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Abstract Background and Aim Obtaining endoscopic biopsies from the ampulla of Vater is important for the diagnosis of lesions that are suspicious for neoplasia. The clinical safety profile is not well defined in the literature. Our aim was to evaluate the procedure‐related readmission rate and complications from ampullary biopsy in patients undergoing duodenoscopy and endoscopic retrograde cholangiopancreatography (ERCP). Methods A retrospective data analysis was performed on adult patients at Austin Hospital who underwent ampullary biopsies between 1 January 2010 and 1 March 12022. Medical records were identified using pathology databases. The electronic health record was reviewed for baseline characteristics including demographics, date, indication for ampullary biopsy, procedure type (duodenoscopy or ERCP), and procedural associated interventions during ERCP. Readmissions to the Austin Emergency Department within 30 days following the biopsy were identified, and complications were noted. Results A total of 506 records were reviewed and 246 episodes of ampullary biopsy met the inclusion criteria. The procedure‐related readmission rate for all episodes was 6.1%, which included pain (3.3%), pancreatitis (2.0%), cholangitis (1.6%), and bleeding (0.8%). Ampullary biopsies with ERCP had a procedure‐related readmission rate of 8.4%, whereas ampullary biopsies without ERCP had a rate of 2.2%. Increased readmissions and complications were associated with male sex (P = 0.01 and P = 0.05, respectively). There was no association between the number of biopsies taken and complications. Conclusion Performing an ampullary biopsy without an associated ERCP carries a low rate of clinical complications and procedure‐related readmissions. The combination of ERCP and ampullary biopsy increases the risk four‐fold.

Background and Aim: Obtaining endoscopic biopsies from the ampulla of Vater is important for the diagnosis of lesions that are suspicious for neoplasia. The clinical safety profile is not well defined in the literature. Our aim was to evaluate the procedure‐related readmission rate and complications from ampullary biopsy in patients undergoing duodenoscopy and endoscopic retrograde cholangiopancreatography (ERCP). Methods: A retrospective data analysis was performed on adult patients at Austin Hospital who underwent ampullary biopsies between 1 January 2010 and 1 March 12022. Medical records were identified using pathology databases. The electronic health record was reviewed for baseline characteristics including demographics, date, indication for ampullary biopsy, procedure type (duodenoscopy or ERCP), and procedural associated interventions during ERCP. Readmissions to the Austin Emergency Department within 30 days following the biopsy were identified, and complications were noted. Results: A total of 506 records were reviewed and 246 episodes of ampullary biopsy met the inclusion criteria. The procedure‐related readmission rate for all episodes was 6.1%, which included pain (3.3%), pancreatitis (2.0%), cholangitis (1.6%), and bleeding (0.8%). Ampullary biopsies with ERCP had a procedure‐related readmission rate of 8.4%, whereas ampullary biopsies without ERCP had a rate of 2.2%. Increased readmissions and complications were associated with male sex (P = 0.01 and P = 0.05, respectively). There was no association between the number of biopsies taken and complications. Conclusion: Performing an ampullary biopsy without an associated ERCP carries a low rate of clinical complications and procedure‐related readmissions. The combination of ERCP and ampullary biopsy increases the risk four‐fold. [ABSTRACT FROM AUTHOR]

Background and Objective: Bezoar is a mass or indigestible substance that accumulates in the gastrointestinal tract, especially in the stomach. The formation of gastric bezoars (especially phytobezoars) is rare in children; however, when they are formed, they present a therapeutic challenge due to their hard composition and consistency as well as their large size. Case Report: A 7-year-old boy with an abdominal mass was investigated in this case report. The patient had eaten a lot of persimmons and pomegranates in the past. Gastroduodenoscopy revealed a large phytobezoar in the stomach, which was removed and treated using a gastroduodenoscope. Conclusion: The gastroduodenoscopic technique is cost-effective in the treatment of gastrointestinal bezoars and has fewer complications for the patient than the surgery. [ABSTRACT FROM AUTHOR]

Aim: The treatment approach, long-term consequences and surveillance protocols of duodenogastric reflux disease (DGRD) are not well established in the pediatric population. The aim of this study was to evaluate the histopathological and clinical responses to treatment with Ursodeoxicolic Acid (UDCA) and Sucralfate in children diagnosed with DGRD. Material and Methods: This is a retrospective pre-post design study performed with children admitted to our clinic with reflux symptoms and diagnosed with duodenogastric reflux disease according to endoscopic and histopathologic evaluation. Patients were treated with Sucralfate 60mg/kg/day orally and UDCA at 10 mg/kg/day orally, for 6 months. We compared symptoms/findings, presence of Helicobacter pylori and histopathologic grade of disease before and after treatment. Results: The presence of all symptoms statistically significantly decreased after treatment. The presence of Helicobacter pylori decreased from 43.8% to 21.9%. There was also statistically significantly histopathologic improvement after six-month treatment of Sucrafate and UDCA. Conclusion: Six-month treatment of Sucralfate and UDCA provided valuable improvements in clinical and histopathologic features in pediatric patients with DGRD. [ABSTRACT FROM AUTHOR]

