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INTRODUCTION: Early neoplastic progression of Barretts esophagus (BE) is often treated with endoscopic therapy. Although effective, some patients are refractory to therapy or recur after apparent eradication of the BE. The goal of this study was to determine whether genomic alterations within the treated BE may be associated with persistent or recurrent disease. METHODS: We performed DNA sequencing on pre-treatment esophageal samples from 45 patients who were successfully treated by endoscopic therapy and did not recur as well as pre-treatment and post-treatment samples from 40 patients who had persistent neoplasia and 21 patients who had recurrent neoplasia. The genomic alterations were compared between groups. RESULTS: The genomic landscape was similar between all groups. Patients with persistent disease were more likely to have pre-treatment alterations involving the receptor tyrosine kinase pathway ( P = 0.01), amplifications of oncogenes ( P = 0.01), and deletions of tumor suppressor genes ( P = 0.02). These associations were no longer significant after adjusting for patient age and BE length. More than half of patients with persistent (52.5%) or recurrent (57.2%) disease showed pre-treatment and post-treatment samples that shared at least 50% of their driver mutations. DISCUSSION: Pre-treatment samples were genomically similar between those who responded to endoscopic therapy and those who had persistent or recurrent disease, suggesting there is not a strong genomic component to treatment response. Although it was expected to find shared driver mutations in pre-treatment and post-treatment samples in patients with persistent disease, the finding that an equal number of patients with recurrent disease also showed this relation suggests that many recurrences represent undetected minimal residual disease.

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

The aim of the present study was three folds; (i) to correlate clinical case history with objective findings of a client presented with sternal discomfort along with odynophagia; (ii) to evaluate the cause for retrosternal discomfort using Functional Esophagoscopy (FE); and (iii) to reaffirm the Cook's (2008) algorithm for clinical diagnosis of esophageal dysphagia in single sitting using Transnasal Esophagoscopy (TNE). A 72 years old male (named 'G') visited a tertiary health care hospital with a complaint of imbalance for past 2 months. Also, had a complaint of pain while swallowing for the past 15 days along with left arm weakness (for past 2 days) and got admitted for treatment. Pertaining to swallowing, a detailed case history was taken and Fiber-optic endoscopic evaluation of swallowing (FEES) was performed to evaluate swallowing safety functions using digital swallowing workstation (KAYPENTAX, New Jersy, USA). A large growth was noticed in the lower border of esophagous using TNE in this patient. The oral, oro-pharyngeal, and pharyngeal phase of swallowing was intact. Esophageal phase of swallowing revealed reduced peristaltic movement including a mass lesion observed in client 'G' from TNE procedure. Clinical correlation of objective findings in this client corroborated well with history. Visualization studies including TNE can be used safely, comfortably in OPD basis without any anesthesia would be few advantages of TNE procedure. Even lesions at lower end of esophagus can be detected using TNE and it is concluded that the symptom retro-sternal discomfort might be clinically correlated with history and objectively determined by TNE procedure as esophageal dysphagia due to structural lesion. Also, algorithm of Cook's (2008) guides the investigation procedure quickly in a single sitting. Therefore, clinical history about patient is imperative that accurately guides further in terms of patient's care for assessment and treatment. Highlights: • Complaint of Retrosternal bolus hold up suggestive of oesophagus is the site of lesion. • Sudden brief history of swallowing problem, consistent and progressive symptom and weight loss are indicative more of esophageal dysphagia (cancer). • Transnasal Esophagoscopy (TNE) is the most widely used objective assessment tool in the field of otolaryngology to identify lesions in esophagus. • Thorough case history clinically would guide further accurate evaluation procedures. • Cook's (2008) algorithm to diagnose dysphagia at esophageal phase of localized origin in single sitting can be established by using TNE. [ABSTRACT FROM AUTHOR]

Extraluminal foreign bodies are rare. Fish bone is the most common foreign body ingested by adults, while coin is the most common foreign body ingested among children. Sharp pricking pain is a sign of sharp foreign body (FB) ingestion. If the symptom persists, one should keep in mind the possibility of a migratory foreign body, even if the esophagoscopy results are negative. In order to ensure that foreign bodies are not missed radiologically, there is the role of consultation from a second radiologist to correlate with the patient's symptoms. Here we present an atypical case of recurrent neck abscess due to a migrating fishbone that penetrated the left thyroid lobe and settled in the left lower third neck subcutaneous tissue within two months. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to create and validate a nomogram model for predicting complications of esophageal injury post-esophagoscopy in patients with esophageal foreign bodies (EFB). Methods: We examined 303 patients who underwent esophagoscopy from January 2019 to December 2022 at a leading hospital in Anhui, known for its expertise in otorhinolaryngology-head and neck surgery. The patients were split into a modeling group and a validation group in a 7:3 ratio. Logistic regression analysis was employed to determine the risk factors for esophageal injury after undergoing esophagoscopy in patients with EFB. Based on these factors, a nomogram risk prediction model was developed and assessed using a goodness of fit test. Results: Logistic regression analysis revealed that the type of foreign body, failure of gastroscopic retrieval, duration of lodgment, lodgment site, and presence of combined cardiovascular and cerebrovascular diseases were significant (p < 0.05) independent risk factors for esophageal injury following esophagoscopy for EFB. The area under the ROC curve for the training set was 0.850, and the Hosmer–Lemeshow goodness of fit test resulted in a p value of 0.908. For the validation set, the area under the ROC curve was 0.848, and the Hosmer–Lemeshow test gave a p value of 0.665. The calibration curve showed a close alignment between the predicted and observed values. Conclusion: The type of foreign body, duration of lodgment, lodgment site, previous failure of gastroscopic retrieval, and history of combined cardiovascular and cerebrovascular diseases are significant risk factors for esophageal injury following EFB esophagoscopy. This model accurately quantifies the risk of esophageal injury after EFB esophagoscopy. [ABSTRACT FROM AUTHOR]

