Search

Background: Lateral displacement of cage is a rarely seen complication of oblique lumbar interbody fusion (OLIF). To the best of our knowledge, this complication has always been revised with posterior open surgery. However, open surgery often associates with large trauma and long period of recovery. Case Presentation: In the case presented, a 64‐year‐old male patient with lateral displacement of cage which consequently caused neurological symptoms after OLIF, was reported and surgically revised with an endoscopic resection and decompression technique. The surgery was performed through a posterolateral approach which was similar to transforaminal approach, with estimated blood loss of 45mL and whole operation time of 70 min. Neurological symptoms were disappeared after operation immediately and the patient was discharged 2 days later. He reported no symptoms other than mild weakness of the lower back at the last follow‐up of 12 months. Conclusion: Endoscopic decompression technique may be an effective alternative to surgically treat lateral displacement of cage after OLIF with advantages of minimal invasion and quick recovery. [ABSTRACT FROM AUTHOR]

Background: Immune checkpoint inhibitor (ICI) monotherapy and neoadjuvant immunochemotherapy have shown promising results in esophageal carcinoma. However, it is still unclear whether more courses of immunochemotherapy are therapeutically better. We aimed to investigate the safety and efficacy of three courses of neoadjuvant treatment for patients with locally advanced esophageal squamous cell carcinoma (ESCC). Methods: Patients with locally advanced ESCC received three courses of camrelizumab plus nab‐paclitaxel and capecitabine before undergoing surgery. Additionally, patients received safety, computed tomography (CT), and endoscopy (with endoscopic ultrasonography and mucosal biopsy) assessments before and in the second and third courses of treatment. We used the CT and endoscopic assessment results from the second and third courses for comparison. Results: From May 2020 to December 2021, 47 patients were enrolled at Sun Yat‐sen University Cancer Center. In our study, 43 patients completed three courses of preoperative chemotherapy combined with anti‐Programmed cell death‐1 (PD‐1) therapy and radical surgical resection. The toxicity of the third course of immunochemotherapy was mild and well tolerated without increased treatment‐related adverse events (TRAEs) and mortality compared with that of the second course of treatment. In terms of efficacy, an additional course of treatment after the second course of treatment was effective, with increased CT and endoscopy T (clinical T stage) downstaging rates by 16.3% and 25.9%, N (clincial N stage) downstaging rates by 7.0% and 11.1%, and objective response rates (ORRs) by 13.6% and 22.0%, respectively. Conclusions: Regardless of downstaging or ORR, three courses of immunochemotherapy appear to be superior to two courses of treatment without increasing TRAEs. [ABSTRACT FROM AUTHOR]

Background: Endocytoscopy (ECS) provides a magnification of approximately 450× for real‐time observation of lesion nuclei. Using ECS, we aimed to evaluate whether sufficient samples for diagnosis can be obtained during bronchoscopy. We also investigated whether ECS can enable two‐class diagnosis of malignant or non‐malignant transbronchial biopsy specimens in real‐time during bronchoscopy. Methods: This was a single‐facility, prospective, observational, ex vivo study. Forty cases with localized peripheral pulmonary lesions underwent transbronchial biopsy with endobronchial ultrasonography using a guide sheath. Each biopsy specimen was immediately observed and evaluated endocytoscopically after the collection by the bronchoscopic procedure. Results: Thirty‐seven cases were enrolled. The diagnostic accuracy achieved by ECS was 91.9% (34/37). The agreement rate between the endocytoscopic evaluation and pathological diagnosis of each specimen (170 specimens) was 65.3% (111/170). The median time required for endocytoscopic evaluation per specimen was 70 s. When we judged a specimen to be malignant a second time on ECS evaluations of five specimens in one case, pathologically malignant specimens were collected in 26 of 27 cases (96.3%). Conclusions: ECS with methylene blue staining may aid in the two‐class diagnosis of malignant or non‐malignant transbronchial biopsy specimens during bronchoscopy. This may reduce the number of tissue biopsies. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated whether radiomic features extracted from radial‐probe endobronchial ultrasound (radial EBUS) images can assist in decision‐making for subsequent clinical management in cases with indeterminate pathologic results. Methods: A total of 494 patients who underwent radial EBUS biopsy for lung nodules between January 2017 and December 2018 were allocated to our training set. For the validation set, 229 patients with radial EBUS biopsy results from January 2019 to April 2020 were used. A multivariate logistic regression analysis was used for feature selection and prediction modeling. Results: In the training set, 157 (67 benign and 90 malignant) of 212 patients pathologically diagnosed as indeterminate were analyzed. In the validation set, 213 patients were diagnosed as indeterminate, and 158 patients (63 benign and 95 malignant) were included in the analysis. The performance of the radiomics‐added model, which considered satellite nodules, linear arc, shape, patency of vessels and bronchi, echogenicity, spiculation, C‐reactive protein, and minimum histogram, was 0.929 for the training set and 0.877 for the validation set, whereas the performance of the model without radiomics was 0.910 and 0.891, respectively. Conclusion: Although the next diagnostic step for indeterminate lung biopsy results remains controversial, integrating various factors, including radiomic features from radial EBUS, might facilitate decision‐making for subsequent clinical management. [ABSTRACT FROM AUTHOR]