The ingestion of caustic substances remains a serious medical problem in Tunisian children. This study was conducted to describe the epidemiological, clinical, and endoscopic findings of caustic ingestion in Tunisian children, and to indentify predictive factors of severe esophageal and gastric injuries. A retrospective review of all children referred to a tertiary pediatric center for caustic ingestion who underwent esophago-gastro-duodenoscopy was conducted. Severe esophageal and gastric injuries were defined as Grade 2b, 3a, 3b, and 4 using the Zargar classification. We conducted multivariate logistic regression analysis to identify predictive factors for severe esophageal and gastric caustic injuries. We analyzed 1059 diagnostic procedures performed for caustic ingestion. The mean age was 41.4± 31.9 months. The most frequently ingested caustic substance was household bleach followed by caustic soda granules. Endoscopy showed severe esophageal and gastric lesions, respectively, in 122 (11.5%) and 56 (5.3%) cases. Predictive factors of severe esophageal injuries were: alkaline ingestion (p <0.001; OR: 17.9; 95% CI: 8.4–38.1) and the presence of symptoms after caustic ingestion (p =0.02; OR: 2.4; 95% CI: 1.1–5.4). The occurrence of complications was significantly associated with the presence of severe gastric lesions at the initial procedure (p =0.046; OR: 2.3;95% CI: 0.9–.3). Esophago-gastro-duodenoscopy should always be performed for symptomatic children, asymptomatic children who have ingested an alkaline product, and asymptomatic children under the age of 6 years. [ABSTRACT FROM AUTHOR]

Background: Management of ampullary tumors (AT) is challenging because of a low level of scientific evidence. This document is a summary of the French intergroup guidelines regarding the management of AT, either adenoma (AA) or carcinoma (AC), published in July 2023, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org)., Methods: A collaborative work was conducted under the auspices of French medical, endoscopic, oncological and surgical societies involved in the management of AT. Recommendations are based on recent literature review and expert opinions and graded in three categories (A, B, C), according to quality of evidence., Results: Accurate diagnosis of AT requires at least duodenoscopy and EUS. All patients should be discussed in multidisciplinary tumor board before treatment. Surveillance may only be proposed for small AA in familial adenomatous polyposis. For AA, endoscopic papillectomy is the preferred option only if R0 resection can be achieved. When not possible, surgical papillectomy should be considered. For AC beyond pT1a N0, pancreaticoduodenectomy is the procedure of choice. Adjuvant monochemotherapy (gemcitabine, 5FU) may be proposed. For aggressive tumors (pT3/T4, pN+, R1, poorly differentiated AC, pancreatobiliary differentiation) with high risk of recurrence, 6 months polychemotherapy (CAPOX/FOLFOX for the intestinal subtype and mFOLFIRINOX for the pancreatobiliary or the mixed subtype) may be a valid alternative. Clinical and radiological follow up is recommended for 5 years., Conclusions: These guidelines help to homogenize and highlight unmet needs in the management of AA and AC. Each individual case should be discussed by a multidisciplinary team., Competing Interests: Conflict of interest VH: AAA, Amgen, Esteve, Ipsen, Deciphera, Merck, Pierre Fabre, Servier AT: personal fees from Servier, Viatris, Incyte Bioscience, BMS, Merck and grants from AstraZeneca and MSD outside the submitted work MC: Medtronic, Boston Scientific, Cook Medical, AMBU CN: Honoraria / consulting: Amgen, AstraZeneca, Baxter, Bristol-Myers Squibb, Fresenius Kabi, Incyte Biosciences, Merck, MSD, Mundipharma, Novartis, Nutricia, OSE Immunotherapeutics, Pierre Fabre, Roche, Sanofi, Servier, Viatris. Research funding / clinical trials: AstraZeneca, Bristol-Myers Squibb, Fresenius Kabi, Nutricia, OSE Immunotherapeutics, Roche, Servier, Viatris. ALB declares consulting for Astra Zeneca , Servier, Ipsen and accomodations or congress registration support for Merck and Ipsen DS: Honoraria / consulting: Amgen, Bayer, Deciphera Pharmaceutical, Ipsen, Pierre fabre, Roche, Servier, Viatris, Travel accomodations: AstraZeneca, Ipsen, Novartis, Pfizer, Pierre Fabre, Roche, Sandoz, Servier GP: honoraria from Servier, Roche and Sanofi OB: honoraria from Amgen, Apmonia Therapeutics, Bayer, Deciphera, Merck KGaA, MSD, Pierre Fabre, Servier. SG: Mylan, IPSEN All other authors declare no conflict of interest related to this article., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: An association between specific endoscopic findings and high-grade dysplasia/carcinoma in superficial nonampullary duodenal epithelial tumors ≤ 5 mm in size has not been reported. We sought to identify the endoscopic findings associated with high-grade dysplasia/carcinoma in patients with superficial nonampullary duodenal epithelial tumors ≤ 5 mm.Methods: We retrospectively assessed the data of 84 patients (88 lesions; low-grade dysplasia: n = 35, high-grade dysplasia/carcinoma: n = 53) with superficial nonampullary duodenal epithelial tumors who underwent initial treatment at a single center (from July 2009 to April 2021). All the patients had lesions sized ≤ 5 mm. We assumed that the endoscopic findings were independently associated with high-grade dysplasia/carcinoma and determined the accuracy, sensitivity, and specificity of a combination of independent factors for diagnosing high-grade dysplasia/carcinoma and low-grade dysplasia.Results: Multivariate logistic regression of significant factors in the univariate analysis revealed that lesions with depressed morphology (odds ratio: 23.9, 95% confidence interval: 2.8-204.2; p = 0.0037) and a reddish color (odds ratio: 175.7, 95% confidence interval: 11.4-2697.1; p = 0.0002) were independently associated with high-grade dysplasia/carcinoma. McNemar's test revealed that combining the macroscopic type and color provided significantly higher sensitivity for diagnosing high-grade dysplasia/carcinoma than color alone (98.1%, 95% confidence interval: 90.1-99.7 vs. 71.7%, 95% confidence interval: 58.4-82.0; p = 0.0002).Conclusions: Reddish and depressed-type lesions before treatment were associated with high-grade dysplasia/carcinoma. Combining the macroscopic type and color can help detect high-grade dysplasia/carcinoma. These findings could help clinicians determine the best therapeutic strategy for patients with smaller (≤ 5 mm) superficial nonampullary duodenal epithelial tumors in clinical settings. [ABSTRACT FROM AUTHOR]

