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Introduction. Colorectal cancer is one of the most common malignancies and is still one of the major causes of cancer-related mortality worldwide. Laterally spreading colorectal tumors (LSTs) are nonpolypoid neoplastic lesions with a diameter of at least 10 mm, which typically extend laterally rather than vertically along the interior luminal wall. LTSs have recently received special attention due to the significant degree of dysplasia and the diagnostic and therapeutic challenge that it represents for clinical practice. LTSs can reach impressive sizes, most of them larger than 2 cm and the classification into granular and non-granular is an important characteristic for establishing the degree of dysplasia and choosing the appropiate treatment. Case presentation. A 73-year-old patient with significant cardiovascular (cardiac pacemaker) and metabolic diseases (diabetes mellitus type 2 and morbid obesity), without a history of digestive diseases, was admitted to our department for abdominal pain. At admisson, blood tests revealed a non-specific inflammatory syndrome, liver cytolysis, without signs of cholestasis and moderate anemia. Likewise, carcinoembryonic antigen and CA19.9 were elevated. Plain X-ray ruled out pneumoperitoneum or intestinal obstruction. Abdominal ultrasound revealed multiple hepatic metastases with the largest measuring approximately 75 mm. Upper digestive endoscopy was performed identifying a deep duodenal ulceration suggestive of possible extrinsic invasion, but with a histopathological result of benign ulceration, without tumoral elements. A computed tomography was then performed with exclusion of a pancreatic neoplasia. We decided to perform a colonoscopy that revealed a pseudodepressed flat type LST which was about 2 cm in diameter, located at about 30 cm from the anal verge with slight central depression (0-IIa+IIc). Histopathology report showed a moderately differentiated adenocarcinoma. Discussion. The initial suspicion of diagnosis was neoplasm of pancreas with liver metastases, with a malignant duodenal invasion, diagnosis that was infirmed by the anatomopathological result that obiectivated the benign etiology of the ulcer. The final diagnosis was colonic adenocarcinoma with hepatic metastases. The patient was addressed to Regional Institute of Oncology for oncological treatment. Conclusion. This case offers a broad and multidirectional diagnostic perspective in a patient without significant symptoms and with multiple comorbidities. [ABSTRACT FROM AUTHOR]

Introduction. Multichannel intraluminal esophageal impedance combined to pH-metry (pH-MII) is a sensitive tool for evaluating gastroesophageal reflux disease (GERD). The impedance-pH monitoring diagnostic test determines the frequency of reflux episodes (both acid or nonacid and liquid, gas or mixed) and the time relationship of reflux episodes and symptoms. Extradigestive manifestations and refractory GERD are two of the main recommendations for the assessment of upper digestive tract by pH-MII. Material and method. We conducted a prospective study between January 2022 - March 2023 at our tertiary referral center in North-Eastern Romania that included 26 patients suspected of GERD. All patients were investigated through pHMII. We used a ZepHr® system from Sandhill Scientific and single-use catheters with one pH electrode and 6 impedance electrodes. Patients who underwent MII-pH testing for refractory GERD were tested on proton pump inhibitor (PPI), while patients with no previous evidence of GERD were assessed off PPI. The diagnosis of GERD and phenotypes were based on Lyon metrics. Results. Out of the 26 patients, 14 (53.8%) were male and 12 (46.2%) female, with a mean age of 48.6±13.5 years. Nineteen patients (73.07%) presented with extradigestive GERD symptoms, of whom 7 patients (36.8%) with chronic cough, 7 patients (36.8%) with chronic laryngitis, 4 patients (21.05%) with non-cardiac chest pain and 1 patient (5.26%) with bronchial asthma. The rest of 7 (26.92%) patients were investigated for refractory GERD. After the final analysis of pH-MII tracks, we found GERD in 10 (38.5%) patients, functional heartburn in 6 (23.1%) patients and hypersensitive esophagus in 3 (15.4%) patients. All the 10 patients diagnosed with GERD had acid reflux, with a mean DeMeester Score of 46.7±83.8 and a mean AET of 12.8±20.9%. The mean total number of GERD episodes was 100.3±7.5 and the mean longest reflux episode was of 53.7±85.7 minutes. Conclusion. Multichannel intraluminal esophageal impedance combined to pH-metry represents an important instrument for assessing extradigestive GERD and refractory GERD. [ABSTRACT FROM AUTHOR]

Introduction. High-resolution manometry (HRM) is one of the most notable recent advances in the field of esophageal function. In the absence of organic lesions, HRM provides measurements of esophageal function, identifies the pathology and guides the treatment. The aim of this study was to assess the HRM particularities of diagnosis, clinical features and therapeutic management in patients evaluated for esophageal motor dysfunction. Material and Methods. Our study included all patients suspected of esophageal motility disorders, admitted in our tertiary referral center in North-Eastern Romania between July 2022 and March 2023. Demographic, clinical and laboratory characteristics were carefully collected from the patients' medical charts. All patients were investigated by upper digestive endoscopy and barium esophagogram prior to HRM. Patients diagnosed with eosinophilic esophagitis were excluded from the study. An ISOLAB HR® system from Standard Instruments, with a 36-pressure channels solid-state catheter was used. The HRM diagnosis of esophageal motor diseases was established based on Chicago 4 protocol and classification. Results. Out of the 38 patients included in the study, 15 (39.5%) were female and 23 (60.5%) male, with a mean age of 61.2±11.9. Regarding clinical features, the majority of patients presented with dysphagia (80.4%). Seven (18.4%) patients associated significant weight loss and 6 (15.8%) reported non-cardiac chest pain. Esophageal motility disorders were found in 29 patients (76.3%), 9 patients (23.6%) having a normal HRM aspect. Achalasia was identified in 15 patients (39.5%), with type I in 3 patients (7.9%), type II in 7 patients (18.4%) and type III in 5 patients (13.2%). Distal esophageal spasm was found in 4 patients (10.5%), hypercontractile esophagus in 2 patients (5.3%), esophagogastric junction outflow obstruction (EGJOO) in 2 patients (5.3%), ineffective esophageal motility in 1 patient (2.6%), absent contractility in 4 patients (10.5%) and dyshagia lusoria was identified in only one patient (2.6%). Regarding therapeutic management, endoscopic dilation was performed in 10 patients (26.3%) and 3 patients (7.8%) were referred to surgery. Conclusion. Esophageal HRM remains an important tool for assessing esophageal motor dysfunction. The esophageal motility disorders still represent a diagnostic and therapeutic challenge in clinical practice. [ABSTRACT FROM AUTHOR]