conditions with an experienced operator, can provide accurate histological assessment of tissue. The remaining techniques show potential for incorporation into endoscopic equipment and practice, although further component development is needed, followed by robust prospective validation of accuracy. Optical coherence tomography illustrates tissue "texture" well and gives good assessment of mucosal thickness and layers. Multiphoton microscopy produces high-resolution images at a subcellular resolution. Raman spectroscopy and hyperspectral imaging are less developed endoscopically but provide a tissue "fingerprint" which can distinguish between tissue types. Molecular imaging may become a powerful adjunct to other techniques, with its ability to precisely label specific molecules within tissue and thereby enhance imaging.
MeSH term(s)	Biopsy/methods ; Colon/pathology ; Colonic Polyps/diagnosis ; Colonic Polyps/pathology ; Colonoscopy/methods ; Humans ; Intestinal Mucosa/diagnostic imaging ; Intestinal Mucosa/pathology ; Microscopy, Confocal/methods ; Microscopy, Fluorescence, Multiphoton/methods ; Precancerous Conditions/diagnosis ; Precancerous Conditions/pathology ; Prospective Studies ; Spectrum Analysis, Raman ; Tomography, Optical Coherence
Language	English
Publishing date	2020-04-30
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2581516-7
ISSN	2155-384X ; 2155-384X
ISSN (online)	2155-384X
ISSN	2155-384X
DOI	10.14309/ctg.0000000000000130
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Article ; Online: Diagnostic Accuracy of Artificial Intelligence and Computer-Aided Diagnosis for the Detection and Characterization of Colorectal Polyps: Systematic Review and Meta-analysis.

Nazarian, Scarlet / Glover, Ben / Ashrafian, Hutan / Darzi, Ara / Teare, Julian

Journal of medical Internet research

2021 Volume 23, Issue 7, Page(s) e27370

Abstract: Background: Colonoscopy reduces the incidence of colorectal cancer (CRC) by allowing detection and resection of neoplastic polyps. Evidence shows that many small polyps are missed on a single colonoscopy. There has been a successful adoption of ... ...

Abstract	Background: Colonoscopy reduces the incidence of colorectal cancer (CRC) by allowing detection and resection of neoplastic polyps. Evidence shows that many small polyps are missed on a single colonoscopy. There has been a successful adoption of artificial intelligence (AI) technologies to tackle the issues around missed polyps and as tools to increase the adenoma detection rate (ADR). Objective: The aim of this review was to examine the diagnostic accuracy of AI-based technologies in assessing colorectal polyps. Methods: A comprehensive literature search was undertaken using the databases of Embase, MEDLINE, and the Cochrane Library. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Studies reporting the use of computer-aided diagnosis for polyp detection or characterization during colonoscopy were included. Independent proportions and their differences were calculated and pooled through DerSimonian and Laird random-effects modeling. Results: A total of 48 studies were included. The meta-analysis showed a significant increase in pooled polyp detection rate in patients with the use of AI for polyp detection during colonoscopy compared with patients who had standard colonoscopy (odds ratio [OR] 1.75, 95% CI 1.56-1.96; P<.001). When comparing patients undergoing colonoscopy with the use of AI to those without, there was also a significant increase in ADR (OR 1.53, 95% CI 1.32-1.77; P<.001). Conclusions: With the aid of machine learning, there is potential to improve ADR and, consequently, reduce the incidence of CRC. The current generation of AI-based systems demonstrate impressive accuracy for the detection and characterization of colorectal polyps. However, this is an evolving field and before its adoption into a clinical setting, AI systems must prove worthy to patients and clinicians. Trial registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020169786; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020169786.
MeSH term(s)	Artificial Intelligence ; Colonic Polyps/diagnosis ; Colonoscopy ; Colorectal Neoplasms/diagnosis ; Computers ; Humans
Language	English
Publishing date	2021-07-14
Publishing country	Canada
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1438-8871
ISSN (online)	1438-8871
ISSN	1438-8871
DOI	10.2196/27370
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Article ; Online: A case for improved assessment of gut permeability: a meta-analysis quantifying the lactulose:mannitol ratio in coeliac and Crohn's disease.

