Search

CO2-Plume Geothermal (CPG) power plants can produce heat and/or electric power. One of the most important parameters for the design of a CPG system is the CO2 mass flowrate. Firstly, the flowrate determines the power generated. Secondly, the flowrate has a significant effect on the fluid pressure drawdown in the geologic reservoir at the production well inlet. This pressure drawdown is important because it can lead to water flow in the reservoir towards and into the borehole. Thirdly, the CO2 flowrate directly affects the two-phase (CO2 and water) flow regime within the production well. An annular flow regime, dominated by the flow of the CO2 phase in the well, is favorable to increase CPG efficiency. Thus, flowrate optimizations of CPG systems need to honor all of the above processes. We investigate the effects of various operational parameters (maximum flowrate, admissible reservoir-pressure drawdown, borehole diameter) and reservoir parameters (permeability anisotropy and relative permeability curves) on the CO2 and water flow regime in the production well and on the power generation of a CPG system. We use a numerical modeling approach that couples the reservoir processes with the well and power plant systems. Our results show that water accumulation in the CPG vertical production well can occur. However, with proper CPG system design, it is possible to prevent such water accumulation in the production well and to maximize CPG electric power output., Geothermics, 98, ISSN:0375-6505

The Kingdom of Saudi Arabia (KSA) has vast geothermal energy resources. When developed, these markedly strengthen the country's goals of achieving a carbon-neutral economy. To demonstrate the feasibility and techno-economic performance of small-scale, hydrothermal well doublet systems for direct use in KSA, we perform reservoir and wellbore flow and heat-transport simulations as well as an economic analysis. The maximum permissible flowrate is constrained to avoid thermoelastic fracturing in the near-wellbore region. Reservoir conditions of a sedimentary basin along the Red Sea coast (near Al Wajh) provide an ideal study case to which we add economic parameters considered representative for KSA. We derive a Levelized Cost of Heat (LCOH) ranging from 49 to 128 $/MWh for 50-mD hydrothermal doublet systems with an optimal well spacing of 600 m and a flowrate ranging from 110 kg/s to 50 kg/s. LCOH is strongly influenced by decreasing reservoir transmissivity. Also, a minimum injection temperature is required to avoid thermoelastic fracturing. Our economic analysis further highlights that capacity factor and well-drilling cost have the greatest impact on LCOH. Thus, this study provides a guide and workflow to conduct techno-economic investigations for decision-making, risk mitigation, optimizing geothermal-energy-extraction and economic-performance conditions of hydrothermal doublet systems.

Transport in Porous Media, ISSN:0169-3913, ISSN:1573-1634

Contains fulltext : 252148.pdf (Publisher’s version ) (Closed access)

Esophageal adenocarcinoma is increasing in incidence and is the most common subtype of esophageal cancer in Western societies. The stepwise progression of Barrett´s metaplasia to high-grade dysplasia and invasive adenocarcinoma provides an opportunity for screening and surveillance. There are important unresolved issues, which include (i) refining the definition of the screening population in order to avoid unnecessary invasive diagnostics, (ii) a more precise prediction of the (very heterogeneous) individual progression risk from metaplasia to invasive cancer in order to better tailor surveillance recommendations, (iii) improvement of the quality of endoscopy in order to reduce the high miss rate for early neoplastic lesions, and (iv) support for the diagnosis of tumor infiltration depth in order to guide treatment decisions. Artificial intelligence (AI) systems might be useful as a support to better solve the above-mentioned issues.

A known near-surface heat-flow density anomaly exists in the Canton of Aargau in Northern Switzerland. With previously calculated specific heat-flow values of up to 140mWm2, it is a region of interest for deep geothermal energy exploration. In this pilot study, we want to better understand the nature of this heat-flow anomaly and characterize the heat-flow distribution in its vicinity to facilitate future assessment of the geothermal potential of this region. To achieve a complete characterization of the heat-flow values as well as their spatial uncertainty, we develop a workflow comprising: (i) integration and standardization of different types of geological and geophysical data, (ii) development of a geological model with focus on parameters controlling heat transport, and (iii) numerical simulations of the dominant heat transport processes in the region. One important geological structure in the study region is a Permocarboniferous Trough (PCT), likely linked to the heat flow anomaly. Based on available data, we describe two geological model hypotheses which differ in the lateral extent of the trough. Using a Markov Chain approach, we condition probable geological models using gravity data, reducing the conditional probability of one hypothesis. Heat transport is then simulated in models passing the gravity conditioning. Temperature observations in boreholes can be replicated by simulating purely conductive heat transport. Advective models show upflow at the graben boundaries, just not in the vicinity of boreholes. For increasing usability, we designed the work flow in a way that makes it easy to 1) add and change data, and 2) apply the same principal concept to other regions.