Lipoma is the most common soft tissue benign tumor in the body. It can occur in the head and neck area as well. Fibrolipoma is a variant of lipoma that contains fibrous tissue. Fibrolipomas of the head and neck are relatively rare, and their presentation depends largely on their size and location; some slowly growing tumors might go unnoticed until they reach significant size and become symptomatic. Here, we report a case of 64-year-old male who presented with large pedunculated oropharyngeal fibrolipoma that originated from the posterior oropharyngeal wall and extended downward into the postcricoid area and cervical esophagus. It was excised transorally using rigid endoscope, and ACE Harmonic scalpel was utilized to excise this 16.7 cm long mass. The postoperative pain was minimal, the surgical site showed complete healing, and oral diet was resumed easily in 5 days. [ABSTRACT FROM AUTHOR]

Objectives Oral intake of corrosive substances is a significant cause of morbidity and sometimes mortality in childhood. Early evaluation is essential in determining the course of possible damage. This study aimed to compare early endoscopic evaluation and clinical observation methods in patients with corrosive substance ingestion. Materials and Methods Seventy-five patients with corrosive substance ingestion were hospitalized in a tertiary pediatric surgery clinic between January 2019 and December 2020. They were enrolled in a prospective randomized controlled manner, 35 of whom were in the endoscopy group and 40 in the clinical observation group, and their data were collected after obtaining consent from their families. Results It was observed that the most common chemical agents in hospitalized patients with a history of corrosive substance intake were dish polishers and sink openers, and contact with strong alkaline substances was the most common case. Endoscopic evaluation increased the total cost compared with clinical observation but decreased the nil per os (nothing by mouth) duration, the number of drugs they took, and the inpatient duration (p < 0.05). Neither the presentation symptoms nor physical examination findings were to the pH level of the corrosive substance ingested (p > 0.05). Conclusions Endoscopic evaluation could be a choice for reducing the length of hospital stay, drug doses, and the nil per os period, but it increases the total cost. Since no cases with significant esophageal damage were detected in our clinic at the time of this study, the results should be supported by larger series. [ABSTRACT FROM AUTHOR]

Ingested foreign bodies, although fairly common among children, can present in individuals of all age. Most common risk factors for such cases in adults include psychiatric illness, alcohol abuse and ill-fitting dentures. Most of the ingested foreign bodies pass through the gastrointestinal tract but intervention maybe required in case of impaction, obstruction or perforation. Foreign bodies mostly tend to get impacted at anatomical constrictions like cricopharyngeus, aortic arch and lower esophageal sphincter. We present a rare case of impacted denture in esophagus which could not be retrieved despite multiple esophagoscopic retrieval attempts leading to removal by successful esophagotomy. Investigations including X-ray and rigid esophagoscopy confirmed the presence of denture with its hooks impacted in the esophageal wall at the level of C6-C7 vertebra. Majority of the foreign bodies can be removed by flexible endoscopy or esophagoscopy but due to its impaction in esophageal wall these techniques were unsuccessful. Therefore, multidisciplinary team decided to opt for an esophagotomy with transcervical approach. Successful esophagotomy was performed with the retrieval of sharp hook like body. Our case underscores the importance of early surgical intervention in case of failed attempt to remove the foreign body through minimally invasive techniques to prevent complications in form of perforation and mediastinitis.

Introduction: To mitigate gastroparesis as well as other post-operative complications, we undertook a prospective multicenter study to assess the feasibility, safety, and efficacy in the short-term outcomes of laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon dilatation. Methods: A prospective descriptive study on 37 patients with laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon dilatation from January 2019 to March 2023. The perioperative indications, clinical data, intra-operative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated. Results: In our study, all patients were male, with dysphagia as the predominant symptom (45.9%). Esophageal cancer incidence was similar between middle and lower thirds. Nodules were the primary finding on esophagoscopy (48.6%). Preoperative pyloric dilation averaged 31.2 min without complications. Surgical duration ranged from 225 to 400 min (mean 305). Gastric tube fluid volume averaged 148.9 ± 110.66 ml per day. Among 34 post-operative cases underwent gastric transit scans, most had non-dilated stomachs with efficient pyloric drug circulation. Three cases required prolonged ventilation, precluding pyloric circulation scans. Four patients developed chylous fistula, one requiring chest tube embolization. Recurrent laryngeal nerve damage occurred in 10.8% of cases. Conclusion: After evaluating esophageal cancer patients undergoing laparoscopic whole-stomach esophagectomy with preoperative pyloric balloon dilatation, it was found that this procedure is safe, effective, and significantly reduces postoperative gastroparesis and related complications. [ABSTRACT FROM AUTHOR]

INTRODUCTION- Foreign body ingestion is widespread, particularly in the paediatric age range, but in adults, it is more likely in alcoholics, convicts, and individuals with psychiatric illnesses or mental retardation. Thankfully, the majority of these enter the gastrointestinal system without causing any harm. That being said, just 1% or fewer will require surgery, and 10-20% will require nonoperative treatments. AIM - To study, about different types of procedures for different type of foreign bodies removal from oesophagus. METHODOLOGY - Cases of foreign body in esophagus, a detailed history, investigation and management of patients, complications, and length of hospitalization. RESULTS - Foreign body removal through different types of procedure like through laryngoscopy, esophagoscopy and esophagostomy and Ryle's tube feeding for = 21 days after esophagostomy then allowed semisolid diet orally. CONCLUSIONS - The presence of a foreign body in the esophagus is a challenging problem. Impaction mandates immediate extraction. [ABSTRACT FROM AUTHOR]

This case report highlights complexities in an intellectually disabled adult who ingested a chicken bone, resulting in a rare complication—superior thyroid artery injury. Presentation, diagnostic challenges, and a multidisciplinary approach are detailed. Initial attempts at esophagoscopy under general anesthesia were hindered by blood coughing, leading to a change of plan. Subsequent findings revealed mucosal edema and continuous bleeding from the site. Challenges in anesthetizing intellectually disabled individuals are emphasized, stressing tailored induction methods. The case concluded with successful embolization but developed neurological complication which was successfully managed showcasing the significance of a collaborative and adaptable approach. [ABSTRACT FROM AUTHOR]