Gan, Jonathan / Nazarian, Scarlet / Teare, Julian / Darzi, Ara / Ashrafian, Hutan / Thompson, Alex J

BMC gastroenterology

2022 Volume 22, Issue 1, Page(s) 16

Abstract: Background: A widely used method in assessing small bowel permeability is the lactulose:mannitol test, where the lactulose:mannitol ratio (LMR) is measured. However, there is discrepancy in how the test is conducted and in the values of LMR obtained ... ...

Abstract	Background: A widely used method in assessing small bowel permeability is the lactulose:mannitol test, where the lactulose:mannitol ratio (LMR) is measured. However, there is discrepancy in how the test is conducted and in the values of LMR obtained across studies. This meta-analysis aims to determine LMR in healthy subjects, coeliac and Crohn's disease. Methods: A literature search was performed using PRISMA guidance to identify studies assessing LMR in coeliac or Crohn's disease. 19 studies included in the meta-analysis measured gut permeability in coeliac disease, 17 studies in Crohn's disease. Outcomes of interest were LMR values and comparisons of standard mean difference (SMD) and weighted mean difference (WMD) in healthy controls, inactive Crohn's, active Crohn's, treated coeliac and untreated coeliac. Pooled estimates of differences in LMR were calculated using the random effects model. Results: Pooled LMR in healthy controls was 0.014 (95% CI: 0.006-0.022) while pooled LMRs in untreated and treated coeliac were 0.133 (95% CI: 0.089-0.178) and 0.037 (95% CI: 0.019-0.055). In active and inactive Crohn's disease, pooled LMRs were 0.093 (95% CI: 0.031-0.156) and 0.028 (95% CI: 0.015-0.041). Significant differences were observed in LMR between: (1) healthy controls and treated coeliacs (SMD = 0.409 95% CI 0.034 to 0.783, p = 0.032), (2) healthy controls and untreated coeliacs (SMD = 1.362 95% CI: 0.740 to 1.984, p < 0.001), (3) treated coeliacs and untreated coeliacs (SMD = 0.722 95% CI: 0.286 to 1.157, p = 0.001), (4) healthy controls and inactive Crohn's (SMD = 1.265 95% CI: 0.845 to 1.686, p < 0.001), (5) healthy controls and active Crohn's (SMD = 2.868 95% CI: 2.112 to 3.623, p < 0.001), and (6) active Crohn's and inactive Crohn's (SMD = 1.429 (95% CI: 0.580 to 2.278, p = 0.001). High heterogeneity was observed, which was attributed to variability in protocols used across different studies. Conclusion: The use of gut permeability measurements in screening and monitoring of coeliac and Crohn's disease is promising. LMR is useful in performing this function with significant limitations. More robust alternative tests with higher degrees of clinical evidence are needed if measurements of gut permeability are to find widespread clinical use.
MeSH term(s)	Celiac Disease ; Crohn Disease ; Humans ; Lactulose ; Mannitol ; Permeability
Chemical Substances	Mannitol (3OWL53L36A) ; Lactulose (4618-18-2)
Language	English
Publishing date	2022-01-10
Publishing country	England
Document type	Journal Article ; Meta-Analysis
ZDB-ID	2041351-8
ISSN	1471-230X ; 1471-230X
ISSN (online)	1471-230X
ISSN	1471-230X
DOI	10.1186/s12876-021-02082-z
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Article ; Online: A Review of New and Emerging Techniques For Optical Diagnosis of Colonic Polyps.