In this study, we aimed to develop an artificial intelligence clinical decision support solution to mitigate operator-dependent limitations during complex endoscopic procedures such as endoscopic submucosal dissection and peroral endoscopic myotomy, for example, bleeding and perforation. A DeepLabv3-based model was trained to delineate vessels, tissue structures and instruments on endoscopic still images from such procedures. The mean cross-validated Intersection over Union and Dice Score were 63% and 76%, respectively. Applied to standardised video clips from third-space endoscopic procedures, the algorithm showed a mean vessel detection rate of 85% with a false-positive rate of 0.75/min. These performance statistics suggest a potential clinical benefit for procedure safety, time and also training.

CO2-Plume Geothermal (CPG) power plants can produce heat and/or electric power. One of the most important parameters for the design of a CPG system is the CO2 mass flowrate. Firstly, the flowrate determines the power generated. Secondly, the flowrate has a significant effect on the fluid pressure drawdown in the geologic reservoir at the production well inlet. This pressure drawdown is important because it can lead to water flow in the reservoir towards and into the borehole. Thirdly, the CO2 flowrate directly affects the two-phase (CO2 and water) flow regime within the production well. An annular flow regime, dominated by the flow of the CO2 phase in the well, is favorable to increase CPG efficiency. Thus, flowrate optimizations of CPG systems need to honor all of the above processes. We investigate the effects of various operational parameters (maximum flowrate, admissible reservoir-pressure drawdown, borehole diameter) and reservoir parameters (permeability anisotropy and relative permeability curves) on the CO2 and water flow regime in the production well and on the power generation of a CPG system. We use a numerical modeling approach that couples the reservoir processes with the well and power plant systems. Our results show that water accumulation in the CPG vertical production well can occur. However, with proper CPG system design, it is possible to prevent such water accumulation in the production well and to maximize CPG electric power output. ISSN:0375-6505

(1) Background: The COVID-19 pandemic forced healthcare workers to adapt to challenges in both patient care and self-protection. Dental practitioners were confronted with a potentially high possibility of infection transmission due to aerosol-generating procedures. This study aims to present data on healthcare worker (HCW) screening, infection status of HCWs, pre-interventional testing, the use of personal protective equipment (PPE) and the economic impact of the pandemic in dental facilities. (2) Methods: Dental facilities were surveyed nationwide using an online questionnaire. The acquisition of participants took place in cooperation with the German Society for Dentistry, Oral and Maxillofacial Medicine. (3) Results: A total of 1094 private practices participated. Of these, 39.1% treated fewer than 600 patients per quarter and 59.9% treated over 600 patients per quarter. Pre-interventional testing was rarely performed in either small (6.6%) or large practices (6.0%). Large practices had a significantly higher incidence of at least one SARS-CoV-2-positive HCW than small practices (26.2% vs.14.4%, p < 0.01). The main source of infection in small practices was the private environment, and this was even more significant in large practices (81.8% vs. 89.7%, p < 0.01). The procedure count either remained stable (34.0% of small practices vs. 46.2% of large practices) or decreased by up to 50% (52.6% of small practices vs. 44.4% of large practices). Revenue remained stable (24.8% of small practices vs. 34.2% of large practices) or decreased by up to 50% (64.5% of small practices vs. 55.3% of large practices, p = 0.03). Overall, employee numbers remained stable (75.5% of small practices vs. 76.8% of large practices). A vaccination readiness of 60–100% was shown in 60.5% (n = 405) of large practices and 59.9% (n = 251) of small practices. (4) Conclusion: Pre-interventional testing in dental practices should be increased further. Economic challenges affected small practices as well as large practices. Overall, a steady employee count could be maintained. Vaccination readiness is high in dental practices, although with some room for improvement.

