Common Endoscopic Findings Research Articles

An association of Helicobacter pylori infection with endoscopic and histological findings in the Nepalese population.

Background:Helicobacter pylori (H. pylori) is one of the most common human infections worldwide particularly in the developing countries. We aimed to study an association of H. Pylori infection with endoscopic and histological findings in the Nepalese population.Materials and Methods:We conducted a study between Oct 2014 and Jan 2015 after meeting inclusion and exclusion criteria. Institutional Review Board approval was obtained from National Academy of Medical Sciences. Endoscopic findings and histopathological diagnosis were documented and data were analysed.Results:A total of 113 patients who had complete endoscopy were enrolled. The prevalence of H. pylori infections recorded was 27 (23.9%) patients. There were 17 (62%) male and 10 (37%) female infected with H. pylori (P = 0.33). All biopsied specimens were sent to pathology lab for examination. The most common endoscopic findings was erythematous antral gastritis (40.7%) followed by erosive gastritis 34 (30.1%), pangastritis 10 (8.8%), duodenal ulcer 13 (11.5%), gastric ulcer 9 (8%), erosive fundal gastritis 2 (1.8%), reflux esophagitis 10 (37%) (P < 0.04). Histology revealed that 23 (85.2%) patients had chronic active gastritis (CAG); (P < 0.001).Conclusions:Our study revealed that H. pylori infection is strongly associated with chronic active gastritis (CAG) and Reflux esophagitis in Nepalese adults.

Evaluation of the gastrointestinal clinical, endoscopic, and histological findings in patients with bile reflux diseases: A cross-sectional study

Background: Bile reflux occurs when the bile flows upward from the duodenum to the stomach and esophagus. It occurs when the pyloric sphincter is damaged or fails to work correctly; bile can enter the stomach and then be transported into the esophagus as in gastric reflux. Objective: This study aims to evaluate clinical findings and the endoscopic and histological changes caused by bile reflux disease on gastric mucosa. Patients and Methods: This is a cross-sectional study carried out at Gastrointestinal Endoscopy Unit in Al-Yarmouk Teaching Hospital in Baghdad during the period from January 2016 to October 2016, upper endoscopy done to 50 patients in the Gastrointestinal Tract Center of Al-Yarmouk Teaching Hospital, in whom there is endoscopic evidence of bile reflux disease and biopsies from gastric mucosa were taken and send for histopathology and Helicobacter pylori examination. Results: Bile reflux was noted in 19 males (38%) and 31 females (62%). Bile reflux disease was more in age below 50 years (29 patients), more in the female, while after the age of 65 years, the male/female ratio was 1.5/1. The most common symptoms were epigastric pain. The most common endoscopic findings were gastric erythema. The major risk factors were cholecystectomy (8%). Pylori were present in about 24% of the patients. Conclusion: Bile reflux disease was more common in young female and cholecystectomy was common risk factor.

Looks Can Be Deceiving: An Atypical Presentation of Mantle Cell Lymphoma

Introduction: Primary gastrointestinal(GI) mantle cell lymphoma (MCL) is a rare and aggressive malignancy. Endoscopy typically shows multiple lymphomatous polyposis (MLP) but other findings have been reported. We describe a case of primary GI MCL diagnosed during routine colon cancer screening. Case: A 61-year-old Hispanic female presented for a routine colonoscopy. Fifteen years prior, she underwent colonoscopy with polypectomy in El Salvador; report was not available. She denied fevers, chills, weight loss, diaphoresis, abdominal pain, melena, and hematochezia. Abdominal exam was benign and without lymphadenopathy. On colonoscopy, 3 sigmoidal polyps- all less than 5mm- were resected; the remaining mucosa was normal in appearance. Histology for 2 of the polyps showed lymphoid infiltrate with CD20+ B cells, reactive germinal centers, and expanded mantle zones, consistent with mantle cell lymphoma. The third polyp was an adenoma. Patient was referred to oncology and a workup of CT scans, FDG-PET CT, bone marrow biopsy and flow cytometry were normal. Patient declined chemotherapy and was observed. A colonoscopy 3 months later showed normal-appearing mucosa but biopsies from each colonic segment demonstrated diffuse MCL. Discussion: Primary GI MCL accounts for 1-4% of all GI lymphomas. The most common endoscopic finding is intestinal MLP but previous cases report ulcerated lesions, mucosal color changes or thickening, and frank masses. Our patient only had 3 small polyps on the initial screening and normal-appearing mucosa on the repeat endoscopy. Microscopic evidence of MCL is actually seen in two-thirds of cases with endoscopically normal mucosa but the significance of this on patient outcome is unclear. Primary GI MCL is often diagnosed in end stages and has a poor prognosis but the median survival remains to be studied. Chemotherapy regimens such as CHOP achieved high remission rates but for short time periods. More recently, the hyper-CVAD/MA regimen with rituximab has been established as an effective cytoreductive regimen with a high response rate. Our patient was offered bendamustine and rituximab, an effective regimen often utilized in older MCL patients. Specific regimens vary based on disease severity and patient's functional status. This case highlights an atypical presentation of a rare malignancy, the importance of timely screening colonoscopies, and the consideration of performing random colon biopsies on patients with MCL polyp pathology.