Glover, Ben / Teare, Julian / Patel, Nisha

Journal of clinical gastroenterology

2019 Volume 53, Issue 7, Page(s) 495–506

Abstract: Background and aims: Endoscopic imaging is a rapidly progressing field and benefits from miniaturization of advanced imaging technologies, which may allow accurate real-time characterization of lesions. The concept of the "optical biopsy" to predict ... ...

Abstract	Background and aims: Endoscopic imaging is a rapidly progressing field and benefits from miniaturization of advanced imaging technologies, which may allow accurate real-time characterization of lesions. The concept of the "optical biopsy" to predict polyp histology has gained prominence in recent years and may become clinically applicable with the advent of new imaging technology. This review aims to discuss current evidence and examine the emerging technologies as applied to the optical diagnosis of colorectal polyps. Methods: A structured literature search and review has been carried out of the evidence for diagnostic accuracy of image-enhanced endoscopy and emerging endoscopic imaging technologies. The image-enhanced endoscopy techniques are reviewed, including their basic scientific principles and current evidence for effectiveness. These include the established image-enhancement technologies such as narrow-band imaging, i-scan, and Fuji intelligent chromoendoscopy. More recent technologies including optical enhancement, blue laser imaging, and linked color imaging are discussed. Adjunctive imaging techniques in current clinical use are discussed, such as autofluorescence imaging and endocytoscopy. The emerging advanced imaging techniques are reviewed, including confocal laser endomicroscopy, optical coherence tomography, and Raman spectroscopy. Conclusions: Large studies of the established image-enhancement techniques show some role for the optical diagnosis of polyp histology, although results have been mixed, and at present only the technique of narrow-band imaging is appropriate for the diagnosis of low-risk polyps when used by an expert operator. Other image-enhancement techniques will require further study to validate their accuracy but show potential to support the use of a "resect-and-discard" approach to low-risk polyps. New technologies show exciting potential for real-time diagnosis, but further clinical studies in humans have yet to be performed.
MeSH term(s)	Colonic Polyps/diagnostic imaging ; Colonoscopy/methods ; Humans ; Image Enhancement ; Microscopy, Confocal ; Narrow Band Imaging ; Spectrum Analysis, Raman ; Tomography, Optical Coherence
Language	English
Publishing date	2019-05-20
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	448460-5
ISSN	1539-2031 ; 0192-0790
ISSN (online)	1539-2031
ISSN	0192-0790
DOI	10.1097/MCG.0000000000001222
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Article ; Online: Current treatments for obesity.

Ruban, Aruchuna / Stoenchev, Kostadin / Ashrafian, Hutan / Teare, Julian

Clinical medicine (London, England)

2019 Volume 19, Issue 3, Page(s) 205–212

Abstract: Obesity is a major health and economic crisis facing the modern world. It is associated with excess mortality and morbidity and is directly linked to common conditions such as type 2 diabetes mellitus, coronary heart disease and sleep apnoea. The ... ...

Abstract	Obesity is a major health and economic crisis facing the modern world. It is associated with excess mortality and morbidity and is directly linked to common conditions such as type 2 diabetes mellitus, coronary heart disease and sleep apnoea. The management of obesity and its associated complications has evolved in recent years, with a shift towards more definitive strategies such as bariatric surgery. This review encompasses the dietary, pharmacological and surgical strategies currently available for the management of obesity.
MeSH term(s)	Bariatric Surgery/adverse effects ; Bariatric Surgery/methods ; Diabetes Mellitus, Type 2/complications ; Diet Therapy/methods ; Humans ; Obesity/complications ; Obesity/therapy ; Weight Loss
Language	English
Publishing date	2019-04-23
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2048646-7
ISSN	1473-4893 ; 1470-2118
ISSN (online)	1473-4893
ISSN	1470-2118
DOI	10.7861/clinmedicine.19-3-205
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Article ; Online: Malignant Melanoma of the Gastrointestinal Tract: Symptoms, Diagnosis, and Current Treatment Options.