The subsurface is a vast reservoir which we exploit in various ways. We extract energy in the form of oil/gas or heat from it. We use it for the storage of energy, e.g., in shallow geothermal applications or for the underground storage of natural gas. A lot of recent research has studied the potential for storing hydrogen (H 2 ) in the subsurface. We also use the subsurface to dispose of energy-related waste, e.g., radioactive materials, carbon dioxide (CO 2 ), and acid gas. For a long time, the subsurface was considered sterile below a few metres, probably stemming from work carried out in the 1950s which suggested that bacteria in Pacific sediments most likely disappeared somewhere just below 8m (Morita and ZoBell, 1955). This observation seems to have been extrapolated to the subsurface in general, but over time, as methods developed and microbiologists probed harder, this view changed, and it is now recognised that microbial communities exist at depths where the subsurface is exploited for most types of geo-energy. This raises questions about what sort of microbial community exists, how active it is, what limits and drives that activity and how this might impact geo-energy operations. Cited as : Ebigbo, A., Gregory, S. P. The relevance of microbial processes in geo-energy applications. Advances in Geo-Energy Research, 2021, 5(1): 5-7, doi: 10.46690/ager.2021.01.02

Background: Small intestinal bacterial overgrowth (SIBO) is often found in patients with gut dysbiosis such as irritable bowel syndrome. Recently, the association of SIBO and inflammatory bowel disease (IBD) has been described in some cases. While clinical symptoms might be similar in IBD and SIBO, treatment is quite different for both diseases. Therefore, the differentiation between SIBO or a flare in IBD patients is key to optimizing treatment for these patients. Methods: We retrospectively investigated our patients with IBD receiving a glucose breath test for SIBO and correlated the results with the clinical symptoms (clinical remission or active disease). Results: 128 patients with the diagnosis “colitis” were analyzed in our cohort. Fifty-three (41.4%) patients had Crohn’s disease and 22 (17.2%) patients were suffering from ulcerative colitis. Seventy-four (57.8%) were female and 54 (42.2%) were male patients. A total of 18 (14.1%) patients had a positive testing for SIBO. Eleven (61.1%) cases were associated with CD patients and two (11.1%) with UC. IBD patients in clinical remission had a positive SIBO in six (19.4%) cases, while IBD patients with active disease were positive in nine (15.3%) cases. The proportion of positive SIBO in active IBD patients was higher; however, it did not reach significance. Older age was a risk factor for SIBO in patients with CD (p < 0.003). Conclusions: In our study, we could show that an increased amount of SIBO was found in IBD patients and was especially more frequent in patients with CD than in those with UC. In UC patients, SIBO rates were not different to patients with other gastrointestinal diseases investigated (e.g., infectious colitis, collagenous colitis, or irritable bowel syndrome). In active IBD, positive SIBO was detected more often numerically compared to quiescent disease; however, due to the low number of patients included, it was not significant. However, older age was a significant risk factor for SIBO in patients with CD. SIBO is of clinical relevance in the vulnerable patient cohort with IBD, and its real prevalence and impact needs to be investigated in further and larger clinical trials.

Endoscopic mucosal resection (EMR) is a technique allowing efficacious and minimally invasive resection of precancerous lesions across the entire gastrointestinal tract. However, conventional EMR, involving injection of fluid into the submucosal space, is imperfect, given the high rate of recurrence of post-endoscopic resection adenoma, especially after piecemeal resection. In light of these observations, modifications of the technique have been proposed to overcome the weakness of conventional EMR. Some of them were designed to maximize the chance of en bloc resection-cap-assisted EMR, underwater EMR, tip-in EMR, precutting, assisted by ligation device-while others were designed to minimize the complications (cold EMR). In this review, we present their modes of action and summarize the evidence regarding their efficacy and safety.

