Search

Patient: Male, 21-day-old Final Diagnosis: Button battery induced tracheoesophageal fistula and recurrence Symptoms: Vomiting Clinical Procedure: Endoscopy Specialty: Gastroenterology and Hepatology • Pediatrics and Neonatology Objective: Unusual clinical course Background: Although the ingestion of button batteries (BBs) in neonates is exceedingly rare, it poses severe clinical challenges with potentially catastrophic outcomes. The increase in such cases, particularly among toddlers, is largely due to the widespread availability of portable electronic devices. Ingestion of button or disk batteries is notably more dangerous than other foreign bodies, often leading to acute complications such as burns and esophageal perforation. This report details the diagnosis and management of a 21-day-old neonate who presented with a button battery lodged in the esophagus. Case Report: We report the case of a 21-day-old neonate who initially presented with 3 days of persistent vomiting. Diagnostic imaging with a chest radiograph revealed a radiopaque foreign body in the esophagus, identified as a button battery. It was suspected that the battery was inadvertently placed in the neonate's mouth by a sibling with an intellectual disability. Initial attempts to remove the battery using 4-, 5-, and 6-mm endoscopes were unsuccessful. However, extraction was eventually accomplished with a 2.5-mm rigid esophagoscope. Following the removal, the neonate developed significant complications, including a tracheoesophageal fistula and esophageal stenosis. Extensive follow-up care led to a full recovery, demonstrating resilience despite the severe initial challenges. Conclusions: This report emphasizes the critical need for swift identification and removal of ingested button batteries. It details the diagnostic and management strategies employed for a neonate, illustrating the urgency and precision required in such cases. [ABSTRACT FROM AUTHOR]

In this study, we present the case of a 38-year-old woman who was diagnosed with primary cardiac undifferentiated sarcoma after hospital admission. Following postoperative treatment that included radiotherapy and immunotherapy, the patient developed esophagus stenosis. [ABSTRACT FROM AUTHOR]

Background and Aims: Self-expanding metal stents (SEMSs) are effective for symptom palliation in patients with esophageal obstruction. However, their placement can lead to adverse events such as stent migration and restenosis. A novel fully covered SEMS (FCSEMS) with antimigration properties has been developed to address these issues. This study aimed to evaluate the feasibility and safety of this novel stent in treating malignant esophageal obstruction. Methods: This prospective pilot study enrolled patients with malignant esophageal obstruction treated with the novel stent at a tertiary referral center. Primary outcomes included technical and clinical efficacy, whereas secondary outcomes were adverse events. Treatment outcomes were compared between the novel stent and historical control groups. Results: 137 patients were analyzed, comprising 32 in the novel stent group and 105 in the historical control group. In the novel stent group, technical success was achieved in 100% of patients and clinical success in 96.9%. No stent placement-related events, including bleeding or perforation, were observed. Though no significant differences in adverse events were found, the novel stent group had a lower migration rate than the historical control group (9.4% vs. 14.3%, p = 0.565). Median stent patency was similar between the groups (70.5 vs. 43.0 days, p = 0.185). Conclusions: The novel multisegmented FCSEMS demonstrated high technical and clinical efficacy with a low migration rate, presenting a promising treatment option for malignant esophageal obstruction. Further studies with larger samples are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Refractory esophageal stricture is the common complication of extensive endoscopic submucosal dissection (ESD), without satisfactory endoscopic treatment strategies. We evaluated the efficacy, safety, and long-term patency of the modified endoscopic radial incision and selective cutting combined with short-term stenting (RISC-STS) for the treatment of refractory esophageal stenosis. Methods: This was a retrospective study. Patients diagnosed with refractory esophageal stricture from June 2016 to June 2023 were enrolled. Efficacy, safety, and risk factors for dysphagia after RISC-STS operation were assessed. Results: Compared with clinical symptoms before RISC-STS, there was no significant improvement in the times of stricture recurred (p = 0.75). However, the narrowest diameter of esophageal stenosis was significantly larger after RISC-STS treatment (p = 0.04). Corresponding dysphagia scores after RISC-STS were obviously lowered according to the Mellow–Pinkas grading scale (p = 0.002). More cases ((14 (60.87%) vs 5 (21.74%)) received valid symptom-relief periods after RISC-STS (p = 0.0004). The complications of RISC-STS include perforation (4.35%), fever (4.35%), and pain (30.43%). Univariate Cox analysis suggested that resection length >7 cm of scar tissue was a risk factor for refractory dysphagia after RISC-STS. Conclusion: The present study revealed that RISC-STS is an effective and safe technique for refractory esophageal stricture with lower restenosis, higher valid symptom-relief rate, and fewer complications. [ABSTRACT FROM AUTHOR]

