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Background: Anesthesia is required for endoscopic removal of esophageal foreign bodies (EFBs) in children. Historically, endotracheal intubation has been the de facto gold standard for airway management in these cases. However, as more elective endoscopic procedures are now performed under propofol sedation with natural airway, there has been a move toward using similar Monitored Anesthesia Care (MAC) for select patients who require endoscopic removal of an EFB. Methods: In this single‐center retrospective cohort study, we compared endoscopic EFB removal with either MAC or endotracheal intubation. Descriptive statistics summarized factors stratified by initial choice of airway technique, including intra‐ and postanesthesia complications and the frequency of mid‐procedure conversion to endotracheal intubation in those initially managed with MAC. To demonstrate the magnitude of associations between these factors and the anesthesiologist's choice of airway technique, univariable Firth logistic and quantile regressions were used to estimate odds ratios (95% CI) and beta coefficients (95% CI). Results: From the initial search, 326 patients were identified. Among them, 23% (n = 75) were planned for intubation and 77% (n = 251) were planned for MAC. Three patients (0.9%) who were initially planned for MAC required conversion to endotracheal intubation after induction. Two (0.6%) of these children were admitted to the hospital after the procedure and treated for ongoing airway reactivity. No patient experienced reflux of gastric contents to the mouth or dislodgement of the foreign body to the airway, and no patient required administration of vasoactive medications or cardiopulmonary resuscitation. Patients had higher odds that the anesthesiologist chose to utilize MAC if the foreign body was a coin (OR, 3.3; CI, 1.9–5.7, p <.001) or if their fasting time was >6 h. Median total operating time was 15 min greater in intubated patients (11 vs. 26 min, p <.001). Conclusions: This study demonstrates that MAC may be considered for select pediatric patients undergoing endoscopic removal of EFB, especially those who have ingested coins, who do not have reactive airways, who have fasted for >6 h, and in whom the endoscopic procedure is expected to be short and uncomplicated. Prospective multi‐site studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Introduction: Management of severe chronic rhinosinusitis with nasal polyps (CRSwNP) has changed significantly in recent years, with different treatments now available including biologics and endoscopic sinus surgery (ESS), although there are still few comparative studies. We aimed to compare 1‐year outcomes of patients with severe CRSwNP treated with dupilumab or ESS plus intranasal corticosteroids (INCS). Methods: In this retrospective, real‐life, observational, cohort study, we enrolled 101 patients with severe CRSwNP who were treated with INCS and either ESS (n = 49) or dupilumab (n = 52). The following outcomes were considered: nasal polyp score (NPS), Sino Nasal Outcome Test‐22 (SNOT‐22), visual analogue scale (VAS) for specific symptoms, Sniffin' Sticks identification test (SSIT), need for oral corticosteroids (OCS) and local eosinophilia detected by nasal cytology. Results: ΔNPS was significantly higher in the surgery group up to 12 months when the difference with dupilumab group was no longer significant (ΔNPS: 4 vs. 4.1). ΔVAS rhinorrhoea, ΔVAS smell and ΔSNOT‐22 were significantly higher in the dupilumab group at 12 months (p <.05). SSIT scores were significantly better in the dupilumab group starting from the first month of follow‐up (p <.05). In the dupilumab group, only 6.1% of patients had detectable local eosinophilia compared to 57% in the surgery group alongside with a lower need for OCS (16.3% vs. 61%). Conclusions: Both dupilumab and ESS were effective in improving outcomes in patients with severe CRSwNP over 12 months. Nevertheless, patients treated with dupilumab had greater improvement in terms of SNOT‐22, VAS rhinorrhoea, VAS smell and SSIT scores, with better control of local inflammation and less need for OCS. [ABSTRACT FROM AUTHOR]

Objectives: Existing knowledge on health‐related quality of life (HRQoL) after surgical removal of sinonasal inverted papilloma (IP) is limited. Moreover, predictors for a better or worse post‐operative HRQoL outcome are not known. Our aim was to assess HRQoL in all three health domains (physical, psychological, and social), track its post‐operative trajectory, investigate if pre‐operative observations could predict distinct post‐operative HRQoL outcomes, and evaluate whether physicians' interventions could contribute to improved post‐operative HRQoL. Design: Prospective cohort study. Setting: Tertiary referral hospital. Participants: Seventy‐four patients who underwent surgery for an IP were included. They were asked to fill in the Endonasal Endoscopic Sinus and Skull‐Base Surgery Questionnaire (EES‐Q) pre‐operatively, and then 2 weeks, 3 months, and 1 year post‐operatively. Main Outcome Measures: Linear mixed models analyses were performed to evaluate the overall post‐operative HRQoL and the separate health domains, as well as the impact of specific variables (sex, age, American Society of Anaesthesiologists [ASA] classification, smoker, Krouse staging, pre‐operative EES‐Q score, type of surgery, and post‐operative antibiotics) on HRQoL improvement. Results: The total EES‐Q score (p <.001) as well as the physical (p <.001), psychological (p =.049), and the social (p =.002) domains significantly improved post‐operatively. ASA classification (p =.049), pre‐operative EES‐Q score (p <.001) and post‐operative antibiotics (p =.036) were significant variables. Conclusions: Overall HRQoL, as well as each of the three health domains, improved significantly. A higher ASA score, a higher pre‐operative EES‐Q score, and the administration of post‐operative antibiotics were significant predictors for better HRQoL recovery post‐operatively. Further research is necessary to confirm these results. [ABSTRACT FROM AUTHOR]

This article compares two types of external ear canal packing options, Spongostan and Silastic, for endoscopic ear surgery. The study found that there was no statistically significant difference in post-operative healing outcomes between the two dressings. Both dressings were considered viable options for endoscopic ear surgery. The study aimed to fill a gap in the literature regarding packing options for this type of surgery. However, the study has limitations and further research is needed to determine the optimal timing of leaving the Spongostan dressing in place. [Extracted from the article]

Objective: Identify the benefits and caveats of combining minimal access approaches to the infratemporal fossa (ITF), such as the endoscopic transnasal, endoscopic transorbital, endoscopic transoral, and endoscopic sublabial transmaxillary approaches to address extensive lesions not amenable to a single approach. The study provides anatomical metrics including area of exposure and degree of surgical freedom. Methods: Five human cadaveric specimens (10 sides) were dissected to expose and methodically analyze the anatomical intricacies of the ITF using the following minimal access approaches: endoscopic transnasal transpterygoid (EETA), endoscopic sublabial transmaxillary, endoscopic transorbital via infraorbital foramen, and endoscopic transoral techniques. Area of exposure at the pterygopalatine fossa and surgical freedom at the ITF were obtained for each approach. Results: The endoscopic sublabial transmaxillary sinus and the combined approach afford a significantly greater exposure than an isolated EETA. The difference in exposure (mean) between the endoscopic sublabial transmaxillary and EETA was 1.62 ± 0.85 cm2 (p < 0.001), and the difference between the combined approach and EETA was 4.25 ± 0.85 cm2 (p < 0.001). Conclusions: Combining minimal access endoscopic approaches to the ITF can provide significantly greater exposure than an isolated EETA; thus, providing enhanced access to address lesions with extensive involvement of the ITF, especially those with superolateral and inferolateral extensions. In addition, some approaches may have an adjunctive role to the resection, such as the endoscopic transoral approach offering the potential for early control of the internal maxillary artery and its branches, some of which may be supplying the tumor in the ITF; or the endoscopic transorbital approach yielding a direct line of sight to the superior ITF and middle cranial fossa. Level of Evidence: NA. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to ascertain the prevalence of left-handedness (LH) among otolaryngology--head and neck surgery (ORLHN) practitioners, investigate dexterity's impact on LH trainees, and identify common patterns in their training to improve the training experience. Methods: A web-based survey was distributed anonymously via email to members of the Saudi Otorhinolaryngology Society. The survey targeted ORLHN attending consultants, board-certified registrars, and current residents. It consisted of three sections: the first focused on the experience of attending consultants in training LH individuals, the second investigated common maneuvers employed by rhinologists, and the third explored the experiences and impacts reported by LH trainees. Results: The study included 174 participants, and found a 13.2% LH prevalence among them. Rhinologists showed disparities, with 50% advising trainees to stand on the left side of the bed and use their left hand for the scope, whereas the other half asked otherwise. Additionally, 94.4% of the participants had not encountered any courses specifically tailored for LH trainees. Among LH trainees, 57% and 41% reported difficulties in learning and performing side-specific procedures such as functional endoscopic sinus surgery and endoscopic septoplasty, respectively, often attempting to switch to their nondominant hand, and feeling disadvantaged due to their laterality. Conclusions: Left-handedness presents challenges for both LH trainees and their trainers in surgical specialties, particularly in ORLHN, in which specific positioning and instruments are crucial to gain access to the desired surgical field. Despite these challenges, there is insufficient support for LH individuals. We recommend encouraging LH trainees to openly disclose and discuss their left-handedness, provide them with mentors, establish standardized operating room setups and techniques, supply appropriate instruments, and demonstrate flexibility in accommodating their needs. Level of evidence: Level 5. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the perioperative outcomes of patients who underwent hysterectomy for benign gynecologic diseases using transvaginal natural orifice transluminal endoscopic surgery (vNOTES) or transumbilical laparoendoscopic single‐site surgery (TU‐LESS). Methods: A total of 314 patients who underwent hysterectomy for benign uterine disease at West China Second University Hospital between October 2018 and December 2021 were enrolled in this retrospective study. vNOTES (n = 157) and TU‐LESS (n = 157) recipients were matched 1:1 in terms of uterine volume. The operation time, blood loss, postoperative decrease in hemoglobin, uterus weight, postoperative hospital stay, postoperative pain score at 12 h, postoperative indwelling catheter time, and other clinical indicators were compared between the two groups. Results: All 314 patients successfully completed the surgery, and the two groups had similar baseline characteristics, with no statistical difference. Regarding intraoperative outcomes, the operation time was shorter in the vNOTES group than in the TU‐LESS group (80 vs 100 min, P = 0.04), and there were no significant differences in intraoperative blood loss, intraoperative blood transfusion rate, postoperative decrease in hemoglobin, or uterine weight. Concerning postoperative outcomes, vNOTES hysterectomy was significantly superior to TU‐LESS hysterectomy in terms of the length of hospital stay (3 vs 4 days, P < 0.001), visual analog scale score for pain at 12 h after surgery (P = 0.04), postoperative indwelling catheter time (39.5 vs 64.0 h, P < 0.001), and postoperative exhaust time (24.0 vs 42.0 h, P < 0.001). There were no significant differences in postoperative complications between the two groups. Conclusion: vNOTES and TU‐LESS seem safe and feasible for hysterectomy, but vNOTES hysterectomy was more conducive to the postoperative rehabilitation of patients, with less trauma, less pain, and better cosmetic effects than TU‐LESS hysterectomy. As an emerging surgical approach, more studies, including large‐sample, multicenter, randomized controlled trials, are needed to validate our findings. Synopsis: vNOTES hysterectomy was found to be comparable and more conducive to the postoperative rehabilitation of patients to TU‐LESS. [ABSTRACT FROM AUTHOR]