Practices and hospitals are facing great challenges in coping with the COVID-19-pandemic. So far, data on the impact of the pandemic on gastroenterological facilities are lacking, especially on a temporal course. A database is lacking, especially for the outpatient care sector. University Hospital of Augsburg was commissioned to generate data on this as a part of the collaborative project B-FAST of the Network of University Medicine (NUM).Gastroenterological institutions nationwide were surveyed by an online questionnaire. Recruitment was carried out via the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) and the Professional Association of Gastroenterologists in Private Practice (bng). This manuscript provides an overview of data on the use of protective equipment, pre-interventional testing of patients, staff screening and economic impact over the course of the pandemic.429 facilities answered the questionnaire. Practices tested their patients pre-interventionally significantly less often than clinics (7.8% vs. 82.6%). In clinics, inpatients (93.1%) were tested significantly more often than outpatients (72.2%). The use of personal protective equipment (PPE) increased significantly during the pandemic. It was shown that over 70% of facilities screened their staff for SARS-CoV-2 without cause. Clinics cancelled elective procedures significantly more often than practices in quarter 4/2020. Procedures and turnover decreased in 2020 compared to the previous year. However, fewer facilities were affected by a loss of revenue than expected in previous studies.Our data demonstrate the variable implementation of pre-interventional SARS-CoV-2 testing in outpatient and inpatient care. The use of adequate PPE and staff screening increased during the pandemic.In der Bewältigung der COVID-19-Pandemie stehen Praxen und Kliniken vor großen Herausforderungen. Zu den Auswirkungen der Pandemie auf gastroenterologische Einrichtungen, insbesondere über einen zeitlichen Verlauf, gibt es bislang kaum Daten. Besonders für den ambulanten Versorgungssektor fehlt eine Datenbasis. Das Universitätsklinikum Augsburg wurde im Rahmen des Verbundprojektes B-FAST des Nationalen Forschungsnetzwerks der Universitätsmedizin beauftragt hierzu Daten zu generieren.Es wurden bundesweit mittels Onlinefragebogen gastroenterologische Einrichtungen befragt. Die Rekrutierung erfolgte über die Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und den Berufsverband niedergelassener Gastroenterologen (bng). Das vorliegende Manuskript gibt einen Überblick über Daten zur Verwendung von Schutzausrüstung, präinterventioneller Testung von Patienten, Mitarbeiterscreenings sowie wirtschaftlichen Auswirkungen über den Pandemieverlauf.429 Einrichtungen beantworteten den Fragebogen. Praxen testeten ihre Patienten präinterventionell signifikant seltener als Kliniken (7,8 % vs. 82,6 %). In Kliniken wurden stationäre Patienten (93,1 %) signifikant häufiger getestet als ambulante Patienten (72,2 %). Die Verwendung von persönlicher Schutzausrüstung (PSA) nahm im Verlauf der Pandemie signifikant zu. Es konnte gezeigt werden, dass über 70 % der Einrichtungen ihre Mitarbeiter nicht-anlassbezogen auf SARS-CoV-2 screenten. Kliniken sagten im Quartal 4/2020 signifikant häufiger elektive Prozeduren ab als Praxen. Die durchgeführten Prozeduren und die Umsatzentwicklung nahmen 2020 im Vergleich zum Vorjahr ab. Jedoch waren weniger Einrichtungen von einem Umsatzverlust betroffen als in vorangegangenen Studien erwartet wurde.Unserer Daten veranschaulichen die unterschiedliche Umsetzung präinterventioneller SARS-CoV-2 Testung in der ambulanten und stationären Patientenversorgung. Die Verwendung adäquater PSA und Mitarbeiterscreeningmaßnahmen konnten im Verlauf der Pandemie gesteigert werden.

ObjectiveHealthcare workers (HCW) are at high risk of SARS-CoV-2 infection due to exposure to potentially infectious material, especially during aerosol-generating procedures (AGP). We aimed to investigate the prevalence of infection among HCW in medical disciplines with AGP.DesignA nationwide questionnaire-based study in in- and outpatient settings was conducted between 12/16/2020 and 01/24/2021. Data on SARS-CoV-2 infections among HCW and potential risk factors were investigated.Results2,070 healthcare facilities with 25,113 employees were included in the study. Despite a higher rate of pre-interventional testing, clinics treated three times more confirmed SARS-CoV-2 cases than private practices (28.8% vs. 88.4%, pConclusionHCW in GIE seem to be at higher risk of infection than those in other AGP, especially in the clinical setting. Regions having comparably higher incidences as well as the number of procedures performed per day were also significantly associated with increased risk of infection.Significance of this studyWhat is already known on this subject?Health care workers, especially those exposed to aerosol generating procedures, are assumed to have an increased risk of SARS-CoV-2 infection. However, data confirming this are lacking, especially for the outpatient care setting.What are the new findings?Health care workers in gastrointestinal endoscopy have a higher risk of SARS-CoV-2-infection than in other AGPs. This risk is particularly higher-in clinical settings compared to private practices-in regions having comparably higher incidences-the more procedures are performed per dayHow might it impact on clinical practice in the foreseeable future?Our study suggests making additional efforts to protect HCW in the gastrointestinal work field.