Objective To explore the value of triple mirror combination technique in patients with dilated choledocholithiasis. Methods A retrospective analysis of 81 patients with dilated common bile duct stones （common bile duct diameter 0.8cm） were admitted to the Second Affiliated Hospital of Kunming Medical University from December 2019 to October 2021.Depending on the surgical method, patients were divided into three-mirror group group A （n = 40）, sequential laparoscopic cholecystectomy LC + laparoscopic-choledotoscopy combined exploration lithotomy LCBDE + endoscopic nasal bile duct drainage ENBD + primary common biliary suture PS.Double-mirror Group B （n = 41）, sequential rows of LC + LCBDE + PS. The observation indexes included preoperative indexes （stone size, total bile duct diameter）, intraoperative indexes （bleeding amount, operation time） and postoperative indexes （near-term complication rate, residual stone rate） and statistical treatment. Results Both groups of preoperative indicators, and the intraoperative indicators had no statistically significant differences. Operation time and bleeding volume were better in group B than in group A. Postoperative residual rate had no significant difference between the two groups. In terms of recent complications, the incidence of bile leakage in group A was lower than that in group B, and the long-term complications were relatively insignificant. Conclusions Application of triple oscopy combined primary suture in patients with cholangiogenic cholelithiasis can reduce the incidence of bile leakage in the first-phase bile duct suture technique, reduce the pain of patients, improve the patient compliance, and does not increase the incidence of complications and tube wearing time. It is worthy of clinical promotion and use. [ABSTRACT FROM AUTHOR]

A 44-year-old woman presented with right upper abdominal pain and nausea with a 4-day duration. An abdominopelvic CT scan revealed a 2.3-cm sized cystic lesion in the duodenum with inflammatory changes and partial thrombosis in the distal main portal vein. Empirical antibiotics were initiated considering acute duodenal diverticulitis, but the symptoms worsened. Side-viewing duodenoscopy revealed purulent fluid draining spontaneously from a small diverticular opening. After enlarging the opening using an extraction balloon, sweeping followed by saline irrigation was performed, and pus and food debris gushed out into the duodenal lumen. The patient recovered rapidly and was discharged uneventfully on the 5th day post-hospitalization with oral antibiotics and warfarin. A follow-up CT scan and duodenoscopy 1 month later revealed a normal-appearing duodenal diverticulum and complete resolution of the portal vein thrombosis. This paper reports a rare case of portal vein thrombosis associated with duodenal diverticulitis. Overall, endoscopic therapy can be effective when conservative management fails and might be a viable alternative to surgery for treating duodenal diverticulitis.

BackgroundUndifferentiated pleomorphic sarcoma (UPS) is a malignant tumor that originates in the mesenchymal tissue and is common in the extremities and retroperitoneum. Primary UPS of the duodenal papilla is rare and a distinct clinical entity.Case presentationIn this report, a 48-year-old Chinese man was admitted to our hospital with symptoms of melena. The patient underwent choledochectomy and choledochaljejunostomy for obstructive jaundice 8 years before admission. Endoscopic examination after admission confirmed a mass located at the duodenal papilla. Then, the duodenal papilla and tumor resection were performed, and the histopathology report confirmed the diagnosis of UPS. The patient refused further treatment and died 2 months later due to local recurrence and intrahepatic metastasis.ConclusionsIt is rare that the mass in the duodenal papilla is diagnosed as UPS. The unpredicted behavior of these tumors warrants a careful plan considering their indolent nature and possible recurrence and metastasis. The prognosis was poor despite the early complete resection.

