Abnormal Endoscopic Findings Research Articles

Patterns of upper gastrointestinal diseases among patients undergoing esophagogastroduodenoscopy at three hospitals in Asella town, Southeast Ethiopia

Upper gastrointestinal (UGI) symptoms are among the common complaints among patients visiting health facilities. Because of the scarcity of gastrointestinal endoscopy services and gastroenterologists, the pattern of common upper gastrointestinal diseases has not been well studied in the study setting. This study aimed to determine the pattern of upper gastrointestinal diseases among patients undergoing esophagogastroduodenoscopy (EGD). An institution-based cross-sectional study was conducted at three hospitals in Asella town, southeast Ethiopia. A total of 279 study subjects were included in the study. Three-fourths (74%) of the study participants had abnormal endoscopic findings. The clinical indications for endoscopic examination were dyspepsia (32.6%), peptic ulcer disease (PUD) (27.2%), suspicion of gastric cancer (13.3%), and suspicion of esophageal cancer (11.5%). The abnormal endoscopic findings were esophageal cancer (10.4%), gastric cancer (10%), duodenal ulcer (DU) (9.3%), and gastritis (8.6%). The abnormal biopsy findings were esophageal cancer (7.5%), gastric adenocarcinoma (6.4%), and gastritis (3.9%). Dyspepsia, peptic ulcer disease, and suspicion of UGI malignancies were the most common clinical indications for endoscopic examination, while esophageal cancer and gastric cancer were the most common abnormal endoscopic findings. The most common abnormal biopsy results were esophageal squamous cell carcinoma and gastric adenocarcinoma. It is advised to have a high index of suspicion for esophageal cancer and gastric cancer for patients who present with alarming upper gastrointestinal symptoms in the study setting.

Posttransplant inflammatory bowel disease after successful solid organ transplantation: Not out of the woods yet.

Gastrointestinal symptoms can occur following pediatric solid organ transplantation (SOT), and a subset of children will develop chronic inflammatory bowel disease (IBD) posttransplant. The goal of this study was to characterize patients who developed IBD following SOT, their treatment modalities, and clinical course. A retrospective review was performed of electronic medical records of patients 0-18 years of age who underwent heart, kidney, liver, or intestinal transplantation at our center from January 2009 to April 2019. Patients who developed IBD were included in the final analysis. Demographics, symptoms, and clinical information were recorded. Endoscopic and histologic data and initial and current medications were noted for each patient. Outcomes of interest included phenotype at the time of IBD diagnosis, surgical interventions for IBD, and clinical trajectory at last median follow-up. Eight patients with IBD after heart (n = 3, 37.5%), kidney (n = 2, 25.0%), liver (n = 1, 12.5%), intestinal (n = 1, 12.5%), or multivisceral (heart and kidney, n = 1, 12.5%) transplants were included. Before IBD diagnosis, most patients developed diarrhea (n = 5, 62.5%) and abdominal pain (n = 5, 62.5%). Abnormal endoscopic findings were most common in the colon. Patients were started on medications including 5-aminosalicylates, steroids, and azathioprine. Two patients required biologic therapy and were receiving vedolizumab at last follow-up. Some patients required adjustment of immune suppression. Posttransplant IBD can occur following SOT. Patients exhibit inflammatory, nonstricturing disease though one patient experienced fistulizing disease. Complications are uncommon and many patients enter remission with 5-aminosalicylates alone, though some require adjustment in primary immune suppression.

Spectrum of Upper Gastrointestinal Endoscopy Findings in Patients with Dyspepsia

Introduction: This retrospective study was designed to see the endoscopic findings in patients with dyspepsia. Materials and Methods: This was a hospital-based retrospective observational study which included adult patients who underwent upper gastrointestinal endoscopy for dyspepsia from December 2020 to November 2022. Result: Total of 802 patients, male 405 (50.5%) and female 397 (49.5%), age ranging from 14 to 87 years (mean 42.2382 and SD 15.45) were included in this study. Most common abnormal endoscopic finding was non erosive antral gastritis seen in 341 patients (42.5%), followed by pangastritis in 63 (7.86%) and erosive antral gastritis in 52 (6.48%) patients, duodenal ulcer disease including active, with or without outlet obstruction and remission phase 127 (15.82%), gastric ulcer 34 (4.24%) and oesophageal varices 21 (2.62%). In addition, 24 (2.99%), seven (0.87%) and five (0.62%) patients had carcinoma stomach, carcinoma oesophagus and carcinoma duodenum respectively with higher incidence among elderly patients. While, duodenal malignancy and haital hernia were more common in elderly patients, erosive antral gastritis and pangastritis were more common at younger age groups. However, oesophageal varix, duodenal ulcer and antral carcinoma were more common among male patients. Conclusion: Gastritis was the most common endoscopic finding among dyspeptic patients. The incidence of upper GI malignancy was low, but comparatively higher in elderly patients. Medicine Today 2024, Vol.36 (2): 90-94

Which Alarm Symptoms Are Associated With Abnormal Gastrointestinal Endoscopy Among Thai Children?