ABSTRACT: Introduction: Anastomotic narrowing post-Type 3 esophageal atresia (EA) primary repair has been linked to life-threatening respiratory complications and failure to thrive during infancy. It becomes important to find some method to ensure anastomotic adequacy in these patients. We in the study here aimed to find the role of follow-up esophagogram and esophagoscopy in detecting anastomotic stricture (AS) in the early stage and to find whether these help in reducing the morbidity in these patients. Materials and Methods: Neonates with EA Type 3, who were successfully managed with primary anastomosis were prospectively enrolled and followed up in the study. Irrespective of symptoms, contrast esophagography and esophagoscopy were performed at the age of 2–4 months. Those with AS on endoscopy were followed for the need of dilatations required, respiratory complications, and failure to thrive if any. Results: Out of 64 patients, 32 patients could be followed up till the completion of the study. An esophagogram conducted at 2 months of age revealed significant dye retention in 10 patients, esophageal narrowing in two patients, and normal results in the remaining 18 patients. Endoscopy confirmed AS in 11 out of 32 (34.4%). Preendoscopy, 44% of patients exhibited respiratory morbidity. After endoscopic dilation, none of the patients developed pneumonia requiring admission. Failure to thrive was noted in 9% of the cases. Conclusion: The use of esophagograms and endoscopies during the healing phase of anastomosis not only aids in the detection of ASs during its formation but also eases the process of their management. [ABSTRACT FROM AUTHOR]

Copyright of Acta Materiae Compositae Sinica is the property of Acta Materiea Compositae Sinica Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT Phosphoribosylaminoimidazole carboxylase (PAICS) deficiency, caused by biallelic variants in PAICS gene, is an inborn error of de novo purine synthesis. Only two patients from a consanguineous family have been reported, with multiple congenital malformations, resulting in early neonatal death. Molecular analysis identified a homozygous p.(Lys53Arg) missense variant. We report the third case of PAICS deficiency in a 7 years old boy, presenting with polymalformative syndrome, but normal neurodevelopment. We report malformations not previously described in PAICS deficiency, notably congenital cardiopathy, and support the consistency of skeletal and oesophageal defects. Genome Sequencing identified the homozygous pathogenic variant p.(Lys53Arg), suggesting a recurrent variant in PAICS. A probable recurrence of PAICS deficiency occurred in a sibling, with a similar polymalformative syndrome antenatally diagnosed, but could not be confirmed molecularly. We further delineate the phenotype of PAICS deficiency and provide new insights concerning prognosis, notably in terms of neurodevelopment. [ABSTRACT FROM AUTHOR]

Esophageal stricture is the most common and disabling complication of esophageal injury caused by ingestion of corrosive substances. In our case, the patient developed esophageal stenosis due to ingestion of strong alkaline substances and underwent colon replacement surgery after repeated failed dilation treatments. After surgery, anastomotic stenosis and tracheocolonic fistula occurred successively, and the entire diagnosis and treatment cycle of this disease lasted for more than 20 years. Based on experience and the actual situation of the patient, we conclude that esophageal stents should be the primary treatment option, while tracheal stents should be carefully selected, and secondary surgery is not recommended. [ABSTRACT FROM AUTHOR]

Ethylicin is a pesticide with excellent bactericidal ability. The incidence of poisoning has increased in recent years with the widespread use of ethylicin in green agriculture, but reports are lacking. In this study, we described three cases of oral ethylicin poisoning. Patients developed severe upper gastrointestinal bleeding after oral administration of ethylicin. Gastroscopy showed extensive mucosal erosions and ulcerations in the esophagus, stomach, and duodenum. Impaired consciousness, multiorgan injury, irreversible shock, and cardiac arrest were observed in cases where larger doses of ethylicin were ingested. Patients were treated with comprehensive therapeutic measures, including total gastrointestinal decontamination, medications such as proton pump inhibitors and somatostatin to reduce gastric bleeding. Endoscopic hemostasis was performed when pharmacologic hemostasis was not effective. Parenteral nutritional support and organ function support were given. In patients' follow up, esophageal stenosis and dysphagia during feeding was noted, which severely affected the quality of life. Ethylicin poisoning has been a public health problem and the awareness should be raised. [ABSTRACT FROM AUTHOR]

Abstract Magnetic compression anastomosis (MCA) for esophageal stenosis requires the insertion of magnets through two channels, transoral and transgastrostomy. Herein, we designed a Y-Z deformable self-assembled magnetic anastomosis ring (Y-Z DSAMAR) for esophageal stricture anastomosis through the transoral passage only. We introduce a Y-Z DSAMAR and verify its feasibility for single-access esophageal stenosis anastomosis in isolated organs. We procured esophagi from 10 pigs. Next, we ligated the middle part of these esophagi with 7 − 0 silk to prepare an esophageal stenosis model. The linear Y-Z DSAMAR completed the deformation self-assembly and transitioned from its initial linear shape to a circular one while passing through the esophageal stenosis. The operation time, the success rate of the deformation self-assembly of Y-Z DSAMARs, and the successful MCA for esophageal stenosis were recorded. We successfully obtained a trapezoidal magnetic unit. Ten such magnetic units can self-assemble into a ring after the hard guide wire is withdrawn. The success rates for both self-assembly deformation and esophageal stenosis anastomosis were 93.33%, while that for esophageal stenosis anastomosis with successful deformation was 100%. Y-Z DSAMARs exhibit remarkable deformation-controllable characteristics. Further optimization of the operational procedure and verification through animal experiments are needed before they can be clinically applied.