A Surprising Life-Changing Screening Colonoscopy

Gastrointestinal (GI) tract represents the largest lymphoid organ in the body and is frequently affected by opportunistic infections in immunocompromised patients with Acquired Immunodeficiency Syndrome (AIDS). Mycobacterium avium intracellulare complex (MAC) is a well-established opportunistic infection and is an AIDS-defining illness. We report a case of AIDS diagnosed as a consequence of a snare polypectomy during a screening colonoscopy. A 52 year old otherwise healthy, asymptomatic gentleman was referred for screening colonoscopy. Review of systems was negative. Physical examination was unremarkable. A single, sessile, 10 mm cecal polyp of benign endoscopic appearance was identified at screening colonoscopy. Snare polypectomy was performed. Microscopic examination revealed a polypoid aggregate of histiocytes and mixed inflammatory cells within the submucosa with overlaying mucosal erosion. Immunohistochemical (IHC) staining was positive for vimentin and negative for cytokeratin, indicating mesenchymal origin; IHC was also positive for CD45 and CD68 confirming inflammatory cell infiltrate and presence of histiocytes respectively. IHC was negative for S100, synaptophysin and CD117 thus making melanoma, neuroendocrine and gastrointestinal stromal tumors unlikely. Abundant acid-fast organisms were noted in the cytoplasm of histiocytes on acid-fast stain with appearances characteristic of MAC. Pathology and IHC of the cecal polyp were thus suggestive of an atypical histiocytic pseudotumor with abundant acid-fast organisms, and negative for malignancy. Human Immunodeficiency virus (HIV) infection, CD4 T-lymphocyte deficiency and AIDS with MAC were diagnosed on subsequent serological testing. Treatment with emtricitabine-tenofovir, raltegravir, azithromycin, ethambutol and bactrim were commenced. GI MAC infection may be the first presentation of AIDS associated opportunistic infection. MAC often causes abdominal pain, weight loss, diarrhea or fever and commonly involves the small intestine, with duodenum being the most common site followed by rectum, ileum, colon, esophagus, jejunum and stomach. Cecal involvement is not commonly reported. Multiple raised nodules, ulceration, erythema, edema, friability, stricture, aphthous erosions are common endoscopic findings. Our patient was otherwise asymptomatic despite harboring MAC in a cecal polyp discovered incidentally and was subsequently diagnosed with AIDS, all following routine screening colonoscopy.1858 Figure 1. A single, sessile, 10 mm cecal polyp removed by snare polypectomy at screening colonoscopy.

Portal Hypertensive Polyposis in Advanced Liver Cirrhosis: The Unknown Entity?