Alarm symptoms (red flag signs) are crucial indications for management decisions on pediatric gastrointestinal endoscopy. We aimed to identify items in the alarm symptoms and pre-endoscopic investigations that predict abnormal endoscopy results. A retrospective descriptive study was conducted among children aged under 18 years undergoing endoscopy. The patients were classified into normal and abnormal endoscopic groups. The incidence of alarm symptoms and pre-endoscopic investigations were compared between the groups. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors for abnormal endoscopy. Of 148 participants, 66 were classified in the abnormal endoscopy group. Compared with the normal group, the abnormal group had a significantly higher prevalence of alarm symptoms. Moreover, hematemesis/hematochezia, anemia, low hemoglobin level, hypoalbuminemia, rising erythrocyte sedimentation rate, increased serum lipase, and blood urea nitrogen/creatinine ratio were significantly higher in the abnormal endoscopy group than in the normal group. Multivariate logistic regression analysis indicated that hematemesis/hematochezia and low hemoglobin level were independent risk factors for abnormal endoscopy. The alarm symptoms and pre-endoscopic investigations were evaluated using predictive factors for abnormal pediatric endoscopic findings. According to multivariate logistic regression analysis, hematemesis/hematochezia and low hemoglobin levels were independent risk factors for abnormal endoscopy.

Esophagogastrostomy Versus Double Tract Reconstruction for Laparoscopic Proximal Gastrectomy: Short-term Outcomes Based on Nutritional Parameters and Skeletal Muscle Index.

The optimal reconstruction method for laparoscopic proximal gastrectomy (LPG) remains controversial. The present study aimed to compare short-term outcomes, including assessment of nutritional parameters and skeletal muscle, between two different methods, double-tract reconstruction (DTR) versus esophagogastrostomy (EG). Data from patients who underwent LPG for gastric tumor(s) between 2018 and 2021, were retrospectively analyzed. Patients were divided into two group: DTR (n=11) and EG (n=17). Since 2020, the authors have applied the modified side overlap with fundoplication by Yamashita (mSOFY) method as the EG technique. Compared with DTR, EG was associated with a shorter reconstruction time (p=0.003). Complications of grade ≥3 occurred only in the EG group [n=4 (23.5%)] and the incidence of abnormal endoscopic findings after surgery was numerically higher in the EG group (n=2 vs. n=9; p=0.047). Across virtually all data points on the line graph, the EG group exhibited greater changes in post-discharge nutritional parameters, with Skeletal Muscle Index also demonstrating significant superiority (0.83 vs. 0.89; p=0.045). Among reconstruction methods for LPG, EG demonstrated superiority over DTR in preserving nutritional parameters and skeletal muscle mass. However, further research, including larger cohorts and longer-term follow-up, is necessary to validate this finding.

Endobronchial mucosal biopsy in patients with suspected pulmonary sarcoidosis

BACKGROUND: Sarcoidosis affects the lung in more than 90% of cases, but also affect any organ of the body. The bronchoscope allows for several different diagnostic samples; however, bronchoscopists often underestimate the value of endobronchial biopsy (EBB) in the histological confirmation of sarcoidosis.METHODS: We included 20 patients having suspected pulmonary sarcoidosis (based on clinical and radiological presentation) and being ≥18 years of age. All included patients were subjected to flexible bronchoscopy. Any abnormal endoscopic findings suggestive of endobronchial sarcoidosis was reported. Bronchoalveolar lavage and endobronchial biopsies were obtained.RESULTS: EBB was positive for characteristic non-caseating granuloma of sarcoidosis in 10 patients with a diagnostic yield of 50%. The pathological yield was statistically correlated with the presence of endobronchial mucosal abnormalities but not with the radiological stage. Bronchoalveolar lavage (BAL) was predominantly lymphocytic in 16 (80%) cases, only in 4 (20%) cases their lavage was neutrophilic. There was no statically significant relationship between differential cell count and the biopsy result. The mean value for CD4/CD8 ratio was 1.24±0.45. There was statically significant relationship between CD4/CD8 count in the BAL and the result of mucosal biopsy. The CD4/CD8 count was higher in positive cases with a mean value of 1.46±0.44.CONCLUSIONS: This study provides circumstantial evidence that endobronchial involvement is common in sarcoidosis and EBB can increase the yield of fiber optic diagnosis of sarcoidosis with high diagnostic ratio in cases with mucosal abnormalities. A normal looking endobronchial mucosa should not stop the bronchoscopists from performing EBB.

Causes of gastrointestinal bleeding in children based on endoscopic evaluation at a tertiary care center in Bahrain.