Objective: Thoracic spinal epidural abscess (SEA) is a rare but dangerous condition, and traditional surgical methods are accompanied by extensive trauma and approach‐related complications. Here we introduce the technique of full‐endoscopic transforaminal debridement and decompression and evaluate its feasibility for treating brucellar thoracic SEA. Methods: We performed thoracic full‐endoscopic transforaminal decompression and debridement on two patients with neurological deficits caused by brucellar SEA, which is mainly composed of granulation tissue rather than pus. Postoperative MRI was conducted to confirm the presence of any residual abscess compressing the nerves. Frankel grading was employed to assess the recovery of neurological function, and complications were documented. Results: There were no occurrences of dural tear, postoperative hematoma, or pulmonary complications. Their neurological function had significantly improved after surgery, and postoperative MRI confirmed no residual abscess compressing the spinal cord. During the 2‐year follow‐up, one patient achieved complete recovery (from Frankel‐C to Frankel‐E), while another patient improved from Frankel‐A to Frankel‐D. Neither patient experienced infection recurrence, instability, nor kyphotic deformity. Conclusion: We described the novel application of transforaminal endoscopic surgery in brucellar thoracic granulomatous SEA and preliminarily indicated the feasibility of this technique as a minimally invasive alternative to open surgery. [ABSTRACT FROM AUTHOR]

Background and Aim: We aimed to compare the risk of erosive esophagitis (EE) among individuals with different phenotypes based on metabolic health status and obesity and investigate the role of changes in metabolic health in EE risk. Methods: A cohort of 258 892 asymptomatic adults without EE at baseline who underwent ollow‐up esophagogastroduodenoscopy (EGD) were categorized into the following four groups according to metabolic health and obesity status: (i) metabolically healthy (MH) non‐obese; (ii) metabolically unhealthy (MU) non‐obese; (iii) MH obese; and (iv) MU obese. EE was defined as the presence of grade A or higher mucosal breaks on EGD. Results: During a median follow‐up of 4.5 years, the incidence rates of EE were 0.6/103 person‐years (PY), 1.7/103 PY, 1.7/103 PY, and 3.1/103 PY in the MH non‐obese, MU non‐obese, MH obese, and MU obese groups, respectively. The multivariable‐adjusted hazard ratio (HR) (95% confidence intervals [CI]) for developing EE comparing the MH obese, MU non‐obese, and MU obese groups with the MH non‐obese group were 1.49 (1.29–1.71), 1.56 (1.25–1.94), and 2.18 (1.90–2.49), respectively. The multivariable‐adjusted HR (95% CI) comparing the progression of MH to MU, regression of MU to MH, and persistent MU with the persistent MH group were 1.39 (1.10–1.76), 1.39 (1.09–1.77), and 1.86 (1.56–2.21), respectively. The increased risk of EE among the persistent MU group was consistently observed in individuals without obesity or abdominal obesity. Conclusion: Metabolic unhealthiness and obesity were independent risk factors for the development of EE, suggesting that maintaining both normal weight and metabolic health may help reduce the risk of EE. [ABSTRACT FROM AUTHOR]

Background and Aim: There has been no report on a direct comparison between linked color imaging (LCI) and second‐generation narrow‐band imaging (2G‐NBI) for surveillance of epithelial neoplasms in the upper gastrointestinal tract (UGIT). The aim of this study was to verify the superiority of LCI to 2G‐NBI for surveillance esophagogastroduodenoscopy and to clarify how each endoscopic system should be used. Methods: This study was conducted as an open‐label, two‐arm‐parallel (1:1), multicenter, randomized controlled trial at six institutions. Patients aged 20–85 years with a treatment history of epithelial neoplasms in the UGIT were recruited. Patients were assigned to a 2G‐NBI group and an LCI group, and esophagogastroduodenoscopy was performed with primary image‐enhanced endoscopy followed by white light imaging (WLI). The primary endpoint was the detection rate of one or more epithelial neoplasms in the primary image‐enhanced endoscopy. A WLI‐detected epithelial neoplasm was defined as a lesion that was detected in only WLI. Results: A total of 372 patients in the 2G‐NBI group and 378 patients in the LCI group were analyzed. Epithelial neoplasms in the UGIT were detected by 2G‐NBI in 18 patients (4.6%) and were detected by LCI in 20 patients (5.3%) (P = 0.87). WLI‐detected epithelial neoplasms were in 11 patients in the 2G‐NBI group (3.0%) and in 1 patient in the LCI group (0.27%) (P = 0.003). Conclusions: Linked color imaging did not show superiority to 2G‐NBI for the detection of epithelial neoplasms. Also, the percentage of WLI‐detected epithelial neoplasms in primary NBI was significantly higher than that in primary LCI. [ABSTRACT FROM AUTHOR]

This article provides a guide on strategies for effective endoscopic closure of gastrointestinal defects. It emphasizes the importance of understanding the type of defect being treated, such as full-thickness defects or non-full-thickness defects, as this determines the approach and techniques used for closure. The article also discusses the significance of defect location, size, and tissue quality in determining the appropriate tools and devices for closure. It highlights the importance of preprocedural preparation, drainage of fluid collections, reducing downstream obstructions, stent fixation to prevent migration, optimizing fistula closure, and monitoring post-procedure. The article concludes by suggesting the consideration of innovative techniques for complex refractory defects. [Extracted from the article]

Objectives: Based on different physicochemical properties, common submucosal injection solutions could be classified into three categories: normal saline solution (NS), hypertonic solution (HS), and viscous solution (VS). We compared the efficacy and safety of various categories of solutions in this network meta‐analysis of randomized controlled trials (RCTs) to identify the optimal submucosal injection fluid. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched for RCTs that compared the efficacy and safety of NS, HS, and VS during endoscopic resection for gastrointestinal (GI) mucosal lesions. Pairwise and network analyses were conducted to determine the ranking of different fluids. Results: Thirteen RCTs were included in the final analysis with 1637 patients (1639 lesions). HS outperformed NS in rates of en bloc (pooled relative risk [RR] 1.50; 95% confidence interval [CI] 1.10–1.90), overall bleeding (pooled odds ratio [OR] 0.33; 95% CI 0.10–0.88; lesions >10 mm OR 4.65 × 10−2; 95% CI 1.10 × 10−3–0.46), and intraoperative bleeding (lesions >10 mm OR 7.10 × 10−6; 95% CI 4.30 × 10−18–0.26). HS showed the highest probability of ranking first in each outcome except for the volume of injection. Although VS was superior to NS in rates of en bloc, overall, and intraoperative bleeding in the lesions >10 mm subgroup, and required less fluid in pooled analysis, it ranked last in cost of submucosal injection solution. Conclusions: Both HS and VS were superior to NS in comparisons of efficacy and safety. Considering the better performance and potentially low cost, HS might be an optimal choice during gastrointestinal endoscopic resection, especially for colorectal endoscopic mucosal resection. [ABSTRACT FROM AUTHOR]

Key points: Expanded types of functional endoscopic sinus surgery (FESS) significantly improve quality of life and reduce revision surgeries rates, supporting their early application for moderate‐to‐severe cases.Minimal clinically important difference may play as a crucial role in defining surgical treatment response (i.e., responder and super‐responder conditions).Expanded FESS benefits patients with chronic rhinosinusitis with nasal polyps but more data are required to have a clearer understanding of its uses due to varied approaches and reported outcomes in the literature. [ABSTRACT FROM AUTHOR]