Over 17.7 million gastrointestinal (GI) endoscopic procedures are performed annually, contributing to 68% of all endoscopic procedures in the United States. Usually, endoscopic procedures are low risk, but adverse events may occur, including cardiopulmonary complications, bleeding, perforation, pancreatitis, cholangitis, and infection. Infections after the GI endoscopies most commonly result from the patient's endogenous gut flora. Although many studies have reported infection after GI endoscopic procedures, a true estimate of the incidence rate of post-endoscopy infection is lacking. In addition, the infection profile and causative organisms have evolved over time. In recent times, multi-drug-resistant microorganisms have emerged as a cause of outbreaks of endoscope-associated infections (EAI). In addition, lapses in endoscope reprocessing have been reported, with some but not all outbreaks in recent times. This systematic review summarizes the demographical, clinical, and management data of EAI events reported in the literature. A total of 117 articles were included in the systematic review, with the majority reported from North America and Western Europe. The composite infection rate was calculated to be 0.2% following GI endoscopic procedures, 0.8% following ERCP, 0.123% following non-ERCP upper GI endoscopic procedures, and 0.073% following lower GI endoscopic procedures. Pseudomonas aeruginosa was the most common culprit organism, followed by other Enterobacteriaceae groups of organisms and Gram-positive cocci. We have also elaborated different prevention methods such as antimicrobial prophylaxis, adequate sterilization methods for reprocessing endoscopes, periodic surveillance, and current evidence supporting their utilization. Finally, we discuss disposable endoscopes, which could be an alternative to reprocessing to minimize the chances of EAIs with their effects on the environmental and financial situation. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical efficacy and safety of Chaihu Paishi Decoction through bile duct perfusion combined with duodenoscopy in the treatment of difficult choledocholithiasis. Methods A prospective randomized controlled study was carried out on the patients with difficult choledocholithiasis admitted in our department from August 2018 to January 2020. They were randomly divided into an experimental group and a control group, with 30 cases in each group. In the experimental group, 20~50 mL Chaihu Paishi Decoction was injected into the nasobiliary duct under the guidance of duodenoscopy, and the end of the duct was clamped for 2 h. The above treatment was given 3 times per day, for 10 d. The control group was treated with normal saline in the same way. The stone dissolution, lysis rate and stone remove were observed to evaluate the efficiency. On the 10th day, ultrasound examination was performed, and duodenoscopy was carried out. Results The stone dissolution and lysis rates were significantly higher in the experimental group than those in the control group (P < 0.01). The experimental group had obviously shorter operation time and less blood loss (P < 0.01) and notably higher one-shot stone removal rate (P < 0.05) when compared with the control group. The experimental group did not differ from the other group in the incidence of postoperative acute pancreatitis. Conclusion Chaihu Paishi Decoction through bile duct perfusion combined with duodenoscopy is safe and effective in the treatment of difficult common bile duct stones, which provides a new basis for the treatment in combination with traditional Chinese and Western medicine.

The aim. Improving the algorithm for diagnosing patients with post cholecystectomy syndrome (PCS), taking into account functional and organic changes in the major duodenal papilla (MDP). Materials and methods. 208 patients with PCS were examined. Laparoscopic cholecystectomy (CE) was performed in 172 patients in history, open CE was performed in 36 patients. 47 patients had obstructive jaundice, 84 had signs of biliary hypertension without an increase in bilirubin, 77 had no signs of biliary hypertension and an increase in bilirubin. The following instrumental research methods were used: abdominal organs ultrasound examination (AO USE), duodenoscopy, endoscopic retrograde cholangiopancreatography (ERCP), computed tomography (CT). In the main group, to study the morphofunctional changes in MDP, duodenoscopy with parietal impedancemetry, ultrasound of the hepatobiliary zone with a choleretic load were used. Results. In the main group, 34 patients underwent ultrasound of the hepatobiliary zone and Vater’s nipple area with a choleretic breakfast according to Boyden according to the method of Grigoriev P.Ya. in our modification, 21 patients had an expansion of the choledochus by 2 mm. At the same time, taking meverin led to a decrease in the diameter of the choledochus, which indicated functional changes in the MDP. In 13 patients, the expansion of the choledochus, observed when taking a choleretic breakfast, persisted with the use of antispasmodics, which indicated the presence of an organic pathology of MDP. Duodenoscopy with impedancemetry was performed in 41 patients: 20 patients had 760–820 Ohm, which indicated the presence of functional changes, 12 patients had inflammatory changes in the MDP and 703–760 Ohm were detected, 9 patients with cicatricial fibrous changes had indicators impedance measurement 640–703 Ohm. The use of ultrasound with a choleretic breakfast and duodenoscopy with parietal impedancemetry in patients of the main group made it possible to identify functional and organic (inflammatory, fibrous) changes in the MDP, which made it possible to develop a therapeutic algorithm using both conservative therapy and the use of various options for transpapillary endoscopic interventions. Conclusions. Conducting an in-depth diagnosis of morpho-functional changes in MDP using parietal impedancemetry of MDP and ultrasound of the hepatobiliary zone with choleretic load allows us to identify both functional and morphological changes in MDP, which makes it possible to develop a therapeutic algorithm using drug therapy and transpapillary endoscopic techniques. [ABSTRACT FROM AUTHOR]

Secondary aorto-enteric fistula (SAEF) is a rare life-threatening complication occurring in patients with previous infrarenal aortic prosthetic reconstruction. The main symptom is a gastrointestinal bleeding. Its diagnosis is challenging due to the lack of a specific clinical signs. The failure of early diagnosis and treatment of this entity can lead to fatal issue. Actually, the abdominal computed tomography angiogram represents the principal exploration to confirm the diagnosis, but it is associated with a moderate specificity and sensibility. Duodenoscopy can highlight the communication between the duodenum and the prosthetic graft, but it is often inconclusive. We report in this manuscript a case of secondary aorto-enteric fistula revealed by occult gastrointestinal bleeding in an elderly patient who is admitted for severe anemia. The SAEF diagnosis was suspected by the computed tomography scan and confirmed by the duodenoscopy showing an exceptional image of Dacron graft protruding in the third duodenum lumen. Unfortunately, the patient died from cataclysmic shock before intervention. We overview also the rare previous published case reports concerning the endoscopic images of secondary aortoenteric fistula and we contrast our findings with those reported in the literature.