Gastrointestinal bleeding (GIB) is a serious health problem worldwide, particularly during childhood. This can be an alarming sign of an underlying disease. Gastrointestinal endoscopy (GIE) is a safe method for the diagnosis and treatment of GIB in most cases. To determine the incidence, clinical presentation, and outcomes of GIB in children in Bahrain over the last two decades. This was a retrospective cohort review of the medical records of children with GIB who underwent endoscopic procedures in the Pediatric Department at Salmaniya Medical Complex, Bahrain, between 1995 and 2022. Demographic data, clinical presentation, endoscopic findings, and clinical outcomes were recorded. GIB was classified into upper (UGIB) and lower (LGIB) GIB according to the site of bleeding. These were compared with respect to patients' sex, age, and nationality using the Fisher's exact, Pearson's χ 2, or the Mann-Whitney U tests. A total of 250 patients were included in this study. The median incidence was 2.6/100000 per year (interquartile range, 1.4-3.7) with a significantly increasing trend over the last two decades (P < 0.0001). Most patients were males (n = 144, 57.6%). The median age at diagnosis was 9 years (5-11). Ninety-eight (39.2%) patients required upper GIE alone, 41 (16.4%) required colonoscopy alone, and 111 (44.4%) required both. LGIB was more frequent (n = 151, 60.4%) than UGIB (n = 119, 47.6%). There were no significant differences in sex (P = 0.710), age (P = 0.185), or nationality (P = 0.525) between the two groups. Abnormal endoscopic findings were detected in 226 (90.4%) patients. The common cause of LGIB was inflammatory bowel disease (IBD) (n = 77, 30.8%). The common cause of UGIB was gastritis (n = 70, 28%). IBD and undetermined cause for bleeding were higher in the 10-18 years group (P = 0.026 and P = 0.017, respectively). Intestinal nodular lymphoid hyperplasia, foreign body ingestion, and esophageal varices were more common in the 0-4 years group (P = 0.034, P < 0.0001, and P = 0.029, respectively). Ten (4%) patients underwent one or more therapeutic interventions. The median follow-up period was two years (0.5-3). No mortality was reported in this study. GIB in children is an alarming condition, whose significance is increasing. LGIB, commonly due to IBD, was more common than UGIB, commonly due to gastritis.

A105 CHRONIC DIARRHOEA AND ELEVATED LIVER ENZYMES IN A PATIENT WITH AUTOIMMUNE POLYGLANDULAR SYNDROME TYPE 1

Abstract Background Autoimmune polyendocrine syndrome type 1 (APS1) is a rare inherited autoimmune disease, characterized by primary adrenocortical insufficiency and hypoparathyroidism. Pathologic mutations in the autoimmune regulator (AIRE) gene, which participates in the regulation of T-cell self-tolerance can lead to APS-1. Defective function of AIRE encourages production of multiple anti-cytokine and organ-specific autoantibodies, leading to severe autoimmune disease across multiple organs. Autoimmune enteropathy is one of the autoimmune conditions associated with APS-1. Symptoms include chronic diarrhoea and weight loss. Extraintestinal manifestations can include haemolytic anaemia and hepatitis. Purpose To report on a patient with APS-1 who exhibited exacerbations of acute-on-chronic diarrhoea and transaminitis. Method We describe the case of a 14-year-old female, the first child of healthy, first-cousin consanguineous parents, with a history of APS type 1 with a homozygous disease-causing variant in the AIRE gene (c.415C&amp;gt;T, p.139*), hypoparathyroidism and Addison’s disease who presented with worsening diarrhoea and unintentional weight loss (15kg) in the past year. Upper and lower endoscopies performed 10 months and 2 months prior to this admission revealed chronic gastritis and patchy active colitis, without features of a specific etiology. Enteroendocrine cells were present. Celiac disease, inflammatory bowel disease, eosinophilic gastroenteritis, and IPEX syndrome were clinically and histologically ruled out. Result(s) On admission, the patient was having five watery stools per day with associated hypocalcemia and hypokalemia which were felt to be more resistant to treatment than should be explained by her Addison’s disease alone. Albumin was preserved (46 g/L). A stool PCR test for Adenovirus was positive, though serum adenovirus PCR was negative. ALT was 231 U/L and AST was 283 U/L. IgG level was elevated (17.7 g/L), anti-nuclear antibody (ANA) was positive (1:320), and anti-smooth muscle antibody (ASMA) was also positive (1:160). It was therefore suspected that he had autoimmune enteropathy and autoimmune hepatitis, and a liver biopsy was performed as well as upper and lower endoscopies. Liver biopsy demonstrated only minimal macrosteatosis (less than 5%) but no evidence of hepatitis. No abnormal endoscopic findings were observed. Histology showed no typical features of autoimmune enteropathy. Enteroendocrine cells were noted in both small and large intestinal biopsies. Her elevated liver enzymes and diarrhea were resolved spontaneously over a 2-week period. Conclusion(s) We present a patient with APS-1 with acute-on-chronic diarrhoea and transaminitis with elevated IgG and positive ANA and ASMA. Endoscopy and liver biopsy did not reveal evidence of autoimmune enteropathy or autoimmune hepatitis. This case raises the importance of maintaining a broad differential diagnosis when diarrhoea is encountered in APS-1 as this may occur for reasons outside of autoimmune enteroendocrine cell loss. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared ENDOSCOPY, TECHNOLOGY &amp; IMAGING