Background: No studies have investigated the systemic and local sinonasal profile of obesity‐related chronic rhinosinusitis (CRS), despite its observed association in recent retrospective studies. The objectives of our study were to assess the impact of obesity on the clinical and cytokine profile of patients with CRS and evaluate treatment response with functional endoscopic sinus surgery. Methods: This was a prospective observational study at the Cleveland Clinic that included patients with CRS (n = 54) between December 2021 and September 2022. Data collection included demographics, body mass index (BMI), comorbidities, baseline sinonasal outcome test scores, baseline radiologic scores (Lund–Mackay), postoperative sinonasal outcome test scores (at 3–4 months), and local and systemic alarmins/T‐helper cytokines. Results: Out of the 54 CRS patients, there were 20 CRS patients without nasal polyps (37%) and 34 with nasal polyps (63%). Patients were categorized based on obesity (BMI ≥ 30 kg/m2). Obese CRS patients had lower systemic alarmins (interleukin [IL]‐33 and Thymic stromal lymphopoietin (TSLP)) compared to non‐obese CRS patients (IL‐33: 744.2 ± 1164.6 pg/mL vs. 137.5 ± 320.0 pg/mL, p = 0.005; TSLP: 627.7 ± 1806.3 pg/mL vs. 28.1 ± 85.4 pg/mL, p = 0.017). CRS patients with nasal polyps with BMI ≥30 kg/m2 had higher postoperative sinonasal outcome test scores and lower levels of nasal eotaxin‐3 and IL‐33 compared to BMI <30 kg/m2 counterparts. Conclusions: In conclusion, patients with obese CRS and nasal polyps displayed diminished levels of intranasal alarmins and reduced intranasal eotaxin‐3. These results potentially imply the presence of a unique, obese type 2‐low CRS phenotype that warrants further exploration. [ABSTRACT FROM AUTHOR]

Background: Rectal neuroendocrine tumours (rNETs) are rare but are increasing in incidence. Current management and surveillance recommendations are based on low‐grade evidence. Follow‐up practices are often inconsistent and costly. This retrospective study analyses a single‐centre's experience with rNETs to assess incidence, management practices, outcomes, and guideline adherence. Methods: This is a single‐centre retrospective study from Queensland Australia, spanning from 2012 to 2023. Twenty‐eight rNET cases met inclusion criteria. Examined parameters included incidence, management, outcomes and adherence to European Neuroendocrine Tumour Society (ENETS) guidelines. R1 resection rate was analysed for associations with resection technique and lesion recognition and recurrence rate was assessed in all patients. Results: This study shows an increasing incidence of rNETs during the study period, reflecting a global trend. R1 resection rate at initial endoscopy was 75%. There was a general lack of advanced endoscopic techniques utilized and poor lesion recognition, however a statistically significant correlation was not established between these factors and an R1 result (P < 0.05). Most patients with an R1 result had subsequent re‐resection to render the result R0, however five patients (33%) underwent surveillance with no reports of recurrence on follow‐up. Overall, follow‐up practices in our cohort were inconsistent and did not adhere to guidelines. Conclusion: rNETs are increasing in incidence, emphasizing the need for standardized management and surveillance. Further training is required for rNET recognition and advanced endoscopic resection techniques. Further research is required to assess long‐term outcomes in surveilled R1 cases, understand optimal endoscopic resection techniques and further develop local surveillance guidelines. [ABSTRACT FROM AUTHOR]

Key Points Utilization of orbital decompressions (ODS) increased (CAGR: +3.2%) from 2000 to 2019. FDA approved teprotumumab in January 2020; ODS utilization decreased (CAGR: −14.9%) from 2019 to 2022. In 2022, total spending was substantially higher for teprotumumab ($325 million) than surgery ($580,000). [ABSTRACT FROM AUTHOR]

Objectives: Lymphovascular invasion (LVI) is a critical risk factor for lymph node metastasis (LNM), which requires additional surgery after endoscopic resection of T1 colorectal cancer (CRC). However, the impact of additional staining on estimating LNM is unclear. This systematic review aimed to evaluate the impact of additional staining on determining LNM in T1 CRC. Methods: We searched five electronic databases. Outcomes were diagnostic odds ratio (DOR), assessed using hierarchical summary receiver operating characteristic curves, and interobserver agreement among pathologists for positive LVI, assessed using Kappa coefficients (κ). We performed a subgroup analysis of studies that simultaneously included a multivariable analysis for other risk factors (deep submucosal invasion, poor differentiation, and tumor budding). Results: Among the 64 studies (18,097 patients) identified, hematoxylin–eosin (HE) and additional staining for LVI had pooled sensitivities of 0.45 (95% confidence interval [CI] 0.32–0.58) and 0.68 (95% CI 0.44–0.86), specificities of 0.88 (95% CI 0.78–0.94) and 0.76 (95% CI 0.62–0.86), and DORs of 6.26 (95% CI 3.73–10.53) and 6.47 (95% CI 3.40–12.32) for determining LNM, respectively. In multivariable analysis, the DOR of additional staining for LNM (DOR 5.95; 95% CI 2.87–12.33) was higher than that of HE staining (DOR 1.89; 95% CI 1.13–3.16) (P = 0.01). Pooled κ values were 0.37 (95% CI 0.22–0.52) and 0.62 (95% CI 0.04–0.99) for HE and additional staining for LVI, respectively. Conclusion: Additional staining for LVI may increase the DOR for LNM and interobserver agreement for positive LVI among pathologists. [ABSTRACT FROM AUTHOR]

Background: Existing patient-reported outcome measures (PROMs) for chronic rhinosinusitis (CRS) use a variety of recall periods and response scales to assess CRS symptom burden. Global perspectives of CRS patients regarding optimal recall periods and response scales for CRS PROMs are unknown. Methods: This was a multi-center, cross-sectional study recruiting 461 CRS patients from sites across the United States, Saudi Arabia, New Zealand, and Austria. Participants chose which CRS symptom recall period (1 day, 2 weeks, 1 month, >1 month) was most reflective of their current disease state and upon which to best base treatment recommendations (including surgery). Participants also chose which of six response scales (one visual analogue scale and five Likert scales ranging from four to eight items) was easiest to use, understand, and preferred. Results: A plurality of participants (40.0%) felt their CRS symptoms' current state was best reflected by a 1-month recall period. However, most patients (56.9%) preferred treatment recommendations to be determined by symptoms experienced over a >1 month period. The four- and five-item Likert scales were the easiest to understand (26.0% and 25.4%, respectively) and use (23.4% and 26.7%, respectively). The five-item (26.4% rating it most preferred and 70.9% rating it preferred) and four-item Likert (22.3% rating it most preferred and 56.4% rating it preferred) response scales were most preferred. Conclusion: Future PROMs for CRS should consider assessment of symptoms over a 1-month period and use a four- or five-itemLikert response scale to reflect global patient preferences. These findings also inform interpretation of current CRS PROMs. [ABSTRACT FROM AUTHOR]

A study published in the International Forum of Allergy & Rhinology examined the impact of using both electronic and conventional cigarettes on the diagnosis and surgery for chronic rhinosinusitis (CRS). The study found that individuals who used both types of cigarettes had a higher risk of CRS or functional endoscopic sinus surgery (FESS) compared to those who only used one type. However, there was no significant difference in the risk of polyposis between the two groups. The study suggests that this effect may be due to various factors such as bacterial, immune cell, genetic, and mucociliary changes. However, the study has limitations and further research is needed to fully understand the effects of using both types of cigarettes on sinonasal disease. [Extracted from the article]

Background: The chronic rhinosinusitis patient-reported outcome (CRS-PRO) is a recently published disease-specific questionnaire designed for CRS patients, with fewer entries and ease of completion. This study aimed to translate the CRS-PRO questionnaire into Chinese and assess its reliability, validity, and responsiveness to provide Chinese patients with a more concise and efficient subjective assessment instrument. Methods: The Chinese version of the CRS-PRO was created through forwardbackward translations and cultural adaptation. Here, 168 CRS patients (118 patients CRS with nasal polyps [CRSwNP] and 50 patients with CRS without nasal polyps [CRSsNP]) and 43 healthy individuals were enrolled. All participants completed the CRS-PRO, 22-item Sinonasal Outcome Test (SNOT-22), and EuroQol five dimensions questionnaire (EQ-5D) questionnaires preoperatively as well as 3 and 6 months after surgery. Results: The Chinese version of the CRS-PRO demonstrated good internal consistency, with a Cronbach's a of 0.813. It also exhibited a higher criterion validity (r=0.65, p<0.05) than the SNOT-22.Amoderate associationwas found between the CRS-PRO and objective indicators such as the Lund-Mackay and endoscopic scores. Furthermore, the CRS-PRO, like the SNOT-22, could clearly distinguish CRS patients from healthy subjects (p < 0.01), as well as between the CRSwNP and CRSsNP subtypes (p < 0.01). Additionally, changes in the CRS-PRO exhibited a larger effect size compared to changes in the SNOT-22 (Cohen's d = 1.05 and 0.93 vs. 0.71 and 0.90 for 3 and 6 months, respectively, all p < 0.01). Conclusions: The Chinese version of the CRS-PRO is a concise, reliable, and responsive instrument that can be utilized as a novel subjective evaluation tool for future clinical practice. [ABSTRACT FROM AUTHOR]