Kohoutova, Darina / Worku, Dominic / Aziz, Hala / Teare, Julian / Weir, Justin / Larkin, James

Cells

2021 Volume 10, Issue 2

Abstract: Malignant melanoma (MM) has become the fifth most frequent cancer in the UK. It is the most common carcinoma to metastasize to the gastrointestinal (GI) tract. MM particularly has an affinity to spread to the small bowel, which is followed by the ... ...

Abstract	Malignant melanoma (MM) has become the fifth most frequent cancer in the UK. It is the most common carcinoma to metastasize to the gastrointestinal (GI) tract. MM particularly has an affinity to spread to the small bowel, which is followed by the involvement of the stomach and large intestine. Excellent endoscopic options including video capsule endoscopy and enteroscopy are available for a precise diagnosis of GI involvement by a metastatic MM. The complete surgical resection of GI metastatic MM in carefully selected patients not only provides symptom control, but has also been associated with an increase in overall survival. The approval of BRAF-targeted therapies and immune checkpoint inhibitors has transformed therapeutic approaches for patients with metastatic MM over the past decade. Currently, the overall survival of patients with advanced metastatic MM who have been treated with a combination of immunotherapeutic agents reaches 52% at five years. The role of surgery for patients with the metastatic involvement of the GI tract with MM is evolving in the era of effective systemic treatments.
MeSH term(s)	Gastrointestinal Neoplasms/diagnosis ; Gastrointestinal Neoplasms/pathology ; Gastrointestinal Neoplasms/therapy ; Gastrointestinal Tract/pathology ; Humans ; Immunotherapy/methods ; Melanoma/diagnosis ; Melanoma/pathology ; Melanoma/therapy
Language	English
Publishing date	2021-02-05
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2661518-6
ISSN	2073-4409 ; 2073-4409
ISSN (online)	2073-4409
ISSN	2073-4409
DOI	10.3390/cells10020327
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Article: Diagnostic accuracy of i-scan image enhancement for real-time endoscopic diagnosis of small colorectal polyps: a meta-analysis.

Glover, Ben / Patel, Nisha / Ashrafian, Hutan / Teare, Julian

Therapeutic advances in gastroenterology

2018 Volume 11, Page(s) 1756284818814948

Abstract: Objective: i-Scan is a digital image enhancement technology, reported to improve diagnostic performance during endoscopy. Previous studies have investigated the accuracy of i-scan for distinguishing between neoplastic and non-neoplastic colonic polyps ... ...

Abstract	Objective: i-Scan is a digital image enhancement technology, reported to improve diagnostic performance during endoscopy. Previous studies have investigated the accuracy of i-scan for distinguishing between neoplastic and non-neoplastic colonic polyps and suggested diagnostic accuracy close to that required for use in routine clinical practice. The aim of this study was to perform a meta-analysis of the available literature investigating diagnostic accuracy for i-scan optical diagnosis when made in real time for colorectal polyps <10 mm in size. Data sources: The databases of Methods: A bivariate random effects model was used to produce pooled sensitivity and specificity values, and univariable meta-regression was applied for subgroup analysis. Results: The meta-analysis included 15 studies, and diagnosis of 2817 polyps. The area under the hierarchical summary receiver-operating characteristic curve was 0.96. The pooled sensitivity of i-scan optical diagnosis was 0.92 (95% confidence interval 0.85-0.95). The specificity was 0.90 (95% confidence interval 0.83-0.94). Conclusions: This meta-analysis updates and summarizes the available evidence concerning the diagnostic performance of i-scan for small colorectal polyps. An acceptable degree of accuracy was found, showing potential to support a 'resect and discard' strategy for colonic polyps. There was not found to be a significant difference in diagnostic performance between different clinical settings (i.e. teaching hospitals or general hospitals).
Language	English
Publishing date	2018-12-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2440710-0
ISSN	1756-2848 ; 1756-283X
ISSN (online)	1756-2848
ISSN	1756-283X
DOI	10.1177/1756284818814948
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