Usefulness of Endoscopy for the Detection and Diagnosis of Primary Esophageal Motility Disorders and Diseases Relating to Abnormal Esophageal Motility

Esophagogastroduodenoscopy (EGD) is performed to rule out organic diseases in the diagnosis of esophageal motility disorders (EMDs). Abnormal endoscopic findings can be observed during EGD, which indicate the presence of EMDs. Several endoscopic findings at both the esophagogastric junction and esophageal body that are related to EMDs have been reported. Gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) could be detected during EGD, and these diseases are often associated with abnormal esophageal motility. Image-enhanced endoscopy (IEE) could improve the detection of these diseases during EGD. Although no report has been published previously on the potential usefulness of IEE in the endoscopic diagnosis of EMDs, IEE can be used to detect disorders that can be associated with abnormal esophageal motility.

Magnetic resonance diagnosis of laryngeal chondritis after transoral laser microsurgery for laryngeal cancer.

Laryngeal chondritis (LC) is a rare complication of carbon dioxide transoral laser microsurgery (CO2 TOLMS) for laryngeal tumours and can pose a diagnostic challenge. Its magnetic resonance (MR) features have not been previously described. This study aims to characterise a cohort of patients who developed LC after CO2 TOLMS and describe its clinical and MR findings. Clinical records and MR images of all patients presenting with LC after CO2 TOLMS between 2008 and 2022 were reviewed. Seven patients were analysed. Timing of LC diagnosis ranged from 1 to 8 months after CO2 TOLMS. Four patients were symptomatic. Abnormal endoscopic findings included suspected tumour recurrence in 4 patients. MR documented focal or extensive signal changes involving the thyroid lamina and para-laryngeal space with T2 hyperintensity, T1 hypointensity and intense contrast enhancement (n = 7), and minimally reduced mean apparent diffusion coefficient (ADC) values (1.0-1.5 x 10-3 mm2/s) (n = 6). A favourable clinical outcome was achieved in all patients. LC after CO2 TOLMS has a distinctive MR pattern. When tumour recurrence cannot be confidently excluded based on imaging, antibiotic therapy, close clinical and radiological follow-up and/or biopsy are recommended.

Hepatobiliary and Pancreatic: Hepatic mass discovered incidentally with telangiectasia.

A 48-year-old woman with no history of alcohol use or medical history was referred to our hospital for abnormal endoscopic and liver sonography findings collected at another hospital. An gastric angiodysplasia (telangiectasia) on endoscopy and two suspicious liver echogenic masses in hepatic S4 and S6 were detected. Her laboratory tests, including liver function tests and tumor markers, were within the normal ranges and the viral markers were negative. Autoimmune antibodies related to autoimmune hepatitis were negative. As she had a severe allergic reaction to the computed tomography (CT) contrast agent, she underwent liver magnetic resonance imaging (MRI) for further evaluation. The liver MRI revealed dozens of hypervascular nodules of various sizes with a central scar and diffuse vascular abnormalities with peripheral vascular obliteration (Fig. 1a). She had experienced intermittent bleeding of the tongue and several telangiectasias were observed on her tongue (Fig. 1b). The differential diagnoses included hepatocellular adenoma and multiple focal nodular hyperplasia (FNH) syndrome with primary or secondary hepatic vascular abnormalities. Osler-Weber-Rendu disease (hereditary hemorrhagic telangiectasia [HHT]) was also possible considering the diffuse vascular abnormalities in the liver and the telangiectasia on the tongue. The pathology report based on the targeted liver biopsy described a hepatocellular nodular lesion composed of bland looking hepatocytes with sinusoidal dilatation and abnormal vessels, suggesting FNH or hepatocellular adenoma; however, immunohistochemical staining did not confirm either disease (Fig. 2). On the annual MRI follow up, innumerable hypervascular nodules, irregular heterogeneous enhancement of the liver (Fig. 3a), and diffuse vascular abnormalities with peripheral vascular obliteration (Fig. 3b) were the major findings, with no changes seen from the previous exam. Given that the pathology report did not definitively diagnose hepatocellular adenoma or multiple FNH syndrome, a hepatic vascular disorder such as HHT was considered in the differential diagnosis and genetic testing was performed. HHT is an autosomal dominant inherited disorder that affects the vasculature and is considered a rare disease, with a prevalence of 1 in 5000 or 1 in 10 000 births. The pathogenesis of HHT is a heterozygous mutation in the endoglin (ENG) gene or the activin receptor-like kinase type 1 gene, both of which are associated with the transforming growth factor-β superfamily signaling pathway, expressed mostly in the vascular endothelium. As 97% of patients with definite HHT carry a mutation in one of three genes, including ENG, a mutation in a locus mapped to chromosome 5, or an activin receptor-like kinase-1 (ACVRL1), we consulted the genetics department to evaluate the patient for HHT. HHT has traditionally been diagnosed based on clinical features (the Curacao criteria), but can now also be diagnosed by genetic testing. HHT is clinically suspected if two of the four Curacao criteria are met (family history of the disease, hemorrhage, telangiectasia, and visceral involvement) and definite if more than three of the criteria are met. The presence of intrahepatic shunts, disseminated intraparenchymal telangiectases, and other vascular lesions are the typical findings of hepatic involvement. In this patient, three (epistaxis, telangiectasia, and visceral involvement) of the four Curacao criteria were satisfied, leading to a definite diagnosis of HHT. Next-generation sequencing (NGS) panel performed also showed heterozygous mutation of the ACVRL1 (ALK1) gene, which is consistent with HHT type 2.