Background: Biologics are effective for chronic rhinosinusitis with nasal polyposis (CRSwNP) by reducing type 2 inflammation. Nonresponders often require functional endoscopic sinus surgery (FESS) and represent a challenging population potentially due to non-type 2 pathophysiology. This study characterizes the histopathologic features of biologic nonresponders. Methods: A retrospective review of 257 CRSwNP patients undergoing FESS was conducted. The biologic nonresponder group included patients with prior biologic therapy who exhibited persistent symptoms and polyp burden. Those with CRSwNP not prescribed biologic therapy were selected as controls. Demographics, comorbidities, and structured histopathology consisting of 13 variables were collected. Results: Of 257 CRSwNP patients, 20 were on biologics prior to FESS. Fourteen patients (70.0%) received dupilumab, one (5.0%) receivedmepolizumab, one (5.0%) received omalizumab, and four (20.0%) tried multiple biologics. The mean age for the biologic nonresponder groupwas 45.8 years compared to 50.4 years for the controls. Nonresponders had a significantly increased incidence of reduced tissue eosinophilia, defined as <5 per high power field (55% vs. 31.2%, p = 0.044) and increased basement membrane thickening (100% vs. 78.1%, p = 0.019). The remaining 11 variables did not reach statistical significance. Conclusion: Histopathologic analysis of biologic nonresponders demonstrates decreased eosinophilia and thickened basement membranes. These findings, particularly low tissue eosinophils, are consistent with a non-type 2 CRSwNP that may be recalcitrant to biologic therapies. Histopathologic analysis done in conjunction with FESS may aid clinicians in understanding response to biologic therapies in patients with CRSwNP who have persistent symptom burden necessitating FESS. [ABSTRACT FROM AUTHOR]

Background: Biologic therapy targeting type 2 chronic rhinosinusitiswith nasal polyps (CRSwNP) has greatly improved disease control but nonresponders exist in a proportion of patients in phase 3 trials and clinical practice. This study explores the serum and histologic changes in biologic treated CRSwNP that predict disease control. Methods: A cross-sectional study was performed of patients with CRSwNP on biologics for their asthma, who underwent endoscopic sinus surgery while on biologic therapy. At the 6-month postoperative assessment, patients with poorly controlled CRSwNP while on biologic therapy were compared to patients who were controlled. Blood and mucosal samples taken at the time of surgery 6 months prior were assessed to predict disease control. Results:Atotal of 37 patientswere included (age 47.8±12.4 years, 43.2% female). Those with poorly controlled disease had reduced tissue eosinophils (% >100 cells/high-powered field: 8.3% vs. 50.0%, p < 0.001) and increased serum neutrophils (5.2 ± 2.7 vs. 3.7 ± 1.1 × 109 cells/L, p = 0.02). Logistic regression analysis demonstrated that reduced tissue eosinophil was predictive for poorly controlled disease (OR = 0.21, 95% CI [0.05, 0.83], p = 0.03). Receiver-operating characteristic analysis showed that need for rescue systemic corticosteroid was predicted at a serum neutrophil cut-off level of 5.75 × 109 cells/L (sensitivity = 80.0%, specificity = 96.9%, AUC = 0.938, p = 0.002). Conclusion: Low tissue eosinophils and increased serum neutrophils while on biologics predict for poor response in the biological treatment of with CRSwNP. A serum neutrophil level of =5.75 × 109 cells/L predicts for poor response to current biologic therapy. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to analyze advantages and disadvantages of mucus and serum for biomarker analysis. Methods: This study includes prospective study of 61 CRS with nasal polyps patients who were followed over 24months and over nine time points after functional endoscopic sinus surgery. At each time points, the nasal polyp score (NPS) was assessed and mucus as well as serum was collected. Selected were measured in mucus and serum. Mean, standard deviation and variance, undetectable values, and the correlation of the biomarkers to the NPS over time and to early recurrences were calculated, and the effect of surgery on the biomarkers was assessed. Additionally, the diurnal rhythm of all biomarkers was measures in order to assure stable biomarker values during sampling times. Results: All biomarkers showed stable values during sampling times. Serum biomarker levels displayed higher percentages of undetectable values compared to mucus biomarkers. Mucus periostin (p<0.001, r=0.89), mucus IgE (p<0.001, r = 0.51), serum periostin (p < 0.001, r = 0.53), mucus CST1 (p < 0.001, r = 0.27), and serum IgE (p < 0.01, r=-0.18) were the best marker andmedium combinations to track the NPS over time and to predict recurrences. Mucus serpinF2 was negatively correlated and predicted early recurrences (p = 0.026, R2 = 0.015). Conclusions: Serum and mucus both represent viable mediums for "liquid biopsies." The most promising biomarker/medium combinations over time to track disease severity were mucus periostin, mucus IgE, serum periostin, mucus CST1, and serum IgE. Mucus serpinF2 was the best biomarker to predict early recurrences. [ABSTRACT FROM AUTHOR]

Following the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) treatment algorithm for chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), patients suffering from severe uncontrolled CRSwNP are recommended to receive oral corticosteroids, (revision) sinus surgery, systemic biologicals and/or aspirin treatment after desensitization (ATAD). Given the major differences in indications, outcomes, practical considerations, risks and costs of these key pillars of treatment, there is a growing need to define criteria for each treatment option and list the clinically relevant and major considerations for them. This EUFOREA document therefore provides an expert panel overview of the expected outcomes, specific considerations and (contra)indications of the five major treatment arms of severe uncontrolled CRSwNP: oral corticosteroids, primary and revision sinus surgery, biological treatment and ATAD. This overview of treatment considerations is needed to allow physicians and patients to consider the different options in the context of providing optimal and personalized care for severe uncontrolled CRSwNP. In conclusion, the five major treatment options for severe uncontrolled CRSwNP have intrinsic advantages, specific indications and considerations that are of importance to the patient, the physician and the society. This EUFOREA statement supports the unmet need to define criteria for the indication of every treatment pillar of CRSwNP. [ABSTRACT FROM AUTHOR]

Summary: Background: Acute upper gastrointestinal bleeding (UGIB) is a common emergency requiring hospital‐based care. Advances in care across pre‐endoscopic, endoscopic and post‐endoscopic phases have led to improvements in clinical outcomes. Aims: To provide a detailed, evidence‐based update on major aspects of care across pre‐endoscopic, endoscopic and post‐endoscopic phases. Methods: We performed a structured bibliographic database search for each topic. If a recent high‐quality meta‐analysis was not available, we performed a meta‐analysis with random effects methods and odds ratios with 95% confidence intervals. Results: Pre‐endoscopic management of UGIB includes risk stratification, a restrictive red blood cell transfusion policy unless the patient has cardiovascular disease, and pharmacologic therapy with erythromycin and a proton pump inhibitor. Patients with cirrhosis should be treated with prophylactic antibiotics and vasoactive medications. Tranexamic acid should not be used. Endoscopic management of UGIB depends on the aetiology. For peptic ulcer disease (PUD) with high‐risk stigmata, endoscopic therapy, including over‐the‐scope clips (OTSCs) and TC‐325 powder spray, should be performed. For variceal bleeding, treatment should be customised by severity and anatomic location. Post‐endoscopic management includes early enteral feeding for all UGIB patients. For high‐risk PUD, PPI should be continued for 72 h, and rebleeding should initially be evaluated with a repeat endoscopy. For variceal bleeding, high‐risk patients or those with further bleeding, a transjugular intrahepatic portosystemic shunt can be considered. Conclusions: Management of acute UGIB should include treatment plans for pre‐endoscopic, endoscopic and post‐endoscopic phases of care, and customise treatment decisions based on aetiology and severity of bleeding. [ABSTRACT FROM AUTHOR]

Objective: To perform a systematic review and meta‐analysis on the efficacy and safety of sialendoscopy in the treatment of obstructive diseases of the major salivary glands. Materials and Methods: We searched four databases for literature. The primary outcome assessed was the success rate. Secondary outcomes included the use of supportive devices, number of sialadenectomies and complications. Risk of bias was assessed. Meta‐analyses with subgroup analysis were performed. Results: In total, 91 studies were included, comprising 8218 patients undergoing 9043 sialendoscopic procedures. The majority of studies had a medium or high risk of bias. The incidence of sialadenectomy varied from 0% to 14%. No major complications were reported. Meta‐analysis revealed a weighted pooled success rate of 80.9%. Subgroup analyses showed the weighted pooled success rate in patients with sialoliths (89.6%), stenoses (56.3%), submandibular glands (88.3%), parotid glands (81.2%), patients treated by an endoscopic‐assisted transoral removal of a sialolith (86.3%), patients treated by a combined approach of the parotid gland (78.2%), patients with JRP (67.0%) and with RAIS (45.8%). Conclusion: The success rate of sialendoscopy did not considerably change in the last 9 years. Sialendoscopy is an efficient and safe procedure for the treatment of major salivary gland obstructive disease. [ABSTRACT FROM AUTHOR]