Background: Esophageal cancer posed significant global health challenges, particularly due to poor survival rates, especially in advanced stages. Primary endoscopic resection had emerged as an alternative treatment for early esophageal cancer, aiming to preserve organ function and reduce surgical morbidity. Methods: This retrospective multicenter cohort study included 334 patients with early esophageal cancer (T1a-b, N0) from 30 French-speaking European centers between 2000 and 2010. Patients underwent either primary endoscopic resection followed by esophagectomy (E group, n = 36) or esophagectomy alone (S group, n = 298). Cox proportional hazards models adjusted for TNM stage and propensity score weighting were used to assess the impact of primary endoscopic resection on recurrence-free survival (RFS), overall survival (OS), and postoperative complications. Results: Primary endoscopic resection did not significantly influence RFS (adjusted HR 0.92, 95% CI 0.31 to 2.68, p = 0.88) or OS (adjusted HR 1.06, 95% CI 0.35 to 3.13, p = 0.92) compared to esophagectomy alone. Initial higher thromboembolic complications in the endoscopic resection group were not significant after adjustment (adjusted OR 4.73, 95% CI 0.34 to 64.27, p = 0.24). Conclusions: Primary endoscopic resection followed by esophagectomy for early esophageal cancer did not alter oncological outcomes or overall survival in this retrospective cohort. These findings supported the role of primary endoscopic resection as a safe initial treatment strategy, warranting validation in larger prospective studies. Registration: Our study was registered retrospectively on the Clinicaltrials.com website under the identifier NCT 01927016. We acknowledge the importance of prospective registration and regret that this was not done before the commencement of the study [ABSTRACT FROM AUTHOR]

Background: Achalasia is an esophageal motility disorder with three subtypes based on manometry that can treated with per-oral endoscopic myotomy (POEM). With the advent of impedance planimetry (EndoFLIP®), we hypothesized the three achalasia subtypes would have different pre-POEM EndoFLIP® diameter and distensibility index (DI) measurements but would be similar after POEM. Methods: A single-institution, retrospective review of consecutive POEM cases by a single surgeon-endoscopist team from 04/07/2017 to 08/28/2023. Patients with a diagnosis of achalasia were stratified into type 1, 2, or 3 based on pre-POEM manometry. Patient characteristics, Eckardt scores, and pre-and-post-POEM diameter and DI were compared by subtype with descriptive, univariate, and multivariable linear regression statistics. Results: Sixty-four patients met inclusion criteria, of whom 9(14.1%) had Type 1, 36(56.3%) had Type 2, and 19(29.7%) had Type 3. There were no differences between Types with respect to median pre-POEM Eckardt scores (9[IQR:7–9) vs. 8[IQR:6–9] vs. 7[IQR:5–8], p = 0.148), median post-POEM Eckardt scores (0[IQR:0–1] vs. 0[IQR:0–0] vs. 0[IQR0-0.5], p = 0.112). EndoFLIP® data revealed variation in median pre-POEM diameter and DI between Subtypes (6.9[IQR:6–8.5] vs. 5.5[IQR:5–6.8] vs. 5[IQR:5–6.1], p = 0.025 and 1.8[IQR:1.3–3.2] vs. 0.9[IQR:0.6–1.6] vs. 0.6[IQR:0.5–0.8], p = 0.003, respectively), but not in the change in diameter or DI post-POEM (5.1[IQR:4.3–5.9] vs. 5.1[IQR:4.1–7.1] vs. 5.9[IQR:5–6.4], p = 0.217 and 3.9[IQR:2.5–4.7] vs. 3.4[IQR:2.4–4.7] vs. 2.7[IQR:2.3–3.7], p = 0.461, respectively). However, after adjusting for potentially confounding factors, pre- or post-POEM diameter and DI did not demonstrate statistically significant differences among subtypes. Conclusions: Achalasia subtypes did not demonstrate different pre-POEM diameters or DI as measured by EndoFLIP® nor are there differences after POEM completion. While achalasia subtypes may have slightly different pathophysiology based on manometry findings, similar pre- and post-POEM impedance planimetry findings, along with similar Eckardt scores, support the use of POEM in the treatment of any achalasia subtype. [ABSTRACT FROM AUTHOR]

Background: Oesophageal soft food bolus obstruction is a common presentation to emergency departments. Often these patients are given medication with little evidence of efficacy. Although many cases self-resolve, some require removal of the obstruction. Delay in removal can lead to complications such as oesophageal perforation and mediastinitis. Traditionally, removal was performed by ENT surgeons using rigid oesophagoscopy, but oesophago-gastro duodenoscopy offers a safer alternative that does not require a general anaesthetic. Method: The current performance, pathways and outcomes of patients attending emergency departments across three health boards in Scotland were reviewed. Results: In total, 313 patients admitted for oesophageal soft food bolus obstruction were identified. Mixed practice for a single common presentation was observed. In addition, it was found that the majority of patients are already managed by surgery and gastroenterology services with good outcomes and low morbidity. Conclusion: Patients presenting with soft food bolus obstruction should be referred to local surgery and gastroenterology services in the first instance. [ABSTRACT FROM AUTHOR]

Sleeve gastrectomy (SG) is one of the most commonly performed bariatric procedures. However, the available literature on histological examination of the excised sleeved stomachs is widely inconsistent. This study aimed at assessing the histopathological findings after SG compared to the routinely performed preoperative oesophagogastroduodenoscopy (OGD) and the intraoperative findings. We conducted a case series study using the electronic bariatric unit database of all patients who had SG procedures from June 2007 to December 2019. Out of the 620 sleeve gastrectomies performed, there were 219 patients with complete data, including preoperative OGD reports, operative notes, and postoperative histopathology reports. We found normal specimens in 43.83% (n = 96) and evidence of inflammation in 50.68% (n = 111) of cases. There were 10 (4.56%) specimens with evidence of inflammation and other lesions and two (0.91%) specimens with lesions only. Twenty-five patients had inflammation, and 10 had lesions on preoperative OGD with negative histopathology reports. Routine histopathology examination after sleeve gastrectomy does not change the management. Preoperative OGD can detect inflammatory changes and lesions that could have been missed on histology analysis only. [ABSTRACT FROM AUTHOR]

