Medicine › Surgery

Esophageal and GI Pathology

Works Count: 82267

Wikipedia

Description

This cluster of papers explores the evolving techniques and advancements in the management of esophageal perforation, endoscopic stenting for benign and malignant diseases, palliative treatment of gastric outlet obstruction using self-expanding metal stents, and the use of endoluminal vacuum therapy. It also covers topics such as esophageal atresia, tracheoesophageal fistula, and the management of anastomotic leaks.

Keywords

Esophageal Perforation; Endoscopic Stenting; Gastric Outlet Obstruction; Self-Expanding Metal Stents; Benign and Malignant Diseases; Anastomotic Leaks; Esophageal Atresia; Tracheoesophageal Fistula; Endoluminal Vacuum Therapy; Palliative Treatment

VACTERL/VATER Association

2011-01-01

Benjamin D. Solomon

VACTERL/VATER association is typically defined by the presence of at least three of the following congenital malformations: vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities. … VACTERL/VATER association is typically defined by the presence of at least three of the following congenital malformations: vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities. In addition to these core component features, patients may also have other congenital anomalies. Although diagnostic criteria vary, the incidence is estimated at approximately 1 in 10,000 to 1 in 40,000 live-born infants. The condition is ascertained clinically by the presence of the above-mentioned malformations; importantly, there should be no clinical or laboratory-based evidence for the presence of one of the many similar conditions, as the differential diagnosis is relatively large. This differential diagnosis includes (but is not limited to) Baller-Gerold syndrome, CHARGE syndrome, Currarino syndrome, deletion 22q11.2 syndrome, Fanconi anemia, Feingold syndrome, Fryns syndrome, MURCS association, oculo-auriculo-vertebral syndrome, Opitz G/BBB syndrome, Pallister-Hall syndrome, Townes-Brocks syndrome, and VACTERL with hydrocephalus. Though there are hints regarding causation, the aetiology has been identified only in a small fraction of patients to date, likely due to factors such as a high degree of clinical and causal heterogeneity, the largely sporadic nature of the disorder, and the presence of many similar conditions. New genetic research methods offer promise that the causes of VACTERL association will be better defined in the relatively near future. Antenatal diagnosis can be challenging, as certain component features can be difficult to ascertain prior to birth. The management of patients with VACTERL/VATER association typically centers around surgical correction of the specific congenital anomalies (typically anal atresia, certain types of cardiac malformations, and/or tracheo-esophageal fistula) in the immediate postnatal period, followed by long-term medical management of sequelae of the congenital malformations. If optimal surgical correction is achievable, the prognosis can be relatively positive, though some patients will continue to be affected by their congenital malformations throughout life. Importantly, patients with VACTERL association do not tend to have neurocognitive impairment.

View PDF Chat

The VATER association

1973-01-01

Linda Quan , David W. Smith

Barrett's esophagus: congenital or acquired? An experimental study of esophageal mucosal regeneration in the dog.

1970-07-01

Cedric G. Bremner , V P Lynch , F. Henry Ellis

Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia.

1989-03-01

Attila Csendes , Italo Braghetto , A Henríquez +1 more

Late results in 81 patients with achalasia treated in a prospective randomised study comparing forceful pneumatic dilatation with the Mosher bag and surgical anterior oesophagomyotomy by abdominal route, are reported. … Late results in 81 patients with achalasia treated in a prospective randomised study comparing forceful pneumatic dilatation with the Mosher bag and surgical anterior oesophagomyotomy by abdominal route, are reported. There were no deaths from either of the treatments. Two patients (5.6%) had a perforation of the abdominal oesophagus after pneumatic dilatation and were excluded from late follow up. In patients having surgery at radiological evaluation there was gullet diameter significantly increased at the oesophagogastric junction and decreased at the middle third of the oesophagus. One patient was lost from follow up and one died of an oesophageal carcinoma, leaving 95% of excellent results at the late follow up (median 62 months). Resting gastro-oesophageal sphincter pressure decreased significantly to approximately 10 mmHg; this was maintained five years after surgery. By contrast, in patients having pneumatic dilatation, there were good results in only 65% (follow up median 58 months), with 30% failures. One patient was lost from follow up and one developed oesophageal carcinoma. Measurement of resting gastro-oesophageal sphincter pressure after dilatation was highly predictive of the outcome. The study shows that surgical treatment offers a better final clinical result than pneumatic dilatation with the Mosher bag.

View PDF Chat

Biologic Prosthesis Reduces Recurrence After Laparoscopic Paraesophageal Hernia Repair

2006-01-01

Brant K. Oelschlager , Carlos A. Pellegrini , John G. Hunter +7 more

Laparoscopic paraesophageal hernia repair (LPEHR) is associated with a high recurrence rate. Repair with synthetic mesh lowers recurrence but can cause dysphagia and visceral erosions. This trial was designed to … Laparoscopic paraesophageal hernia repair (LPEHR) is associated with a high recurrence rate. Repair with synthetic mesh lowers recurrence but can cause dysphagia and visceral erosions. This trial was designed to study the value of a biologic prosthesis, small intestinal submucosa (SIS), in LPEHR.Patients undergoing LPEHR (n = 108) at 4 institutions were randomized to primary repair -1 degrees (n = 57) or primary repair buttressed with SIS (n = 51) using a standardized technique. The primary outcome measure was evidence of recurrent hernia (> or =2 cm) on UGI, read by a study radiologist blinded to the randomization status, 6 months after operation.At 6 months, 99 (93%) patients completed clinical symptomatic follow-up and 95 (90%) patients had an UGI. The groups had similar clinical presentations (symptom profile, quality of life, type and size of hernia, esophageal length, and BMI). Operative times (SIS 202 minutes vs. 1 degrees 183 minutes, P = 0.15) and perioperative complications did not differ. There were no operations for recurrent hernia nor mesh-related complications. At 6 months, 4 patients (9%) developed a recurrent hernia >2 cm in the SIS group and 12 patients (24%) in the 1 degrees group (P = 0.04). Both groups experienced a significant reduction in all measured symptoms (heartburn, regurgitation, dysphagia, chest pain, early satiety, and postprandial pain) and improved QOL (SF-36) after operation. There was no difference between groups in either pre or postoperative symptom severity. Patients with a recurrent hernia had more chest pain (2.7 vs. 1.0, P = 0.03) and early satiety (2.8 vs. 1.3, P = 0.02) and worse physical functioning (63 vs. 72, P = 0.03 per SF-36).Adding a biologic prosthesis during LPEHR reduces the likelihood of recurrence at 6 months, without mesh-related complications or side effects.

Transesophageal Echocardiography: Technique, Anatomic Correlations, Implementation, and Clinical Applications

1988-07-01

James B. Seward , Bijoy K. Khandheria , JAE K. OH +6 more

The surgical treatment of carcinoma of the oesophagus with special reference to a new operation for growths of the middle third

1946-07-01

Ivor Lewis

Journal Article The surgical treatment of carcinoma of the oesophagus with special reference to a new operation for growths of the middle third Get access Ivor Lewis Ivor Lewis North … Journal Article The surgical treatment of carcinoma of the oesophagus with special reference to a new operation for growths of the middle third Get access Ivor Lewis Ivor Lewis North Middlesex County Hospital, London Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 34, Issue 133, July 1946, Pages 18–31, https://doi.org/10.1002/bjs.18003413304 Published: 05 December 2005

The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns

1991-03-01

Showkat Ali Zargar , Rakesh Kochhar , Saroj Mehta +1 more

Monsel's Solution

1964-08-01

Ernst Epstein

Monsel's solution is simply ferric sulfate solution. Its styptic action depends upon its content of ferric ion, as ferric ion is a powerful protein precipitant. Ferric chloride is a more … Monsel's solution is simply ferric sulfate solution. Its styptic action depends upon its content of ferric ion, as ferric ion is a powerful protein precipitant. Ferric chloride is a more convenient source of ferric ions than Monsel's solution, National Formulary; a 3.8 molar solution of ferric chloride can replace Monsel's solution as a styptic for minor surgery.

Management of antithrombotic agents for endoscopic procedures

2009-11-04

Michelle A. Anderson , Tamir Ben‐Menachem , S. Ian Gan +7 more

Congenital malformations among infants whose mothers had gestational diabetes or preexisting diabetes

2001-03-01

Anders Åberg , Lena Westbom , Bëngt Källén

Selective Nonoperative Management of Contained Intrathoracic Esophageal Disruptions

1979-05-01

John L. Cameron , Richard F. Kieffer , Thomas R. Hendrix +2 more

Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review

2007-06-08

Suzanne M. Jeurnink , Casper HJ van Eijck , Ewout W. Steyerberg +2 more

Abstract Background Gastrojejunostomy (GJJ) is the most commonly used palliative treatment modality for malignant gastric outlet obstruction. Recently, stent placement has been introduced as an alternative treatment. We reviewed the … Abstract Background Gastrojejunostomy (GJJ) is the most commonly used palliative treatment modality for malignant gastric outlet obstruction. Recently, stent placement has been introduced as an alternative treatment. We reviewed the available literature on stent placement and GJJ for gastric outlet obstruction, with regard to medical effects and costs. Methods A systematic review of the literature was performed by searching PubMed for the period January 1996 and January 2006. A total of 44 publications on GJJ and stents was identified and reported results on medical effects and costs were pooled and evaluated. Results from randomized and comparative studies were used for calculating odds ratios (OR) to compare differences between the two treatment modalities. Results In 2 randomized trials, stent placement was compared with GJJ (with 27 and 18 patients in each trial). In 6 comparative studies, stent placement was compared with GJJ. Thirty-six series evaluated either stent placement or GJJ. A total of 1046 patients received a duodenal stent and 297 patients underwent GJJ. No differences between stent placement and gastrojejunostomy were found in technical success (96% vs. 100%), early and late major complications 7% vs. 6% and 18% vs. 17%, respectively) and persisting symptoms (8% vs. 9%). Initial clinical success was higher after stent placement (89% vs. 72%). Minor complications were less frequently seen after stent placement in the patient series (9% vs. 33%), however the pooled analysis showed no differences (OR: 0.75, p = 0.8). Recurrent obstructive symptoms were more common after stent placement (18% vs. 1%). Hospital stay was prolonged after GJJ compared to stent placement (13 days vs. 7 days). The mean survival was 105 days after stent placement and 164 days after GJJ. Conclusion These results suggest that stent placement may be associated with more favorable results in patients with a relatively short life expectancy, while GJJ is preferable in patients with a more prolonged prognosis. The paucity of evidence from large randomized trials may however have influenced the results and therefore a trial of sufficient size is needed to determine which palliative treatment modality is optimal in (sub)groups of patients with malignant gastric outlet obstruction.