Introduction: Luminal esophageal temperature (LET) monitoring during atrial fibrillation (AF) ablation is widely used to reduce the incidence of endoscopically detected esophageal lesion (EDEL). We sought to assess whether specific patterns of LET variation are associated with EDEL. Methods: A high‐fidelity multisensor probe was used to record LET in AF patients undergoing radiofrequency ablation (RFA) or cryoballoon ablation (CBA). Explainable machine learning and SHapley Additive exPlanations (SHAP) analysis were used to predict EDEL and assess feature importance. Results: A total of 94 patients (38.3% persistent AF, 71.3% male, 72 RFA, and 22 CBA) were included. EDEL was detected in 11 patients (10 RFA and one CBA). In the RFA group, the highest LET recorded was similar between patients with and without EDEL (40.6 [40.1–41]°C vs. 40.2 [39.1–40.9]°C; p =.313), however, the rate of LET rise for the highest recorded peak was higher (0.08 [0.03–0.12]°C/s vs. 0.02 [0.01–0.05]°C/s; p =.033), and the area under the curve (AUC) for the highest peak was smaller (412.5 [206.8–634.1] vs. 588.6 [380.4–861.1]; p =.047) in patients who had EDEL. In case of CBA, the patient with EDEL had a faster LET decline (0.12 vs. 0.07 [0.02–0.14]°C/s), and a smaller AUC for the lowest trough (2491.3 vs. 2629.3 [1712.6–5283.2]). SHAP analysis revealed that a rate of LET change higher than 0.05°C/s and an AUC less than 600 were more predictive of EDEL in RFA. Conclusion: The rate of LET change and AUC for the recorded temperature predicted EDEL, whereas absolute peak temperatures did not. [ABSTRACT FROM AUTHOR]

Aim: Natural orifice specimen extraction (NOSE) in left‐sided colorectal surgery requires application of the circular stapler anvil to the proximal bowel without exteriorization through an additional abdominal incision. We describe an intracorporeal method to secure the stapler anvil, termed the intracorporeal antimesenteric ancillary trocar (IAAT) technique. Method: The ancillary trocar is attached to the stapler anvil before introduction into the abdominal cavity through the anal or vaginal orifice. The colon is incised before the trocar spike is brought out through the antimesenteric surface 3–4 cm within the cut edge. A linear stapler is used to seal the bowel end. The ancillary trocar is detached and retrieved via the NOSE conduit. Following the NOSE procedure, a side‐to‐end colorectal anastomosis is performed with the transanal circular stapler. Results: Ten consecutive patients underwent elective left‐sided colorectal resection with IAAT for NOSE (seven transanal, three transvaginal) from January to June 2023. Median age and body mass index were 66 (range 47–74) years and 24.3 (range 17.9–30.8) kg/m2 respectively. Two (20%) patients underwent sigmoid colectomy for sigmoid volvulus while eight (80%) underwent anterior resection for colorectal cancer. Median operating time, operative blood loss and postoperative length of hospital stay were 170 (range 140–240) min, 20 (range 10–40) mL and 1 (range 1–3) day respectively. There were no postoperative complications, readmissions or reoperations. Median follow‐up duration was 3 (range 1–6) months. Conclusion: The IAAT double‐stapling side‐to‐end anastomotic technique is safe and feasible for patients undergoing left‐sided colorectal resection with NOSE, resulting in good outcomes. [ABSTRACT FROM AUTHOR]

Objective: Unilateral biportal endoscopic (UBE) surgery has recently been used as a minimally invasive procedure for the treatment of lumbar spinal stenosis and is associated with less perioperative blood loss. However, perioperative hidden blood loss (HBL) may be neglected during UBE. This study aimed to examine the volume of HBL and discuss the influential risk factors for HBL during unilateral biportal endoscopic surgery. Methods: From January 2022 to August 2022, 51 patients underwent percutaneous unilateral biportal endoscopic surgery for lumbar spinal stenosis at the Department of Spinal Surgery of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University and were enrolled in this study. The data included general indicators (age, sex and body mass index [BMI]), underlying disease (hypertension and diabetes), laboratory test results (prothrombin time [PT], activated partial thromboplastin time [APTT], fibrinogen [Fbg]), and preoperative and postoperative hematocrit and hemoglobin), related imaging parameters (severity of intervertebral disc [IVD] degeneration and soft tissue thickness of the interlaminar approach), number of operated vertebrae and operation time. Total blood loss (TBL) and HBL during surgical procedures were measured via the Gross formula. Influential factors were further analyzed by multivariate linear regression analysis and t‐tests. Results: The mean HBL was 257.89 ± 190.66 mL for single‐operation patients and 296.58 ± 269.75 mL for two‐operation patients. Patients with lower PT (p = 0.044), deeper tissue thickness (p = 0.047), and diabetes mellitus were determined to have more HBL during UBE. The operation time might also be an important factor (p = 0.047). However, sex (p = 0.265), age (p = 0.771/0.624), BMI (p = 0.655/0.664), APTT (p = 0.545/0.751), degree of degenerated IVD (p = 0.932/0.477), and hypertension (p = 0.356/0.896) were not related to HBL. Conclusion: This study determined the different influential factors of HBL during UBE. PT, tissue thickness, and diabetes mellitus are the independent risk factors that affect HBL incidence. Long PT may decrease the volume of HBL within a certain range. Tissue thickness and diabetes mellitus can lead to an increased volume of HBL. [ABSTRACT FROM AUTHOR]

Objectives: Prediction of the risk of esophageal squamous cell carcinoma (SCC) by endoscopic findings without iodine staining, which is irritating to the esophagus, would be beneficial. In a previous retrospective study, we found that multiple foci of dilated vascular areas (MDV) of the esophageal mucosa, seen in narrow‐band imaging (NBI)/blue laser imaging (BLI), are associated with iodine‐unstained lesions and, thus, may be a predictor of esophageal SCC. This prospective study aimed to investigate the association between MDV and metachronous esophageal SCC. Methods: Patients with a history of endoscopic resection for esophageal SCC were included in the study. First, evaluation of the MDV using NBI or BLI was conducted during the initial endoscopy. The patients were then monitored for metachronous esophageal SCC by endoscopic surveillance. The association between the number of MDV and incidence of metachronous esophageal SCC was investigated. Results: From February 2018 to May 2019, 206 patients were enrolled and 201 patients were included in the analysis. Patients were followed up until October 2022. The median (interquartile range) endoscopic follow‐up period was 1260 (1105–1348) days. The incidence of metachronous esophageal SCC at 2 years was 7.1% in patients with MDV ≤4 and 13.9% in patients with MDV ≥5 (P < 0.01). In the multivariate analysis, MDV was an independent predictor of metachronous esophageal SCC, with an odds ratio (95% confidence interval) of 2.37 (1.06–5.31). Conclusion: Multiple foci of dilated vascular area is a useful predictor for stratifying the risk of metachronous esophageal SCC. [ABSTRACT FROM AUTHOR]

Objectives: The resection of vertical margin‐negative submucosally invasive colorectal cancer (CRC) relies on the pathological risk assessment of lymph node metastasis. However, no large‐scale study has clarified the endoscopic resection (ER) outcome for submucosally invasive CRC, focusing on the vertical margin status. This retrospective study aimed to examine vertical margin involvement in ER for submucosally invasive CRC and explore the treatment consequences associated with vertical margin status. Methods: We analyzed 395 submucosally invasive CRC cases in 389 patients who underwent ER at our hospital between 2008 and 2020. The presence of residual tumors and simultaneous lymph node metastasis in patients who underwent additional surgery was assessed and compared between the vertical incomplete ER and the vertical margin‐negative groups. Results: Among the patients, 270 were men, with a median age of 69 years. The vertical incomplete ER rate was 21.5%, with positive vertical margins and unclear vertical margins identified in 12.2% and 9.3% of the cases, respectively. Among 154 patients who underwent additional surgery after ER, the vertical incomplete ER group had a significantly higher residual tumor rate than the vertical margin‐negative group (P = 0.001). The vertical incomplete ER group had a significantly higher lymph node metastasis rate than the vertical margin‐negative group (P = 0.029). Conclusion: This study clarified the substantial risk of vertical incomplete ER in submucosally invasive CRC and revealed the high risk of residual tumor and lymph node metastasis in vertical incomplete ER for submucosal CRC. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Gastrointestinal stromal tumors are the most common malignant subepithelial lesions involving the gastrointestinal tract. Surgical techniques have been the mainstay of treatment, however, in recent times hybrid surgeries are being introduced yielding better clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether chronic rhinosinusitis (CRS) endotypes show a differential response to endoscopic sinus surgery (ESS). We explored patient mucous inflammatory cytokine expression and associations with patient‐reported and clinically measured post‐operative outcome measures. Methods: Patients with CRS were prospectively recruited between 2016 and 2021 into a national multicenter, observational study. Mucus was collected from the olfactory cleft preoperatively and evaluated for 26 biomarkers using cluster analysis. Patient‐reported outcome measures included the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) and Questionnaire of Olfactory Dysfunction (QOD). Additional clinical measures of disease severity included threshold, discrimination, and identification (TDI) scores using "Sniffin' Sticks" testing and Lund–Kennedy endoscopic score (LKES). Results: A total of 115 patients were clustered into type 2 inflammatory, non–type 2 inflammatory, noninflammatory, and two indeterminate clusters based on individual protein levels. Overall, the type 2 inflammatory cluster was found to have the highest mean improvement in both SNOT‐22 (−28.3 [standard deviation, ±16.2]) and TDI (6.5 [standard deviation, ±7.9]) scores 6 months after ESS. However, on average, all endotype clusters demonstrated improvement in all outcome measures after ESS without statistically significant between‐group differences in SNOT‐22 (p = 0.738), QOD (p = 0.306), TDI (p = 0.358), or LKES (p = 0.514) measures. Conclusions: All CRS endotype clusters responded favorably to surgery and showed improvements in patient‐reported and objective outcome measures. Thus, ESS should be considered a more generalized CRS therapy, and benefits appear to not be limited to specific endotypes. [ABSTRACT FROM AUTHOR]