Foreign bodies (FBs) in pediatric otorhinolaryngology represent up to 10% of cases in emergency departments (ED) and are primarily present in children under five years old. They are probably the result of children’s curiosity and tendency to explore the environment. Aural and nasal FBs are the most common and accessible, and the removal methods differ depending on the exact location and type of FB, which can be organic or inorganic. A fish bone stuck in one of the palatine tonsils is the most common pharyngeal FB. Laryngopharyngeal FBs can obstruct the upper respiratory tract and thus become acutely life-threatening, requiring an urgent response. Aspiration of FBs is common in children between 1 and 4 years old. A history of coughing and choking is an indication of diagnostic and therapeutic methods to rule out or confirm a tracheobronchial FB. Regardless of the availability of radiological diagnostics, rigid bronchoscopy is the diagnostic and therapeutic method of choice in symptomatic cases. Radiological diagnostics are more significant in treating esophageal FBs since most are radiopaque. Flexible or rigid esophagoscopy is a successful method of removal. A delayed diagnosis, as with tracheobronchial FBs, can lead to fatal consequences.

INTRODUCTION: Variability in adherence rates to the Seattle protocol and to surveillance interval recommendations, established quality indicators (QIs) in Barretts esophagus (BE), is unknown. METHODS: We evaluated endoscopist and site-based adherence rates to these QIs from January 2018 to May 2021 using the GI Quality Improvement Consortium national registry with matched endoscopy and pathology data. RESULTS: Across 153 practices with 572 endoscopists performing 20,155 endoscopies, adherence to the Seattle protocol varied by endoscopists (median 93.8%, IQR 18.9%) and by site (median 90.0%, IQR 20.1%). Adherence to appropriate surveillance intervals for nondysplastic BE also varied by endoscopist (median 82.4%, IQR 36.3%) and site (median 77.2%, IQR 29.8%). The overall dysplasia detection rate was 3.1% and varied among endoscopists and sites. DISCUSSION: These US population-based results can serve as a benchmark for quality initiatives and intervention trials aimed at improving outcomes for patients with BE.

Key Clinical Message: Foreign bodies such as bone with a sharp end can penetrate the esophageal wall and lie extramurally. When a foreign body is not found on rigid oesophagoscopy, reassessing with imaging is important. The transcervical approach is a better alternative for such patients to remove the foreign bodies. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive esophagectomy is the first-line approach for esophageal cancer; however, there has recently been a paradigm shift toward robotic esophagectomy (RE). We investigated the clinical outcomes of patients who underwent RE compared with those of patients who underwent conventional minimally invasive thoracoscopic esophagectomy (TE) for locally advanced cT3 or cT4 esophageal cancer using a propensity-matched analysis. Methods: Overall, 342 patients with locally advanced cT3 or cT4 esophageal cancer underwent transthoracic esophagectomy with total mediastinal lymph node dissection between 2018 and 2022. The propensity-matched analysis was performed to assign the patients to either RE or TE by covariates of histological type, tumor location, and clinical N factor. Results: Overall, 87 patients were recruited in each of the RE and TE groups according to the propensity-matched analysis. The total complication rate and the rates of the three major complications (recurrent laryngeal nerve paralysis, anastomotic leakage, and pneumonia) were not significantly different between the RE and TE groups. However, the peak C-reactive protein concentration on postoperative day 3, rate of surgical site infection, and intensive care unit length of stay after surgery were significantly shorter in the RE group than in the TE group. No significant differences were observed in the harvested total and mediastinal lymph nodes. The total operation time was significantly longer in the RE group, while the thoracic operation time was shorter in the RE group than in the TE group. There was no significant difference between the two groups in the recurrence rate of oncological outcomes after surgery. Conclusion: RE may facilitate early recovery after esophagectomy with total mediastinal lymph node dissection and has the same technical feasibility and oncological outcomes as TE. [ABSTRACT FROM AUTHOR]

Case summary: A 15-year-old male castrated domestic shorthair cat was presented for acute lethargy, vomiting and hyporexia. Abdominal and thoracic radiographs revealed a caudal thoracic/esophageal soft tissue opacity with concern for an esophageal mass or an esophageal foreign body. Esophagoscopy confirmed the presence of a large, irregular, mid-esophageal mass. Laser ablation using esophagoscopy was utilized to debulk the mass. Approximately 80% of the mass was removed without complication and an esophagostomy feeding tube was placed. The cat was discharged the same day of the procedure. Histopathology and immunohistochemistry staining were consistent with a plasma cell tumor. Recheck esophagoscopy 2 weeks after the procedure revealed no evidence of regrowth and resolved clinical signs in the patient. Relevance and novel information: Laser ablation of esophageal neoplasms in cats represents a novel, lower cost, minimally invasive, palliative treatment alternative to surgery. To the authors' knowledge, this is the first published report of successful partial laser ablation treatment of a large esophageal plasma cell tumor in a cat. [ABSTRACT FROM AUTHOR]

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

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

Foreign bodies (FBs) in pediatric otorhinolaryngology represent up to 10% of cases in emergency departments (ED) and are primarily present in children under five years old. They are probably the result of children's curiosity and tendency to explore the environment. Aural and nasal FBs are the most common and accessible, and the removal methods differ depending on the exact location and type of FB, which can be organic or inorganic. A fish bone stuck in one of the palatine tonsils is the most common pharyngeal FB. Laryngopharyngeal FBs can obstruct the upper respiratory tract and thus become acutely life-threatening, requiring an urgent response. Aspiration of FBs is common in children between 1 and 4 years old. A history of coughing and choking is an indication of diagnostic and therapeutic methods to rule out or confirm a tracheobronchial FB. Regardless of the availability of radiological diagnostics, rigid bronchoscopy is the diagnostic and therapeutic method of choice in symptomatic cases. Radiological diagnostics are more significant in treating esophageal FBs since most are radiopaque. Flexible or rigid esophagoscopy is a successful method of removal. A delayed diagnosis, as with tracheobronchial FBs, can lead to fatal consequences. [ABSTRACT FROM AUTHOR]