View PDF Chat

Endoscopic gastrojejunostomy with survival in a porcine model

2005-07-26

Sergey V. Kantsevoy , Sanjay Jagannath , Hideaki Niiyama +7 more

Self-Expanding Metal Stents for Gastroduodenal Malignancies: Systematic Review of their Clinical Effectiveness

2004-06-01

Arno J. Dormann , Søren Meisner , Nathalie Verin +1 more

Background and Study Aims: The current standard approach to the management of malignant gastric outlet obstruction mainly involves bypass surgery, which is associated with significant rates of mortality and morbidity. … Background and Study Aims: The current standard approach to the management of malignant gastric outlet obstruction mainly involves bypass surgery, which is associated with significant rates of mortality and morbidity. Recently, metal stents have emerged as a new therapeutic option. The aim of the present study was to review the currently published evidence on the effectiveness and safety of this form of endoscopic treatment. Materials and Methods: A systematic review of the published data was carried out by searching medline, embase, and abstracts from the major gastroenterological conferences from January 1992 to September 2003. A total of 136 relevant publications were identified (case series, single case reports, letters and editorials, or reviews). The systematic review included 32 case series from a total of 46 publications identified as reporting primary clinical data. Abstracts and single case reports were not taken into account. Analysis of these 32 case series included data on technical success (successful stent placement and deployment), clinical success (relief of symptoms such as nausea and vomiting, and/or improvement of food intake), and complications. Pooled results were calculated from the 32 studies (10 of which were prospective). Results: Stent insertion was attempted in 606 patients with malignant symptomatic gastroduodenal obstruction; 94 % of the patients were unable to take food orally or were mainly ingesting liquids. Stent placement and deployment were successful in 589 of the patients (97 %). Clinical success was achieved in 526 patients in the group in which technical success was reported (89 %; 87 % of the entire group undergoing stenting). Disease-related factors accounted for the majority of clinical failures. Oral intake became possible in all of the patients in whom a successful procedure was carried out, with 87 % taking soft solids or a full diet, with final resolution of symptoms occurring after a mean of 4 days. There was no procedure-related mortality. Severe complications (bleeding and perforation) were observed in seven patients (1.2 %). Stent migration was reported in 31 patients (5 %). Stent obstruction occurred in 104 cases (18 %), mainly due to tumor infiltration. The mean survival period was 12.1 weeks. Conclusions: Published evidence from case series suggests that gastroduodenal stenting offers good palliation and is a safe and effective treatment option in patients with a short remaining lifespan. However, patient selection for this intervention continues to be an issue requiring thorough consideration, and studies comparing the method with surgery are needed.

Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey

1976-03-01

S.E. Silvis

Esophagogastroduodenoscopy (211,410 examinations) had a complication rate of 1.3/1,000 cases. Duodenoscopy with cannulation was performed 3,884 times and had a complication rate of 21.6/1,000 examinations. Diagnostic coloscopy (25,298 examinations) had … Esophagogastroduodenoscopy (211,410 examinations) had a complication rate of 1.3/1,000 cases. Duodenoscopy with cannulation was performed 3,884 times and had a complication rate of 21.6/1,000 examinations. Diagnostic coloscopy (25,298 examinations) had a complication rate of 3.4/1,000. Polypectomies during coloscopy (6,124 cases) had a complication rate of 23.3/1,000 cases. Esophageal dilations (13,139 cases) had a complication rate of 4.25 with mercury bougies, and in 9,431 cases metal olives produced a complication rate of 6.1/1,000 treatments. Dilation for achalasia in 1,224 patients produced a complication rate of 18.4/1,000 procedures. Peritoneoscopy (4,404 examinations) produced a complication rate of 5.4/1,000 patients. The value of these diagnostic and therapeutic procedures is now well established but must be weighed against a potential risk of complications.

Ferrous Sulfate Supplementation Causes Significant Gastrointestinal Side-Effects in Adults: A Systematic Review and Meta-Analysis

2015-02-20

Zoe Tolkien , Lynne Stecher , Adrian Mander +2 more

The tolerability of oral iron supplementation for the treatment of iron deficiency anemia is disputed.Our aim was to quantify the odds of GI side-effects in adults related to current gold … The tolerability of oral iron supplementation for the treatment of iron deficiency anemia is disputed.Our aim was to quantify the odds of GI side-effects in adults related to current gold standard oral iron therapy, namely ferrous sulfate.Systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating GI side-effects that included ferrous sulfate and a comparator that was either placebo or intravenous (i.v.) iron. Random effects meta-analysis modelling was undertaken and study heterogeneity was summarised using I2 statistics.Forty three trials comprising 6831 adult participants were included. Twenty trials (n = 3168) had a placebo arm and twenty three trials (n = 3663) had an active comparator arm of i.v. iron. Ferrous sulfate supplementation significantly increased risk of GI side-effects versus placebo with an odds ratio (OR) of 2.32 [95% CI 1.74-3.08, p<0.0001, I2 = 53.6%] and versus i.v. iron with an OR of 3.05 [95% CI 2.07-4.48, p<0.0001, I2 = 41.6%]. Subgroup analysis in IBD patients showed a similar effect versus i.v. iron (OR = 3.14, 95% CI 1.34-7.36, p = 0.008, I2 = 0%). Likewise, subgroup analysis of pooled data from 7 RCTs in pregnant women (n = 1028) showed a statistically significant increased risk of GI side-effects for ferrous sulfate although there was marked heterogeneity in the data (OR = 3.33, 95% CI 1.19-9.28, p = 0.02, I2 = 66.1%). Meta-regression did not provide significant evidence of an association between the study OR and the iron dose.Our meta-analysis confirms that ferrous sulfate is associated with a significant increase in gastrointestinal-specific side-effects but does not find a relationship with dose.

View PDF Chat

Minimally Invasive Surgery for Achalasia

1999-10-01

Marco G. Patti , Carlos A. Pellegrini , Santiago Horgan +6 more

Background Seven years ago, the authors reported on the feasibility and short-term results of minimally invasive surgical methods to treat esophageal achalasia. In this report, they describe the evolution of … Background Seven years ago, the authors reported on the feasibility and short-term results of minimally invasive surgical methods to treat esophageal achalasia. In this report, they describe the evolution of the surgical technique and the clinical results in a large group of patients with long follow-up. Patients and Methods Between January 1991 and October 1998, 168 patients (96 men, 72 women; mean age 45 years, median duration of symptoms 48 months), who fulfilled the clinical, radiographic, endoscopic, and manometric criteria for a diagnosis of achalasia, underwent esophagomyotomy by minimally invasive techniques. Forty-eight patients had marked esophageal dilatation (diameter >6.0 cm). Thirty-five patients had a left thoracoscopic myotomy, and 133 patients had a laparoscopic myotomy plus a partial fundoplication. Follow-up to October 1998 was complete in 145 patients (86%). Results Median hospital stay was 72 hours for the thoracoscopic group and 48 hours for the laparoscopic group. Eight patients required a second operation for recurrent or persistent dysphagia, and two patients required an esophagectomy. There were no deaths. Good or excellent relief of dysphagia was obtained in 90% of patients (85% after thoracoscopic and 93% after laparoscopic myotomy). Gastroesophageal reflux developed in 60% of tested patients after thoracoscopic myotomy and in 17% after laparoscopic myotomy plus fundoplication. Laparoscopic myotomy plus fundoplication corrected reflux present before surgery in five of seven patients. Patients with a dilated esophagus had excellent relief of dysphagia after laparoscopic myotomy; none required an esophagectomy. Conclusions Minimally invasive techniques provided effective and long-lasting relief of dysphagia in patients with achalasia. The authors prefer the laparoscopic approach for three reasons: it more effectively relieved dysphagia, it was associated with a shorter hospital stay, and it was associated with less postoperative reflux. Laparoscopic Heller myotomy and partial fundoplication should be considered the primary treatment for esophageal achalasia.

Power Doppler US: a potentially useful alternative to mean frequency-based color Doppler US.

1994-03-01

Jonathan M. Rubin , Ronald O. Bude , Paul L. Carson +2 more

PURPOSE: The authors present a preliminary report to demonstrate a new color Doppler (CD) ultrasonography (US) technique called power Doppler (PD), which displays the total integrated Doppler power in color, … PURPOSE: The authors present a preliminary report to demonstrate a new color Doppler (CD) ultrasonography (US) technique called power Doppler (PD), which displays the total integrated Doppler power in color, and to compare PD with CD imaging, which generally displays an estimate of the mean Doppler frequency shift. MATERIALS AND METHODS: Two standard commercial US scanners that encode the integrated power in the Doppler signal in color were used to demonstrate PD. A standard nonflow-containing US phantom, a normal right kidney, and a torsive and normal contralateral testis were scanned in the power mode. In the phantom and kidney, results with CD and PD were directly compared. RESULTS: PD does not alias, is relatively angle independent, and displays background noise in a way that increases the usable dynamic range of a US scanner. This extended dynamic range should increase machine sensitivity and may demonstrate increased flow in certain circumstances. CONCLUSION: PD is a new CD imaging imaging mode that might be superior to CD in some cases.

Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients

2002-01-01

Douglas G. Adler , Todd H. Baron

Malignant gastric outlet obstruction is seen in the setting of a variety of cancers, most commonly pancreatic. Self-expanding metal stents can be used to palliate these patients and restore the … Malignant gastric outlet obstruction is seen in the setting of a variety of cancers, most commonly pancreatic. Self-expanding metal stents can be used to palliate these patients and restore the ability to eat.We reviewed the Mayo Clinic experience in the endoscopic treatment of malignant gastric outlet obstruction. Thirty-six patients (26 male, 10 female) were treated between October, 1998 and January, 2001. Data were collected from charts, endoscopy reports, x-rays, and telephone calls. A scoring system was created to grade the ability to eat.All procedures were successful. Thirty-one of 36 patients (86%) required one stent at initial endoscopy, and 5/36 patients (14%) required two or more stents. Pretreatment, 19/36 patients (53%) were nil per os, 15/36 (42%) drank liquids, and 2/36 were able to eat soft solids. After stent placement, only 1/36 (3%) was still nil per os, 13/36 (36%) drank liquids, 13/36 (36%) ate soft solids, and 9/36 (25%) ate a full diet. The improvement in ability to eat using the scoring system was statistically significant (p < 0.0001). Nine of 36 patients (25%) required reintervention for recurrent symptoms. Sixteen of 36 patients (44%) had concomitant or subsequent development of biliary obstruction, of which 15 were successfully decompressed.Self-expanding metal stents are a safe and efficacious method for palliating malignant gastric outlet obstruction. The majority of patients do not require reintervention, and those that do can usually be managed nonoperatively.

Multiple dose-dependent roles for Sox2 in the patterning and differentiation of anterior foregut endoderm

2007-05-24

Jianwen Que , Tadashi Okubo , James R. Goldenring +6 more

Sox2 is expressed in developing foregut endoderm, with highest levels in the future esophagus and anterior stomach. By contrast, Nkx2.1 (Titf1) is expressed ventrally, in the future trachea. In humans, … Sox2 is expressed in developing foregut endoderm, with highest levels in the future esophagus and anterior stomach. By contrast, Nkx2.1 (Titf1) is expressed ventrally, in the future trachea. In humans, heterozygosity for SOX2 is associated with anopthalmia-esophageal-genital syndrome (OMIM 600992), a condition including esophageal atresia (EA) and tracheoesophageal fistula (TEF), in which the trachea and esophagus fail to separate. Mouse embryos heterozygous for the null allele, Sox2EGFP, appear normal. However, further reductions in Sox2, using Sox2LPand Sox2COND hypomorphic alleles, result in multiple abnormalities. Approximately 60% of Sox2EGFP/COND embryos have EA with distal TEF in which Sox2 is undetectable by immunohistochemistry or western blot. The mutant esophagus morphologically resembles the trachea,with ectopic expression of Nkx2.1, a columnar, ciliated epithelium, and very few p63+ basal cells. By contrast, the abnormal foregut of Nkx2.1-null embryos expresses elevated Sox2 and p63, suggesting reciprocal regulation of Sox2 and Nkx2.1 during early dorsal/ventral foregut patterning. Organ culture experiments further suggest that FGF signaling from the ventral mesenchyme regulates Sox2 expression in the endoderm. In the 40%Sox2EGFP/COND embryos in which Sox2 levels are ∼18% of wild type there is no TEF. However, the esophagus is still abnormal, with luminal mucus-producing cells, fewer p63+ cells, and ectopic expression of genes normally expressed in glandular stomach and intestine. In all hypomorphic embryos the forestomach has an abnormal phenotype, with reduced keratinization, ectopic mucus cells and columnar epithelium. These findings suggest that Sox2 plays a second role in establishing the boundary between the keratinized, squamous esophagus/forestomach and glandular hindstomach.

View PDF Chat

Antibiotic prophylaxis for GI endoscopy

2008-03-29

Subhas Banerjee , Bo Shen , Todd H. Baron +7 more

Immediate Reconstruction of the Cervical Esophagus by a Revascularized Isolated Jejunal Segment

1959-02-01

B Seidenberg , Stephen S. Rosenak , Elliott S. Hurwitt +1 more

SEIDENBERG, BERNARD M.D.; ROSENAK, STEPHEN S. M.D.; HURWITT, ELLIOTT S. M.D.; SOM, MAX L. M.D. Author Information SEIDENBERG, BERNARD M.D.; ROSENAK, STEPHEN S. M.D.; HURWITT, ELLIOTT S. M.D.; SOM, MAX L. M.D. Author Information

Peroral endoscopic myotomy (POEM) for esophageal achalasia

2010-03-30

Haruhiro Inoue , Hironobu Minami , Yasutoshi Kobayashi +7 more

See also: Commentaire de travail de H. Inoue et al., pp. 265Endoscopy 2010; 42(04): 350-350DOI: 10.1055/s-0031-1291851 Referred to by: Peroral endoscopic myotomy (POEM) opens the door of third-space endoscopyEndoscopy 2019; … See also: Commentaire de travail de H. Inoue et al., pp. 265Endoscopy 2010; 42(04): 350-350DOI: 10.1055/s-0031-1291851 Referred to by: Peroral endoscopic myotomy (POEM) opens the door of third-space endoscopyEndoscopy 2019; 51(11): 1010-1012DOI: 10.1055/a-1019-1865

The Gastroesophageal Sphincter in Healthy Human Beings

1956-01-01

Earl Fyke , Charles F. Code , Jerry F. Schlegel

Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial

2009-12-09

Suzanne M. Jeurnink , Ewout W. Steyerberg , Jeanin E. van Hooft +5 more

The Oesophagus Lined with Gastric Mucous Membrane

1953-06-01

P. R. Allison , A. S. Johnstone

View PDF Chat

International Consensus on Standardization of Data Collection for Complications Associated With Esophagectomy

2015-01-21

Donald E. Low , Derek Alderson , Ivan Cecconello +7 more

In Brief Introduction: Perioperative complications influence long- and short-term outcomes after esophagectomy. The absence of a standardized system for defining and recording complications and quality measures after esophageal resection has … In Brief Introduction: Perioperative complications influence long- and short-term outcomes after esophagectomy. The absence of a standardized system for defining and recording complications and quality measures after esophageal resection has meant that there is wide variation in evaluating their impact on these outcomes. Methods: The Esophageal Complications Consensus Group comprised 21 high-volume esophageal surgeons from 14 countries, supported by all the major thoracic and upper gastrointestinal professional societies. Delphi surveys and group meetings were used to achieve a consensus on standardized methods for defining complications and quality measures that could be collected in institutional databases and national audits. Results: A standardized list of complications was created to provide a template for recording individual complications associated with esophagectomy. Where possible, these were linked to preexisting international definitions. A Delphi survey facilitated production of specific definitions for anastomotic leak, conduit necrosis, chyle leak, and recurrent nerve palsy. An additional Delphi survey documented consensus regarding critical quality parameters recommended for routine inclusion in databases. These quality parameters were documentation on mortality, comorbidities, completeness of data collection, blood transfusion, grading of complication severity, changes in level of care, discharge location, and readmission rates. Conclusions: The proposed system for defining and recording perioperative complications associated with esophagectomy provides an infrastructure to standardize international data collection and facilitate future comparative studies and quality improvement projects. Complications affect every major outcome parameter after major cancer surgery. No internationally accepted system for documenting complications after esophagectomy currently exists. Using the Delphi process, high-volume esophageal surgeons from 14 countries have reached a consensus on a standardized list of complications, quality measures, and definitions for specific complications.

Reducing Hospital Morbidity and Mortality Following Esophagectomy

2004-10-01

B. Zane Atkins , Ashish S. Shah , Kelley A. Hutcheson +4 more

View PDF Chat

A lexicon for endoscopic adverse events: report of an ASGE workshop

2010-02-27

Peter B. Cotton , Glenn M. Eisen , Lars Aabakken +7 more

Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis

2000-02-01

Mark B. Orringer , Becky Marshall , Mark D. Iannettoni

View PDF Chat

Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia

2007-08-17

Pankaj J. Pasricha , Rami Hawari , I. Ahmed +6 more

See also: Commentaire de travail de P. J. Pasricha et al., pp. 761Endoscopy 2007; 39(09): 930-930DOI: 10.1055/s-0032-1308864 See also: Commentaire de travail de P. J. Pasricha et al., pp. 761Endoscopy 2007; 39(09): 930-930DOI: 10.1055/s-0032-1308864

Long-term Complications of Congenital Esophageal Atresia and/or Tracheoesophageal Fistula

2004-09-01

Thomas Kovesi , Steven Rubin

Evolving options in the management of esophageal perforation

2004-04-01

Clayton J. Brinster , Sunil Singhal , Lawrence Lee +3 more

Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery

2001-09-01

Julie Bruce , Z H Krukowski , G Al-Khairy +2 more

Abstract Background Anastomotic leak after gastrointestinal surgery is an important postoperative event that leads to significant morbidity and mortality. Postoperative leak rates are frequently used as an indicator of the … Abstract Background Anastomotic leak after gastrointestinal surgery is an important postoperative event that leads to significant morbidity and mortality. Postoperative leak rates are frequently used as an indicator of the quality of surgical care provided. Comparison of rates between and within institutions depends on the use of standard definitions and methods of measurement of anastomotic leak. The aim of this study was to review the definition and measurement of anastomotic leak after oesophagogastric, hepatopancreaticobiliary and lower gastrointestinal surgery. Methods A systematic review was undertaken of the published literature. Searches were carried out on five bibliographical databases (Medline, Embase, The Cochrane Library, Cumulative Index for Nursing and Allied Health Literature and HealthSTAR) for English language articles published between 1993 and 1999. Articles were critically appraised by two independent reviewers and data on definition and measurement of anastomotic leak were extracted. Results Ninety-seven studies were reviewed and a total of 56 separate definitions of anastomotic leak were identified at three sites: upper gastrointestinal (13 definitions), hepatopancreaticobiliary (14) and lower gastrointestinal (29). The majority of studies used a combination of clinical features and radiological investigations to define and detect anastomotic leak. Conclusion There is no universally accepted definition of anastomotic leak at any site. The definitions and values used to measure anastomotic failure vary extensively and preclude accurate comparison of rates between studies and institutions.