Background Portal hypertension is a serious complication of liver cirrhosis. Objective To identify relevant endoscopic findings in patients with advanced cirrhosis and consecutive portal hypertension. Methods This was a retrospective study of liver transplant candidates who underwent upper gastrointestinal endoscopy between April 2011 and November 2015. Results A total of 1,045 upper endoscopies were analyzed. Portal hypertensive gastric and duodenal polyps were frequently observed and were associated with thrombocytopenia (p = 0.040; OR: 2.4, 95% CI 1.04–5.50), Child-Pugh score > 6 (p = 0.033; OR: 2.3, 95% CI 1.07–4.92), Model for End Stage Liver Disease score > 16 (p = 0.030; OR: 4.1, 95% CI 1.14–15.00), and previous rubber band ligation (p < 0.001; OR = 5.2, 95% CI 2.5–10.7). These polyps often recurred after polypectomy; however, no malignant transformation occurred during the observational time until October 2017. The most common endoscopic finding was esophageal varices, observed in more than 90% of patients. Conclusion Portal hypertensive polyposis is common in patients with advanced cirrhosis. Our data suggest that these polyps have benign characteristics.

Pancolitis associated with higher mortality risk of cytomegalovirus colitis in patients without inflammatory bowel disease.

BackgroundCytomegalovirus (CMV) colitis typically presents in immunocompromised and inflammatory bowel disease (IBD) patients. Several studies have been conducted on the endoscopic characteristics of CMV colitis in IBD patients.ObjectivesThe endoscopic findings of CMV colitis in non-IBD patients and their relationship with inhospital mortality are unclear. We aimed to describe the endoscopic presentation in these patients and to determine the endoscopic predictors of inhospital mortality.Patients and methodsPatients with CMV colitis diagnosed using histology between April 2002 and December 2016 at the Linkou Chang Gung Memorial Hospital, Taiwan, were retrospectively enrolled. Patients diagnosed with IBD during follow-up were excluded. Patient data, including underlying diseases, endoscopic presentation, laboratory data, clinical course, complications, and clinical outcomes, were collected. The independent risk factors for inhospital mortality were analyzed with logistic regression. The difference of overall survival was compared using Kaplan–Meier survival curve and log rank test. All statistical calculations were performed using SPSS software, version 21.ResultsSixty-nine patients were enrolled, and 8 IBD patients were excluded. Within the 61 non-IBD patients, 31 were diagnosed by colonoscopy and others by sigmoidoscopy. Ulceration (77%) was the most common endoscopic finding, followed by a cobblestone appearance (19.7%), colitis with/without erosions (9.8%), pseudomembrane (9.8%), and tumor/polyp-like lesions (8.2%). Among the patients who underwent full-length colonoscopy, 35.3% presented with right-sided colitis, 23.5% with left-sided colitis, and 32.4% with pancolitis. Pancolitis was identified as a negative predictor of inhospital mortality (odds ratio, 6.8; 95% confidence interval, 1.233–37.497; p=0.028) and overall survival (log rank p=0.018).ConclusionColonoscopy is recommended for precise CMV colitis diagnosis and outcome prediction in non-IBD patients.

Role of Diagnostic Preoperative Upper Gastrointestinal Endoscopy in Radiologically Confirmed Gastric Volvulus.

Gastric volvulus (GV) is a life-threatening condition that warrants prompt diagnosis and treatment. GV is a radiologic diagnosis. The role of preoperative upper gastrointestinal endoscopy (UGIE) for individuals with radiologically confirmed GV is poorly defined. Our objective was to assess the diagnostic yield of UGIE in the preoperative evaluation of patients presenting with radiologically confirmed GV. Retrospective review of all adult patients undergoing surgery for GV between July 1996 and August 2016 has been carried out. We performed analyses evaluating diagnostic yield of preoperative UGIE and compared outcomes in patients who did and did not undergo preoperative UGIE. Outcomes were diagnostic yield of preoperative UGIE, length of hospital stay, postoperative complications, and mortality at 30days and 1year. In the preoperative UGIE group, the diagnostic yield was 34.6% (27/78). The most common endoscopic findings were erosive esophagitis (13/27) and clean based gastric or duodenal ulcers (5/27). There were no cases of esophago-gastric malignancy. Three patients had ulcers with stigmata of recent bleeding, and three patients had features suggestive of gastric ischemia. Endoscopic findings did not influence surgical management. There was no statistically significant difference in mortality between patients who did and did not undergo preoperative UGIE, both at 30days (0 vs. 2.5%) and 1year (3.8 vs. 7.5%). Among patients with radiologically confirmed GV, preoperative UGIE rarely demonstrates clinically significant findings and can potentially delay definitive surgical intervention.