The study aimed to make a bibliometric analysis of the current research situation in unilateral biportal endoscopy/biportal endoscopic spinal surgery (UBE/BESS). Research data sets were acquired from the Web of Science database. The study chosed "biportal endoscopic spinal surgery" OR "two portal endoscopic spinal surgery" OR "percutaneous biportal endoscopic decompression" OR "unilateral biportal endoscopy" OR "irrigation endoscopic discectomy" as the search terms. The literature search was limited to articles published before March 5, 2021. We only included original articles and reviews. VOS viewer and Citespace software were used to analyze the data and generate visualization knowledge maps. Annual trend of publications, distribution, H‐index status, co‐authorship status, and research hotspots were analyzed. A total of 74 publications met the requirement. The sum number of citations was 31,204, in which 19,336 were no self‐citations. The average citation of all the papers was 21.84 times. The H‐index of all the publications was 85. South Korea's total number of articles was far higher than that of other countries and regions (61, 82.4%), followed by United Arab Emirates, Egypt, and Peoples Republic of China (three, ranking second, accounting for 12.2% of the total). For the most productive authors, Choi ranked first with 21 articles, Kim ranked second with 16 articles, and Heo ranked third with 12 articles. The journal with the greatest number of publications was World Neurosurgery, with a total of 18 (39.1%) papers. Clinics in Orthopedic Surgery ranked second with six (13.0%) papers. In third place, there were fix articles published by Asian Spine Journal and Neurospine, accounting for 21.8% of the total articles. These top three journals accounted for 73.9% of all the papers. Spondylolisthesis and endoscopic decompression were the research hotspots in recent years. The number of publications has showed an upward trend with a stable rise in recent years. South Korea is the country with the highest productivity, not only in quality, but also in quantity. Barun Hosp and Leon Wiltse Mem Hosphave published most articles. Choi is the most productive author. World Neurosurgery is the most productive journal. Spondylolisthesis and endoscopic decompression are the research hotspots in recent years. Indeed, this study provides new insight into the growth and development of UBE/BESS. [ABSTRACT FROM AUTHOR]

This report shows a rare case of gastric heterotopia in the duodenum presented as a large polypoid lesion, differently from data reported in literature, which enters into differential diagnosis with other duodenal lesions that are not always benign. [ABSTRACT FROM AUTHOR]

Summary: Background: Barrett's endoscopic therapy (BET) is well established for neoplasia in Barrett's oesophagus using a concept of complete eradication of all Barrett's. However, long‐term efficacy is not known. Aims: To perform a systematic review and meta‐analysis to examine long‐term efficacy of BET for Barrett's neoplasia. Methods: Electronic databases were searched for studies meeting stringent criteria: (a) subjects with high‐grade dysplasia and/or superficial adenocarcinoma who underwent BET (ablation ± endoscopic mucosal resection); (b) BET completion by confirmation of complete eradication of neoplasia (CE‐N) and intestinal metaplasia (CE‐IM) with systematic sampling and (c) clearly defined follow‐up (endoscopy and biopsy) protocol of ≥2 years thereafter for detection of recurrence. Pooled estimates of CE‐N and CE‐IM after BET completion and follow‐up were analysed. Results: Eight studies met the stringent criteria (n = 794, males 89%, age 64.6 years). Despite high efficacy of BET at therapy completion (CE‐N: 95.9 [91.7‐98.7]%; CE‐IM: 90.9 [83‐96.6]%), this declined (CE‐N: 89 [73.4‐98.2]%; CE‐IM: 77.8 [65.6‐88]%) over 3.4 years of follow‐up. There was considerable heterogeneity. Only two studies reported a post‐BET follow‐up of >5 years (CE‐IM 50 [41.5%‐58.5]%). Higher person years of follow‐up seem to correlate with decrease in BET efficacy. Conclusion: Using stringent criteria for appropriate study selection with sufficient follow‐up, a lack of high‐quality controlled intervention trials becomes evident for assessment of long‐term durable remission rates of BET despite initial high success rates. We plea for a uniform documentation of study details which could be used in future trials. [ABSTRACT FROM AUTHOR]