View PDF Chat

Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial

2004-10-01

Marjolein Y.V. Homs , Ewout W. Steyerberg , Wilhelmina M.H. Eijkenboom +7 more

Gastroesophageal Reflux Might Cause Esophagitis Through a Cytokine-Mediated Mechanism Rather Than Caustic Acid Injury

2009-08-05

Rhonda F. Souza , Xiaofang Huo , Vivek Mittal +7 more

View PDF Chat

Complications of colonoscopy

2003-04-01

Standards of practice committee , Jason A. Dominitz , Glenn M. Eisen +7 more

Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study

2007-08-17

Evelyn Williams , Shirley M. Taylor , P D Fairclough +7 more

Analyses of endoscopic retrograde cholangiopancreatography (ERCP) complication are often constrained by the number of endpoints observed. This large-scale study aimed to identify the principal risk factors for ERCP complication.This was … Analyses of endoscopic retrograde cholangiopancreatography (ERCP) complication are often constrained by the number of endpoints observed. This large-scale study aimed to identify the principal risk factors for ERCP complication.This was a prospective multicenter study of ERCP complications, based in five English regions. An exploratory univariable analysis of patients' first recorded procedures identified potentially important patient- and procedure-related factors. For overall complications and pancreatitis, variables significant in univariable analysis were included in multiple regression.A total of 66 centers collected data on 5264 ERCPs, performed on 4561 patients. A therapeutic intervention was attempted in 3447/4561 (76%) of patients as part of their first recorded ERCP. Following first recorded ERCP, 230 patients (5.0%) suffered > or = 1 complication: pancreatitis in 74 (1.6%), cholangitis in 48 (1.0 %), hemorrhage in 40 (0.9%), perforation in 20 (0.4%), and miscellaneous in 54 (1.2%). Significant factors from multiple regression were included in a multi-level analysis, which incorporated variables measured at the level of the endoscopist and hospital. For overall complication, risk factors ( P value, odds ratio [OR], 95% confidence interval [CI]) were: cannulation attempts > 1 ( P = 0.094, OR 1.32, 95% CI 0.95-1.83), precut ( P = 0.033, OR 1.55, 95 % CI 1.04-2.32), and suspected sphincter of Oddi dysfunction ( P = 0.121, OR 1.97, 95 % CI 0.84-4.64). For pancreatitis, risk factors ( Pvalue, OR, and 95 % CI) were: cannulation attempts > 1 ( P = 0.0001, OR 3.14, 95% CI 1.74-5.67), female sex ( P < 0.001, OR 2.22, 95% CI 1.43-3.45), age ( P < 0.002, OR 1.09 per 5 year decrease, 95% CI 1.03-1.15), and performance in a district (as opposed to university) hospital ( P = 0.034, OR 2.41, 95% CI 1.08-5.41).Careful patient selection combined with skilled cannulation minimizes complications. Higher-risk procedures should be performed in specialist centers.

Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy

1991-07-01

Janet B. Arrowsmith , B. Burt Gerstman , David E. Fleischer +1 more

Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: A randomized trial

1988-12-01

H A Shepherd , G T Royle , A P R Ross +3 more

A total of 52 jaundiced elderly patients who had malignant obstruction of the distal common bile duct and who required palliative biliary decompression were randomized to receive either an endoscopically … A total of 52 jaundiced elderly patients who had malignant obstruction of the distal common bile duct and who required palliative biliary decompression were randomized to receive either an endoscopically placed biliary endoprosthesis (10 French gauge) or conventional surgical bypass. Patients within the two treatment groups were well matched and 51 were followed until their death. Patients treated with endoprosthesis had a significantly shorter initial hospital stay than those treated surgically. In the long term, overall survival in the two groups was similar and jaundice was relieved in over 90 per cent of patients. Despite more re-admissions to hospital for those patients treated endoscopically, the total time spent in hospital still remained significantly shorter in this treatment group compared with those subjected to surgery. The endoscopically placed biliary endoprosthesis is a valuable alternative to conventional surgical bypass in the palliation of extrahepatic biliary obstruction.

$OElig;SOPHAGEAL ATRESIA: TRACHEO-$OElig;SOPHAGEAL FISTULA A Study of Survival in 218 Infants

1962-04-01

David Waterston

A Controlled Trial of an Expansile Metal Stent for Palliation of Esophageal Obstruction Due to Inoperable Cancer

1993-10-28

K. Knyrim , Hans‐Joachim Wagner , N. Bethge +2 more

Esophageal obstruction due to cancer can produce debilitating dysphagia. Rapid palliation is usually possible with endoscopic placement of a plastic esophageal prosthesis, but this device has a high rate of … Esophageal obstruction due to cancer can produce debilitating dysphagia. Rapid palliation is usually possible with endoscopic placement of a plastic esophageal prosthesis, but this device has a high rate of complications. A new alternative is a metal-mesh stent that collapses to 3 mm in diameter at placement but can then expand up to 16 mm.

View PDF Chat

Expandable Metal Stents for the Treatment of Cancerous Obstruction of the Gastrointestinal Tract

2001-05-31

Todd H. Baron

Expandable metal stents have been approved by the Food and Drug Administration for the treatment of gastrointestinal obstruction due to cancer. Although they have not been approved for use in … Expandable metal stents have been approved by the Food and Drug Administration for the treatment of gastrointestinal obstruction due to cancer. Although they have not been approved for use in benign disease, there are specific clinical indications for which expandable metal stents may be beneficial. This article reviews the uses of expandable metal stents for gastrointestinal obstruction due to cancer.General ConceptsGastrointestinal stents are placed by gastroenterologists under endoscopic guidance with the aid of fluoroscopy or by interventional radiologists using fluoroscopic guidance alone. Expandable metal stents are made of metal alloys and have varying shapes and sizes, depending on . . .

Paraesophageal Hernias: Operation or Observation?

2002-10-01

Nicholas Stylopoulos , G. Scott Gazelle , David W. Rattner

Objective To examine the hypothesis that elective laparoscopic repair should be routinely performed on patients with asymptomatic or minimally symptomatic paraesophageal hernias. Summary Background Data The management of asymptomatic paraesophageal … Objective To examine the hypothesis that elective laparoscopic repair should be routinely performed on patients with asymptomatic or minimally symptomatic paraesophageal hernias. Summary Background Data The management of asymptomatic paraesophageal hernias is a controversial issue. Most surgeons believe that all paraesophageal hernias should be corrected electively on diagnosis, irrespective of symptoms, to prevent the development of complications and avoid the risk of emergency surgery. Methods A Markov Monte Carlo decision analytic model was developed to track a hypothetical cohort of patients with asymptomatic or minimally symptomatic paraesophageal hernia and reflect the possible clinical outcomes associated with two treatment strategies: elective laparoscopic paraesophageal hernia repair (ELHR) or watchful waiting (WW). The input variables for ELHR were estimated from a pooled analysis of 20 published studies, while those for WW and emergency surgery were derived from the 1997 HCUP-NIS database and surgical literature published from 1964 to 2000. Outcomes for the two strategies were expressed in quality-adjusted life-years (QALYs). Results Analysis of the HCUP-NIS database showed that published studies overestimate the mortality of emergency surgery (17% vs. 5.4%). The mortality rate of ELHR was 1.4%. The annual probability of developing acute symptoms requiring emergency surgery with the WW strategy was 1.1%. For patients 65 years of age, ELHR resulted in reduction of 0.13 QALYs (10.78 vs. 10.65) compared with WW. The model predicted that WW was the optimal treatment strategy in 83% of patients and ELHR in the remaining 17%. The model was sensitive only to alterations of the mortality rates of ELHR and emergency surgery. Conclusions If ELHR is routinely recommended, it would be more beneficial than WW in fewer than one of five patients. WW is a reasonable alternative for the initial management of patients with asymptomatic or minimally symptomatic paraesophageal hernias, and even if an emergency operation is required, the burden of the procedure is not as severe as was thought in the past.

Endoscopic oesophagectomy through a right thoracoscopic approach.

1992-08-01

S Sabanathan , Alan J. Mearns , J Richardson

THE LOWER ESOPHAGUS LINED BY COLUMNAR EPITHELIUM

1963-01-01

Richard H. Adler

Nitrosamine and related food intake and gastric and oesophageal cancer risk: A systematic review of the epidemiological evidence

2006-01-01

Paula Jakszyn

CONCLUSION:The available evidence supports a positive association between nitrite and nitrosamine intake and GC, between meat and processed meat intake and GC and OC, and between preserved fish, vegetable and … CONCLUSION:The available evidence supports a positive association between nitrite and nitrosamine intake and GC, between meat and processed meat intake and GC and OC, and between preserved fish, vegetable and smoked food intake and GC, but is not conclusive.

View PDF Chat

Endoscopic Complications

1976-03-01

Stephen E. Silvis

Efficacy of Bedside Upper Gastrointestinal Technique in NICU Infants

2025-06-25

Danielle E. Weiss , Saloni Dagar , Christian Brooks +3 more | Research Square (Research Square)

<title>Abstract</title> Objective To review our experience with the bedside upper GI technique in determining the duodenojejunal junction (DJJ) position in neonatal intensive care (NICU) infants with suspected midgut volvulus. Materials … <title>Abstract</title> Objective To review our experience with the bedside upper GI technique in determining the duodenojejunal junction (DJJ) position in neonatal intensive care (NICU) infants with suspected midgut volvulus. Materials and methods Bedside UGI series in NICU infants less than 6 months old between 2014–2024 were identified using the hospital database and independently reviewed by two pediatric radiologists blinded to the original interpretation. Studies were evaluated for DJJ location and categorized as normal, abnormal or nondiagnostic. Nondiagnostic studies were investigated to determine the reason for failure to identify the DJJ. Clinical and surgical outcomes were recorded. Results 163 bedside UGI studies were reviewed. Most (91.4%) were normal. Four (2.5%) were abnormal, one with midgut volvulus confirmed at surgery. Ten (6.1%) were nondiagnostic due to: contrast filled loops obscuring the DJJ (4), insufficient duodenal opacification (2), organoaxial gastric positioning (2), patient rotation (1) and enteric tube malposition (1). Four nondiagnostic cases had immediate fluoroscopic UGI series using Barium. One had midgut volvulus confirmed at surgery. The remaining 6 nondiagnostic studies were originally interpreted as normal and therefore had no further imaging. There were no false positive or negative exams. Conclusion In NICU patients in whom malrotation with volvulus is suspected, bedside UGI is a reliable tool for assessing the DJJ position, as it eliminates the need to transport the infant. Any diagnostic uncertainty due to insufficient contrast, obscuration of the DJJ or patient rotation should prompt immediate follow-up UGI series with barium in the fluoroscopy suite to avoid a missed diagnosis.