535 OUTCOMES OF GASTROINTESTINAL BLEEDING IN PATIENTS WITH LEFT VENTRICULAR ASSIST DEVICES: A TERTIARY CARE CENTER EXPERIENCE

Left Ventricular Assist Device (LVAD) placement is a therapeutic modality for patients with end-stage congestive heart failure. Gastrointestinal bleeding (GIB) is one of the most common complications after LVAD implantation. Limited data exists on the etiology, management and outcomes in these patients. To our knowledge, this is the largest single-center study reporting the risk factors, endoscopic findings, and outcomes in the management of LVAD patients presenting with GIB. We performed a retrospective chart review of all patients who underwent LVAD placement and had a subsequent GIB at our tertiary care academic referral center from January 2008 to June 2017. Patient-specific data was collected including demographics, clinical presentation at time of GIB, and comorbidities. Procedural details (endoscopic/radiologic) were also obtained. Descriptive analysis was performed utilizing SPSS software. A Cox regression model using SAS was employed to assess factors predictive of GIB. During the study period, 345 patients underwent LVAD implantation. Of these, 125 patients (36.2%) presented with a total of 297 bleeding events. Median time to first GIB following LVAD placement was 6.5 months. Patient demographics and characteristics are summarized in Table 1. The top presenting symptom of GIB was melena (n = 134; 45.1%). At the time of GIB, 97% of patients were on an antithrombotic regimen (Table 2); the most frequent combination was warfarin plus aspirin (n = 216; 73.0%). Lab values, transfusion requirement, and medical management are summarized in Table 1. During the study period, 533 endoscopic procedures were performed for evaluation of GIB: 228 EGDs, 125 colonoscopies, 79 push enteroscopies, 68 video capsule endoscopies, 26 antegrade and 7 retrograde double balloon enteroscopies. The most common endoscopic finding was AVM (n = 121; 42.2%). GIB source was most often located in the stomach (n = 113; 39.4%). 226 endoscopic therapeutic interventions were performed for hemostasis, with the most common being APC (n = 77; 34.1%) and endoclip placement (n = 67; 29.6%). Overall success of therapeutic interventions in achieving hemostasis was 96.2%. 30-day post-procedure complications are summarized in Table 2. The overall complication rate was 6.6%. Cox model analysis revealed that older age at implant, male gender, African-American race, DM and pulmonary hypertension were statistically significant predictors of GIB during post-LVAD follow-up. GIB doubled the risk of mortality in a multivariate adjusted model. Danazol and Octreotide were associated with an increased risk of recurrent GI bleeding. LVAD patients have a high risk (36.2%) of GIB. The most common bleeding sources were AVMs located in the stomach or small bowel. These can be successfully treated endoscopically in > 95% of patients with a low complication rate.

Short article: The endoscopic and histologic findings of infants who have experienced brief resolved unexplained events.

A brief resolved unexplained event (BRUE) describes an event associated with a change in muscle tone, color, respiration, and responsiveness that is unexplained after an appropriate examination. Some infants with higher risk BRUE may undergo endoscopy as part of their evaluation. This retrospective study aimed to identify the endoscopic findings in infants who have experienced a higher risk BRUE. We also compared the characteristics, prenatal, natal, and postnatal risk factors between 23 infants who underwent endoscopic evaluation and 23 race-matched/sex-matched/term-matched/preterm-matched infants who did not undergo endoscopic evaluation. This was a retrospective descriptive study. Infants were identified from a query of medical records using the ICD-10 code for BRUE (R68.13). Of 119 infants with BRUE, 23 infants with higher risk BRUE underwent an esophagogastroduodenoscopy and flexible sigmoidoscopy. Apnea (87%) was the most common presentation of BRUE. Most were female (57%) with a mean age at BRUE presentation of 2.73 months. We found 10 (43.5%) term infants and 13 (56.5%) preterm infants in our study. There were no significant differences in characteristics, prenatal, natal, and postnatal risk factors between the infants who underwent endoscopy and those who did not undergo endoscopy. The most common abnormal endoscopic finding was lymphonodular hyperplasia (LNH) associated with eosinophilia in the rectosigmoid colon. The proportion of females in the LNH group was significantly higher than the non-LNH group. Rectosigmoid LNH and eosinophilia, which are associated with milk soy protein intolerance (MSPI), were the most common findings on endoscopic evaluation. Although there is no proof of causation between MSPI and BRUE, MSPI should be considered in the differential diagnosis for higher risk BRUE.