A 10‐year‐old, female, spayed golden retriever crossbreed dog was referred for persistent vomiting and hypersalivation after eating. Thoracic radiographs showed a small, circular soft tissue opacityin the region of the mid‐caudal thoracic oesophagus An intraluminal, pedunculated mid‐caudal thoracic oesophageal mass was identified on subsequent computed tomography of the thorax. Oesophagoscopy guided endoscopic biopsies were consistent with a plasmacytoma, a neoplasm rarely diagnosed in the canine oesophagus. Thoracotomy via a rib pivot method, longitudinal oesophagotomy and partial longitudinal oesophagectomy were performed with successful mass excision. Histopathology confirmed the diagnosis of plasmacytoma excised with complete surgical margins, and the dog's clinical signs resolved. Repeat computed tomography and oesophagoscopy 7 months following surgical excision showed no recurrence, and the dog remained clinically well. [ABSTRACT FROM AUTHOR]

Foreign bodies (FB) in the aerodigestive tract are common, especially in children. The type of foreign body in the esophagus can vary and include magnets. A magnet that lodges in the esophagus should be extracted within 24 hours to prevent complications due to associated chemical reactions. In rural areas, there are several limitations to extracting FBs from the esophagus. We report a case of a magnetic FB that lodged in the esophagus of a three-year-old boy. The extraction was successfully done by esophagoscopy with the modification of a hook that was attached to the endoscope. This innovation may help physician all over the world, especially in rural areas. In the future, this innovation could be produced on an industrial scale.

Objective: To determine the frequencies of different esophageal foreign bodies ingested by children presenting to Ayub Teaching Hospital Abbottabad. Study Design: Cross-sectional study. Setting: Department of Otorhinolaryngology, Ayub Teaching Hospital Abbottabad. Period: 2nd July 2020 to 31st December 2022. Methods: Following the application of inclusion and exclusion criteria, a total of 168 patients, aged between 6 months and 11 years, presenting with suspected esophageal foreign bodies, were included in the study after obtaining written consent. Socio-demographic information, clinical history, and symptoms were carefully recorded. Diagnostic procedures included neck X-rays, extended to the chest, and abdominal X-rays as necessary. Rigid esophagoscopy, performed under general anesthesia, was utilized to confirm and remove foreign bodies. Subsequently, the nature and type of the extracted foreign bodies were identified and documented using a standardized pro forma. Results: The mean age of the patients was 5.63 ± 3.097, ranging from 1 to 11 years. Regarding the gender distribution, 105 (62.5%) were male, and 63 (37.5%) were female. When considering the types of foreign bodies, 129 (76.8%) presented with coins, 12 (7.1%) with metallic objects, 7 (4.2%) with battery cells, and 9 (5.4%) with fruit seeds. Additionally, there were a few cases of chicken bones, fish bones, and safety pins, accounting for 9 (5.4%) in the category of other foreign bodies. Conclusion: This study underscores the frequent occurrence of esophageal foreign body ingestion in young children, particularly males under the age of 5, with coins identified as the predominant culprits. [ABSTRACT FROM AUTHOR]

Esophageal stenosis can cause vomiting or dysphagia in children and is commonly treated with esophageal balloon dilation. However, surgery may be required if the stenosis does not respond to dilation. Although esophageal actinomycosis can cause severe esophageal strictures and be refractory to balloon dilation, it has been reported to respond effectively to antimicrobial therapy in adults. However, the course of the disease and appropriate treatment strategies in children are not well understood. We present a case of a previously healthy 2-year-old boy diagnosed with esophageal stenosis because of actinomycosis. The patient was treated with intravenous penicillin G, followed by oral amoxicillin for 8 weeks and 6 months, respectively. After completion of the antimicrobial treatment, the patient showed improvement in symptoms and endoscopic findings. At the 1-year follow-up, the patient showed consistent weight gain and normal growth without further intervention. This case highlights the importance of considering esophageal actinomycosis as a potential cause of esophageal stenosis in children and the potential effectiveness of anti-microbial therapy in avoiding surgical intervention. [ABSTRACT FROM AUTHOR]

Background: Esophageal submucosal tumors (SMTs) are rare, occurring in less than 1% of esophageal neoplasms. For surgical treatment of esophageal SMTs, enucleation is usually the procedure of choice for benign tumors. This study aimed at evaluating the surgical technique and outcomes of thoracoscopic enucleation with esophagoscopy for esophageal SMTs. Methods: Patients with esophageal SMTs who underwent thoracoscopic enucleation between 2015 and 2022 were retrospectively investigated. Surgery was performed with the patient in the prone position. First, an esophagoscope was inserted, and a sodium hyaluronate solution with indigo carmine dye was injected into the submucosal layer just below the tumor. Next, under thoracoscopy, the tumor was exposed through a thoracoscopic incision and dissection of the muscularis propria and adventitia was performed at the tumor site. The colored layer resulting from the previously injected dye was identified, and tumor enucleation was performed under guidance of the dye so as not to damage the mucosa or pseudocapsule. Results: In total, 5 surgeries were performed. The mean operative time was 122.6 minutes (range 84–168 minutes), mean blood loss was 21.1 mL (range 0–80 mL), and mean postoperative hospital stay was 8 days (range 7–10 days). There were no postoperative complications. Pathological diagnosis revealed 2 cases of gastrointestinal stromal tumors, 2 cases of schwannoma, and 1 case of leiomyoma. Conclusions: We believe that this technique is a useful and safe method of performing thoracoscopic enucleation of esophageal SMTs because the injected dye provides an indicator of the resection line during enucleation. [ABSTRACT FROM AUTHOR]