Tolerability of Flexible and Rigid Cystoscopy during DJ Stent Removal in Women

2025-06-25

Wesh Ansari , Prakrit Dhakal , Ananya Singh Bogati | Nepal Medical College Journal

Cystoscopy is routinely done in urological practice. It may be for diagnostic or therapeutic purpose. Generally, it is done to rule of urethra and bladder pathology. Many of time cystoscopy … Cystoscopy is routinely done in urological practice. It may be for diagnostic or therapeutic purpose. Generally, it is done to rule of urethra and bladder pathology. Many of time cystoscopy is performed under local anesthesia, however sometime patient need spinal or general anesthesia. DJ stent is another surgery which is routinely practiced after many endourological as well as open surgery in Urology. It is general practice to remove DJ stent within 6 weeks to 3months but this duration may vary on type of surgery, need of DJ stent and development of complications like lower urinary tract symptoms(LUTs) due to DJ stent. Cystoscopy is done to remove all DJ stent. Its surgeon’s choice to remove DJ stent with either rigid cystoscopy or flexible cystoscopy. This observational study was conducted in Nepal Medical College Teaching Hospital with objective to evaluate the tolerability of flexible versus rigid cystoscopy in women during DJ stent removal and to find out the pain (VAS SCORE); intraoperative, post-operative and need for analgesia following Cystoscopy. Total 64 patients fulfilling the inclusion criteria were included and were randomly divided into 2 groups i.e. group A and group B. Storz 18 Fr flexible cystoscopy was used for group A and 18 Fr rigid cystoscopy was used for group B. Cystoscopy was done in both group, DJ stent was identified and removed. VAS score was calculated during and after the procedure. Mean age for group A was 40.84 years and group B was 36.8 years. VAS score intraoperative for group A was 3.7±1.4 and for group B was 6.1±0.7. Postoperative VAS score for group A was 2.4±1.2 and group B was 5.3±0.7, VAS showing P value <0.001 for both intraoperative and postoperative which is statically significant. In addition, need of analgesia was less in flexible cystoscopy during and after cystoscopy (P value <0.0001).

Boerhaave Syndrome

2025-06-25

Penghui Wei , Wenyong Zhu | New England Journal of Medicine

Definition of Skills and Roles of the Digestive Endoscopy Nurse

2025-06-25

Daniele Napolitano , Maria Luigia Candela , Mirko Gaggiotti +7 more | Gastroenterology Nursing

Endoscopy nurses work in all phases of endoscopic procedures, guaranteeing privacy, respect for dignity, comfort, and safety by applying specific theoretical knowledge and practical skills. However, in several countries, a … Endoscopy nurses work in all phases of endoscopic procedures, guaranteeing privacy, respect for dignity, comfort, and safety by applying specific theoretical knowledge and practical skills. However, in several countries, a structured training process in this specific area is lacking. This document defines the skills and roles of nurses working in the endoscopy and gastroenterology units in Italy. The National Association of Endoscopic Technique Operators - National Association of Gastroenterology Nurses and Associates (ANOTE-ANIGEA) National Committee created a working group including 20 expert nurses and 2 physicians, divided into 4 working groups. Each group worked on one level of training: trainee endoscopy nurse, competent endoscopy nurse, advanced endoscopy nurse, and nontechnical skills. For the final declaration, the Delphi method was adopted. This position paper defined the role and training of endoscopy nurses, proposing three progressive levels of professional preparation. This is the first document aimed at defining the role and training of endoscopy nurses, suggesting progressive levels of professional preparation. It could be an appropriate tool for both nurses who are beginning to work in an endoscopic unit, as well as for all subjects involved in training nurses practicing in digestive endoscopy.

Executive Summary of the American Radium Society Appropriate Use Criteria for the Use of Esophageal Stents in Patients With Esophageal Cancer

2025-06-25

Suzanne Russo , Christopher J. Anker , Don C. Codipilly +7 more | American Journal of Clinical Oncology

Objectives: Esophageal cancer (EC) often presents with dysphagia due to tumor obstruction. Esophageal stenting has the potential of palliating dysphagia, improving nutrition, preventing aspiration, and improving quality of life (QoL) … Objectives: Esophageal cancer (EC) often presents with dysphagia due to tumor obstruction. Esophageal stenting has the potential of palliating dysphagia, improving nutrition, preventing aspiration, and improving quality of life (QoL) but may be associated with risks. The present systematic review and guidelines are intended to assist treatment decision-making when considering stent placement in patients with EC based on the available evidence. Methods: Using the population, intervention, comparator, outcome, timing and study design framework, the evidence was assessed using Cochrane and PRISMA 2020 methodology. Eligible studies included prospective phase II-III trials and retrospective analyses published between January 1, 2010 and December 3, 2024 in the Ovid Medline database. These references were assessed by American Radium Society (ARS) Appropriate Use Criteria (AUC) methodology. RAND-UCLA consensus methodology was used to rate the appropriateness of the use of stents. Results: ARS AUC recommendations include (1) esophageal stenting is usually not appropriate in patients with early-stage EC in whom upfront surgery is planned; (2) esophageal stenting is usually not appropriate in patients with locally-advanced EC in whom neoadjuvant/perioperative therapy and esophagectomy or definitive chemoradiation is planned; (3) esophageal stenting may be appropriate in the setting of metastatic EC, especially in patients with short life expectancy with limited treatment options; (4) esophageal stenting is usually not appropriate for benign stricture following curative-intent therapy; (5) esophageal stenting is usually not appropriate for locally recurrent tumor in the setting of prior radiation; and (6) esophageal stenting is usually appropriate for management of tracheoesophageal fistula before curative-intent treatment. Conclusions: This ARS AUC summary provides guidelines for the use of esophageal stents in patients with EC provides based on available evidence.

Oh Mg! A Review of Magnesium Membranes in Oral Surgery

2025-06-24

H. El-Awour | International Journal of Oral and Maxillofacial Surgery

A retrospective analysis of the burden and treatment patterns of esophageal cancer over one year in a tertiary healthcare institution in the Western Himalayan region

2025-06-24

Nidhi Mahlawat , Nitin Patiyal , Poorva Vias +2 more | International Journal of Basic & Clinical Pharmacology

Background: Esophageal cancer (EC) is a highly aggressive malignancy with a poor prognosis, particularly in advanced stages. By 2024, EC incidence is expected to increase by 63.5% over 2020. The … Background: Esophageal cancer (EC) is a highly aggressive malignancy with a poor prognosis, particularly in advanced stages. By 2024, EC incidence is expected to increase by 63.5% over 2020. The objective of the study was to analyse the EC burden and treatment patterns in Dr. RPGMC, Kangra, Himachal Pradesh, Radiotherapy and Oncology Department, with a focus on palliative radiotherapy. Methods: A retrospective analysis of 83 patients treated at our institute between 2023 and 2024 for esophageal cancer (7.9% of all new cases). Patients received treatment in two groups: palliative (n=34) and radical (n=49). Analysis was done on demographic, histopathological, cancer staging, and treatment modalities data. Self-expandable metallic stent (SEMS) implantation, palliative chemotherapy, or radiotherapy were all considered forms of palliative care. It was evaluated if palliative radiotherapy improved dysphagia. Results: Almost 8% of all cancers were esophageal cancers. There were 30.1% women and 69.8% men, with an average age of 63.9±9.6 years. In 98% of cases, squamous cell carcinoma was found. Of the palliative patients, three had SEMS placement, nine had chemotherapy, and twenty-two had radiotherapy. Following radiotherapy, dysphagia improved in 63.6% of palliative cases, or 68% of cases. Alcohol consumption and smoking were prevalent among men (76%). Conclusions: The study highlights the burden of EC and the importance of tailored treatment strategies. While radical treatment remains the preferred approach, palliative care plays a crucial role in symptom management for advanced cases (alleviating dysphagia, improving QOL).

Esophageal perforation caused by impacted hot potato successfully managed nonoperatively: A rare case report from Ethiopia and literature review

2025-06-24

Abdi Alemayehu , Irko Worku , Gulilat Sisay +3 more | Radiology Case Reports

Endoscopic management of postsurgical complications

2025-06-23

Jörn Bernhardt , Mark Ellrichmann | Visceral Medicine

A rare case of esophageal intramural pseudodiverticulosis

2025-06-23

Manhal K Aldaher , Mohamed Elbayoumy , Abdulrahman Alangari +1 more | European Journal of Case Reports in Internal Medicine

We report the case of a 45-year-old male who presented with 10-month progressive dysphagia to solids and liquids and was subsequently diagnosed with oesophageal intramural pseudodiverticulosis (EIPD). EIPD is an … We report the case of a 45-year-old male who presented with 10-month progressive dysphagia to solids and liquids and was subsequently diagnosed with oesophageal intramural pseudodiverticulosis (EIPD). EIPD is an uncommon benign condition characterized by multiple small outpouchings within the oesophageal wall, measuring about 1-4 mm in length and 1-2 mm in width. This case emphasizes the importance of thorough diagnostic evaluation to exclude associated conditions and potential complications. The patient’s symptoms, diagnostic workup, and treatment approaches are discussed, emphasizing the importance of recognizing this rare condition in the differential diagnosis of dysphagia and highlighting the importance of patient follow-up for optimal patient outcomes and to avoid complications. The clinical presentation can vary, but dysphagia is the most common symptom. Treatment of oesophageal intramural pseudodiverticulosis has historically been limited to addressing the underlying condition and symptom management with acid suppression, anti-fungal therapy, and endoscopic dilation in areas of stricture.