Background: Delayed wound healing is a potention complication after Achilles tendon suture repair and occurs for various reasons. The conventional treatment for delayed wound healing is open surgery, but patients face long recovery times and postoperative care is difficult. Case Presentation: This report presents three patients who were seen at our institute from April 2008 to October 2017 due to long‐term non‐healing wounds after surgery. All three patients had undergone surgery at least 2 months previously. We performed endoscopic surgery on these patients. After the operation, patients received less antibiotics and simpler care than would be required for conventional open surgery. There is no need to keep the wound open after the operation or perform wound cleaning for multiple times at the same time, which can reduce healing time. At the last follow up, all postoperative scores among the patients were significantly improved compared to before surgery. The Achilles tendon total rupture scores were excellent and the American Orthopedic Foot and Ankle Society scores were satisfactory, indicating improvements in Achilles tendon function and movement in patients after surgery. Conclusion: Our case reports demonstrate that arthroscopic treatment for delayed wound healing after Achilles tendon suture repair is satisfactory and reliable; frequent opening of the wound for cleaning is not required after the operation, thus reducing the healing time. [ABSTRACT FROM AUTHOR]

Objective: To provide an overview of Endoscopic Ear Surgery, its development, principles, and penetration in otology practice in 2018. Data Source: PubMed review of literature and cross‐sectional email survey of otologists. Methods: We reviewed all PubMed published articles on use of endoscopy in practice of otology over the last 50 years. Articles were categorized based on date of publication and pattern of utilizing the endoscope. We also conducted two identical email surveys in 2010 and 2018 of otologists on the use of endoscope and tabulated and compared results. Results: The number of publications on use of endoscope has increased from 6 in 1990 to an accumulated total of 451 in 2018. There has been a clear shift in the area of interest away from diagnostic endoscopy, to endoscope‐assisted surgery, and lately, to transcanal endoscopic ear surgery (TEES). Survey results further documented the increased awareness of the value of the endoscope and its increased use in clinical practice. Conclusion: TEES has gained traction as a subject of research interest and in clinical practice and has lately dominated the discussion on the use of endoscope in otology. Level of Evidence: NA [ABSTRACT FROM AUTHOR]

Objective: To assess the usefulness of modified esophagogastroduodenoscopy (EGD) for the detection of second primary malignancies of the esophagus or hypopharynx in patients with oral squamous cell carcinoma and determine the association between the oral lesion subsite and esophageal or hypopharyngeal lesion occurrence. Study Design: Retrospective review. Methods: In total, 166 patients with oral squamous cell carcinoma without any established symptoms of esophageal or hypopharyngeal squamous cell carcinoma underwent modified EGD based on the Valsalva maneuver and U‐turn method, image‐enhanced endoscopy, and chromoendoscopy using Lugol's iodine for diagnosis. All suspected lesions were biopsied to determine the clinical stages and duplication rates. Odds ratios for the occurrence of duplicate lesions according to the oral lesion subsite were determined. Results: In total, 37 esophageal and 16 hypopharyngeal lesions were detected. According to the Union for International Cancer Control/American Joint Committee on Cancer classification (2009), 75.7% and 5.4% esophageal lesions were classified as stage IA and IB, respectively, and 50% and 18.8% hypopharyngeal lesions as stage II and stage I, respectively. Approximately 59.1% and 50% esophageal and hypopharyngeal lesions, respectively, were successfully treated by endoscopic resection. Oral lesions involving the floor of the mouth were more frequently accompanied by second primary malignancies of the esophagus or hypopharynx. Conclusions: Modified EGD is an effective noninvasive technique for early diagnosis and treatment of second primary malignancies of the esophagus and hypopharynx in patients with oral squamous cell carcinoma. In particular, patients with floor of the mouth lesions need close monitoring for hypopharyngeal and esophageal lesions. Level of Evidence: 3b. [ABSTRACT FROM AUTHOR]