Diamond-Blackfan anemia syndrome (DBAS) is a rare inherited bone marrow failure (BMF) syndrome characterized by erythroid aplasia, congenital malformations, and cancer predisposition. With its genetic heterogeneity, variable penetrance and expressivity, DBAS poses significant diagnostic challenges, necessitating advancements in genetic testing for improved accuracy. Here, we present the case of an 18-year-old male with a long-standing macrocytic anemia that remained undiagnosed despite standard whole exome sequencing (WES). Revisiting a family-trio WES analysis with clinical insight led to the identification of a likely pathogenic variant in the Ribosomal Protein S17 (RPS17) gene, previously masked due to analytical challenges and conservative filter settings. This variant, an initiation codon mutation, was confirmed in heterozygosity in both the proband and his mother through Sanger sequencing. Comprehensive imaging studies showed no malformations or organ anomalies in either individual, except for mild esophageal stenosis observed in both. RPS17 mutations, particularly those affecting the initiation codon, have previously been linked to the DBAS phenotype, but strong pathogenic association has not yet been firmly established. Our case warns of potential underdiagnosis of RPS17 variants in DBAS, highlighting the importance of clinical context and interdisciplinary collaboration in interpreting WES data to avoid false-negative results. [ABSTRACT FROM AUTHOR]

Introduction. Endoscopic esophageal dilation is an effective therapeutic option for the treatment of esophagus strictures and motor disorders. To perform it, it is essential to know the etiology and anatomy of the injury and to have clinical experience. These factors determine the indication and development of the procedure. The objective of this study was to report the experience in the management of patients with esophageal stricture at a reference center institution for digestive diseases in Bogotá, D.C., Colombia. Methods. A descriptive, retrospective cohort study was carried out, in which patients undergoing esophageal dilation by the Gastroenterology Service were evaluated, from January 2021 to June 2023. All patients over 18 years of age with esophageal stenosis of any etiology and achalasia were included. Results. 27 patients were identified, 92.6% men. The most prevalent etiology was post-surgical stenosis (40.7%), followed by achalasia (29.6%), gastroesophageal reflux disease (18.5%), and inflammatory diseases (11.1%). The 'rule of three' was safely used in postsurgical and peptic strictures. The majority of the dilations (81.5%) were successful and a single complication of esophageal perforation occurred. Conclusion. Endoscopic dilation is a safe procedure for the treatment of esophageal stenosis and achalasia. Correct procedure indication, type of stenosis, appropriate choice of dilator and professional expertise are crucial aspects for the effectiveness of this technique and for the detection and management of potential complications. [ABSTRACT FROM AUTHOR]

Introduction: Gastroesophageal reflux disease (GERD) is a frequent digestive disorder that presents with a broad spectrum of symptoms. Global consensus on which patients should be selected for anti-reflux surgery is lacking. Areas covered: This evidence-based review will analyze current indications for anti-reflux surgery, outcomes of the operation, and potential side effects. Expert commentary: Treatment of GERD has three main purposes: control symptoms, improve quality of life, and prevent potential serious complications such as bleeding, esophageal stenosis, Barrett's esophagus, and esophageal adenocarcinoma. Although medical therapy is effective in the majority of patients, some might require anti-reflux surgery in order to achieve these goals. Adequate patient selection for anti-reflux surgery is critical to obtain optimal outcomes. Most patients undergoing a fundoplication have adequate long-term symptomatic relief. However, potential side effects of anti-reflux surgery should also be discussed with patients to help manage expectations from the operation. [ABSTRACT FROM AUTHOR]

Background: Proximal gastrectomy (PG) is recommended for upper-third gastric cancer and esophagogastric junction (EGJ) cancer, preserving organ function while reducing postoperative symptoms. The double-flap technique (DFT) is one approach to minimize reflux after PG. However, laparoscopic PG with DFT (LPG-DFT) has drawbacks of increased complexity, such as hand sutures for anastomosis. Robotic surgery offers potential advantages for DFT reconstruction, but the safety of robotic DFT following PG (RPG-DFT) in the introductory phase is unknown. Methods: This retrospective study compared the outcomes of RPG-DFT with LPG-DFT. Data from 402 patients (321 LPG-DFT, 81 RPG-DFT) between 2009 and 2023 were analyzed. Propensity score matching balanced patient demographics and tumor characteristics. Surgical parameters, complications, and long-term outcomes were assessed. Results: The surgery time of LPG-DFT has stabilized in patients since 2016. Thus, LPG-DFT from 2016 was defined as a stable procedure. RPG-DFT was started in 2019, after minimally invasive DFT reconstruction had been mastered at our center. Therefore, we compared the surgical outcomes of introductory RPG-DFT with stable LPG-DFT. Matched analysis revealed that RPG-DFT in the introductory phase had significantly longer surgery times but less bleeding and shorter reconstruction times and hospital stays than stable LPG-DFT. Frequencies of short-term complications and reflux esophagitis were comparable in both groups. Although RPG-DFT in the introductory phase exhibited higher incidence of anastomotic stenosis than stable LPG-DFT, the incidence of anastomotic stenosis decreased over time. Conclusions: This study demonstrated the safety of RPG-DFT in the introductory phase for EGJ and upper-third stomach tumors, with outcomes comparable to stable LPG-DFT. RPG-DFT offers shorter reconstruction time and less blood loss compared with LPG-DFT. However, anastomotic stenosis is a complication to monitor in early robotic surgery. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Lymphangitic carcinomatosis is a metastatic disease with a poor prognosis and poorly understood pathophysiology. We present a case of rapidly worsening lung adenocarcinoma with diffusely spreading cancerous lymphangitis in lung, mediastinum, retroperitoneum, and gastrointestinal tract. Our findings suggest cancer dissemination in this patient was predominantly caused by direct lymphatic invasion. [ABSTRACT FROM AUTHOR]