Postoperative reintubation as risk factor for anastomotic stricture after congenital esophageal atresia

2025-06-23

Bo Li , Jie Dong , Chanjuan Zou +3 more | Pediatric Surgery International

Ösophagusperforation nach akzidentellem Verschlucken eines Tablettenblisters

2025-06-23

Matteo Haupt , Anna-Maria Kratzel , Martin Maurer | RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren

NHIỄM TOAN CETON ĐƯỜNG HUYẾT BÌNH THƯỜNG CHU PHẪU DO THUỐC ỨC CHẾ SLGT-2: BÁO CÁO CA LÂM SÀNG VÀ PHÂN TÍCH Y VĂN

2025-06-23

Đào Nguyễn Thị Ngọc , Vũ Phan Tôn Ngọc , Phát Trần Thành +6 more | Tạp chí Y học Việt Nam

Đặt vấn đề: Nhiễm toan ceton đường huyết bình thường (euDKA) ở người bệnh dùng thuốc ức chế kênh đồng vận chuyển natri – glucose 2 (SGLT-2) chu phẫu là … Đặt vấn đề: Nhiễm toan ceton đường huyết bình thường (euDKA) ở người bệnh dùng thuốc ức chế kênh đồng vận chuyển natri – glucose 2 (SGLT-2) chu phẫu là biến chứng hiếm gặp nhưng nguy hiểm đến tính mạng. Tình trạng này đặt ra những thách thức về quản lý, theo dõi và chẩn đoán trong giai đoạn chu phẫu, đặc biệt khi phẫu thuật cấp cứu. Báo cáo ca lâm sàng: Người bệnh nữ, 63 tuổi, đang sử dụng Empagliflozin do đái tháo đường type 2 trải qua phẫu thuật cấp cứu cắt túi mật điều trị viêm túi mật cấp do sỏi kẹt cổ túi mật. Hậu phẫu ngày 2, người bệnh bị euDKA với pH 7,33; PaCO2 25 mmHg; HCO3- 13,2 mmol/l; BE: -10,5; khoảng trống anion 20,2 mmol/l, ceton huyết thanh 3,46 mmol/l, đường huyết 159 mg/dL. Người bệnh được điều trị theo phác đồ điều trị euDKA và nhập hồi sức tích cực 5 ngày, xuất viện sau 12 ngày điều trị. Kết luận: Cần cảnh giác với euDKA ở người bệnh dùng thuốc ức chế SGLT-2 trải qua phẫu thuật. Khi phẫu thuật cấp cứu cần ngưng thuốc ngay khi nhập viện và có chiến lược theo dõi phù hợp. Khi phẫu thuật chương trình cần ngưng thuốc ít nhất 3 ngày.

Endoscopic Balloon Dilation Using a Novel Nonslip Balloon Catheter in a Patient With Pancreaticojejunal Anastomotic Stricture

2025-06-22

Koh Kitagawa , Yuki Motokawa , Hitoshi Yoshiji | Digestive Endoscopy

The Importance of Demographic and Biochemical Parameters on Prognosis in Corrosive Substance Poisonings in Infancy and Play Childhood Period

2025-06-21

Süleyman Nogay , Turgut Dolanbay , Bilgehan Demir +2 more | European Journal of Therapeutics

Objective: Corrosive substances are chemicals with strong acidic or alkaline properties that can cause tissue damage. In children, the most common cause of corrosive exposure is accidental ingestion. Our study … Objective: Corrosive substances are chemicals with strong acidic or alkaline properties that can cause tissue damage. In children, the most common cause of corrosive exposure is accidental ingestion. Our study presents the demographic, clinical, and laboratory characteristics of pediatric patients admitted due to corrosive intake and investigates the prognostic relevance of these parameters. The primary objective is to highlight corrosive poisonings and emphasize predictive markers for risk and complications to guide emergency management. Methods: Data of patients admitted to the emergency department due to corrosive substance ingestion and subsequently hospitalized were retrospectively analyzed. This study aimed to evaluate the prognostic significance of demographic features, the agent’s chemical nature, and laboratory parameters. Results: The median age of the patients was 27 months, with seven being male. Sixteen patients were discharged within two days and no mortality was recorded. In this study, leukocyte counts were significantly elevated in patients who ingested acidic corrosive agents. No statistically significant relationship was found between gender and admission to the intensive care unit (ICU). Similarly, ICU admission did not differ significantly based on whether the agent was acidic or alkaline. Endoscopy rates showed no significant difference according to whether the substance was a household cleaning product. No association was found between product type and gender. Conclusion: Corrosive poisonings during infancy and early childhood generally result from accidental ingestion of small amounts. Inadequate or delayed intervention may lead to severe complications. Prompt diagnosis and appropriate treatment are essential to prevent these outcomes and reduce morbidity.

Modified low-cost EndoVac is safe and efficacious for treatment of postoperative leaks even at low pressures

2025-06-20

Sridhar Sundaram , Rahul Puri , Devyani Niyogi +6 more | Surgical Endoscopy

Postoperative gastrointestinal leaks are often treated using Endoscopic Vacuum therapy (EndoVac). We aim to study the role of modified low-cost EndoVac (mEndoVac) for treatment of postoperative leaks when used at … Postoperative gastrointestinal leaks are often treated using Endoscopic Vacuum therapy (EndoVac). We aim to study the role of modified low-cost EndoVac (mEndoVac) for treatment of postoperative leaks when used at low pressure for upper GI and standard pressure for lower GI leaks. Retrospective review of prospectively maintained endoscopy database from January 2022 till March 2024 was done for patients who underwent treatment for upper and lower GI leaks using mEndoVac. All upper GI leaks were treated with low pressure (25-30 mmHg-modulated using Sinapi™) while lower GI leaks were treated with standard high pressure (125-150 mmHg). The primary outcome was clinical success (resolution of leak cavity). Eighteen patients underwent mEndoVac for anastomotic leaks (14 post-esophagectomy leaks, 4 rectal leaks). mEndoVac therapy was started at median 6 days after detection of leak. Intracavitatory mEndoVac placement was done in all patients. Median of 3.5 sessions (2-7) were done. Clinical success was achieved in 88.8% cases (16/18). Mortality at 6 months was seen in 3 cases (16.6%). Complications were seen in 5 (27.7%) patients (all mild). mEndoVac is safe and effective even at lower pressure for upper GI leaks and at standard pressure for lower GI leaks.

Gastrointestinal Motility Recording Using Balloon Insertion

2025-06-20

Tong Li , Xiaoxi Wang | Journal of Visualized Experiments

Neue zielgerichtete Therapie bei der tumorassoziierten Kachexie

2025-06-19

Andreas Neubauer , Camilla Leithold , S. Nitschmann +1 more | Deleted Journal

Outcomes of near-infrared fluorescence guided colonic interposition for corrosive esophageal stricture

2025-06-19

Eswaravaka Saikrishna , Vaibhav Kumar Varshney , Subhash Soni +7 more | Surgery

Boundary Formation of the Human Caudal Foregut During the Early Fetal Period: Three-Dimensional Analysis Using T1-Weighted and Diffusion Tensor Images

2025-06-19

Toru Kanahashi , Hirohiko Imai , Hiroki Otani +3 more | Cells Tissues Organs

Introduction: While caudal foregut development in human fetuses has been outlined in previous research, the formation of its border region remains unclear. This study aimed to visualize the precise timeline … Introduction: While caudal foregut development in human fetuses has been outlined in previous research, the formation of its border region remains unclear. This study aimed to visualize the precise timeline of caudal foregut boundary formation. Methods: Three-dimensional images of the foregut from T1-weighted scans of 24 fetuses (crown–rump length [CRL]: 34–103 mm) were analyzed to measure the wall thickness and lumen diameter at nine specific sites. The internal structure in the border region was verified using histological sections and diffusion tensor imaging (DTI) tractography. Results: The lower esophageal and pyloric canal walls were thicker in samples with a CRL ≥50 mm. The esophageal wall at the esophageal hiatus, where the lower esophageal sphincter is located, was particularly thick in samples with a CRL ≥88 mm. Increased wall thickness at the esophageal hiatus and pyloric canal resulted in a narrower lumen. The pyloric canal lumen narrowed from its distal to proximal sections. The lumen diameter-to-wall thickness ratio at the esophageal hiatus and proximal pyloric was negatively correlated with CRL. The thickened esophageal wall at the esophageal hiatus had a thick submucosa, and all layers in the pyloric canal thickened with growth. DTI tractography revealed that the lower esophageal wall mainly comprised longitudinal fibers, whereas the pyloric canal wall consisted solely of circular fibers, with fractional anisotropy increasing with growth. Conclusion: This study provides a comprehensive timeline of normal caudal foregut boundary formation during the early human fetal period, thereby improving the understanding of congenital foregut obstruction pathogenesis.