Background: Comorbid chronic rhinosinusitis (CRS) remains unresolved for many people with cystic fibrosis (PwCF). While highly effective modulator therapy improves quality‐of‐life and symptom severity, the impact of this intervention and other factors associated with pursuing endoscopic sinus surgery (ESS) remains understudied. Methods: Adult PwCF + CRS were enrolled into a prospective, observational, multi‐institutional study. Participants completed validated outcome measures to evaluate respiratory symptom severity, depression, headache, and sleep quality, as well as nasal endoscopy, sinus computed tomography (CT), and olfactory testing. Bivariate comparisons and regression modeling evaluated treatment cofactors, disease characteristics, and outcome measures associated with pursuing ESS. Results: Sixty PwCF were analyzed, including 24 (40%) who elected ESS. Pursuing ESS was associated with worse SinoNasal Outcome Test (SNOT‐22) total, rhinologic, psychological, and sleep dysfunction domain scores; worse Patient Health Questionnaire‐9‐Revised depression scores; worse Pittsburgh Sleep Quality Index total scores; worse weight, role, emotion, and eating domain scores on the Cystic Fibrosis Questionnaire‐Revised; more severe disease on nasal endoscopy; and lack of modulator therapy (all p < 0.050). Multivariable regression identified that worse SNOT‐22 total score was associated with electing ESS (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.02–1.16, p = 0.015) and elexacaftor/tezacaftor/ivacaftor (ETI) treatment (OR 0.04, 95% CI 0.004–0.34, p = 0.004) was associated with pursing medical therapy. Conclusions: Worse sinonasal symptom burden, lack of ETI treatment, sleep quality, depression, and nasal endoscopy scores were associated with electing ESS, while lung disease severity and sinus CT scores were not. ETI use was associated with lower odds of pursuing ESS independent of sinonasal symptom burden. [ABSTRACT FROM AUTHOR]

Background: Poor air quality increases the risk of developing chronic rhinosinusitis (CRS) and other airway diseases. However, there are limited data on air pollutants and CRS‐specific disease severity. We assessed the impact of air pollutants on sinonasal‐specific and general quality‐of‐life (QOL) measures in a multi‐institutional cohort of patients with CRS. Methods: Participants with CRS were prospectively enrolled in a cross‐sectional study and self‐selected continued appropriate medical therapy or endoscopic sinus surgery (ESS). The 22‐item SinoNasal Outcome Test (SNOT‐22) and Medical Outcomes Study Questionnaire Short‐Form 6‐D (SF‐6D) health utility value scores were recorded. Patient exposure to air pollutants was determined using residence zip codes. Unadjusted group differences were compared, and correlation coefficients were evaluated to identify the magnitude of bivariate association. Results: A total of 486 patients were enrolled and followed for a mean of 6.9 (standard deviation [SD] ± 2.3) months. Pollutant exposure did not significantly correlate with baseline SNOT‐22 or SF‐6D scores. Revision ESS was associated with higher median fine particulate matter (PM2.5; Δ = 0.12, [95% confidence interval {CI}: 0.003, 0.234]; p = 0.006) compared with primary surgery. PM2.5, PM10, and nitrogen dioxide concentrations (μg/m3) did not correlate with change in total SNOT‐22 or SF‐6D scores after treatment. Nevertheless, sulfur dioxide (SNOT‐22: ρ = –0.121 [95% CI: –0.210, –0.030]; p = 0.007; SF‐6D: ρ = 0.095 [95% CI: 0.002, 0.186]; p = 0.04) and carbon monoxide (SNOT‐22: ρ = ‐0.141 [95% CI: –0.230, 0.050]; p = 0.002) exposure did correlate with these outcome measures. Conclusion: Air pollutants may contribute, at least in part, to disease severity in CRS; future investigation is needed to further elucidate the nature of this relationship. [ABSTRACT FROM AUTHOR]

This article reports the results of the 16th National Survey conducted by the Japan Society for Endoscopic Surgery (JSES) for 2020 and 2021. Laparoscopic cholecystectomy was first introduced to Japan in 1990 and has rapidly become popular because of its minimally invasive nature. Since then, the number of objective organs and indications for laparoscopic surgery have gradually expanded. In 2021, 290 787 patients underwent endoscopic surgery in all surgical domains. Of these, 124 614, 110 757, 23 156, 21 771, 6543, 2614, 535, 465, 247, and 58 underwent abdominal, obstetric and gynecologic, thoracic, urological, pediatric, orthopedic, bariatric, mammary and thyroid gland, cardiovascular, and plastic surgery, respectively. Owing to the impact of the coronavirus disease 2019 (COVID‐19) infection spread, the incidence of many surgeries decreased in 2020, and levels are only now gradually recovering. However, despite the impact of COVID‐19, robot‐assisted surgeries were increasingly applied. The rate of complications did not change significantly, indicating that the procedure was performed safely, even with the spread of COVID‐19. [ABSTRACT FROM AUTHOR]

Objective: To assess the combination of salivary gland intraductal irrigations (IG) followed by sialoendoscopy irrigations (SI) of the parotid gland on the improvement of salivary gland secretory dysfunction (SGSD). Methods: We retrospectively analyzed the records of SGSD patients who underwent major salivary gland IG followed by SI during 2014–2020. Records included demographics, systemic background, signs, and symptoms. Improvement was assessed by comparing the mean unstimulated and stimulated whole salivary flow rate (UWSF, SWSF) from the baseline point (before IG procedure) to the last point (after SI) using repeated measures. The between‐subjects effects of various factors and covariants were analyzed using repeated measures ANCOVA. Results: One hundred patients were included with an age range of 15–83 years (mean age of 60.1 ± 13.1 years). Improvement was detected on UWSF measurements (p = 0.031, F = 3.83), but not on SWSF measurements (p = 0.165, F = 1.85). The between‐subjects effects on UWSF measurements were statistically significant for sex (p = 0.003, F = 9.526) and salivary gland manipulators use (p < 0.001, F = 15.107) and for the interaction between sex and salivary gland manipulators use (p‐ = 0.002, F = 9.709). Results of long‐term follow‐up for 10.87 ± 11.79 months after the SI procedure demonstrated sustained improvement in UWSF measurements (p = 0.011, F = 4.91). Conclusions: The combination of IG followed by SI increases UWSF salivary secretion in SGSD patients for a relatively extended duration. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion This study aimed to investigate the impact of vNOTES on postoperative sexual dysfunction in patients undergoing adnexal procedures.We analyzed data from patients who underwent vNOTES adnexal surgeries for benign conditions between May 2020 and May 2023. The primary outcome was the presence of new postoperative deep dyspareunia (DD) or other sexual dysfunctions, which were assessed through a phone survey conducted 6 to 24 months after surgery. Secondary outcomes included surgical feasibility, operative times, complications rate, and postoperative pain evaluation.We included 103 patients for primary and secondary outcomes and 111 patients for secondary outcomes analysis only. Newly postoperative DD was reported by three patients (2.9%), remained present at 12 postoperative months in one case (1.0%), and spontaneously disappeared in two cases (1.9%) after four and 10 postoperative months, respectively. In the remaining 100 patients (97.1%), no new DD or other sexual function disorders were reported after surgery. vNOTES procedures were successfully performed in all cases, with a mean operative time of 38.2 ± 19.6 min and a conversion rate to conventional laparoscopy of 0.9%. No significant complication was observed.This study suggests a very limited risk of developing postoperative sexual dysfunction after vNOTES benign adnexal procedures. [ABSTRACT FROM AUTHOR]