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

Objective: To report and analyze outcomes of transnasal esophagoscopy (TNE). Materials and Methods: The present study retrospectively reviewed the medical records of patients who underwent TNE at Sawanpracharak Hospital, a provincial public hospital between September 2022 and August 2023. Data collected included demographics, indications for TNE, biopsy results, timing of the procedure, changes in diagnosis following TNE, and any complications encountered were collected and analyzed. Results: Forty-eight patients underwent the TNE with a mean age of 59.2±13.18 years. The most frequent indications for TNE were dysphagia at 37.5%, biopsy tumor at 20.8%, head and neck cancer surveillance at 20.8%, complete examination for neck node unknown primary at 8.3%, suspected foreign body in aerodigestive tract at 6.3%, and follow-up treatment at 6.3%. Biopsies were performed in 23 cases, with a rapid urease test conducted in nine cases. Of these tests, 44.4% were positive for Helicobacter pylori. Additionally, pathological examination was performed in 14 cases and revealed squamous cell carcinoma in 35.7% of those examined. Importantly, TNE led to a change in diagnosis in 41% of the studied patients. Notably, minor complications were observed in only 2.1% of the cases. Conclusion: TNE emerges as a valuable diagnostic tool for the comprehensive assessment of laryngeal, tracheal, and esophageal lesions. This minimally invasive procedure eliminates the need for sedation, expediting the examination process while minimizing complication risks. Moreover, TNE is well-suited for head and neck cancer patients, facilitating both diagnosis and treatment follow-up. [ABSTRACT FROM AUTHOR]

Background: Congenital h-type tracheoesophageal fistula (H-TEF) without esophageal atresia (EA) represents about 4% of congenital esophageal anomalies. The diagnosis is challenging, and surgery is considered curative. The aim was to report a national survey on the diagnosis, management, and outcome of patients with congenital H-TEF. Methods: Following approval of the Italian Society of Pediatric Surgery, a survey was sent to all Pediatric Surgery Units to retrospectively collect H-TEF treated in the period 2010–2022. Descriptive analysis was performed, and results are given as prevalence, mean ± standard deviation (SD), or median and interquartile range (IQR). Results: The survey was sent to 65 units. Seventeen responded with one or more cases; 78 patients were diagnosed with H-TEF during the study period. Associated malformations were present in 43%, mostly cardiac (31%). The most frequent symptoms were cough (36%), bronchopneumonia (24%), and dysphagia (19%). H-TEF was detected by tracheobronchoscopy (90%), and/or upper GI (58%), and/or esophagoscopy (32%). The median age at diagnosis was 23 days (1 day–18 years). The most common approach was cervicotomy (76%), followed by thoracoscopy (14%) and thoracotomy (9%). The fistula underwent ligation and section of the fistula in 90% of the patients and clip closure and section in 9%. In one patient, the fistula was cauterized endoscopically. H-TEF preoperative cannulation was performed in 68% of cases, and a drain was placed in 26%. One month after surgery, 13% of the patients had mild persisting symptoms, mainly hypophonia. Recurrence occurred in 5%, and a second recurrence occurred in 1%. Conclusions: H-TEF prevalence was six cases/year, consistent with the expected rate of five cases/year in our country. The diagnosis was challenging, sometimes delayed, and, in most patients, required multiple examinations. Fistula ligation and section through cervicotomy were the most frequent treatment. Long-term outcomes are good, and recurrence is a rare event. [ABSTRACT FROM AUTHOR]

Button battery ingestion in pediatric populations is a common occurrence with severe sequelae. Multiple case reports have established the occurrence of death, fistula formation, mucosal erosion, esophageal perforation, and bleeding post-ingestion of button batteries. However, there is a gap in the literature on the occurrence of bilateral vocal cord paralysis post-lithium battery ingestion. We present a case in which a 12-month-old male developed bilateral vocal cord paralysis following ingestion of a button battery. We compare our case to eleven other reports that exist in the literature based on age, sex, time until removal, clinical presentation, day upon which vocal cord paralysis developed, anatomic location, and post-operative course. We conclude that bilateral vocal cord paralysis is a time-sensitive complication which requires prompt diagnosis. Any child with stridor following button battery ingestion should undergo consultation with pediatric otolaryngology immediately. In addition, long-term follow-up is necessary to evaluate return of normal vocal cord function. [ABSTRACT FROM AUTHOR]

A 7‐year 6‐month‐old, male, neutered Shih Tzu had an oesophagostomy tube placed for nutritional support following surgery for management of extrahepatic biliary obstruction secondary to cholelithiasis. The oesophagostomy tube was removed 1 week following surgery, with no abnormalities noted. The dog re‐presented 7 months later with a persistent discharge at the previous stoma site. This was diagnosed as an oesophagocutaneous fistula following oesophagoscopy and ultrasound examination. The fistula was closed surgically, and the dog made a full recovery. [ABSTRACT FROM AUTHOR]

Foreign bodies (FB) in the aerodigestive tract are common, especially in children. The type of foreign body in the esophagus can vary and include magnets. A magnet that lodges in the esophagus should be extracted within 24 hours to prevent complications due to associated chemical reactions. In rural areas, there are several limitations to extracting FBs from the esophagus. We report a case of a magnetic FB that lodged in the esophagus of a three-year-old boy. The extraction was successfully done by esophagoscopy with the modification of a hook that was attached to the endoscope. This innovation may help physician all over the world, especially in rural areas. In the future, this innovation could be produced on an industrial scale.

Barretts esophagus (BE) is a common condition associated with chronic gastroesophageal reflux disease. BE is the only known precursor to esophageal adenocarcinoma, a highly lethal cancer with an increasing incidence over the last 5 decades. These revised guidelines implement Grading of Recommendations, Assessment, Development, and Evaluation methodology to propose recommendations for the definition and diagnosis of BE, screening for BE and esophageal adenocarcinoma, surveillance of patients with known BE, and the medical and endoscopic treatment of BE and its associated early neoplasia. Important changes since the previous iteration of this guideline include a broadening of acceptable screening modalities for BE to include nonendoscopic methods, liberalized intervals for surveillance of short-segment BE, and volume criteria for endoscopic therapy centers for BE. We recommend endoscopic eradication therapy for patients with BE and high-grade dysplasia and those with BE and low-grade dysplasia. We propose structured surveillance intervals for patients with dysplastic BE after successful ablation based on the baseline degree of dysplasia. We could not make recommendations regarding chemoprevention or use of biomarkers in routine practice due to insufficient data.