National Trends in Mortality From Upper Gastrointestinal Bleeding in the United States: Disparities and Implications for Emergency Endoscopic Access

2025-06-19

Juliet Appiah , Ewurabena Plange-Kaye , George S Blewusi +2 more | Cureus

Celastrol alleviates esophageal stricture in rats by inhibiting NLR family pyrin domain containing 3 activation

2025-06-19

Miao-Xin Zhang , Chi Wu , Xinxia Feng +5 more | World Journal of Gastroenterology

The role of NLR family pyrin domain containing 3 (NLRP3) in post-endoscopic submucosal dissection (ESD) esophageal stricture remains incompletely understood. The effect of celastrol (CEL) on the prevention of esophageal … The role of NLR family pyrin domain containing 3 (NLRP3) in post-endoscopic submucosal dissection (ESD) esophageal stricture remains incompletely understood. The effect of celastrol (CEL) on the prevention of esophageal strictures has not yet been investigated. To explore the effect of CEL on the prevention of esophageal stricture in rats. NLRP3, interleukin (IL)-1β, and IL-18 mRNA levels were measured in patients' tissues after esophageal ESD. NLRP3 expression in esophageal fibroblasts was determined using immunohistochemistry and immunofluorescence staining. Lentiviral transfection was used to induce NLRP3 overexpression and thioredoxin reductase 1 (TXNRD1) silencing. The CCK8 assay was used to determine the optimal CEL concentration. Reactive oxygen species (ROS) generation was detected via fluorescence and flow cytometry. Masson's trichrome staining and barium esophagography were performed to assess collagen deposition and esophageal stenosis. The mRNA levels of NLRP3 and IL-1β were higher in human tissues from the ESD resection bed than in normal esophageal mucosa. NLRP3 overexpression in primary rat esophageal fibroblasts led to high collagen 1 expression. Thus, NLRP3 participated in esophageal inflammation and tissue repair after ESD. Comparable to prednisolone, CEL significantly inhibited NLRP3 activation in vitro and in vivo, and esophageal strictures were markedly alleviated. Mechanistically, CEL upregulated TXNRD1 expression and reduced ROS production, thereby inhibiting NLRP3 expression. This effect was reversed by TXNRD1 silencing. Furthermore, TXNRD1 interacted with NLRP3 and promoted its ubiquitination. CEL is a promising alternative therapeutic agent for the prevention of post-ESD esophageal strictures.

Esophageal intramural hematoma: An unusual cause of acute onset chest pain

2025-06-19

Vigneshvarprashanth Umapathy , K Arivarasan | Indian Journal of Case Reports

An elderly lady in her mid-70 s who is known to have coronary artery disease for which she was on dual antiplatelet therapy, presented with acute onset chest pain and … An elderly lady in her mid-70 s who is known to have coronary artery disease for which she was on dual antiplatelet therapy, presented with acute onset chest pain and dysphagia. The cardiac evaluation was unremarkable. Esophagogastroduodenoscopy (EGD) showed a large intramural hematoma in the esophagus, causing luminal narrowing. A diagnosis of esophageal intramural hematoma secondary to antiplatelets was made based on the findings of Gastrografin swallow, EGD, and contrast-enhanced computed tomography of the thorax along with the history of taking dual antiplatelets. Antiplatelets were subsequently stopped. She was managed in the critical care unit with intravenous fluids, pantoprazole infusion, empirical antibiotics, fentanyl infusion, and total parenteral nutrition. The relook EGD showed a resolving hematoma. She was maintained on intravenous pantoprazole, allowed to take oral feeds gradually, and was subsequently discharged. To conclude, intramural hematoma of the esophagus can present with acute chest pain and dysphagia. Careful history taking, especially the drug history and appropriate investigations, are pivotal as there are high chances of misdiagnosis and unwanted anticoagulant therapy.

Safety and efficacy of steroid injection with endoscopic dilatation in pediatric refractory benign esophageal stricture

2025-06-18

Mohamed Anwar , Sayed Elhady , Mohamed Shahin +5 more | Journal of Pediatric Endoscopic Surgery

Combined endoscopic approach with fluoroscopy-guided radial incision and cutting for a complete esophageal stricture

2025-06-18

Akito Furuta , Shunsuke Omoto , Shunsuke Ogata +4 more | Endoscopy

Clinical utility of self-expandable metal stents in the treatment of anastomotic obstruction secondary to recurrent gastric cancer

2025-06-18

Haiyang Lai , Ketong Wu , Yang Liu +4 more | Frontiers in Oncology

Aim The purpose of this study was to assess the efficacy and safety of self−expandable metal stents (SEMS) in treating anastomotic obstruction associated with recurrent gastric cancer. Methods Ten patients … Aim The purpose of this study was to assess the efficacy and safety of self−expandable metal stents (SEMS) in treating anastomotic obstruction associated with recurrent gastric cancer. Methods Ten patients with anastomotic obstruction in recurrent gastric cancer were treated by SEMS implantation under fluoroscopic guidance. All patients presented with refractory nausea, vomiting and complete inability to tolerate oral intake before stent placement, requiring total parenteral nutrition (TPN). Clinical data were retrospectively analyzed the technical and clinical success rates, stent patency and complication rates. Results SEMS was successfully implanted in all patients, and clinical success rate was 100%. The operations were subtotal gastrectomy with Billroth-II reconstruction (n = 3), radical distal gastrectomy (n = 3), total gastrectomy with esophagojejunostomy (n = 3), and palliative gastrojejunostomy (n = 1). Three patients developed stent occlusion due to intrastent tumor ingrowth secondary to disease progression after initial anastomotic stent placement, and underwent secondary stent implantation with successful maintenance of patency postoperatively. One patient developed stent obstruction due to food impaction on postoperative day 10, which was managed endoscopically with successful restoration and maintenance of luminal patency. The mean stent patency was 78 d (range, 8–225 d). No serious complications, such as anastomotic leakage, stent migration and bleeding were observed in these patients. Conclusions Fluoroscopically-guided SEMS placement represents a technically safe and clinically effective intervention for managing anastomotic obstructions in recurrent gastric cancer. SEMS placement offers rapid symptom relief, shorter hospital stays, and improved quality of life compared to surgical alternatives in this patient population. Thus, based on its technical feasibility and clinical outcomes, this method warrants primary consideration in palliative treatment algorithms.

Uncommon complications arising during endoscopic ultrasound-guided gastroenterostomy – splenic injury

2025-06-18

Shanshan Hu , Peng Tang , Jie Hou +2 more | Endoscopy

Machine learning and the nomogram as the accurate tools for predicting postoperative malnutrition risk in esophageal cancer patients

2025-06-18

Zhenmeng Lin , Hao He , Mingfang Yan +3 more | Frontiers in Nutrition

Background Postoperative malnutrition is a prevalent complication following esophageal cancer surgery, significantly impairing clinical recovery and long-term prognosis. This study aimed to develop and validate predictive models using machine learning … Background Postoperative malnutrition is a prevalent complication following esophageal cancer surgery, significantly impairing clinical recovery and long-term prognosis. This study aimed to develop and validate predictive models using machine learning algorithms and a nomogram to estimate the risk of malnutrition at 1 month after esophagectomy. Methods A total of 1,693 patients who underwent curative esophageal cancer surgery were analyzed, with 1,251 patients allocated to the development cohort and 442 to the validation cohort. Feature selection was performed via the least absolute shrinkage and selection operator (LASSO) algorithm. Eight machine learning models were constructed and evaluated, alongside a nomogram developed through multivariable logistic regression. Results The incidence of postoperative malnutrition was 45.4% (568/1,251) in the development cohort and 50.7% (224/442) in the validation cohort. Among machine learning models, the Random Forest (RF) model demonstrated optimal performance, achieving area under the receiver operating characteristic curve (AUC) values of 0.820 (95% CI: 0.796–0.845) and 0.805 (95% CI: 0.771–0.839) in the development and validation cohorts, respectively. The nomogram incorporated five clinically interpretable predictors: female gender, advanced age, low preoperative body mass index (BMI), neoadjuvant therapy history, and preoperative sarcopenia. It showed comparable discriminative ability, with AUCs of 0.801 (95% CI: 0.775–0.826) and 0.795 (95% CI: 0.764–0.828) in the respective cohorts ( p &gt; 0.05 vs. RF). Calibration curves revealed strong agreement between predicted and observed outcomes, while decision curve analysis (DCA) confirmed substantial clinical utility across risk thresholds. Conclusion Both machine learning and the nomogram provide accurate tools for predicting postoperative malnutrition risk in esophageal cancer patients. While RF showed marginally higher predictive performance, the nomogram offers superior clinical interpretability, making it a practical option for individualized risk stratification.

Endoluminal Stenting for Long Term Management of Crohn’s Ileoanal Pouch Stricture

2025-06-17

John Park | International Journal of Clinical Case Reports and Reviews

Fibrostenotic strictures are a challenging complication of Crohn’s disease, particularly when involving the ileal pouch-anal anastomosis (IPAA) in patients with misdiagnosed ulcerative colitis. We present a rare case of a … Fibrostenotic strictures are a challenging complication of Crohn’s disease, particularly when involving the ileal pouch-anal anastomosis (IPAA) in patients with misdiagnosed ulcerative colitis. We present a rare case of a 70-year-old male with Crohn’s disease-related afferent limb strictures following IPAA, successfully managed with endoscopic self-expanding metal stents over more than a decade. Initially treated with a fully covered stent, subsequent replacements with partially covered stents improved stability and reduced complications. Long-term follow-up demonstrated effective symptom control, preserved pouch function, and avoidance of permanent ileostomy. While early management required frequent interventions, the current stent has remained functional for nearly five years. Complications such as bleeding, migration, and mucosal ulceration were managed non-surgically. This case highlights the potential for endoscopic stenting to serve as a durable, organ-preserving alternative to surgery in complex Crohn’s presentations and represents the longest reported use of stenting in this context, warranting further investigation.