Behçet's disease (BD) is a multiorgan inflammatory vascular disease of unknown etiology, affecting vessels of any size and type. While, gastrointestinal involvement in BD is uncommon, esophageal Behçet's disease (EBD) is rarely reported, especially in the Mediterranean region. To report a case with esophageal stenosis as an initial presentation of BD and compare to reported cases worldwide. A 30-year-old Syrian male presented with dysphagia, odynophagia with weight loss 20 kg. He had a history of recurrent oral ulcers and was otherwise healthy. On examination he appeared pale, dehydrated with normal systemic examination. Blood tests revealed anemia (hemoglobin 10.5 mg/dl), elevated erythrocyte sedimentation rate (ESR) (90 mm/1sthr) and C-reactive protein (CRP)(98 mg/dl)levels. Upper gastrointestinal endoscopy showed mild ulceration with edema and mucosal thickness at the upper sphincter of the esophagus, leading to stenosis. Biopsy showed nonspecific inflammation, without granulomas or signs of malignancy. Percutaneous endoscopic gastrostomy (PEG) tube was placed and during hospitalization he developed genital ulcers and hemoptysis, with chest computed tomography revealing pulmonary vasculitis. The patient was diagnosed with BD, and treated with methylprednisolone and cyclophosphamide, leading to significant improvement. After two months he could swallow normally, and the PEG tube was removed with no recurrence after one year follow-up. He was maintained on azathioprine 100 g/day and prednisolone 7.5 mg/day. BD is a diagnostic challenge due to its diverse manifestations and geographic variations. EBD is rare and can cause disability. Early diagnosis of EBD and appropriate treatment are crucial for improving outcomes. [ABSTRACT FROM AUTHOR]

Aim Most cases of oesophageal strictures can be treated effectively with elective outpatient endoscopic dilation in a specialized centre. With this case series review, we aim to evaluate our patient cohort from June 2020 to January 2022. Methods: We retrospectively analyzed 185 consecutive patients submitted to oesophageal and pyloric dilation procedures in day surgery settings from June 2020 to January 2022. Results: In our retrospective case series, we analyzed 185 patients submitted to oesophageal dilation (89%) or pyloric dilation (11%). Analysis of the type of anaesthesia correlated to the primary diagnosis showed that 52% of achalasia patients had deep sedation via native airway, and caustic stricture was corrected in almost all cases during general anaesthesia (89%). It is worth noting that in our study, only 1.6% of patients experienced complications that prevented same-day discharge, such as fever or arrhythmia. Severe complications, including significant bleeding or perforation, were entirely absent. Conclusions: We can conclude that oesophageal dilations were performed with safety and efficiency in our centre, with very few unplanned recoveries and a negligible rate of complications. The standardization of outpatient care pathways has further bolstered our efficiency, ensuring the best possible outcomes for our patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Cryoablation therapy is an emerging modality in the treatment of Barrett's esophagus. Our systematic review collected data on this technique to provide evidence of its efficacy and safety and to compare it with the established RFA. The results from twenty-three studies revealed that the complete eradication of dysplasia and intestinal metaplasia was comparable between RFA and cryoablation. More specifically, cryoablation achieved a complete eradication of dysplasia and intestinal metaplasia at rates of 84.2% (95%CI: 79.1–89.3) and 64.1% (95%CI: 49.2–79.0), respectively, whereas 8.3% (95%CI: 4.7–11.9) of cases presented with recurrence. Studies on cryoballoons seem to be more homogenous in terms of dysplasia treatment, complications, and, especially, strictures. Background: The mainstay approach in endoscopic eradication therapy (EET) for dysplastic Barrett's esophagus (BE) includes the endoscopic resection of visible lesions, accompanied by ablation of the residual metaplastic epithelium. Cryoablation therapy is one such emerging ablation technique in this field. This systematic review with a meta-analysis aims to accumulate pooled data on cryoablation performance in the treatment of patients with BE and to compare this technique to the standard of care radiofrequency ablation (RFA). Methods: The MEDLINE, Cochrane, and Scopus databases were searched until June 2024 for studies evaluating BE management using cryoablation for cumulative results. The primary outcome was the complete eradication of dysplasia (CED) and intestinal metaplasia (CEIM) in BE compared to RFA, while secondary outcomes included the respective pooled rates using cryoablation, recurrence, and adverse events, with a separate analysis for strictures. The meta-analyses were based on a random-effects model, and the results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analyses by type of cryoablation were also performed. Results: Twenty-three studies (1604 patients) were finally included, four of which were comparative. CED and CEIM did not differ significantly between cryoablation and RFA [OR= 0.95 (95%CI: 0.50–1.81) and OR = 0.57 (95%CI: 0.20–1.63), respectively)]. The pooled rates of CED, CEIM, and recurrence after cryoablation were 84.2% (95%CI: 79.1–89.3), 64.1% (95%CI: 49.2–79.0), and 8.3% (95%CI: 4.7–11.9), accompanied by high rates of heterogeneity. Adverse events were noted in 14.5% (95%CI: 9.9–19.2) of cases, and 6.5% (95%CI: 4.1–9.0) developed strictures. In the subgroup analysis, the cryoballoon achieved a reduction in heterogeneity in CED, adverse events, and stricture formation, whereas spray catheters provided homogenous results in terms of recurrence. Conclusions: Cryoablation provides equal outcomes compared to RFA in the treatment of patients with BE, with the cryoballoon achieving relatively homogenous rates of CED and adverse events. [ABSTRACT FROM AUTHOR]