Demographic and Clinical Profile in Patients with Liver Cirrhosis in a Tertiary Care Hospital in Central Nepal

Liver cirrhosis is an important health problem worldwide and is a common disease in Nepal. The profile of cirrhosis may vary due to different factors. This study was undertaken to see the demographic and clinical profiles of patients with cirrhosis of liver attending a tertiary care hospital in Central Nepal. Six hundred patients with clinical features, laboratory and sonological findings suggestive of chronic liver dysfunction and endoscopic evidence of portal hypertension were included in the study. Their demographic and clinical profile, endoscopic findings, outcomes during hospitalization were studied. Ethical approval was taken from Institutional Review Committee of College of Medical Sciences. SPSS 20 was used for statistical analysis. The mean age of subjects was 54±11.84 years with 435 males (72.5%) and 165 (27.5%) females. Majority of 203 (33.8%) patients were from Mongol ethnicity followed by 127 (21.2%) Khas. Two hundred and twenty (36.6%) were farmers followed by 169 (28.2%) retired personnel. A total of 338 (56.4 %) patients were from rural areas. The commonest aetiology of cirrhosis was chronic alcohol consumption and seen in 552 (92%) patients. Abdominal distension was commonest presenting sign and observed in 561 (93.5%) patients. Ascites seen in 555 (92.5%) patients was the commonest complication followed by UGI bleed in 326 (54.3%) patients. Gastro-oesophageal varices observed in 345 (57.5%) patients, was the most common endoscopic finding followed by portal gastropathy, peptic ulcer and erosive mucosal diseases. In patient mortality was noted in 92 (15.3 %) patients. This study highlights the burden of cirrhosis, usually caused by chronic alcohol consumption in Central Nepal. Majority of subjects were male, middle aged, farmers, from rural areas and predominantly observed in some ethnicity like Mongols. Cirrhotic patients usually Keywords: cirrhosis of liver; complications; endoscopy.

Thoracic complications of upper gastrointestinal endoscopy in Zagazig University Hospitals. A cross-sectional single center study

Upper Gastro Intestinal Endoscopy (UGIE) is a commonly performed diagnostic and/or therapeutic procedure for evaluation of patients with various abdominal complaints. UGIE complications vary including; pneumonia, mediastinitis, oesophago-pleural fistula. The reported complications of UGIE are diverse and vary from one center to another. AimThe study aimed to report the thoracic complications in patients underwent UGIE during the period between July and December 2016. Patients and methodsOne hundred and twenty patients, candidates for UGIE were included in the study. All patients were subjected to: thorough medical history, complete general and local chest and abdominal examination, routine laboratory investigations, chest X-ray and chest computed tomography (CT) if needed, spirometric pulmonary function tests (PFT), arterial blood gases (ABGs), pre and post UGIE. ResultsPatients were 84 males and 36 female, age ranged from 25 to 70years old, hematemesis and/or melena was the most common presentation (65%). Oesophageal varices was the most common endoscopic finding (50% of cases). Chest pain, cough and bronchitis were more common among Oesophageal Varices Sclerotherapy (OVS) patients. Pneumonia, atelectasis, pleural effusion and mediastinitis were reported after OVS. There was significant difference regarding spirometric parameters before, 2days and 3weeks after the procedure in patients underwent OVS and Gastric Varices Sclerotherapy (GVS), while no significant difference was reported in patients underwent Oesophageal Varices (OV) band ligation and peptic ulcer diagnosis before, 2days and 3weeks after the procedure. ConclusionsThoracic complications were more common in OVS and GVS than in OV band ligation.