Clinical Evaluation of Non Resolving Dyspepsia by Upper Gastrointestinal Endoscopy: A Diagnostic Perspective

Introduction: Dyspepsia is a common problem in regular outpatient clinical practice. In Kashmir province of North India little research has been done on studying clinically important endoscopic findings in non resolving dyspeptic patients of different ages and ethnicities. The purpose of this study was to assess the diagnostic value of Upper Gastrointestinal Endoscopy (UGIE) in patients with non resolving dyspepsia who had not undergone endoscopic evaluation previously. Aim: To determine the diagnostic value of endoscopy in patients with non resolving dyspepsia and to correlate the endoscopic findings with clinical perspective of patients with or without alarming symptoms and signs. Materials and Methods: This retrospective cross-sectional, single-centre study was done in the Department of General Medicine, SKIMS Medical College and Hospital (tertiary care hospital), Srinagar, Jammu and Kashmir, India, from July 2017 to June 2022. Study involved 1600 patients who presented with non resolving dyspepsia and underwent endoscopic evaluation. Non resolving dyspepsia was defined as persistent upper abdominal discomfort associated with heart burn or bloating after three to six weeks of adequate proton pump inhibitor therapy. Data was gathered and analysis was done based on demographics, clinical symptoms with or without alarming features by using Statistical Package for the Social Sciences (SPSS) software version 22.0. Results: A total of 1600 patients were incorporated in the study. The mean±Standard Deviation (SD) age of the study group was 52±10 years, and 63% of the patients were males. Epigastric pain was the predominant symptom (61%) followed by heartburn (22%). Abnormal endoscopic findings were noted in 47.75% of the patients involved in this study. Gastritis (19.4%) was the most common finding observed. Gastric carcinoma was the least common diagnosis, seen in 2.93% subjects mostly in the elderly age group. Conclusion: In the present study, patients with dyspepsia frequently had normal or clinically insignificant upper gastrointestinal endoscopic findings regardless of age. Based on the present study conducted in a large number of patients invasive procedure like UGIE should be reserved for patients having definite alarming features as majority of patients don’t have clinically significant findings and should be treated adequately on Functional Dyspepsia (FD) protocol before a definitive investigative procedure is performed. The present study strongly indicates overuse of UGIE especially in the absence of alarming features.

Prevalence and Predictors of Post-Thyroidectomy Voice Dysfunction in a Nigerian Cohort.

Advances in surgical techniques have significantly improved the safety of thyroidectomy. Quality of life issues, such as voice changes, however continue to be important considerations. This study evaluated the prevalence and determinants of voice changes following thyroidectomies for non-malignant goiters in a Nigerian Hospital. Consecutive adults who had thyroidectomy for non-malignant goiters were evaluated. Preoperatively, each participant had laryngoscopy and voice assessment using the Voice Handicap Index-10. At surgery, the intubation difficulty score, size of endotracheal tubes, and duration of operation were recorded. Laryngoscopy and VHI-10 assessments were repeated 1week, 1month, and 3months after surgery. Pre and postoperative assessments were compared. Fifty-four patients completed the study. Subtotal thyroidectomy was the commonest operation performed in 17 patients (31.48%), with 14 (25.93%) having total thyroidectomy. Baseline median VHI-10 score was 6.5(IQR-10). Five patients had abnormal preoperative laryngoscopy findings (benign vocal cord lesions). Postoperatively, seven patients had endoscopic evidence of vocal cord paralysis, six were unilateral while one was bilateral. Ten patients (18.5%) had early voice changes. Median VHI-10 score at one week was significantly higher than baseline (10 vs. 6.5, p = 0.01). At 3months, VHI-10 reverted back to baseline in five of the ten patients while five patients (9.3%) had persistent voice changes. Abnormal endoscopic findings predicted the occurrence of early postoperative voice changes. Thyroidectomy for non-malignant goiters is associated with transient voice changes, many of which revert to normal over time. Abnormal endoscopic findings predict its occurrence.