Robotic left gastric vein reimplantation to prevent gastric venous congestion in total pancreatectomy

2025-06-17

Allegra Ripolli , Virginia Viti , Emanuele F. Kauffmann +1 more | Updates in Surgery

Masked Vessel Triggering a Catastrophic Bleed During EUS-Guided Cystogastrostomy

2025-06-17

Rajesh Puri , Anmol Agarwal , Abhishek Yadav +3 more | Digestive Diseases and Sciences

Prediction And Prevention of Complications After Surgical Correction of Esophageal Atresia In Newborns

2025-06-17

Magomed Magomedmuradovich Bayev , Kamilla Dagestanovna Kanbulatova , Ismail Farajov +4 more | Journal of Neonatal Surgery

The article is devoted to an urgent problem of neonatal surgery – prognosis and prevention of complications after surgical correction of esophageal atresia in newborns. The authors present a systematic … The article is devoted to an urgent problem of neonatal surgery – prognosis and prevention of complications after surgical correction of esophageal atresia in newborns. The authors present a systematic analysis of risk factors contributing to the development of postoperative complications, such as anastomosis failure, esophageal strictures, aspiration pneumonia and gastroesophageal reflux. Surgical correction of esophageal atresia remains one of the most difficult operations of neonatal surgery: even with the improvement of anastomosis techniques, early and late postoperative morbidity remains significant. The most common negative outcomes are anastomosis failure, restenosis, recurrence of tracheoesophageal fistula, aspiration-related respiratory episodes, and delayed somatic growth. The purpose of this study was to create a predictive model of complications, as well as to evaluate the effectiveness of a comprehensive preventive strategy, including modification of surgical techniques, targeted respiratory support and personalized nutritional management. The data of 215 newborns operated on in 2000-2024 at the federal center of the third level were analyzed; the median follow- up was twelve months. A multifactorial risk scale was created, confirmed by an AUC of 0.82 (95% CI 0.78–0.86), and a significant decrease in the incidence of severe complications was demonstrated when using the prevention protocol Based on a retrospective analysis of clinical observations, key clinical and instrumental markers have been identified that make it possible to predict the development of complications with high accuracy. Modern approaches and methods of preventing complications are considered, including the improvement of surgical techniques, optimization of postoperative management of patients and the use of early rehabilitation programs. The results obtained can be useful for practicing neonatology surgeons, pediatricians, and neonatal intensive care specialists to improve clinical outcomes and quality of life for young patients.

Surgical Mortality and Morbidity Predictors in Patients With Perforated Peptic Ulcer: A Cohort Study

2025-06-17

Negin Pouroushaninia , Ramin Bozorgmehr , Nazanin Alibeik +4 more | Journal of Surgical Research

‘VACTERL-H in newborn: A rare case report’

2025-06-17

Walid Alhussin , Fathima Sabahath | Journal of Neonatal-Perinatal Medicine

Background VACTERL association is a mnemonically useful acronym for a condition characterized by the sporadic, non-random association of specific birth defects in multiple organ systems. Described in the early 1970s, … Background VACTERL association is a mnemonically useful acronym for a condition characterized by the sporadic, non-random association of specific birth defects in multiple organ systems. Described in the early 1970s, it is typically defined by the presence of three or more of these congenital malformations: vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistulas, renal anomalies, and limb abnormalities. In addition to these core components, patients may also have other congenital anomalies. VACTERL association does not involve neuro-cognitive impairment unless; associated with hydrocephalus, known as VACTERL-H syndrome. VACTERL with hydrocephalus is an extremely rare disorder that affects males and females’ children equally. Case description This report describes the case of a preterm 32 weeks gestation, Asian, male infant who was diagnosed with VACTERL associated with hydrocephalus (VACTERL-H). Conclusion VACTERL syndrome cases are seen very rarely. The diagnosis of VACTERL-H syndrome is primarily based upon a complete physical examination and a few specialized tests to ascertain the features of the syndrome. The treatment of VACTERL-H is directed towards the specific symptoms that are apparent in each individual, which often vary greatly. This case highlights the challenges in managing VACTERL-H syndrome in preterm, who presented with the most serious features of VACTERL. Hence, early diagnosis and early interventions are needed to prevent morbidity and mortality.

Hyperbaric oxygen and steroids for preventing stricture after large esophageal endoscopic submucosal dissection

2025-06-16

Haotian Zeng , Jiaxing Yang , Xi-Min Lin +1 more | Endoscopy International Open

Background and study aims The treatment of esophageal mucosal lesions by endoscopic submucosal dissection (ESD) may lead to the formation of esophageal strictures. The trial was designed to clarify the … Background and study aims The treatment of esophageal mucosal lesions by endoscopic submucosal dissection (ESD) may lead to the formation of esophageal strictures. The trial was designed to clarify the efficacy of HBOT-assisted steroids in preventing postoperative strictures after ESD for large and long-segment esophageal mucosal lesions. Patients and methods Between October 2020 and July 2023, patients who underwent esophageal ESD with a remained mucosal defect of more than three-quarters of the esophageal circumference and longer than 50 mm in diameter were retrospectively analyzed. Patients in the control group were administered one injection of triamcinolone acetonide in the submucosal layer and oral prednisone, whereas patients in the experimental group underwent HBOT along with the abovementioned steroid therapy. Furthermore, the differences in postoperative stricture incidence, and related adverse effects between the two groups were evaluated. Results A total of 35 patients were included in this study. Patients in the experimental group had a significantly lower stricture incidence compared to those in the control group (6.7%, 1/15 patients vs 40%, 8/20 patients; P = 0.048). The stricture incidence of circumferential mucosal defects was significantly lower in the experimental group than that in the control group (0.0%, 0/6 patients vs 71.4%, 5/7 patients; P = 0.021). The incidence of post-ESD complications was similar in both groups (6.7% 1/15 patients vs 25% 5/20 patients, P = 0.207). No HBOT-related adverse reaction was observed. Conclusions HBOT-assisted steroid therapy might be a safe and effective way to prevent postoperative strictures after ESD for large and long-segment esophageal mucosal lesions.

Complications in diagnostic and therapeutic endoscopic procedures on the lower gastrointestinal tract. Collegial discussion of informed consent by the Association of Quality Care Experts

2025-06-16

M. S. Burdyukov , I.E. Usyatinskaya , А. В. Алексеев +7 more | Russian Journal of Evidence-Based Gastroenterology

This article examines the key legal and medical requirements for drafting informed consent (IC) forms for diagnostic and therapeutic endoscopic procedures on the lower gastrointestinal tract (GIT). Special attention is … This article examines the key legal and medical requirements for drafting informed consent (IC) forms for diagnostic and therapeutic endoscopic procedures on the lower gastrointestinal tract (GIT). Special attention is paid to the importance of standardizing the approach to documenting indications, contraindications, and potential complications in IC forms to enhance patient safety and protect healthcare institutions. The authors analyze Russian and international data, emphasizing the necessity of effectively informing patients about the risks of endoscopic procedures, including possible adverse events (AEs) such as perforation, bleeding, and infectious complications. The article highlights that drafting IC forms must consider legislative requirements, clinical guidelines, and up-to-date safety data. Recommendations are provided for minimizing AE risks through staged patient assessments, tailored selection of tools and methods, and enhancing the training of medical personnel. This article serves as a valuable resource for endoscopists, legal experts, and healthcare administrators committed to improving the quality and safety of medical care. The material is accompanied by practical examples and a review of complications associated with colonoscopy.

Giant second part of duodenal perforation: Case report and management challenge

2025-06-14

Atalel Fentahun Awedew , Kidist Hunegn Setargew , Andualem Dagne Tebkew +1 more | International Journal of Surgery Case Reports

[Consensus on the diagnosis and treatment of corrosive injury of the upper digestive tract in children (2025)].

2025-06-14

| PubMed

Subsequent ileal stent placement for synchronous small-bowel obstruction through endoscopic ultrasound-guided ileocolostomy with a lumen-apposing metal stent

2025-06-13

Kyong Joo Lee , Se Woo Park , Dong Hee Koh | Endoscopy

EUS-guided gastroenterostomy using a parallel enteric tube for luminal distension: Prospective multicenter procedural standardization (with video)

2025-06-13

Carlos Chavarría , Vanessa Martín-Álvarez , José Ramón Aparicio +7 more | Endoscopic Ultrasound

Abstract Background and Objectives The EUS-guided gastroenterostomy (EUS-GE) technique remains nonstandardized. We primarily aimed at standardizing parallel enteric tube (PET)–assisted EUS-GE, secondarily assessing reproducibility and outcomes. Methods This prospective multicenter … Abstract Background and Objectives The EUS-guided gastroenterostomy (EUS-GE) technique remains nonstandardized. We primarily aimed at standardizing parallel enteric tube (PET)–assisted EUS-GE, secondarily assessing reproducibility and outcomes. Methods This prospective multicenter study included consecutive adult patients with unresectable malignant gastric outlet obstruction undergoing primary EUS-GE between August 2019 and April 2021. Hierarchical task analysis predefined procedural steps into tasks and subtasks. Subtasks were further categorized into essential (performed in all centers and in more than 85% of the procedures) or optional. Subtask methodology was considered established if performed similarly in all centers or variable if not. Procedure times, injected fluid volume, accessories, adverse events (AEs), and outcomes were recorded. Results Seven endoscopists performed EUS-GE in 65 patients (50.8% male, median [interquartile range] age 77.5 [65.7–86.5] years). EUS-GE was categorized into 4 tasks (enteric tube placement, endoscope exchange, small bowel distention plus targeting, lumen-apposing metal stent placement) and 10 subtasks (7 essential, 3 optional). Five essential subtasks involved an established methodology (guidewire and PET placement, endoscope exchange, delivery system insertion, and lumen-apposing metal stent deployment). Technical and clinical success rates were 98.5% and 83.3%, respectively. AEs occurred in 10 (15.4%) patients. Success and AE rates were not different between expert and nonexperts. Procedure time was longer (35 [30.6–43.7] vs . 21.8 [16.4–29.5] minutes, P < 0.001) and injected fluid volume higher (510 [439–870] vs . 415 [255–480] mL, P = 0.01) in nonexperts. Conclusions PET-assisted EUS-GE was standardized, identifying its key steps and technique variants. PET-assisted EUS-GE appears to be a reproducible procedure among advanced endoscopists with different levels of experience. (ClinicalTrials identification no. NCT04660695).

A novel underwater endoscopic submucosal dissection via continuous irrigation method for esophageal squamous cell carcinoma with severe fibrosis

2025-06-13

Takahiro Muramatsu , Masakatsu Fukuzawa , Sakiko Naito +4 more | Endoscopy

A novel multipoint mucosal bridge technique in endoscopic submucosal tunneling dissection for esophageal lesions

2025-06-13

X. Liu , Dongtao Shi , Yang Xiao-qiang +2 more | Endoscopy