BackgroundEsophageal stricture is one of the major complications after endoscopic submucosal dissection (ESD) of the esophagus. However, even with steroid prophylaxis, stenosis still occurs in up to 45% of patients. Accordingly, the aim of this study was to evaluate the efficacy and safety of steroid therapy in preventing esophageal strictures after ESD, as well as to assess the predictors of esophageal strictures after the application of steroids.MethodsBetween February 2018 and March 2023, 207 patients who underwent esophageal ESD at Southeast University Affiliated Zhongda Hospital were retrospectively enrolled. We evaluated stenosis rate, number of endoscopic dilations after ESD, the interval between the first endoscopic dilatation after ESD and explored risk factors for strictures after steroid prophylaxis.ResultsIn the control group, the oral steroids group, and the combined group, the stenosis rates were 83/87 (95.4%), 44/53 (83.0%), and 56/67 (83.6%), respectively; the number of endoscopic dilations were 3.43 (±2.22), 2.34 (±2.17), and 1.52 (±1.25), respectively; the time intervals between first endoscopic dilation and ESD procedure were 38.36 (±6.87), 68.18 (±9.49), and 96.82 (±8.41) days, respectively; all these indicators were significantly better in the oral and combined groups than in the control group (p

Esophageal stricture is the most common and disabling complication of esophageal injury caused by ingestion of corrosive substances. In our case, the patient developed esophageal stenosis due to ingestion of strong alkaline substances and underwent colon replacement surgery after repeated failed dilation treatments. After surgery, anastomotic stenosis and tracheocolonic fistula occurred successively, and the entire diagnosis and treatment cycle of this disease lasted for more than 20 years. Based on experience and the actual situation of the patient, we conclude that esophageal stents should be the primary treatment option, while tracheal stents should be carefully selected, and secondary surgery is not recommended.

Ethylicin is a pesticide with excellent bactericidal ability. The incidence of poisoning has increased in recent years with the widespread use of ethylicin in green agriculture, but reports are lacking. In this study, we described three cases of oral ethylicin poisoning. Patients developed severe upper gastrointestinal bleeding after oral administration of ethylicin. Gastroscopy showed extensive mucosal erosions and ulcerations in the esophagus, stomach, and duodenum. Impaired consciousness, multiorgan injury, irreversible shock, and cardiac arrest were observed in cases where larger doses of ethylicin were ingested. Patients were treated with comprehensive therapeutic measures, including total gastrointestinal decontamination, medications such as proton pump inhibitors and somatostatin to reduce gastric bleeding. Endoscopic hemostasis was performed when pharmacologic hemostasis was not effective. Parenteral nutritional support and organ function support were given. In patients’ follow up, esophageal stenosis and dysphagia during feeding was noted, which severely affected the quality of life. Ethylicin poisoning has been a public health problem and the awareness should be raised.

Abstract Background Ganglioneuromatosis is a rare type of benign neurogenic tumor that usually affects the sites of the major sympathetic ganglia in the retroperitoneum and the posterior mediastinum. Affection of the gastrointestinal tract is rare, and involvement of the esophagus is exceptional. To the best of our knowledge, only 4 cases of esophageal ganglioneuromatosis in adults were reported in the literature. No cases have been reported in the pediatric age group. Case presentation An 11-year-old boy presented with dysphagia due to severe esophageal stenosis caused by esophageal ganglioneuromatosis. Conclusions Despite its rarity, the present case implies that ganglioneuromatosis should be considered in children with idiopathic esophageal stenosis.