Objectives: To compare the surgical outcomes of total laparoscopic hysterectomy (TLH) and transvaginal endoscopic hysterectomy (TVEH) for benign uterine diseases. Methods: This retrospective, cohort, interrupted time‐series study included patients who underwent TLH between January 2013 and September 2016 and TVEH between October 2016 and June 2020. Median difference regression was used to compare the hospital length of stay (LOS) and operative time between the groups. Risk difference regression was used to analyze the proportion of patients who developed postoperative fever or vaginal stump infection. Results: Of the total 171 patients enrolled, 101 and 70 underwent TVEH and TLH, respectively. The mean ages of patients in the TVEH and TLH groups were 46.49 and 46.17 years, respectively. No conversion was observed. Ureteric injury occurred in one patient in the TVEH group, whereas there was no organ injury in any of the patients in the TLH group. Compared with those in the TLH group, patients in the TVEH group had a significantly shorter median operative time, shorter hospital LOS, lower morphine use, and lower postoperative febrile morbidity rates. However, no significant difference was observed in the rate of vaginal stump infection between the groups. Conclusion: Given the shorter operative time, shorter hospital LOS, less febrile morbidity, and lower morphine use in patients with TVEH than in those with TLH, TVEH should be considered as an alternative hysterectomy procedure for benign uterine diseases. Synopsis: TVEH was associated with better surgical outcomes than TLH, and showed similar organ injury and conversion rates to those in TLH. [ABSTRACT FROM AUTHOR]

Background and Aim: Potassium‐competitive acid blockers more strongly suppress the gastric acid barrier than proton pump inhibitors and cause dysbiosis. However, preventive measures in this regard have not been established. We aimed to evaluate whether 1‐kestose, a known prebiotic, was effective at alleviating dysbiosis caused by potassium‐competitive acid blockers. Methods: Patients scheduled to undergo endoscopic resection for superficial gastroduodenal tumors were enrolled and randomized 1:1 to receive either 1‐kestose or placebo. All patients were started on potassium‐competitive acid blocker (vonoprazan 20 mg/day) and took 1‐kestose 10 g/day or placebo (maltose) 5 g/day for 8 weeks. The primary outcome was the effect of 1‐kestose on potassium‐competitive acid blocker‐induced alterations in the microbiome. The fecal microbiome was analyzed before and after potassium‐competitive acid blocker treatment via MiSeq (16S rRNA gene V3–V4 region). Results: Forty patients were enrolled, and 16 in each group were analyzed. In the placebo group, the Simpson index, an alpha diversity, was significantly decreased and relative abundance of Streptococcus was significantly increased by 1.9‐fold. In the kestose group, the Simpson index did not change significantly and relative abundance of Streptococcus increased 1.3‐fold, but this was not a significant change. In both groups, no adverse events occurred, ulcers were well healed, and pretreatment and posttreatment short‐chain fatty acid levels did not differ. Conclusions: The potassium‐competitive acid blocker caused dysbiosis in the placebo group; this effect was prevented by 1‐kestose. Thus, 1‐kestose may be useful in dysbiosis treatment. [ABSTRACT FROM AUTHOR]

Background and Aim: Endoscopic full‐thickness resection (EFTR) is a promising technique in treating gastric submucosal tumors originating from the muscularis propria (SMT‐MPs). However, it is challenging without counter‐traction. Methods: A snare was inserted through the forceps channel to grasp the part of the tumor or the mucosa connected to the tumor. The outer sheath and inner wire of snare in vitro were fixed by a pair of hemostatic forceps. The handle of snare was cut off, and the endoscope was pulled out without affecting the traction state of snare. Snare‐assisted EFTR (EFTR‐S) was then performed with counter‐traction. One hundred and four patients with gastric SMT‐MPs who received the procedure of EFTR with or without snare traction method were retrospectively analyzed using univariate and multiple regressions, and covariates were adjusted in the multiple analysis. Results: Compared with EFTR group (n = 36), EFTR‐S group (n = 68) showed a higher operative success rate (95.6% vs 72.2%, P = 0.001), a lower incidence of intraoperative hemorrhage (4.4% vs 16.7%, P = 0.038) and shorter operative time among operative successes (53.6 ± 16.6 min vs 67.7 ± 33.4 min, P < 0.001). Univariate logistic analysis showed that snare traction represented a significant factor, which could improve operative successful rate (odds ratio, 8.3; 95% confidence interval, 2.1 to 32.7; P = 0.002). Postoperative outcomes and adverse events among operative successes were similar between the two groups. Conclusions: This novel snare traction method may provide an effective counter‐traction and reduce the difficulty of EFTR for gastric SMT‐MPs. [ABSTRACT FROM AUTHOR]

Background: Endoscopic resection (ER) for jejunoileal lesions (JILs) has been technically challenging. We aimed to characterize the clinicopathologic characteristics, feasibility, and safety of ER for JILs. Method: We retrospectively investigated 52 patients with JILs who underwent ER from January 2012 to February 2022. We collected and analyzed clinicopathological characteristics, procedure‐related parameters, outcomes, and follow‐up data. Results: The mean age was 49.4 years. Of the 52 JILs, 33 ileal tumors within 20 cm from the ileocecal valve were resected with colonoscopy, while 19 tumors in the jejunum or the ileum over 20 cm from the ileocecal valve received enteroscopy resection. The mean procedure duration was 49.0 min. The en bloc resection and en bloc with R0 resection rates were 86.5% and 84.6%, respectively. Adverse events (AEs) included one (1.9%) major AE (delayed bleeding) and five (9.6%) minor AEs. During a median follow‐up of 36.5 months, two patients had local recurrence (3.8%), while none had metastases. The 5‐year recurrence‐free survival (RFS) and disease‐specific survival (DSS) were 92.9% and 94.1%, respectively. Compared with the enteroscopy group, overall AEs were significantly lower in the colonoscopy group (P < 0.05), but no statistical differences were observed in RFS (P = 0.412) and DSS (P = 0.579). There were no significant differences in AEs, RFS, and DSS between the endoscopic submucosal dissection (ESD) and the endoscopic mucosal resection (EMR) group. Conclusions: ER of JILs has favorable short‐term and long‐term outcomes. Both ESD and EMR can safely and effectively resect JILs in appropriately selected cases. [ABSTRACT FROM AUTHOR]

Several advanced imaging techniques are now available for endoscopists managing inflammatory bowel disease (IBD) patients. These tools, including dye‐based and virtual chromoendoscopy, probe‐based confocal laser endomicroscopy and endocytoscopy, are increasingly innovative applications in clinical practice. They allow for a more in‐depth and refined evaluation of the mucosal and vascular bowel surface, getting closer to histology. They have demonstrated a remarkable ability in assessing intestinal inflammation, histologic remission, and predicting relapse and favorable long‐term outcomes. In addition, the future application of molecular endoscopy to predict biological drug responses has yielded preliminary but encouraging results. Furthermore, these techniques are crucial in detecting and characterizing IBD‐related dysplasia, assisting endoscopic mucosal resection and submucosal dissection towards a surgery‐sparing approach. Artificial intelligence (AI) holds great potential in this promising landscape, as it can provide an objective and reproducible assessment of inflammation and dysplasia. Moreover, it can improve the prediction of outcomes and aid in subsequent therapeutic decision‐making. This review aims to summarize the promising role of state‐of‐the‐art advanced endoscopic techniques and related AI‐enabled models for managing IBD, paving the way for precision medicine. [ABSTRACT FROM AUTHOR]

Objectives: Endoscopic management of unresectable hilar malignant biliary obstruction (HMBO) is technically challenging, and effectiveness of stent‐in‐stent using large‐cell, metal stents was reported. A new, large‐cell stent with a 6F tapered delivery system was recently developed. The aim of this study was to compare clinical outcomes of slim‐delivery and conventional large‐cell stents. Methods: This was a multicenter retrospective comparative study of stent‐in‐stent methods using slim‐delivery stents (Niti‐S Large Cell SR Slim Delivery [LC slim‐delivery]) and conventional stents (Niti‐S large‐cell D‐type; LCD) for unresectable HMBO. Results: Eighty‐three patients with HMBO were included; 31 LC slim‐delivery and 52 LCD. Overall technical and clinical success rates were 100% and 90% in LC slim‐delivery group and 98% and 88% in LCD group. Use of the LC slim‐delivery was associated with shorter stent placement time in the multiple regression analysis, with a stent placement time of 18 and 23 min in LC slim‐delivery and LCD groups, respectively. The early adverse event (AE) rate of LC slim‐delivery was 10%, with no cholangitis or cholecystitis as compared to 23% in the LCD group. Recurrent biliary obstruction (RBO) rates and time to RBO were comparable between the two groups: 35% and 44%, and 8.5 and 8.0 months in LC slim‐delivery and LCD groups, respectively. The major cause of RBO was tumor ingrowth (82%) in the LC slim‐delivery group and sludge (43%) and ingrowth (48%) in LCD group. Conclusion: Stent‐in‐stent methods using LC slim‐delivery shortened stent placement time with low early AE rates and comparable time to RBO in patients with HMBO. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to show whether journals pay attention to double‐organ bias in studies on dacryocystorhinostomy (DCR) treatment. Most statistical tests are based on the assumption that each data entry is independent of the other. However, we wanted to understand whether the eye, which is a double organ in the human body, is a cause of bias and whether sufficient attention has been paid to it in published articles. Design: A PubMed search was conducted between November 1997 and November 2021 in the field of ophthalmology and otolaryngology with the terms 'dacryocystorhinostomy' and the limitations of 'people' and 'randomly controlled studies'. Publications containing DCR were searched. The publications published in the 15 journals with the highest impact were selected. The scope of the journal, the scope of the authors, the relevance of the articles, the presence of randomisation, the type of study (drug, endoscopic surgery, laser surgery and external surgery) and the statistical approach to bilateral organ bias were evaluated by two independent observers. Results and Main Outcome Measures: A total of 83 publications were found by Pubmed search. Fifty‐six publications were included in the study. Double‐organ bias was present in 41% (n = 23) of the cases. Of the 23 biased publications, 46.4% were found to be in the Quartile 1 group. Quartile 4 journals showed bias in only four journals. Conclusion: Double‐organ bias can also be seen in journals with high impact factors and published in recent years. Journals may need to pay more attention to double‐organ bias in the publication acceptance process. [ABSTRACT FROM AUTHOR]