Abstract: Herein, we described a novel method as the use of AcuBlade robotic microsurgery system to manage idiopathic subglottic stenosis in a 73‐y‐old lady. Compared to traditional CO2 lasers, AcuBlade facilitated the scar resection by the generation of different shape of beams (straight, curved, or disk). The same setting used for phonomicrosurgery (1‐mm beam length, power of 10 W and pulse duration of 0.05‐s) allowed to obtain fast, long, and uniform cuts. In addition, the reduction of the number of laser passes over the same area prevented injury of adjacent tissue and thus reduced the risk of recurrence. [ABSTRACT FROM AUTHOR]

Background Use of anaesthesia services during endoscopy has increased, increasing cost of endoscopy. Aim To identify risk factors for and develop a clinical prediction score to predict difficult conscious sedation. Methods We performed a retrospective cross-sectional study of all patients who underwent oesophagogastroduodenoscopy ( OGD) and colonoscopy with endoscopist-administered conscious sedation. The endpoint of difficult sedation was a composite of receipt of high doses (top quintile) of benzodiazepines and opioids, or the documentation of agitation or discomfort. Univariate and multivariate analyses were performed to measure association of the outcome with: age, sex, body mass index ( BMI), procedure indication, tobacco use, self-reported psychiatric history, chronic use of benzodiazepines, opioids or other psychoactive medications, admission status and participation of a trainee. A clinical prediction score was constructed using statistically significant variables. Results We identified 13 711 OGDs and 21 763 colonoscopies, 1704 (12.4%) and 2299 (10.6%) of which met the primary endpoint, respectively. On multivariate analysis, factors associated with difficulty during OGD were younger age, procedure indication, male sex, presence of a trainee, psychiatric history and benzodiazepine and opioid use. Factors associated with difficulty during colonoscopy were younger age, female sex, BMI <25, procedure indication, tobacco, benzodiazepine, opioid and other psychoactive medication use. A clinical prediction score was developed and validated that may be used to risk-stratify patients undergoing OGD and colonoscopy across five risk classes. Conclusions Using the Stratifying Clinical Outcomes Prior to Endoscopy ( SCOPE) score, patients may be risk stratified for difficult sedation/high sedation requirement during OGD and colonoscopy. [ABSTRACT FROM AUTHOR]

Aim The aim of the study was to estimate the influence of percutaneous endoscopic gastrostomy (PEG) placement on gastro-oesophageal reflux (GOR) by using multiple intraluminal impedance (MII/pH) measurements in children with neurological impairments. Method Fifteen children with neurological impairments (cerebral palsy, n=10; cerebroidolipofuscinosis, n=2; Aicardi syndrome, n=1; and secondary encephalopathy, n=2) were investigated (interquartile range [IQR] 6y 4mo-14y 8mo; median age 10y 2mo; eight male, seven female). Individuals with nutritional disorders that could not be corrected by physiological means or with swallowing disorders that either caused chronic respiratory symptoms or prevented food intake were included in the study. The exclusion criteria included previous major abdominal surgery and a lack of consent for PEG. Participants underwent MII/pH for a 24-hour period and had an oesophagogastroduodenoscopy before PEG placement, which was repeated 6 to 8 months later. Results At baseline, GOR was detected in 6 of the 15 participants, and the second MII/pH session revealed GOR in 2 of the 15 children. Differences between quantitative GOR indices obtained before and after PEG were not statistically significant, except for the proportion of the acidic/weakly acidic reflux events - among all participants in the first examination, 159 reflux episodes were acidic and 244 were weakly acidic, while in the follow-up recordings the proportion was inverted (244 acidic, 136 weakly acidic; χ2=47.0; p<0.001). Baseline endoscopy did not reveal any macroscopic changes in any of the examined individuals, but the follow-up examination revealed oesophagitis in two participants. The median body weight gain after 6 months as 22.0% (IQR 14.4-29.2%). All participants tolerated PEG feeding well, regardless of MII/pH results. Interpretation Identification of GOR based on MII/pH in children with neurological impairments does not exclude a good clinical response to PEG feeding. [ABSTRACT FROM AUTHOR]

The article presents a consensus statement released by the American College of Veterinary Internal Medicine (ACVIM) on the "Endoscopic, Biopsy, and Histopathologic Guidelines for the Evaluation of Gastrointestinal Inflammation in Companion Animals." A brief discussion of inflammatory bowel disease (IBD) and normal histology of the gastrointestinal tract is provided, along with an overview of the development of standards for diagnosis of gastrointestinal inflammation. Also included are guidelines for endoscopic examination and biopsy.