Introduction: Accidental caustic burns of the esophagus in children represent a significant global health challenge, often necessitating esophageal reconstruction. The aim of this study is to compare the efficacy and morbidity related to esophagus replacement with colonic and gastric tube transplants in a pediatric population followed for caustic stenosis. Methods: This retrospective study was conducted at a tertiary pediatric surgery unit for children treated from January 1989 to December 2022. We compared colonic and gastric tube esophageal replacement. Short term (within 30 days) and mid-term outcomes and complications were reviewed. Statistical evaluation was considered using a Chi-square test for categorical data analysis. Results: A total of 124 children with caustic esophageal burns were included. Among them, 23 (18.5%) had a gastric tube transplant for esophagus replacement and 101 (81.5%) a colonic transplant. During surgical intervention, we found a significantly higher risk of complications when using a colonic transplant (34%, p < 0.001). There was no significant statistical difference in postoperative short term and mid-term complications between the two techniques. Twenty-six (26%) of the children required a reoperation, with a higher risk in the gastric tube transplant group (p < 0.001). Endoscopic dilatation after surgery was also performed on a higher number of children who had received a gastric tube transplant (p = 0.005). Overall, 97.6% recovered full normal oral feeding. Conclusions: We found that colonic and gastric tube replacement are both good options for pediatric esophageal replacement after a caustic injury and show effectiveness over time. Gastric tube transplants carried a slightly higher risk of reoperations and a higher number of dilatations post-surgery. However, our groups are not really comparable, due to the much higher number of colonic transplants. Both surgical options have to be considered during surgery, and the choice depends on the anatomy of the patient. Our future research will focus on assessing long term quality of life and the potential risk of neoplastic complications. [ABSTRACT FROM AUTHOR]

Eosinophilic esophagitis (EoE) is an increasingly prevalent immune‐mediated disease that leads to chronic changes in the oesophagus. These changes can include strictures, narrowing, and stenosis, mediated by an interleukin (IL)‐13 pathway, which leads to remodelling and fibrosis through increasing migration of fibroblasts and subepithelial fibrosis via collagen deposition 1. IL‐13 downregulates TSPAN12, a gene whose expression regulates fibrosis and causes changes in barrier function and higher rates of fibrostenosis in EoE. Dupilumab, a biologic therapy aimed at blocking IL‐13, has been shown to improve EoE‐related inflammation and fibrosis in clinical trials. We report here four unique patients with documented oesophageal stenosis with inability to pass a paediatric endoscope due to structuring disease, requiring dilation, who had resolution of their oesophageal narrowing following dupilumab therapy. [ABSTRACT FROM AUTHOR]

Background: Endoscopic submucosal dissection (ESD) is a potentially efficient therapeutic intervention for superficial esophageal cancer. Additional treatment such as chemoradiotherapy (CRT) or esophagectomy is recommended in cases of muscularis mucosa invasion with positive resection margins or lymphovascular invasion or submucosal layer invasion, which are considered noncurative ESD, due to an increased risk of lymph node metastasis. However, the adequacy of additional CRT after near-circumferential or full-circumferential noncurative ESD has not been fully discussed. In this study, we retrospectively evaluated the efficacy and toxicity of additional CRT for superficial esophageal squamous cell carcinoma (SCC) after near-circumferential or full-circumferential noncurative ESD, which was defined as a mucosal defect measuring ≥ 3/4 of the esophageal circumference. Methods: We retrospectively evaluated 24 patients who received additional CRT for superficial esophageal SCC after near-circumferential or full-circumferential noncurative ESD between 2012 and 2018. Elective nodal irradiation (ENI) was performed in all patients and boost irradiation (BI) was performed after ENI in 4 patients with positive resection margins. The prescription doses of ENI and BI were 41.4 Gy in 23 fractions and 9 Gy in 5 fractions, respectively. Concurrent chemotherapy (a combination of cisplatin or nedaplatin and 5-fluorouracil) was administered to all patients. Results: The 3-year and 5-year overall survival rates were 92% and 78%, respectively, while the 3-year and 5-year progression-free survival rates were 83% and 70%, respectively. Grade 2 esophageal stenosis occurred in 8 (33%) patients. There was no case of Grade 3 or worse esophageal stenosis. Among them, 4 (17%) patients developed stenosis before additional CRT, which persisted after the completion of additional CRT. The remaining 4 (17%) patients developed de novo stenosis within 5 months following the completion of additional CRT. One patient (4%) still requires regular bougie dilation. Grade 3 and Grade 4 acute toxicity, including anemia, neutropenia, thrombocytopenia, and esophagitis occurred in 1 (4%) and 0 (0%), 6 (25%) and 1 (4%), 1 (4%) and 0 (0%), and 1 (4%) and 0 (0%) patients, respectively. One (4%) patient who underwent salvage CRT for the out-of-field lymph node recurrence died with acute myeloid leukemia. Conclusions: Additional CRT is a viable treatment option even in patients who have undergone near-circumferential or full-circumferential noncurative ESD. Esophageal stenosis after additional CRT following near-circumferential or full-circumferential noncurative ESD is manageable and acceptable. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Ganglioneuromatosis is a rare type of benign neurogenic tumor that usually affects the sites of the major sympathetic ganglia in the retroperitoneum and the posterior mediastinum. Affection of the gastrointestinal tract is rare, and involvement of the esophagus is exceptional. To the best of our knowledge, only 4 cases of esophageal ganglioneuromatosis in adults were reported in the literature. No cases have been reported in the pediatric age group. Case presentation: An 11-year-old boy presented with dysphagia due to severe esophageal stenosis caused by esophageal ganglioneuromatosis. Conclusions: Despite its rarity, the present case implies that ganglioneuromatosis should be considered in children with idiopathic esophageal stenosis. [ABSTRACT FROM AUTHOR]