A recent study published in Clinical Otolaryngology evaluated the association between triple combination therapy and the need for endoscopic sinus surgery (ESS) in adult patients with cystic fibrosis (CF) and chronic rhinosinusitis. The study included 128 patients, with 51 receiving triple combination therapy and the remaining patients serving as a control group. The results showed that the group receiving triple combination therapy had a statistically significant reduction in the number of ESS procedures performed compared to the control group. Additionally, the therapy was associated with improvements in sinus CT scores and sinonasal quality of life. However, the study has limitations, and further research is needed to confirm these findings. [Extracted from the article]

Background: Clarithromycin (CAM) resistance is a major contributor to the failure to eradicate Helicobacter pylori (H. pylori). The mixed‐infection ratio of CAM‐susceptible and CAM‐resistant H. pylori strains differs among individuals. Pyrosequencing analysis can be used to quantify gene mutations at position each 2142 and 2143 of the H. pylori 23S rRNA gene in intragastric fluid samples. Herein, we aimed to clarify the impact of the rate of mixed infection with CAM‐susceptible and CAM‐resistant H. pylori strains on the success rate of CAM‐containing eradication therapy. Materials and Methods: Sixty‐four H. pylori‐positive participants who received CAM‐based eradication therapy, also comprising vonoprazan and amoxicillin, were enrolled in this prospective cohort study. Biopsy and intragastric fluid samples were collected during esophagogastroduodenoscopy. H. pylori culture and CAM‐susceptibility tests were performed on the biopsy samples, and real‐time PCR and pyrosequencing analyses were performed on the intragastric fluid samples. The mutation rates and eradication success rates were compared. Results: The overall CAM‐based eradication success rate was 84% (54/64): 62% (13/21) for CAM‐resistant strains, and 95% (39/41) for CAM‐sensitive strains. When the mutation rate of the 23S rRNA gene was 20% or lower for both positions (2142 and 2143), the eradication success rate was 90% or more. However, when the mutation rate was 20% or higher, the eradication success rate was lower (60%). Conclusions: The mutation rate of the CAM‐resistance gene was related to the success of eradication therapy, as determined via pyrosequencing analysis. [ABSTRACT FROM AUTHOR]

Background: The placebo effect observed in clinical trials evaluating medical treatments for chronic rhinosinusitis (CRS) is not well understood. This systematic review and meta‐analysis sought to characterize the placebo effect present within CRS outcomes. Methods: A systematic review of PubMed, Scopus, and Cumulated Index in Nursing and Allied Health Nursing (CINAHL) was performed. Randomized controlled trials (RCTs) evaluating medical treatments for CRS versus placebo were included. We assessed patient‐reported (sino‐nasal outcome test 22 [SNOT‐22], nasal obstruction, sense of smell, nasal obstruction visual analogue score [VAS], sense of smell VAS, anterior rhinorrhea, and postnasal drip) and objective (Lund–Mackay Computed tomography (CT) score, peak nasal inspiratory flow [PNIF], nasal polyp scores, 40‐item Smell Identification Test, serum IgE, and blood eosinophil levels) outcomes. Results: Twenty‐one RCTs were included, comprising 1437 patients (mean age 49.2 years). Biologics were the most common treatment investigated (n = 9). Eleven studies administered background steroids along with placebo. Following placebo administration, multiple patient‐reported outcomes significantly decreased, including SNOT‐22 (mean difference −9.49, 95% confidence interval [CI] [−11.26, −7.73]), nasal obstruction (−0.33 [−0.54, −0.13]), sense of smell (−0.22 [−0.33, −0.11]), nasal obstruction VAS (−2.47 [−2.87, −2.06]), and loss of smell VAS (−2.31 [−4.14, −0.47]) scores. For objective measures, significant changes occurred in Lund–Mackay CT score (−0.82, [−1.48, −0.16]) and PNIF (4.70, [4.76, 24.64]) with placebo. Placebo arms had the greatest impact when no background medications were used. Conclusions: Placebo treatments have a statistically and potentially clinically significant effect on patient‐reported and some objective CRS outcomes. Further investigation is required to fully understand placebo effect, which could improve assessment of RCTs and impact patient care. [ABSTRACT FROM AUTHOR]

Background: Eustachian tube dysfunction (ETD) may occur distinct from, or in conjunction with, chronic rhinosinusitis (CRS+ETD). Intranasal corticosteroid sprays are often prescribed for ETD, although ET distribution may be limited. To date, no anatomic studies compare nasopharynx (NP) distribution between conventional nasal sprays (NS) and exhalation delivery systems (EDS) after surgery. This study utilizes a cadaver model to examine topical NP delivery using EDS vs. NS before and after targeted endoscopic sinus surgery (ESS). Methods: Sixteen sinonasal cavities were administered fluorescein solution via NS and EDS before and after maxillary antrostomy and anterior ethmoidectomy, followed by nasal endoscopy of the NP and ET orifice. Seven blinded experts submitted staining ratings of endoscopy images on a 0‐ to 3‐point scale, with ratings averaged for analysis. Results: Interrater reliability was excellent (intraclass correlation, 0.956). EDS was associated with significantly greater NP staining vs. NS in a pooled cohort of nonsurgical and ESS specimens (1.19 ± 0.81 vs. 0.78 ± 1.06; p = 0.043). Using a logistic regression model, EDS significantly outperformed NS in nonsurgical (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.21–10.09; p = 0.021) and post‐ESS (OR, 9.00; 95% CI, 1.95–41.5; p = 0.005) specimens, with the greatest relative staining observed for EDS after targeted ESS (OR, 18.99; 95% CI, 3.44–104.85; p = 0.001). Conclusions: EDS is more effective than NS in topical delivery to the NP and ET orifices in cadavers. Targeted ESS may facilitate greater NP penetration by EDS compared with NS, with possible synergism after ESS for augmented delivery. These findings suggest a role for EDS delivery methods for ETD management and in CRS+ETD patients undergoing sinus surgery. [ABSTRACT FROM AUTHOR]

Background: Endoscopic vidian neurectomy is expected to provide good therapeutic relief in patients with allergic rhinitis (AR) being refractory to medication therapy or conservative surgery. However, the evidence bases for its benefit remain debatable. In this study, we conducted a systematic review and meta‐analysis to clarify the therapeutic role of various forms of vidian neurectomy in refractory AR. Method: Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines were used to conduct a systematic review of primary studies that reported original patient data for endoscopic vidian neurectomy (EVN) and vidian‐branch neurectomy, which includes selective vidian neurectomy (SVN) and posterior nasal neurectomy (PNN). The primary outcome was patient‐reported outcome measures (PROMs), including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Visual Analog Scale (VAS), to assess an improvement in nasal symptom severity and quality of patient's life. The incidence of surgical complications and other objective outcomes were considered secondary outcomes. Results: This review included 24 clinical studies involving 1677 patients with refractory AR, of which 510 patients in six studies had combined chronic rhinosinusitis with nasal polyps (CRSwNP) and 95 patients in one study had combined asthma. Postoperative PROMs were significantly better than preoperatively in almost all patients who underwent vidianp (RQLQ: standardized mean difference [SMD] = 2.66, 95% confidence interval [CI] = 2.40–2.92, p < 0.001; VAS: SMD = 5.15, 95% CI = 4.29–6.02, p < 0.001) or vidian‐branch neurectomy (RQLQ in PNN: SMD = 3.29, 95% CI = 2.45–4.13, p < 0.001; VAS in PNN: SMD = 4.38, 95% CI = 3.41–5.34, p < 0.001), and were generally better than in the conservative treatment group. Dividing with 18 months as the cutoff point, a subgroup analysis of the follow‐up period was conducted, and the results showed that both long‐term and short‐term postoperative patients had considerably reduced symptoms compared to the preoperative period. The two surgical procedures, SVN and PNN, attributed to vidian‐branch neurectomy have extremely few complications. However, EVN is more likely to cause dry eyes and palatal numbness, with no other serious complications. In patients with AR and CRSwNP, vidian or selective vidian neurectomy combined with functional endoscopic sinus surgery (FESS) is more effective than conventional FESS (RQLQ: SMD = 2.17, 95% CI = 1.66–2.69, p < 0.001; VAS: SMD = 6.42, 95% CI = 4.78–8.06, p < 0.001). For patients who have both AR and asthma, SVN with pharyngeal branch excision is a potential treatment option. Conclusion: EVN and vidian‐branch neurectomy (including SVN and PNN) are effective treatments, but the former has a higher risk of complications. Additionally, vidian‐branch neurectomy with FESS is beneficial for patients with mixed CRSwNP. SVN is a potential approach for patients with coexisting AR and asthma. [ABSTRACT FROM AUTHOR]