Background and Aims: Adenoma detection rate (ADR) varies significantly between endoscopists with up to 26% adenoma miss rate (AMR). Artificial intelligence (AI) systems may improve endoscopic quality and reduce the rate of interval cancer. We evaluated the efficacy of an AI system in real time colonoscopy and its influence on the AMR and the ADR. Patients and methods: In this prospective non-randomized comparative study we analyzed 150 patients (age 65±14, 69 women, 81 men) undergoing diagnostic colonoscopy at a single endoscopy center in Germany from June to October 2020. Every patient was examined concurrently by an endoscopist and AI using two opposing screens. The AI system GI Genius (Medtronic), overseen by a second observer, was not visible to the endoscopist. AMR was the primary outcome. Both methods were compared by the McNemar Test. Results: There was no significant and no clinically relevant difference (p=0.754) in AMR between the AI system (6/197, 3.0%, 95%CI [1.1-6.5]) and routine colonoscopy (4/197, 2.0%, 95%CI [0.6-5.1]). The polyp miss rate of the AI system (14/311, 4.5%, 95%CI [2.5-7.4]) was not significantly different (p=0.720) from routine colonoscopy (17/311, 5.5%, 95%CI [3.2-8.6]). There was no significant difference (p=0.500) between the ADR with routine colonoscopy (78/150, 52.0%, 95%CI [43.7-60.2]) and the AI system (76/150, 50.7%, 95%CI [42.4-58.9]). Routine colonoscopy detected adenomas in two patients that were missed by the AI system. Conclusion: The AI system had a comparable performance to experienced endoscopists during real-time colonoscopy with similar high ADR (>50%).

Unclear recurrent gastrointestinal symptoms even in the absence of neurological changes may reflect a mitochondrial disease. This applies especially to young patients with recurrent anorexia, vomiting and pseudoobstruction. In case of additional symptoms like ophthalmopathy, deafness, diabetes mellitus or signs of a MELAS syndrome the search for a mitochondrial system disorder is mandatory.

We describe the case of a 71-year old medical technician, who was treated for instable angina pectoris in 29 different hospitals 38 times over 9 years. Dramatically presented retrosternal pain regularly started in crowded places, such as bus or railway stations or directly in front of the hospital. Ultrasound and ECG gave evidence of an old inferior myocardial infarction. Invasive diagnostic procedures were rejected by the patient because of an alleged allergy for contrast media. The single, retired patient never admitted former cardiac hospitalizations and restrained the physicians from contacting his local doctor. The patient mostly left the hospital against medical advice and achieved hospitalization in another clinic sometimes the same day. Because of his personality structure, the dramatic presentation of his complaints and the numerous hospitalizations in various hospitals with self-discharge, we made the diagnosis of a cardiac Munchausen syndrome, a so-called cardiopathia fantastica, in the presence of an accompanying coronary heart disease. In the literature we found 52 cases of cardiopathia fantastica since the first description of this phenomenon in the year 1953. Interestingly enough, mostly men were identified. Angina pectoris is by far the most frequent symptom of cardiopathia fantastica. In 8 of 53 patients (15%) an additional cardiac manifestation was present in addition to cardiopathia fantastica. Cardiopathia fantastica on the one hand is an important differential diagnosis of coronary heart disease; on the other hand it may develop in the presence of an underlying cardiac disease.

In summary, DITP should be considered in cases of acute thrombocytopenia during treatment with flucloxacillin.

Iron overload in MR-imaging with decreased signal intensity in T2 weighting of liver, spleen, adrenal gland and pituitary gland in combination with an extremely elevated ferritin level of 9859  ng/mL and a positive family history of hyperferritinaemia led to the diagnosis of the rare hemochromatosis type 4 (synonym: ferroportin disease) in the case of a 62-year-old patient. The autosomal dominant disease was confirmed by analysis of the SLC40A1-gene. Histologically, a liver cirrhosis was detected. This was neither detectable in the case of the two similarly aged cousins (ferritin about 4750  ng/mL, transferrin saturation normal), nor in the case of the 82-year-old mother (ferritin 7860  ng/dL, transferrin saturation 58 %). Hemochromatosis type 4 with worldwide less than 200 described cases is caused by a disorder of the hepcidin ferroportin metabolism, which regulates the iron export from the cells. A hepatocellular carcinoma may occur even without cirrhosis. Therefore, surveillance of these patients is necessary. Treatment options are therapeutic phlebotomies and alternatively iron-chelating drugs (Deferoxamin, Deferasirox) if the patient develops anaemia.