Oesophageal fluoroscopy is a radiological procedure that uses dynamic recording of the swallowing process to evaluate morphology and function simultaneously, a characteristic not found in other clinical tests. It enables a comprehensive evaluation of the entire upper gastrointestinal tract, from the oropharynx to oesophagogastric bolus transport. The number of fluoroscopies of the oesophagus and the oropharynx has increased in recent decades, while the overall use of gastrointestinal fluoroscopic examinations has declined. Radiologists performing fluoroscopies need a good understanding of the appropriate clinical questions and the methodological advantages and limitations to adjust the examination to the patient's symptoms and clinical situation. This review provides an overview of the indications for oesophageal fluoroscopy and the various pathologies it can identify, ranging from motility disorders to structural abnormalities and assessment in the pre- and postoperative care. The strengths and weaknesses of this modality and its future role within different clinical scenarios in the adult population are discussed. We conclude that oesophageal fluoroscopy remains a valuable tool in diagnostic radiology for the evaluation of oesophageal disorders. [ABSTRACT FROM AUTHOR]

Introduction: Malignant esophageal obstructions can lead to malnutrition, mortality, and difficulties in managing the underlying malignancy. Endoscopic stent placement is a palliative treatment method that can provide rapid improvement in dysphagia. The aim of this study is to investigate the short-term effectiveness and safety of endoscopic stent placement in patients with malignant esophageal obstructions. Methods: Patients who underwent endoscopic stent placement due to malignant esophageal strictures between January 2012 and January 2018 were retrospectively reviewed. Demographics, dysphagia scores, complications, and mortality data of the patients with stent placement were evaluated. Results: The mean age of the 46 patients was 67.1±13.3 years, and 19 (41.3%) were female. Endoscopic stents were placed mostly for esophageal cancer in 26 (56.5%) patients. The most common pathological diagnosis was esophageal squamous cell carcinoma (58.6%). A fully covered self-expanding metallic stent was placed in 19 (41.3%) and a partially covered one in 27 (58.7%) patients. The technical success rate was 100%. Forty (86.9%) patients began to eat soft foods 24 hours after stent placement. The most common complication was retrosternal pain (56.5%). Complications requiring endoscopic intervention occurred in 5 (10.8%) patients. Mortality occurred in 40 (87%) patients, and 11 (27.5%) survived for more than 3 months (Min-max: 125-512 days). Discussion and Conclusion: Although the endoscopic placement of a self-expanding metallic stent in patients with malignant dysphagia may have the potential to cause complications, it is a reliable palliative treatment method that can be preferred due to its high technical success rate and rapid relief of dysphagia. [ABSTRACT FROM AUTHOR]

Objective: To analyze the clinical characteristics of esophageal button battery impactions in children and explore safe and effective treatment methods. Methods: This retrospective cohort study was conducted at a single tertiary care center, Shenzhen Children's Hospital, encompassing 89 children diagnosed with esophageal button battery impactions between January 2013 and January 2023. To minimize esophageal mucosal corrosion, prompt removal of the button battery with a first-aid fast track rigid esophagoscopy under general anesthesia was performed within thirty minutes of diagnosis. The clinical features and complications were recorded and analyzed. Results: Button battery as esophageal foreign body was prevalent among children under 3 years old (79.8%), with boys exhibiting a higher incidence rate (56.2%) compared to girls (43.8%), and an average age of 25.8 months. The median duration from ingestion to hospital admission was 3 h (range: 0.5 h to 3 months). Common symptoms included vomiting and dysphagia, with early stage vomiting of brown foamy secretions being a characteristic presentation of esophageal button battery impactions. The majority (77.5%) of batteries were lodged in the upper esophagus. The larger batteries were verified to be more prone to complications. All 89 cases exhibited varying degrees of esophageal mucosal erosion, with 31 cases (34.8%) experiencing severe complications, including esophageal stenosis in 11 cases (35.5%), esophageal perforation in 9 cases (29%) with 4 cases of tracheoesophageal fistula, vocal cord paralysis in 6 cases (19.4%), hemorrhage in 2 cases (6.5%), mediastinitis in 2 cases (6.5%), and periesophageal abscess in 1 case (3.2%). Despite the severity of these complications, none of the patients died after emergency surgery. Conclusion: Esophageal button battery impactions can lead to significant damage to the esophageal mucosa due to its strong corrosiveness. Prompt action is crucial to mitigate the risk of complications. For the first time, we implement a first-aid fast track surgical intervention following diagnosis is imperative to minimize the incidence of adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: Studies have evaluated the efficacy of endoscopic incisional therapy (EIT) for benign anastomotic strictures. We performed a systematic review and meta-analysis to evaluate stricture recurrence after EIT following esophagectomy or gastrectomy. Methods: A systematic search of databases was performed up to April 2nd, 2023, after selection of key search terms with the research team. Inclusion criteria included human participants undergoing EIT for a benign anastomotic stricture after esophagectomy or gastrectomy, age ≥ 18, and n ≥ 5. Our primary outcome was the incidence of stricture recurrence among patients treated with EIT compared to dilation. Our secondary outcome was the stricture-free duration after EIT and rate of adverse events. Meta-analysis was performed with RevMan 5.4.1 using a Mantel–Haenszel random-effects model. Publication bias was evaluated with funnel plots and the Egger test. Results: A total of 2550 unique preliminary studies underwent screening of abstracts and titles. This led to 33 studies which underwent full-text review and five studies met the inclusion criteria. Meta-analysis revealed reduced odds of overall stricture recurrence (OR 0.35, 95% CI 0.13–0.92, p = 0.03; I2 = 71%) and reduced odds of stricture recurrence among naïve strictures (OR 0.32, 95% CI 0.17–0.59, p = 0.0003; I2 = 0%) for patients undergoing EIT compared to dilation. There was no significant difference in the odds of stricture recurrence among recurrent strictures (OR 0.63, 95% CI 0.12–3.28, p = 0.58; I2 = 81%). Meta-analysis revealed a significant increase in the recurrence-free duration (MD 42.76, 95% CI 12.41–73.11, p = 0.006) among patients undergoing EIT compared to dilation. Conclusion: Current data suggest EIT is associated with reduced odds of stricture recurrence among naïve anastomotic strictures. Large, prospective studies are needed to characterize the safety profile of EIT, address publication bias, and to explore multimodal therapies for refractory strictures. [ABSTRACT FROM AUTHOR]