468. THE EFFECT OF ROUTINE ENDOSCOPIC SCREENING FOR SYNCHRONOUS ESOPHAGEAL NEOPLASIA IN PATIENTS WITH HEAD AND NECK SQUAMOUS CELL CARCINOMA

Abstract Esophageal squamous cell carcinoma (ESCC) and head and neck (H&amp;N) cancer coincide in high frequency and early detection of synchronous cancer is inevitable for these patients. The aim of this study is to analyze the effect of routine endoscopic screening for synchronous esophageal cancer in patients with H&amp;N cancer. From April 2020 to March 2022, 35 patients with newly-diagnosed H&amp;N cancer had routine screening endoscopy for synchronous esophageal cancer. All patients with H&amp;N cancer were referred to our department prior to the treatment for H&amp;N cancer. The locations of H&amp;N cancers were oral/oropharyngeal/hypopharyngeal/laryngeal/other H&amp;N cancer; 9/6/9/9/2 respectively. Image-enhanced endoscopy using BLI (blue laser imaging) was performed in all patients. Lugol staining was used in 20 patients and multiple Lugol voiding lesions were detected in 9 patients. Among all patients, abnormal endoscopic findings in esophagus were detected in 15 patients (43%), and biopsy was performed in 11 patients (31%). Biopsy revealed SCC in 5 patients and atypical epithelium in 2 patients. Esophageal lesions were all found in early stage within indication of endoscopic treatment. 3 patients underwent endoscopic treatment after treatment of H&amp;N cancer. Routine endoscopic screening for patients with H&amp;N cancer is effective in early detection of synchronous esophageal cancer with minimally invasive treatment for esophageal neoplasm. The treatment of chemotherapy for H&amp;N cancer may be effective for esophageal lesions, therefore, careful surveillance is required during the treatment of H&amp;N cancer. Routine endoscopy should be continued further for these patients for screening of metachronous cancer.

Pediatric esophagogastroduodenoscopy in china: indications, diagnostic yield, and factors associated with findings

BackgroundLarge-scale data on esophagogastroduodenoscopy (EGD) in China are scarce. This study aimed to assess the indications and diagnostic yield of EGD in children and the relationship between factors (such as age, sex, and indications) and diagnostic yield.MethodsWe performed a prospective cross-sectional observational study involving patients aged < 18 years who underwent diagnostic EGD. The study was conducted in five children’s hospitals, each in a different city. Demographic features, indications for endoscopy, and endoscopic and histopathological findings were collected. Univariable and multivariable ordinal logistic regression analyses of the relationship between the factors and diagnostic yield were performed.ResultsThe study included 2268 patients (male/female ratio, 1.3:1) with a median age of 8.68 years. Among the 2268 children, the most frequent indications were abdominal pain in 1954 (86.2%), recurrent vomiting in 706 (31.1%), weight loss in 343 (15.1%), and others. The endoscopic yield was 62.5% and was the highest in patients with dysphagia (90.9%). The histologic yield was 30.4% and was the highest in patients with unexplained anemia (45.5%). On multivariable regression analysis, the endoscopic yield was associated with dysphagia, gastrointestinal (GI) bleeding, and recurrent vomiting, and the histologic yield was associated with age. Different groups of patients with abdominal pain had variable probabilities of abnormal endoscopic findings.ConclusionsThe most frequent indication of pediatric EGD is abdominal pain, with variable probabilities of abnormal endoscopic findings in different groups. Endoscopic yield and histologic yield are associated with certain alarming features.Trial registrationThe trial registration number (ClinicalTrials. gov): NCT03603093 (The study was registered on 27/07/2018).

The utility of endoscopy prior to bariatric surgery: an 11-year retrospective analysis of 885 patients.