Zusammenfassung Hintergrund In der Bewältigung der COVID-19-Pandemie stehen Praxen und Kliniken vor großen Herausforderungen. Zu den Auswirkungen der Pandemie auf gastroenterologische Einrichtungen, insbesondere über einen zeitlichen Verlauf, gibt es bislang kaum Daten. Besonders für den ambulanten Versorgungssektor fehlt eine Datenbasis. Das Universitätsklinikum Augsburg wurde im Rahmen des Verbundprojektes B-FAST des Nationalen Forschungsnetzwerks der Universitätsmedizin beauftragt hierzu Daten zu generieren. Methode Es wurden bundesweit mittels Onlinefragebogen gastroenterologische Einrichtungen befragt. Die Rekrutierung erfolgte über die Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und den Berufsverband niedergelassener Gastroenterologen (bng). Das vorliegende Manuskript gibt einen Überblick über Daten zur Verwendung von Schutzausrüstung, präinterventioneller Testung von Patienten, Mitarbeiterscreenings sowie wirtschaftlichen Auswirkungen über den Pandemieverlauf. Ergebnisse 429 Einrichtungen beantworteten den Fragebogen. Praxen testeten ihre Patienten präinterventionell signifikant seltener als Kliniken (7,8 % vs. 82,6 %). In Kliniken wurden stationäre Patienten (93,1 %) signifikant häufiger getestet als ambulante Patienten (72,2 %). Die Verwendung von persönlicher Schutzausrüstung (PSA) nahm im Verlauf der Pandemie signifikant zu. Es konnte gezeigt werden, dass über 70 % der Einrichtungen ihre Mitarbeiter nicht-anlassbezogen auf SARS-CoV-2 screenten. Kliniken sagten im Quartal 4/2020 signifikant häufiger elektive Prozeduren ab als Praxen. Die durchgeführten Prozeduren und die Umsatzentwicklung nahmen 2020 im Vergleich zum Vorjahr ab. Jedoch waren weniger Einrichtungen von einem Umsatzverlust betroffen als in vorangegangenen Studien erwartet wurde. Schlussfolgerung Unserer Daten veranschaulichen die unterschiedliche Umsetzung präinterventioneller SARS-CoV-2 Testung in der ambulanten und stationären Patientenversorgung. Die Verwendung adäquater PSA und Mitarbeiterscreeningmaßnahmen konnten im Verlauf der Pandemie gesteigert werden.

ObjectiveArtificial intelligence (AI) may reduce underdiagnosed or overlooked upper GI (UGI) neoplastic and preneoplastic conditions, due to subtle appearance and low disease prevalence. Only disease-specific AI performances have been reported, generating uncertainty on its clinical value.DesignWe searched PubMed, Embase and Scopus until July 2020, for studies on the diagnostic performance of AI in detection and characterisation of UGI lesions. Primary outcomes were pooled diagnostic accuracy, sensitivity and specificity of AI. Secondary outcomes were pooled positive (PPV) and negative (NPV) predictive values. We calculated pooled proportion rates (%), designed summary receiving operating characteristic curves with respective area under the curves (AUCs) and performed metaregression and sensitivity analysis.ResultsOverall, 19 studies on detection of oesophageal squamous cell neoplasia (ESCN) or Barrett's esophagus-related neoplasia (BERN) or gastric adenocarcinoma (GCA) were included with 218, 445, 453 patients and 7976, 2340, 13 562 images, respectively. AI-sensitivity/specificity/PPV/NPV/positive likelihood ratio/negative likelihood ratio for UGI neoplasia detection were 90% (CI 85% to 94%)/89% (CI 85% to 92%)/87% (CI 83% to 91%)/91% (CI 87% to 94%)/8.2 (CI 5.7 to 11.7)/0.111 (CI 0.071 to 0.175), respectively, with an overall AUC of 0.95 (CI 0.93 to 0.97). No difference in AI performance across ESCN, BERN and GCA was found, AUC being 0.94 (CI 0.52 to 0.99), 0.96 (CI 0.95 to 0.98), 0.93 (CI 0.83 to 0.99), respectively. Overall, study quality was low, with high risk of selection bias. No significant publication bias was found.ConclusionWe found a high overall AI accuracy for the diagnosis of any neoplastic lesion of the UGI tract that was independent of the underlying condition. This may be expected to substantially reduce the miss rate of precancerous lesions and early cancer when implemented in clinical practice.