Background: Ingested foreign bodies pose a unique challenge in medical practice, especially when lodged in the oesophagus. While endoscopic retrieval is the standard treatment, certain cases require more innovative approaches. Methods: This paper reports the case of a patient who intentionally ingested a butter knife that lodged in the thoracic oesophagus. After multiple endoscopic attempts, a lateral neck oesophagotomy, aided using a Hopkins rod camera and an improvised trochar as a protective port, was performed. Results: The foreign body was successfully extracted without causing oesophageal perforation. The patient was made nil by mouth, with nasogastric feeding only until a swallow assessment after one week. The patient was discharged and recovered well. Conclusion: This case illustrates a successful, innovative approach to removing a foreign body in a high-risk patient, highlighting the significance of adaptability in surgical practice. It emphasises the need for individualised approaches based on the patient's history, the nature and location of the foreign body, and associated risks. [ABSTRACT FROM AUTHOR]

To assess the feasibility of a deformable self-assembled magnetic anastomosis ring (DSAMAR) in the treatment of esophageal stenosis in beagle dogs via transoral access without temporary gastrostomy. Experimental esophageal stenosis was created in 10 beagle dogs by partial cervical esophageal ligation. The DSAMAR was inserted into the distal esophagus via the narrow section of the esophagus using a gastroscope. A circular DSAMAR was placed in the proximal esophagus. The magnetic rings on both sides of the experimental stenosis automatically attracted each other. We then recorded the operation time, postoperative complications, anastomotic formation time, and magnetic ring discharge time. The dogs were euthanized 4 weeks postoperatively; subsequently, we obtained the esophageal anastomotic specimens and observed the anastomotic formation via the naked eye and by light microscopy. Our esophageal stenosis model produced reproducible stenoses in all dogs, which was confirmed via endoscopy and esophagography. DSAMAR was successfully implanted in all experimental animals under endoscopic and X-ray monitoring, and all linear DSAMARs were successfully transformed into rings. The magnets at both ends of the esophageal stenosis were automatically attracted. All animals survived until euthanasia. No complications, including esophageal perforation, bleeding, and gastrointestinal obstruction, were noted during the perioperative period. The mean operation time of endoscopic magnetic anastomosis was 15.6 ± 2.41 (range, 12–19) min. The mean esophageal anastomotic formation time was 8.8 ± 1.03 (range, 7–10) days, and the mean expulsion time of DSAMAR was 13.94 ± 2.88 (range, 10–19) days. Gastroscopy and esophagography were performed at 4 weeks postoperatively; the esophageal patency was good. Macroscopic observation of the esophageal anastomotic specimens revealed that the esophageal mucosal layer of the anastomosis had good continuity and the anastomosis was smooth. DSAMAR is a feasible option for magnetic recanalization of esophageal stricture via transoral access without temporary gastrostomy. [ABSTRACT FROM AUTHOR]

Background/aimsPatients with Barrett's esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC.MethodsWe conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett's esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM.ResultsOverall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872-0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005-0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007-0.055; I2=0%).ConclusionResults of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.

Background Esophagogastroduodenoscopy (EGD) is vital for the diagnosis and treatment of various gastrointestinal conditions but carries a low risk of venous air embolism (VAE). We report a case of VAE during EGD, confirmed by computed tomographic pulmonary angiography (CTPA). Case A 56-year-old male with a history of hypopharyngeal cancer underwent EGD for dysphagia-related esophageal dilation. Signs of VAE were noted, prompting swift interventions, including oxygen therapy, positional changes, and CTPA. CTPA revealed the Mercedes-Benz sign, pneumomediastinum, and a minimal pneumothorax. The patient’s oxygen saturation improved within 30 min before undergoing CTPA, and he was discharged on postoperative day 4. Conclusions Timely recognition of VAE, resulting in appropriate interventions supported by CTPA, resulted in favorable patient outcomes.