Lymphocytic Gastritis: A Case Series Highlighting the Clinical, Histopathologic, and Endoscopic Findings

Introduction: Lymphocytic gastritis (LG) is an uncommon histopathologic condition found on less than 1% of endoscopies. It is a subtype of microscopic gastritis and is defined as 25 lymphocytes per 100 gastric epithelial cells infiltrating the surface epithelium. It is classified as either secondary LG, [most commonly associated with celiac disease (CD) or H pylori gastritis (HPG)], or idiopathic LG. This study will aim to identify demographics, clinical presentations, concomitant gastrointestinal conditions, as well as histopathologic and endoscopic findings in patients with LG. Methods: A retrospective chart review was performed of all patients with the diagnosis of LG based on pathology reports from 1/1/2000 to 12/1/2014 at a single tertiary care center. The medical records of each of these patients were reviewed for data including demographic information, presenting symptoms, indications for endoscopy, endoscopic findings, histologic findings, and comorbid diseases. Results: 30 patients with biopsy proven LG were identified. The mean age of patients with LG was 56. 60% of patients were male and 40% were female. The mean BMI was 26. The most common signs and symptoms identified included abdominal pain (23.3%), diarrhea (20%), and anemia (16.6%)(Table 1). 23.3% of patients were asymptomatic at the time of presentation. Aside from meeting the other criteria as described for LG, the most common histologic findings were duodenal intraepithelial lymphocytosis (52.9%) and villous blunting (52.9%). The most common endoscopic findings were erythema (40%) and erosions (16.6%)(Table 2). 5 patients with LG also had CD, 1 patient had HPG, and 3 patients had lymphocytic colitis.Table: Table. Presenting Signs and Symptoms in Lymphocytic GastritisTable: Table. Histologic and Endoscopic Findings in Lymphocytic GastritisConclusion: Our case series reinforces that LG has a variable clinical and endoscopic presentation. The diagnosis of LG remains highly dependent on the histopathological interpretation of endoscopic biopsies. Based on the association between LG and certain conditions, patients with LG should be fully evaluated for associated diseases such as CD and HPG before being labeled as having idiopathic LG. Future studies should be aimed at further defining the role of endoscopic monitoring and identifying possible treatments for patients with LG.

Colonic Amyloidoma: A Rarely Encountered Finding

Amyloidosis is a systemic disease characterized by the extracellular deposition of abnormal protein fibrils throughout the body that disrupts normal tissue architecture and function. It can present in many different forms, but the most common form that affects the gastrointestinal tract (GIT) is amyloid light-chain (AL) amyloidosis. Although amyloid deposition in the GIT is not uncommon, less than 50% will develop GI symptoms including GI dysmotility, malabsorptive diarrhea, spontaneous hemorrhage, and pseudo-obstruction. Early diagnosis of AL amyloidosis is essential because most cases are diagnosed late and associated with a poor prognosis. If left untreated it can carry median 1-year mortality rate of approximately 50%. Identifying the classic findings of AL amyloidosis during endoscopy should prompt further evaluation for disease. Our patient is a 54-year-old man with a past medical history significant for AL amyloidosis diagnosed on renal biopsy, who presented with worsening hematochezia. He also reported recurrent abdominal pain, a 60-pound weight loss, chronic diarrhea, and recurrent syncope for the last 4 months. Hemoglobin was 8.4 g/dL on admission. Colonoscopy revealed multiple large and small hemorrhagic polypoid lesions. The largest lesion filled approximately 75% of the colon. Multiple blood clots were also identified, but no active bleeding was seen during endoscopy. Endoscopic biopsies were not pursued given significant bleeding risk and prior diagnosis of AL amyloidosis. AL amyloid deposition within the vascular walls of the GIT increases vessel fragility and can result in hemorrhage beneath the lamina propria, forming submucosal hematomas. During endoscopy, submucosal hematomas appear purple and have a polypoid appearance with a shelf-like base. Other common findings during endoscopy include: mucosal ulcerations, intestinal erosions, yellowish plaque-like infiltrative lesions, and thickened mucosal folds. Rarely, as evident in our case, patients may have tumor-forming deposits of amyloid called amyloidomas, which can be wrongly diagnosed as a primary or metastatic GI malignancy. Given the poor prognosis associated with AL amyloidosis, recognizing common endoscopic findings should prompt the endoscopist to maintain a high index of suspicion and diagnose amyloidosis to improve overall prognosis.Figure: Endoscopy Findings.