Objective To investigate the clinical effect of laparoscopy, choledochoscopy, and duodenoscopy combined with T - tube - free drainage in the treatment of gallstones with common hile duct stones. Methods A retrospective analysis was performed for the clinical data of 564 patients with gallstones and common hile duct stones who were admitted to Department of General Surgery, Pudong New Area People' s Hospital, Shanghai University of Medicine & Health Sciences, from December 2017 to December 2019. According to the surgical procedure, the patients were divided into laparoscopic transcystic common bile duct exploration (LTCBDE) group with 191 patients, three endoscopies + laparoscopic common bile duct exploration and primary suture ( LBEPS ) group with 138 patients, and endoscopic retrograde cholangiopancreatography ( ERCP) + endoscopic sphincterotomy ( EST)/ endoscopic papillary balloon dilation ( EPBD) + laparoscopic cholecystectomy (LC) group with 235 patients. The three groups were analyzed in terms of the general data including sex, age, bile duct diameter, and stone size/ number, and surgical condition and complications were compared between groups. A one - way analysis of variance was used for comparison of normally distributed continuous data between groups, and the Kruskal - Wallis H test was used for comparison of non - normally distributed continuous data between groups; the chi - square test was used for comparison of categorical data between groups. Results There were significant differences between the LBEPS group, the ERCP + EST/ EPBD + LC group and the LTCBDE group in hospital costs, drainage volume, time to first flatus, length of hospital stay and time to extraction of drainage tube ( F = 416. 40, 7 . 80, 33. 99, 143. 70, and 13. 08, P <0. 001, P = 0. 020, P <0. 001, P <0. 001, and P <0. 001). Compared with the LBEPS group and ERCP + EST/EPBD + LC groups, the LTCBDE group had significantly lower hospital costs and a significantly longer time to first flatus, and significantly shorter length of hos)pital stay and time to extraction of drainage tube( all P <0. 05). No serious complication was observed after surgery, and there was no significant difference in the incidence rate of complications between the three groups ( P > 0. 05) . All patients were discharged successfully after surgery. Conclusion The three minimally invasive surgical procedures combined with T - tube - free drainage achieve the goal of little trauma and pain, fast postoperative recovery, and few serious complications, among which LTCBDE has the lowest treatment costs and the best postoperative recovery. [ABSTRACT FROM AUTHOR]

Brain abscess is a rare complication of esophagogastro- duodenoscopy (EGD) with few reported cases in the literature. In this report, we discuss a patient presenting with altered mental status, headache, and dysarthria due to brain abscess caused by S. intermedius shortly after an EGD with an esophageal biopsy showing a new diagnosis of eosinophilic esophagitis. We highlight the rare association of EGD and brain abscess, and discuss the importance of prompt diagnosis and treatment.

Background and Aim: Underwater endoscopic mucosal resection (UEMR) is effective for superficial non‐ampullary duodenal epithelial neoplasms (SNADEN). However, the incidence of residual lesion after UEMR, especially for large lesions (≥20 mm), and their prognosis remain unclear. We aimed to assess the incidence of residual lesions and further outcomes after UEMR for SNADEN. Methods: We carried out a retrospective study at a tertiary cancer institute. Candidates for the study were systematically retrieved from an endoscopic and pathological database from January 2013 to April 2018. Results: A total of 162 SNADEN resected with UEMR were analyzed. Median (range) procedure time was 5 (1–70) min. En bloc resection rates for large lesions (≥20 mm) and small lesions (<20 mm) were 14% and 79%, respectively. Intraprocedural bleeding occurred in one (0.6%) case, but no intraprocedural perforation occurred during the study. Delayed bleeding occurred in two (1.2%) cases and delayed perforation occurred in one (0.6%) case. A total of 157 (97%) lesions were followed up by at least one endoscopic examination. Of these lesions, residual lesions were recognized in seven cases (5%). Additional UEMR was carried out in five lesions and underwater cold snare polypectomy in one lesion. One lesion was observed without additional treatment. After salvage intervention, no cases experienced further residual lesions. Conclusion: Although UEMR for SNADEN can be relevant when other efficacious procedures are unavailable, careful follow up for residual lesions is required especially after piecemeal resection for large lesions. [ABSTRACT FROM AUTHOR]