Objective: This study aims to describe the clinicodemographic profile of patients with foreign bodies in the upper aerodigestive tract and their treatment outcomes. Methods: Design: Retrospective review of records Setting: Tertiary Government Training Hospital Participants: Records of 304 patients diagnosed with aerodigestive foreign bodies Results: Three hundred-four (304) patients were included. The median age was 5.26 years in the pediatric age group and 42.53 years in the adult age group, with a male-to female ratio = 1.97:1. Foreign bodies were ingested in 291 (96%) patients while aspiration occurred in 13 (4%). Overall, 211 (69%) of cases involved the pediatric population (

Background: Suspected upper gastrointestinal bleeding (SUGIB) is a common issue during ICU stay. In the absence of specific guidelines on the indication and timing of esophagogastroduodenoscopy (EGD), there is substantial variability in EGD indication depending on accessibility and clinical presentation. This study aimed to investigate factors associated with the need for per-EGD hemostatic therapy and to create a score predicting therapeutic benefit of emergency bedside EGD in ICU patients with SUGIB. Methods: We conducted a retrospective study in our ICU to identify factors associated with the need for hemostatic procedure during EGD performed for SUGIB. From this observational cohort, we derived a score predicting the need for hemostasis during EGD, the SUGIBI score. This score was subsequently validated in a retrospective multicenter cohort. Results: Two hundred fifty-five patients not primarily admitted for GI bleeding who underwent a bedside EGD for SUGIB during their ICU stay were analyzed. The preeminent EGD indication were anemia (79%), melena (19%), shock (14%), and hematemesis (13%). EGD was normal in 24.7% of cases, while primary lesions reported were ulcers (23.1%), esophagitis (18.8%), and gastritis (12.5%). Only 12.9% of patients underwent hemostatic endotherapy during EGD. A SUGIBI score < 4 had a negative predictive value of 95% (91–99) for hemostatic endotherapy [AUC of 0.81; 0.75–0.91 (p < 0.0001)]. The SUGIBI score for predicting the need for an EGD-guided hemostatic procedure was next validated in a multicenter cohort with an AUC of 0.75 (0.66–0.85) (p < 0.0001), a score < 4 having a negative predictive value of 95% (92–97). Conclusions: Our study shows that the therapeutic usefulness of bedside emergency EGD for SUGIB in critically ill patients is limited to a minority of patients. The SUGIBI score should help clinicians stratify the probability of a therapeutic EGD. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies in achalasia and its clinical management in Australia are limited. Aims: To determine the prevalence and trends in incidence rates and describe the types of treatment stratified by subtypes of achalasia. Methods: A retrospective observational study was conducted at a single site that offers a state‐wide high‐resolution manometry (HRM) service in Western Australia (WA). Patients (aged ≥ 18 years) newly diagnosed with achalasia based on HRM findings between 2012 and 2021 were extracted from the HRM database. The crude incidence rate and age‐standardised incidence rate (ASIR) along with the 2021‐point prevalence were calculated. Trends were assessed by the Kendall τb test. The patients' initial and subsequent treatment modalities were described. Results: A total of 296 new cases were identified, and the median age at diagnosis was 56 years. The patient's median age, sex and year of the first treatment did not vary significantly with the subtypes. The lowest and highest ASIR (cases/100 000 person‐years) were 0.8 in 2012 and 2.1 in 2021, respectively. Only type 2 achalasia showed a significant increasing trend (P = 0.009). The 2021‐point prevalence was 16.9 cases/100 000 people and increased with age. Pneumatic balloon dilatation (PBD) was the most common treatment for types 1 and 2, while laparoscopic Heller myotomy was most common for type 3. Peroral endoscopic myotomy (POEM) has become common in the past 5 years. Conclusion: The ASIR of type 2 achalasia significantly increased in WA. PBD was most commonly performed, although peroral endoscopic myotomy has recently increased as a preferred treatment option. [ABSTRACT FROM AUTHOR]

In Video S1, a new surgical technique for hybrid primary tracheoesophageal (TE) puncture in stapler‐assisted total laryngectomy is shown. The video describes the surgical steps of the procedure and illustrates some tips and tricks. The procedure incorporates an upper mini‐pharyngotomy to enable retrograde placement of the voice prosthesis (VP), eliminating the need for rigid esophagoscopy. This has made it possible to exploit, without additional risks, the potential of the stapler combined with primary TE puncture and VP placement. In our experience, this hybrid procedure in stapler‐assisted total laryngectomy is not related to adverse events such as pharyngocutaneous fistula (PCF), hypertonicity, and functional complications. Therefore, it can be considered a valid technique that allows for easy insertion of a primary voice prosthesis also in case of mechanical sutures. [ABSTRACT FROM AUTHOR]

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Objective: To investigate the clinical benefit of routine esophageal screening in newly diagnosed head and neck squamous cell carcinoma (HNSCC) patients. Study Design: Retrospective cohort study. Setting: Tertiary medical center. Methods: This retrospective study selected newly diagnosed HNSCC patients from the Chang Gung Research Database between January 2007 and December 2019. Patients who underwent endoscopic esophageal examinations within 2 months of the initial diagnosis of HNSCC were included in the screening group. The clinical outcomes of the screening and nonscreening groups were analyzed. Results: In total, 13,627 HNSCC patients were included, comprising 1032 females and 12,640 males (mean age 55.0 years), and the esophageal screening group included 7033 (51.4%) patients. The prevalence rate of esophageal tumors was 4.5%. Hypopharyngeal cancer patients were the most likely to have (13.4%) second primary esophageal tumors. The American Joint Committee on Cancer stage of the esophageal tumor was lower in the esophageal screening group than in the nonesophageal screening group. The oral, oropharyngeal, and hypopharyngeal cancer patients in the esophageal screening group had better survival outcomes than their counterparts in the nonesophageal screening group. Conclusion: Endoscopic esophageal screening of newly diagnosed HNSCC patients can detect esophageal tumors at an early stage and improve overall survival. Esophageal screening could be a routine survey in HNSCC patients, particularly those with lifestyle risk factors and in countries with a high prevalence of esophageal cancer. [ABSTRACT FROM AUTHOR]