Background: The benefits of endoscopic assistance to remove intracranial tumors in small animals are not described. Objective: To evaluate the effectiveness of endoscopic-assisted intracranial tumor removal in dogs and cats. Animals: Thirty-three dogs and 6 cats with intracranial tumors. Methods: Retrospective study. CBC, serum chemistry profile, coagulation testing, blood typing, and systemic tumor staging, which included 3-view thoracic radiographs and abdominal ultrasound examination, were performed to detect other significant underlying disease in preparation of the animal for surgery. Magnetic resonance imaging was used in 37/39 cases to image the brain tumor. Surgical approach was dictated by the location of the tumor. Histopathologic examination of the tumor tissue was performed in all cases. Animals were followed throughout their postoperative course for complications and survival times. Statistical analysis (Kaplan-Meier curves) was performed to obtain median survival times in dogs with meningiomas. Results: Use of an endoscope resulted in visualization of residual tumor and potentially more complete removal of the brain tumors. There were no clinically important complications associated with the use of the endoscope. Median survival time was 2,104 days for dogs with forebrain meningiomas surgically removed with endoscopic assistance and 702 days for dogs with caudal brain meningiomas. Conclusions and Clinical Importance: These results demonstrate that the use of an endoscope to assist in brain tumor removal is apparently safe and might result in improved survival times. [ABSTRACT FROM AUTHOR]

Background Most published reviews concerning the endoscopic treatment of gastro-oesophageal reflux disease date back to 2005. Aim To provide an updated review that includes all papers published up to 2007. Methods A Medline search from January 2005 to June 2007 was performed regarding endoscopic procedures aiming at treating gastro-oesophageal reflux disease. In addition, we retrieved the abstracts presented at Digestive Disease Week during the last 3 years. We included in the review both ‘mechanistic’ studies – that is, papers exploring the potential mechanism of action of the procedure/device – and studies trying to assess its clinical efficacy. Results During the last 3 years, the number of published papers has declined, and some devices are not available any more. The alleged mechanism(s) of action of the various devices or procedures is (are) still not completely elucidated; however, some concerns have arisen as far as durability and potential detrimental effects. Moreover, all the aspects of endoscopic therapy, except for its safety, are either insufficiently explored or not investigated at all, or assessed only in particularly selected patient subgroups. Conclusions None of the proposed antireflux therapies has fulfilled the criteria of efficacy, safety, cost, durability and, possibly, of reversibility. There is at present no definite indication for endoscopic therapy of gastro-oesophageal reflux disease. We suggest a list of recommendations to be followed when a new endoscopic therapeutic procedure is to be assessed for use in clinical practice. [ABSTRACT FROM AUTHOR]

Background The therapeutic approach to patients with chronic pancreatitis (CP) is complicated by the fact that patients are presented to the physician at different stages of disease and in the presence of varying clinical symptoms. Generally, an expectant approach is justified for patients with asymptomatic CP. At present, patients with symptoms related to gland destruction are initially treated by endoscopic means, while surgical treatment of CP is usually reserved for intractable abdominal pain, suspicion of cancer, and complications such as persistent pseudocysts. Aim To review the studies currently available evaluating surgical and/or endoscopic management of CP. Results Improvements in imaging techniques, as well as a better understanding of the pathophysiology of CP and mechanisms causing pain, have led to a more conscious selection of patients for surgery. Type of surgery depends on whether the pancreatic duct is dilated, presence of an inflammatory mass and occurrence of complications (pseudocysts, gastric outlet obstruction). Eventually, after initial endoscopic treatment, a substantial number of patients still need surgery for persistent complaints. Conclusions For patients with symptomatic CP, a multidisciplinary approach is indicated with low threshold to surgical intervention, since long-term pain relief is accomplished more often after surgical treatment than after endoscopic treatment. [ABSTRACT FROM AUTHOR]

Background Over the last decades, gastrointestinal endoscopy has transformed from serving purely diagnostic purposes to therapeutic applications. One recent major progress is taking the endoscope beyond the gastrointestinal lumen into the peritoneal cavity for diagnostic and therapeutic procedures. The first step towards Natural Orifice Translumenal Endoscopic Surgery (NOTES) was translumenal endoscopic debridement of pancreatic necrosis. Aim To overview current status of endoscopic debridement of organized pancreatic necrosis. Finally, we take a short look into the potential future of translumenal endoscopic procedures. Methods Medical databases were searched for relevant publications, dealing with endoscopic debridement of pancreatic necrosis and NOTES. Results All current published studies concerning endoscopic debridement of organized pancreatic necrosis were retrospectivally performed and relatively small (largest n = 25). Succes rates varies from 80–93% and complication rates from 7–20%. There was no procedure related mortality reported. Published NOTES experiments showed feasibilty of a variety of transgastric, transcolonic and transvaginal procedures in the porcine model. Conclusion Endoscopic debridement seems to be an effective and relatively safe minimally invasive therapy in patients with symptomatic organized pancreatic necrosis and is the first step towards NOTES. Further comparative studies need to define its definitive role in the management of these patients. [ABSTRACT FROM AUTHOR]