Introduction: Gastro-oesophageal Reflux Disease (GORD) is a common disorder associated with significant impairment in quality of life. The effect of Helicobacter pylori (H pylori) eradication on GORD symptoms is not clear. Our aim was to determine whether eradication of H pylori is associated with decreased symptom response to GORD treatment. Methods: We recruited 45 consecutive patients presenting to our Tygerberg Hospital gastroenterology department with reflux symptoms and a GerdQ symptom score of 8 or more. Oesophagogastroduodenoscopy with gastric biopsies and a rapid urease test for H pylori was done. All patients were started on omeprazole 20 mg daily. After 4 weeks a second GerdQ questionnaire was administered and patients with H pylori were started on eradication therapy. After 6 weeks a third GerdQ questionnaire was administered. Four categories of outcome were created based on Antral and Corpus Helicobacter pylori result, whether positive or negative or both and associated risk factors were assessed using binary logistic regression. Results with p-values<0.05 were statistically significant. Results: Of the 45 patients evaluated, 73% (n=33) were H pylori positive and 27% (n=12) were negative. There were no statistically significant differences between the two groups (H. Pylori positive and H. Pylori negative) in gender distribution, smoking status, body mass index, waist-hip ratio or haemoglobin A1C levels. All except two patients were of mixed race. The H pylori negative group had a mean 1stGerdQ score of 12.41 compared to 11.45 (p-value 0.37) for the H pylori positive group. There were no statistical difference in the 2nd score (4.08 vs 4.47, p-value 0.316) or the 3rdGORDQ (3.67 vs 3.19, p-value 0.926) comparing the H pylori negative group and H pylori positive groups. Conclusions: Our results demonstrated that eradication of H pylori had no influence on response to proton pump inhibitors among GORD patients. Clinicians should eradicate H pylori if it is found in GORD patients and may prevent future H pylori complications. [ABSTRACT FROM AUTHOR]

A fundic gland polyp (FGP) is a common gastric polyp. Intraepithelial neoplasia in FGPs, referred to as FGP with dysplasia, is often seen in patients with familial adenomatous polyposis (FAP). In sporadic FGPs, low‐grade dysplasia (LGD) is rare, and high‐grade dysplasia (HGD) or carcinoma arising from sporadic FGPs is extremely rare. Because of this rarity, the prognosis and appropriate management of these lesions have not been clarified. In the present case, a sporadic FGP with LGD did not develop into invasive carcinoma, but contained foci of HGD 14 years after diagnosis. The biopsy specimen of the polyp taken at the first esophagogastroduodenoscopy 15 years earlier was diagnosed as FGP without dysplasia. At the second histological examination, LGD was found. Because the polyp increased in size during proton pump inhibitor therapy for 14 years, endoscopic mucosal resection was performed. The pathological diagnosis of the resected specimen was FGP with HGD mixed in LGD, with no invasive carcinoma. Dysplasia in FGPs might have less malignant potential regardless of dysplasia or size. [ABSTRACT FROM AUTHOR]

Aim. To determine celiac disease detection rate in patients with digestive disease. Subjects and methods. A total of 318 gastroenterological patients admitted to be treated at the Central Research Institute of Gastroenterology in September to October 2012 were examined. The patients’ age was 18 to 74 years (mean 51.5±16.4 years). Immunoglobulin A (IgA) and immunoglobulin G (IgG) anti-gliadin antibodies (AGA), IgA anti-tissue transglutaminase (anti-tTG) antibodies and IgG anti-tTG antibodies were determined. When the antibodies were elevated, esophagogastroduodenoscopy with duodenal biopsy was performed. Results. Forty-one of the 318 patients were found to have higher AGA (12.9%); out of them IgA AGA were in 17 (5.35%) patients and IgG AGA were also in 17 (5.35%). Elevated levels of both antibodies (IgA AGA and IgG AGA) were seen in 7 (2.2%) patients. Overall, the detection rate of increased AGA levels was 12.9%. The antibodies were more commonly higher in patients with liver diseases (21.8%) and in those with inflammatory bowel diseases (21.6%). Both IgA anti-tTG, IgG anti-tTG and IgA AGA, IgG AGA were detected in 6 (1.9%) of the 318 patients. The diagnosis of celiac disease was verified by duodenal histological examination in 3 (0.94%) of the 318 patients. Conclusion. The celiac disease detection rate in gastroenterological patients was 0.94%.

Background: Propofol is used to induce deep sedation or general anaesthesia for procedures in children. Adjuvants, such as ketamine, are routinely added to reduce the dose of propofol required and propofol-related adverse events. We conducted a randomised controlled trial to determine the effective bolus dose of propofol in combination with ketamine that induces adequate depth of anaesthesia in 50% of children (ED50) undergoing gastro-duodenoscopy.Methods: Children were randomised to one of four doses of ketamine: 0 (control), 0.25, 0.5, and 1 mg kg-1, followed by a dose of propofol according to Dixon's up-and-down methodology. Excessive movement, coughing, gagging, or airway obstruction that prevented endoscope insertion was considered a failure.Results: The ED50 of propofol (median, 95% CI) was greater in the ketamine 0, 0.25, and 0.5 mg kg-1 groups compared with the ketamine 1 mg kg-1 group (6.1, 4.1-8.1; 4.5, 2.9-6; 4.7, 3.1-6.2 mg kg-1vs 1.1, 0.5-1.8 mg kg-1, respectively, P<0.008). Total dose of propofol administered during the procedure was reduced with ketamine 1 mg kg-1. The mean arterial pressure was lower in the ketamine 0 mg kg-1 group compared with the 1 mg kg-1 group during and immediately after the procedure. The ketamine 1 mg kg-1 group experienced a higher incidence of nausea and visual disturbances.Conclusions: Ketamine at 0.5-1 mg kg-1 reduces the dose of propofol required to provide general anaesthesia for gastro-duodenoscopy in children and may reduce the incidence of propofol-related changes in haemodynamics.Clinical Trial Registration: NCT 02295553. [ABSTRACT FROM AUTHOR]