Perceptive analysis of nasal surgery outcomes for headache

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Headache is the most common symptom requiring visit to a medical practitioner, sinus headache is one of the sub types of headache. Sinus related headaches are curable by surgical methods with a view to restore the functions of the maxilla-ethmo-turbinal ventilation. In this background we conducted a prospective study to investigate the perceptive relief of symptom of proven rhinosinugenic headache in patients undergoing functional endoscopic sinus surgery with septoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective study, done at a command hospital, Bangalore, a tertiary PG Teaching Hospital during 2010-2011. Even though 200 patients enrolled for the study, only 98 subjects could be assessed at the end of 1 year duration. A patient centric subjective perceptional questionnaire was given preoperatively and then postoperatively on definitive intervals and the patient’s subjective score was tabulated. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Rhinosinugenic headache is common amongst 36.73% of the population in the age group of 20 to 30 years age group, followed by 25.5% in the 41 to 50 years age group. Gender distribution- 56% of females in the age group of 31 to 50 years are suffering from headache, and 28% of women in the age group of 31 to 40 years. The most common endoscopic findings were bulla ethmoidalis with a prevalence of 37.75%, followed by middle turbinate anomalies of 31.63%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Endoscopy could not pick up any finding in 8.16% of the study group which was picked up by the non-contrast computerized tomography, perceptive analysis– there was an overall improvement of patient centric headache symptom alleviation of 98% after FESS with septoplasty.&lt;/p&gt;

Sporadic Fundic Gland Polyps and Gastric Acid Suppression Level

BackgroundFundic gland polyps (FGPs) are a common endoscopic finding and are known to be associated with proton pump inhibitors (PPIs) use. It is not known if their prevalence is affected by gastric acidity levels. This study aimed to assess whether there is a correlation between FGPs and gastric acidity levels as identified on 24-hour ambulatory impedance-pH studies in patients on PPI therapy. MethodsWe performed a review of 402 consecutive patients who take at least once daily PPI and underwent esophagogastroduodenoscopy with combined impedance-pH studies in the same setting (time and place) between January 2010 and December 2014. Patients were classified into 2 groups based on the presence or absence of biopsy-confirmed FGPs during endoscopy. ResultsOf the 402 patients, 30 (7%) had FGPs. One of these polyps was found with low-grade dysplasia. There was no significant difference of the distributions of the [H+] in the FGPs versus the nonpolyp groups (P = 0.741). There was no significant difference between the 2 groups regarding PPI dose frequency regimens (once and twice) (P = 0.074). However, we found weak ordinal association with PPI duration (P = 0.01) (Spearman = 0.1). ConclusionsFGPs are common endoscopic lesions. Incidence of dysplasia in FGPs is not only rare, but also of unknown clinical significance. Although they seem to be associated with PPIs, the mechanism remains unclear, as we found no correlation between the presence of FGPs and gastric acid control or PPI dose. Future studies would be useful to elucidate an alternate mechanism.

External Dacryocystorhinostomy; Success Rate and Causes of Failure in Endoscopic and Pathologic Evaluations