Main RecommendationThere is a need for well-organized comprehensive strategies to achieve good training in ESD. In this context, the European Society of Gastrointestinal Endoscopy (ESGE) have developed a European core curriculum for ESD practice across Europe with the aim of high quality ESD training.Advanced endoscopy diagnostic practice is advised before initiating ESD training. Proficiency in endoscopic mucosal resection (EMR) and adverse event management is recommended before starting ESD trainingESGE discourages the starting of initial ESD training in humans. Practice on animal and/or ex vivo models is useful to gain the basic ESD skills. ESGE recommends performing at least 20 ESD procedures in these models before human practice, with the goal of at least eight en bloc complete resections in the last 10 training cases, with no perforation. ESGE recommends observation of experts performing ESD in tertiary referral centers. Performance of ESD in humans should start on carefully selected lesions, ideally small ( Endoscopists performing ESD should be able to correctly estimate the probability of performing a curative resection based on the characteristics of the lesion and should know the benefit/risk relationship of ESD when compared with other therapeutic alternatives. Endoscopists performing ESD should know how to interpret the histopathology findings of the ESD specimen, namely the criteria for low risk resection (“curative”), local risk resection, and high risk resection (“non-curative”), as well as their implications. ESD should be performed only in a setting where early and delayed complications can be managed adequately, namely with the possibility of admitting patients to a ward, and access to appropriate emergency surgical teams for the organ being treated with ESD.

Artificial intelligence (AI) tools increase detection of precancerous polyps during colonoscopy and might contribute to long-term colorectal cancer prevention. The aim of the study was to investigate the incremental effect of the implementation of AI detection tools in screening colonoscopy on colorectal cancer incidence and mortality, and the cost-effectiveness of such tools.We conducted Markov model microsimulation of using colonoscopy with and without AI for colorectal cancer screening for individuals at average risk (no personal or family history of colorectal cancer, adenomas, inflammatory bowel disease, or hereditary colorectal cancer syndrome). We ran the microsimulation in a hypothetical cohort of 100 000 individuals in the USA aged 50-100 years. The primary analysis investigated screening colonoscopy with versus without AI every 10 years starting at age 50 years and finishing at age 80 years, with follow-up until age 100 years, assuming 60% screening population uptake. In secondary analyses, we modelled once-in-life screening colonoscopy at age 65 years in adults aged 50-79 years at average risk for colorectal cancer. Post-polypectomy surveillance followed the simplified current guideline. Costs of AI tools and cost for downstream treatment of screening detected disease were estimated with 3% annual discount rates. The main outcome measures included the incremental effect of AI-assisted colonoscopy versus standard (no-AI) colonoscopy on colorectal cancer incidence and mortality, and cost-effectiveness of screening projected for the average risk screening US population.In the primary analyses, compared with no screening, the relative reduction of colorectal cancer incidence with screening colonoscopy without AI tools was 44·2% and with screening colonoscopy with AI tools was 48·9% (4·8% incremental gain). Compared with no screening, the relative reduction in colorectal cancer mortality with screening colonoscopy with no AI was 48·7% and with screening colonoscopy with AI was 52·3% (3·6% incremental gain). AI detection tools decreased the discounted costs per screened individual from $3400 to $3343 (a saving of $57 per individual). Results were similar in the secondary analyses modelling once-in-life colonoscopy. At the US population level, the implementation of AI detection during screening colonoscopy resulted in yearly additional prevention of 7194 colorectal cancer cases and 2089 related deaths, and a yearly saving of US$290 million.Our findings suggest that implementation of AI detection tools in screening colonoscopy is a cost-saving strategy to further prevent colorectal cancer incidence and mortality.European Commission and Japan Society of Promotion of Science.

Objectives Esophagitis dissecans superficialis (EDS) is a desquamative disorder of the superficial esophageal epithelium with variable clinical characteristics. Endoscopically there is an appearance of superficial peeling of sheets of epithelium. Histologically there is two-toned epithelium with coagulative necrosis of the superficial epithelium. Currently, there is paucity of data regarding this condition in children. Methods A ten-year retrospective search of the pathology information system was performed for cases with a pathologic diagnosis of EDS in a tertiary care pediatric center. Demographic data, clinical history, endoscopic findings and histopathologic reports were reviewed. Results Thirteen patients (nine female; ages 3-18 years), were identified with histologic findings of EDS. Esophageal food impaction, dysphagia, vomiting, and abdominal pain were the most common presenting symptoms. Sixty-nine percentage of the patients had underlying comorbidities and 76% were on at least one medication chronically. Eosinophilic esophagitis (23%), inflammatory bowel disease (23%) and gastro-esophageal reflux disease (15%) were the most common associated diagnoses. Of the 13 patients, five had repeat endoscopies showing complete resolution of EDS with no complications. Conclusions EDS is an under-recognized entity that endoscopists should be familiar with. In our series, the most prevalent associations were with food impaction and eosinophilic esophagitis. Contact injury and/or inflammation may precede the development of EDS. Pediatric EDS appears to be an incidental finding without significant morbidity or mortality.