Carbapenemase-producing Klebsiella pneumoniae (OXA-48 CPE) were identified in five patients who underwent an endoscopy with the same duodenoscope in October 2015. The endoscope was the only epidemiological link between these cases. A transient contamination of the duodenoscope following a failure in the disinfection process may have been the cause of transmission. [ABSTRACT FROM AUTHOR]

Obstructive jaundice is a common manifestation of malignancies involving pancreaticobiliary area of the gastrointestinal tract. The palliation of obstructive jaundice involves bypassing the obstruction by an endoprosthesis using either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage route. Endoscopic ultrasound-guided choledochoduodenostomy (ECD) is a challenging alternative for obstructive jaundice due to distal bile duct obstruction in patients who have failed ERCP. In this report, we describe a challenging case of disseminated urinary bladder cancer that presented with extensive duodenal as well as periduodenal infiltration leading on to gastrointestinal bleed and severe pruritus along with obstructive jaundice and was successfully managed with initial argon plasma coagulation of bleeding duodenal lesions followed by ECD. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical effect of octreotide-assisted duodenoscopy on the acute edematous biliary pancreatitis. Method: 100 patients with acute edematous biliary pancreatitis were selected and randomly divided into the study group and the control group with 50 cases in each group. Both groups of patients were given fasting, anti infection, nutritional support, enzyme inhibitor therapy, the control group was treated with duodenal endoscopy and the study group was treated with octreotide-assisted duodenoscopy at the same time. The abdominal pain relief time, white blood cells (WBC), temperature recovery time, hemodlastase and urine amylase, changes of serum CRP, IL-6, TNF-αlevels before treatment (T0), on the 3rd day after treatment (T1), on the 7th day after treatment(T2) were compared between the two groups. Results: ① The relief time of abdominal pain, WBC, body temperature returned to normal time of study group were all significantly shorter than those of the control group (P<0.05). ②The hemodlastase and urine amylase level at T1, T2 of both groups of patients were significantly lower than those at T0 and hemodlastase and urine amylase level at T2 lower than T1 (P＜0.05). The hemodlastase and urine amylase levels of study group were lower than those of the control group at T1, T2(P＜0.05). ③ The serum CRP, IL-6, TNF-αlevels in both groups at T1, T2 were significantly lower than at T0 with and T2 lower than T1 (P＜0.05), the serum CRP, IL-6, TNF-α levels of study group were lower than those of the control group at T1, T2 (P＜0.05). Conclusion: Octreotide- assisted duodenoscopy could effectively enhance the early clinical efficacy and relieve the inflammatory response of acute edematous biliary pancreatitis patients. [ABSTRACT FROM AUTHOR]

Cholelithiasis is a kind of common and multiple diseases. In recent years, traditional laparotomy has been challenged by a minimally invasive surgery. Through literature review, the therapeutic method, effect, and complications of minimally invasive treatment of intrahepatic and extrahepatic bile duct stones by combining our practical experience were summarized as follows. (1) For intrahepatic bile duct stones, the operation may be selected by laparoscopic liver resection, laparoscopic common bile duct exploration (LCBDE), or percutaneous transhepatic cholangioscopy. (2) For concomitant gallstones and common bile duct stones, the surgical approach can be selected as follows: laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilatation, LC plus laparoscopic transcystic common bile duct exploration, LC plus LCBDE, and T-tube drainage or primary suture. (3) For concomitant intrahepatic and extrahepatic bile duct stones, laparoscopic liver resection, choledochoscopy through the hepatic duct orifice on the hepatectomy cross section, LCBDE, EST, and percutaneous transhepatic cholangioscopic lithotripsy could be used. According to the abovementioned principle, the minimally invasive treatment approach combined with the surgical technique and equipment condition will be significant in improving the therapeutic effect and avoiding the postoperative complications or hidden dangers of intrahepatic and extrahepatic bile duct stones. [ABSTRACT FROM AUTHOR]

We aimed to assess the frequency of celiac disease (CD) in patients with Familial Mediterranean Fever (FMF). This prospective study was carried out from October 2015 to March 2016 and included 303 patients with FMF. We used 98 sex- and age-matched healthy subjects as a control group. Levels of total IgA and tissue transglutaminase (tTG) IgA antibody were measured in all groups. Those with increased level of tTG IgA were tested for anti-endomysium IgA antibodies (EMA). Patients with positive EMA underwent gastro-duodenoscopy and intestinal biopsy for a definite diagnosis of CD. Only 9 of 303 patients (2.9%) were positive for tTG IgA. Patients positive for tTG IgA were then tested for EMA and only one of them (0.3%) had a positive result. This patient underwent gastro-duodenoscopy. The pathological report was compatible with Marsh 0 classification score for the diagnosis of CD. Two subjects from the control group were positive for tTG IgA but none of them had positive EMA antibodies. We did not find CD in the large cohort of childhood FMF patients. The prevalence of CD did not show association with presence of childhood FMF in this study and CD would not be a considerable complication of childhood FMF. [ABSTRACT FROM AUTHOR]