Recurrent tracheoesophageal fistula is a rare complication of esophageal atresia surgery with an incidence of 3-15%. The presentation is subtle and is often missed, presenting as choking episodes during feed and recurrent chest infections. It is both a diagnostic and management challenge and requires a dedicated multidisciplinary pediatric surgical setup with adequate infrastructure for optimal management. We present a case of recurrent tracheoesophageal fistula which was diagnosed at our center. The patient underwent successful surgical management and is thriving well at six months follow-up period. [ABSTRACT FROM AUTHOR]

Dysphagia after anterior cervical spine surgery (ACSS) may be secondary to pharyngoesophageal diverticulum. Our objectives are to (1) highlight the heterogeneity in clinical presentation, (2) discuss pathophysiology and management, and (3) present a comprehensive literature review of these diverticula. All patients undergoing pharyngoesophageal diverticulum repair between 2013 and 2019 were identified. Cases with ACSS history underwent detailed review of clinical presentation, assessment, and management. Literature review and analysis of all reported ACSS-associated pharyngoesophageal diverticula was performed. Two hundred forty-three cases of pharyngoesophageal diverticulum repair were performed during the study period; 13 cases were ACSS-associated. Four types of clinical presentation were identified: (Type A) Spinal hardware present, with videofluoroscopic evidence of exposed hardware; (Type B) Spinal hardware present, without videofluoroscopic evidence of exposed hardware; (Type C) Spinal hardware absent due to prior spinal hardware removal or ACSS performed without hardware; and (Type D) Concurrent esophago-esophageal fistula (EEF) present. All of our cases were evaluated using modified barium swallow study and esophagoscopy and definitively managed with endoscopic diverticulotomy. Literature review identified 21 cases of ACSS-associated pharyngoesophageal diverticulum repair from 18 publications. The majority of cases were identified using barium esophagram (N = 18, 86%) and managed with open diverticulectomy (N = 19, 90%). There were no reports of EEF. ACSS-associated pharyngoesophageal diverticulum must be evaluated with fluoroscopy and endoscopy, which determine presentation type. Presentation type guides management. Esophageal perforation requires hardware removal and perforation repair with flap placement. Endoscopic diverticulotomy was found essential to definitive management.Level of Evidence: 4.

Tracheoesophageal (TE) puncture with voice prosthesis placement is a common method for vocal rehabilitation in patients who have undergone total laryngectomy. Tracheoesophageal voice prosthesis (TEP) placement after laryngectomy, known as secondary TE puncture, is traditionally done in the operating room, using rigid esophagoscopy. Traditional secondary TEP placement carries a number of downsides including risks associated with general anesthesia, high cost, and technical challenges associated with anatomical variables. As a result, in‐office secondary TE puncture has become an increasingly utilized procedure with many advantages but currently lacks standardization. Here, we describe a kit‐based, awake, in‐office secondary TE puncture with primary TEP placement technique. This technique calls for an endoscopic snare in the event there is difficulty passing the guidewire in the cranial trajectory. No surgical technique videos demonstrating in‐office secondary TE puncture currently exist. Here, we present a video tutorial of our technique, breaking down the procedure into 10 steps from analgesia to voicing. [ABSTRACT FROM AUTHOR]

Background Older patients with myelodysplastic syndromes (MDS), particularly those with no or one cytopenia and no transfusion dependence, typically have an indolent course. Approximately, half of these receive the recommended diagnostic evaluation (DE) for MDS. We explored factors determining DE in these patients and its impact on subsequent treatment and outcomes. Patients and Methods We used 2011-2014 Medicare data to identify patients ≥66 years of age diagnosed with MDS. We used Classification and Regression Tree (CART) analysis to identify combinations of factors associated with DE and its impact on subsequent treatment. Variables examined included demographics, comorbidities, nursing home status, and investigative procedures performed. We conducted a logistic regression analysis to identify correlates associated with receipt of DE and treatment. Results Of 16 851 patients with MDS, 51% underwent DE. patients with MDS with no cytopenia (n = 3908) had the lowest uptake of DE (34.7%). Compared to patients with no cytopenia, those with any cytopenia had nearly 3 times higher odds of receiving DE [adjusted odds ratio (AOR), 2.81: 95% CI, 2.60-3.04] and the odds were higher for men than for women [AOR, 1.39: 95%CI, 1.30-1.48] and for Non-Hispanic Whites [vs. everyone else (AOR, 1.17: 95% CI, 1.06-1.29)]. The CART showed DE as the principal discriminating node, followed by the presence of any cytopenia for receiving MDS treatment. The lowest percentage of treatment was observed in patients without DE, at 14.6%. Conclusion In this select older patients with MDS, we identified disparities in accurate diagnosis by demographic and clinical factors. Receipt of DE influenced subsequent treatment but not survival. [ABSTRACT FROM AUTHOR]

Esophageal symptoms are common and may indicate the presence of gastroesophageal reflux disease (GERD), structural processes, motor dysfunction, behavioral conditions, or functional disorders. Esophageal physiologic tests are often performed when initial endoscopic evaluation is unrevealing, especially when symptoms persist despite empiric management. Commonly used esophageal physiologic tests include esophageal manometry, ambulatory reflux monitoring, and barium esophagram. Functional lumen imaging probe (FLIP) has recently been approved for the evaluation of esophageal pressure and dimensions using volumetric distension of a catheter-mounted balloon and as an adjunctive test for the evaluation of symptoms suggestive of motor dysfunction. Targeted utilization of esophageal physiologic tests can lead to definitive diagnosis of esophageal disorders but can also help rule out organic disorders while making a diagnosis of functional esophageal disorders. Esophageal physiologic tests can evaluate obstructive symptoms (dysphagia and regurgitation), typical and atypical GERD symptoms, and behavioral symptoms (belching and rumination). Certain parameters from esophageal physiologic tests can help guide the management of GERD and predict outcomes. In this ACG clinical guideline, we used the Grading of Recommendations Assessment, Development and Evaluation process to describe performance characteristics and clinical value of esophageal physiologic tests and provide recommendations for their utilization in routine clinical practice.