Our aim was to evaluate the diagnostic yield of routine preoperative esophagogastroduodenoscopy (p-EGD) in patients undergoing bariatric surgery. Many medical problems that are common in patients with obesity, including gastroesophageal reflux disease (GERD) and hiatal hernias, have important implications for patients undergoing bariatric surgery. While p-EGD is considered standard of care prior to antireflux surgery, the role of p-EGD in bariatric surgery patients remains controversial. We performed a retrospective chart review of 885 patients who underwent primary bariatric surgery at a university hospital-based bariatric surgery program between March 2011 and February 2022. Clinical history, demographics, and preoperative EGD reports were reviewed for abnormal findings. Of the 885 patients evaluated in this study, one or more abnormal EGD findings were observed in 83.2% of patients. More than half of our patients (54.7%) presented with history of heartburn, reflux, or GERD. EGD findings demonstrated a hernia in 43.1% of patients [(Type I: 40.6%; Type II: 0.5%; Type III: 2.1%)]. 68.0% of patients were biopsied. Among patients who were biopsied, other findings included gastritis (32.4%), esophagitis (8.0%), eosinophilic esophagitis (4.7%), or duodenitis (2.7%). We found ulcers in 6.7% of patients. Pathology was consistent with H. pylori in 9.8% of biopsies taken and consistent with BE in 2.7%. Following routine p-EGD, 11.2% of patients were placed on PPI and 8.3% were recommended to stop NSAIDs. Gastroesophageal reflux disease and associated pathology are common in the bariatric population. Preoperative EGD in patients undergoing bariatric surgery frequently identifies clinically significant UGI pathology. This may have important implications for medical and surgical management. Given the rate of abnormal preoperative endoscopic findings in obese patients, the work-up for bariatric surgery should align with the current recommendations for foregut surgery.

Impact of preoperative esophagogastroduodenoscopy in patients undergoing bariatric surgery and development of a model to predict clinically significant abnormal endoscopic findings.

BackgroundPreoperative esophagogastroduodenoscopy (EGD) in patients undergoing bariatric surgery can help surgeons detect abnormalities in the upper gastrointestinal (UGI) tract that may require a change in surgical plan. However, the need for EGD before bariatric surgery is controversial.ObjectivesWe aimed to determine the prevalence of UGI abnormalities and evaluate the predictive factors of abnormal findings that require a change in surgical plan or cause a delay in surgical treatment in patients undergoing bariatric surgery and develop a prediction model.MethodsThe medical records from January 2012 to July 2020 were retrospectively reviewed in patients who underwent EGD before bariatric surgery. The EGD findings were classified into four groups based on their effects on management. Group 1 had normal findings. Group 2 had abnormal findings that did not require a change in surgical management. Group 3 had abnormal findings that required a change in the surgical plan or caused a delay in surgical treatment. Group 4 had contraindications to surgery. Predictive factors for Groups 3 and 4 were analyzed using univariate and multivariate analyses. A model visualized as a nomogram was developed based on significant factors. Discrimination and calibration were evaluated.ResultsA total of 461 patient records (63.8% female) were reviewed. The mean age was 35.1 ± 11.2 years and the mean BMI was 47.7 ± 8.7 kg/m2. The prevalence of endoscopic findings in Groups 1, 2, 3, and 4 were 42.5%, 35.6%, 21.9%, and 0%, respectively. The most common abnormal findings were non-erosive gastritis (31.2%) followed by Helicobacter pylori infection (18.7%) and hiatal hernia (10.2%). Male sex and NSAID use were significantly associated with detection of lesions in Group 3 either on univariate or multivariate analysis, while type 2 diabetes mellitus (T2DM) was a significant protective factor on multivariate analysis. On subgroup analysis in patients ≥ 40 years old, multivariate analysis revealed age, BMI, and NSAID use were significantly associated with the detection of lesions in Group 3, while T2DM was still a significant protective factor. A nomogram to predict lesions in Group 3 for this subgroup was developed and showed good discrimination (C-statistics 0.737, 95% CI 0.721‒0.752).ConclusionA high prevalence of abnormal endoscopic findings was observed in Thai patients who are undergoing bariatric surgery. Preoperative EGD screening is helpful in detecting UGI abnormalities that require a change in the surgical decision plan. The new nomogram may help rational utilization of EGD prior to bariatric surgery.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s00464-022-09391-8.

Endoscopic surveillance after bariatric surgery: Results from a large, single-institution cohort