There is a lack of non-invasive screening modalities to diagnose chronic atrophic gastritis (CAG) and intestinal metaplasia (IM). Thus, the aim of the present study was to determine the sensitivity and specificity of serum pepsinogen I (PGI), PGI:II, the PGI:II ratio and gastrin-17 (G-17) in diagnosing CAG and IM, and the correlations between these serum biomarkers and pre-malignant gastric lesions. A cross-sectional study of 72 patients (82% of the calculated sample size) who underwent oesophageal-gastro-duodenoscopy for dyspepsia was performed in the present study. The mean age of the participants was 56.2±16.2 years. Serum PGI:I, PGI:II, G-17 and Helicobacter pylori antibody levels were measured by enzyme-linked immunosorbent assay. Median levels of PGI:I, PGI:II, the PGI:II ratio and G-17 for were 129.9 µg/l, 10.3 µg/l, 14.7 and 4.4 pmol/l, respectively. Subjects with corpus CAG/IM exhibited a significantly lower PGI:II ratio (7.2) compared with the control group (15.7; P<0.001). Histological CAG and IM correlated well with the serum PGI:II ratio (r=-0.417; P<0.001). The cut-off value of the PGI:II ratio of =10.0 demonstrated high sensitivity (83.3%), specificity (77.9%) and area under the receiver operating characteristic curve of 0.902 in detecting the two conditions. However, the sensitivity was particularly low at a ratio of =3.0. The serum PGI:II ratio is a sensitive and specific marker to diagnose corpus CAG/IM, but at a high cut-off value. This ratio may potentially be used as an outpatient, non-invasive biomarker for detecting corpus CAG/IM. [ABSTRACT FROM AUTHOR]

Introduction: Metabolic surgery is known to impact glucose tolerance but the exact mechanism is still unclear. Based on recently-published data, especially the role of the hindgut may require redefinition. Methods: Either a loop duodeno-jejunostomy (DJOS) with exclusion of one third of total intestinal length, a loop duodeno-ileostomy (DiOS, exclusion of two thirds), or SHAM operation was performed in 9-week-old Zucker diabetic fatty rats. One, 3, and 6 months after surgery, an oral glucose tolerance test (OGTT) and glucose-stimulated hormone analyses were conducted. Body weight was documented weekly. Results: DJOS and DiOS animals showed significantly better glucose control in all OGTTs than the SHAM group (two-way ANOVA p < 0.0001). Body weight developed largely parallel in both intervention groups; SHAM animals had gained significantly less weight after 6 months (Mann-Whitney DJOS/DiOS vs. SHAM p < 0.05, DJOS vs. DiOS p > 0.05). Operative interventions had no impact on GLP-1 and GIP levels at any time point (Mann-Whitney p > 0.05 for all). DJOS/DiOS operations could preserve insulin production up to 6 months, while there was already a sharp decline of insulin levels in the SHAM group (Mann-Whitney: DJOS/DiOS vs. SHAM p < 0.05 for all time points). Additionally, insulin sensitivity was improved significantly 1 month postoperative in both intervention groups compared to SHAM (Mann-Whitney DJOS/DiOS vs. SHAM p < 0.05). Conclusion: The data of the current study demonstrate a sharp amelioration of glucose control after duodenal exclusion with unchanged levels of GLP-1 and GIP. Direct or delayed hindgut stimulation had no impact on glucose control in our model. [ABSTRACT FROM AUTHOR]

A 13 years old girl admitted due to epigastric pain. She had a history of osteoid osteoma operation and a cousin diagnosed as familial adenomatosis polyposis. She was found to have polypoid structures beginning from antrum to the end of the first part of duodenum at gas- troduodenoscopy which are reported as parietal hyperplasia. Her complaints were increased with proton pump inhibitor treatment and two more gastroduodenoscopy were needed to be diagnosed as Menetrier's disease. No etiologic factor could be demonstrated. She’s been followed for the last year. [ABSTRACT FROM AUTHOR]

A magnetic resonance imaging (MRI) duodenoscope is demonstrated, by combining nonmagnetic endoscope components with a thin-film receiver based on a magneto-inductive waveguide. The waveguide elements consist of figure-of-eight shaped inductors formed on either side of a flexible substrate and parallel plate capacitors that use the substrate as a dielectric. Operation is simulated using equivalent circuit models and by computation of two- and three-dimensional sensitivity patterns. Circuits are fabricated for operation at 127.7MHz by double-sided patterning of copper-clad Kapton and assembled onto non-magnetic flexible endoscope insertion tubes. Operation is verified by bench testing and by 1H MRI at 3T using phantoms. The receiver can form a segmented coaxial image along the length of the endoscope, even when bent, and shows a signal-to-noise-ratio advantage over a surface array coil up to three times the tube diameter at the tip. Initial immersion imaging experiments have been carried out and confirm an encouraging lack of sensitivity to RF heating. [ABSTRACT FROM AUTHOR]