: Percutaneous endoscopic gastrostomy tubes are placed with high frequency and relative safety for a variety of indications. One of these indications is temporary nutritional support for patients expected to resume oral nutrition.: To determine if baseline clinical characteristics can predict which patients attain the clinical goal of resuming oral nutrition with consequent tube removal.: We conducted a single site observational cohort study from December 1999 to April 2001, enrolling all patients scheduled for percutaneous endoscopic gastrostomy placement. Standard descriptive and bivariate analyses were performed. Cox proportional hazard models were constructed to identify patient characteristics prior to percutaneous endoscopic gastrostomy placement that might predict resumption of oral nutrition with tube removal.: Bivariate analyses revealed four potential clinical predictors: age<65 years, localized head and neck cancer, serum albumin≥3.75 g/dL, and serum creatinine≤1.1 mg/dL. In multivariable analysis, age<65 years (HR = 3.7, 95% CI: 1.0–14.3) and a diagnosis of localized head and neck cancer (HR = 4.6, 95% CI: 1.4–15.0) predicted resumption of oral nutrition with percutaneous endoscopic gastrostomy removal.: When discussing percutaneous endoscopic gastrostomy placement, doctors should consider the likelihood of achieving clinically important outcomes such as the resumption of oral nutrition with tube removal. This clinical goal is unlikely for older patients with diagnoses other than localized head and neck cancer. [ABSTRACT FROM AUTHOR]

Summary Background Severe facial blushing may have a strong negative impact on the quality of life and is one of the cardinal symptoms of social phobia. If traditional therapeutic options such as psychotherapy and pharmacological treatment fail, interruption of the sympathetic innervation to the face offers good results, however long-term results may not be good. Aim To investigate whether endoscopic thoracic sympathecotomy (ETS) remains an effective treatment of facial blushing more than one year's follow up. Method 1314 consecutive patients with severe facial blushing were treated with bilateral ETS. The results were evaluated by questionnaire and symptoms assessed with visual analogue scales (0–10). Results The questionnaire was completed by 831 patients (63%) a mean of 29 months (± 11 days) after surgery. Facial blushing was reduced from 8.8 ± 0.05 to 2.5 ± 0.09, P < 0.0001 by the operation. The quality of life was substantially improved. The main side-effect was redistribution of sweating from the upper to the lower part of the body (compensatory sweating). Increased sweating of the trunk occurred in 83% of the responses. Overall, 85% of the respondents were satisfied with the result and 15% were to some degree not satisfied. Conclusions As this is an open study and 37% of patients did not respond to the questionnaire, the results must be viewed with caution. ETS, however, appears to be an effective, safe and lasting surgical method for the treatment of severe facial blushing. Side-effects, especially compensatory sweating on the trunk and legs are common, and may be severe but only rarely result in the patient regretting the operation. [ABSTRACT FROM AUTHOR]

In a 91-year-old female patient admitted with an ileus, ultrasound and computed tomography demonstrated the obstruction of the upper jejunum by a large gallstone. Due to concurrent diseases the patient was unfit for surgery. An attempt was made to remove the impacted stone endoscopically. After successful mobilization and fragmentation by mechanical lithotripsy the obstruction was cleared away. Since the patient improved considerably after this procedure, the gallbladder and the cholecystoduodenal fistula were left in place. [ABSTRACT FROM AUTHOR]

The author discusses the effectiveness of endoscopic dilation in treating patients suffering from benign oesophageal stricture. The topics discussed include the clinical outcomes and challenges of self dilation approach, the symptoms experienced by patients, and the reasons why most patients preferred self dilation.

The authors reflect on the results of the study by E. Alexandridis and colleagues on the differences between standard upper endoscopy (SOGD) and unsedated transnasal endoscopy (TNE). The results reportedly revealed that TNE is better that SOGD when regards to acceptability, cardiovascular stress, and comfort. They note that TNE is not widely used even if it reduces the cost of sedation and places patient at risk of getting the worst results from cancer.