Abstract Objective Sleeve gastrectomy (SG) and Roux-en-Y-gastric bypass (RYGB) are associated with long- term abnormalities, including erosive esophagitis (EE), hiatal hernia (HH), gastritis, Barrett`s esophagus and ulcers. The aim of this study is to assess the prevalence of abnormal endoscopic and histologic findings after SG and RYGB in a large cohort. Methods This is a retrospective analysis of 720 consecutive patients who underwent esophagogastroduodenoscopy (EGD) after primary SG or RYGB. Patients were invited for a control EGD after two years of follow-up. EGD was also performed in order to evaluate postoperative symptoms, such as nausea, vomiting or reflux. If revisional surgery was planned, an EGD was included in the prerevisional work up. Results 304 post-SG patients (64.1% female) and 416 post-RYGB patients (85% female) were included. The mean age at the time of operation was 43.9 years (95% confidence intervals (CI) 42.5–43.3 years) for the post-SG group and 40.5 years (95% CI 39.4–41.6 years) for the post-RYGB group (p&amp;lt;0.001). The mean preoperative body mass index (BMI) was 44.2 kg/m2 (95%CI 43.4–44.9) and 41.1 kg/m2 (95%CI 40.7–41.5) for the post-SG and the post-RYGB group respectively (p&amp;lt;0.001). EE, gastritis and HH were more prevalent after SG than RYGB (38.8% vs 8.9%, 62.5% vs 27.6% and 28% vs 2.6% respectively, p&amp;lt;0.001). RYGB was associated with more postoperative ulcers than SG (14.4% vs 0.7%, p&amp;lt;0.001). The incidence of anastomotic strictures requiring anastomotic dilatation after RYGB was 4.6%. No significant difference was found in the prevalence of Barrett`s esophagus (4.3% post SG vs. 4.1 post RYGB, p=1.000) and Helicobacter pylori (3.3% post SG vs. 1.2% post RYGB, p=0.065) between the two groups. Conclusion SG is associated with higher rates of EE, gastritis and HH, while the prevalence of ulcers is higher post RYGB. There is a low risk of anastomotic stricture post RYGB. The incidence of Barrett`s oesophagus is low after both procedures. Routine use of EGD after bariatric surgery should be evaluated.

Diversion colitis in inflammatory bowel disease (IBD) is distinct from that in non-IBD: Reappraisal of diversion colitis

The significant histologic overlap between diversion colitis and inflammatory bowel disease (IBD) poses a diagnostic challenge. We aimed to identify histologic features that are characteristic of diverted colon segments among patients with IBD and compare them with histologic features identified in IBD colectomies. Archived slides from resected diverted colon segments from patients with (n=79) and without (n=80) IBD and the corresponding prior colectomies (n=52) of the IBD patients were reviewed. Clinical and endoscopic data were collected, and a series of histologic features were evaluated and graded. Compared to the non-IBD group, IBD patients were more likely to be symptomatic and present with abnormal endoscopic findings (P<.05). The severity of inflammatory activity, crypt architectural distortion, mucosal atrophy, transmural inflammation, intramucosal lymphoid aggregates (IMLAs), and transmural lymphoid aggregates (TMLAs) were significantly greater in diverted segments in IBD cases than controls (P<.001). The severity of inflammatory activity, IMLAs, TMLAs, and transmural inflammation and the presence of ulcer(s) in the diverted colon segments of IBD patients were associated with the histologic features reflective of IBD activity such as inflammatory activity, transmural inflammation and ulcer(s) in the preceding colectomies (P<.05). Diversion colitis developing in the setting of IBD is endoscopically and histologically distinct from that observed among individuals without IBD. Inflammatory activity, presence of ulcer(s), IMLAs, TMLAs, and transmural inflammation in diverted colon segments of IBD patients may, in part, reflect the severity of underlying IBD rather than pure diversion colitis.

P251 Endoscopic and pathologic findings of the esophago-gastroduodenal involvement of Crohn’s disease in Korea: a prospective cohort study

Abstract Background The characteristics and incidence of esophago-gastroduodenal involvement of Crohn’s disease (CD) are unclear in Korea. We aim to investigate the prevalence and clinicopathological characteristics of CD with esophago-gastroduodenal involvement. Methods A total of 115 patients with CD who underwent esophagogastroduodenoscopy (EGD) including esophageal, gastric and duodenal biopsies were enrolled prospectively between 2020 and 2021 at a tertiary care center. Total of five specimens obtained from the esophagus, gastric body and antrum, and duodenal bulb and second portion respectively during endoscopy were histologically reviewed. The presence of Helicobater pylori was evaluated by immunohistochemical analysis. Results The median age was 30.0 (interquartile range [IQR] 25.0–37.0) years and 74.8% were male. Of total, 32.2% had were symptoms including epigastric pain (29.7%), bloating (27.0%) and dyspepsia (13.5%). Based on histological features, 56 patients (48.7%) were identified as having UGI involvement (15 esophageal, 44 gastric, and 36 duodenal). Of 115 included patients, bamboo- joint-like appearance in the stomach was founded in 81 (70.4%) and their histologic findings were mostly revealed as non-specific feature. Notable histopathological findings included non-caseating granulomas in 8 cases (7.0%), focally enhanced gastritis in 38 cases (33.0%), and lymphocytic esophagitis in 13 cases (10.7%). Among 115 cases, 6 cases (5.2%) were H. pylori positive and 109 cases (94.8%) were H. pylori negative. Conclusion The prevalence of esophago-gastroduodenal involvement of CD was relatively high among CD patients who underwent EGD in Korea. A high suspicion of CD with esophago-gastroduodenal involvement with endoscopic biopsy is warranted when patients have abnormal endoscopic findings.