External dacryocystorhinostomy (DCR) is the method of choice to treat nasolacrimal duct (NLD) obstruction and the other approaches are compared with it, with a failure rate of 4% to 13%. The current study aimed to assess the causes of failure in external DCR by postoperative endoscopic and pathological evaluation. The current retrospective cross sectional study followed-up113 patients with external DCR and silicone intubation for three months. Silicone tubes were removed after the third months. Failure was confirmed based on the clinical findings and irrigation test. Paranasal sinus computed tomography (CT) scanning, and endoscopic and pathological evaluations were performed in the failed cases. Totally, 113 patients underwentexternal DCR. The patients included 71 females and 42 males. The mean age of the patients was 55.91 years; ranged from 18 to 86. Epiphora was the most common complaint before surgery (90.3%). Clinically, epiphora continued in 17 cases (15%), of which 94.11% had at least one sinus CT abnormality and 82.35% had at least one endoscopic abnormality. The most common endoscopic findings were deviated septum (70.6%), scar tissue (52.94%), concha bullosa (46.9%), septal adhesion (47.05%), enlarged middle turbinate (41.2%), and sump syndrome (11.7%). The failure was significantly associated with the chronicity of the initial symptoms (P-value=0.00). Pathologically, there were significant relationship amongst the failure rate, scar formation, and allergic rhinitis (P-values =0.00 and <0.05, respectively). Preoperative endonasal evaluation and consultation with an otolaryngologist can improve surgical outcomes and help to have a better conscious to intranasal abnormalities before external DCR surgery.

Upper gastrointestinal bleeding in patients with end stage renal disease: causes, characteristics and factors associated with need for endoscopic therapeutic intervention

The risk of upper gastrointestinal bleeding (UGIB) is increased among the end-stage renal disease (ESRD) patients. The aim of the current study was to describe the causes and characteristics of UGIB in ESRD patients at our center and to assess the need for endoscopic therapeutic intervention (ETI) using Rockall (RS) and Glasgow Blatchford scores (GBS). All patients with ESRD and UGIB with age ≥14 years were included. Frequencies and percentages were computed for categorical variables. Chi square test or Fischer's exact test was used for statistical analysis. A total of 59 subjects had a mean age of 47.25 ± 15 years.The most common endoscopic findings seen were erosions in 33 (55.9%) patients, followed by ulcers in 18 (30.3%) patients. ETI was required in 33 (55.9%) patients, which included adrenaline injection in 19 (32.3%), hemoclip in 9 (15.2%) and argon plasma coagulation in 5 (8.4%) patients. Factors associated with the need of ETI were identified as: a combined presentation of hematemesis and melena (P=0.033), ulcer (P=0.002) and associated chronic liver disease (P=0.015). Six (10.1%) patients died. Death was more common if ETI was not performed (P=0.018). ETI was more commonly required in patients on maintenance hemodialysis with UGIB, who had presence of combined hematemesis and melena, ulcers and associated chronic liver disease. A Glasgow Blatchford score of >14 was helpful in assessing the need for ETI in these patients.

Celiac disease prevalence in a large series of patients with Behçet's disease.

There are common findings between Behçet's disease (BD) and celiac disease (CD) based on similar immunological pathogenesis and there is only limited data available investigating the link between these two diseases. Furthermore, documented gastrointestinal (GI) involvement with marked upper GI symptoms in BD has been rarely reported. The aim of this study was to assess the prevalence of CD and to evaluate endoscopic findings in Turkish BD patients. A total of 210 BD patients were included in the study. All patients underwent serological testing for anti-gliadin and tissue transglutaminase antibodies. Endoscopic examinations were performed in 190 patients who accepted upper GI system endoscopy. Multiple biopsies were taken from the second portion of the duodenum in patients with positive serological assessment for CD. A total of 4.2% of patients with BD had positive anti-gliadin and tissue transglutaminase antibody immunoglobulin A (IgA) and IgG antibodies. The prevalence of biopsy-confirmed CD was 1.05% in Turkish BD patients. The most common endoscopic findings of patients with BD were found to be antral gastritis, duodenitis and esophagitis. Although BD and CD share many similar clinical manifestations, our results did not support a possible association between these two diseases.

Ambulatory 24-hour multichannel intraluminal impedance-pH monitoring and high resolution endoscopy distinguish patients with non-erosive reflux disease from those with functional heartburn.

AimsTo assess the contribution of 24-h esophageal multichannel intraluminal impedance and pH (MII-pH) monitoring and high resolution endoscopy (HRE) with i-scan imaging in differentiating non erosive reflux disease (NERD) from functional heartburn (FH).MethodsThis is a retrospective cohort study of patients with heartburn from the Endoscopy Unit. NERD patients and FH patients were defined by 24-h MII-pH monitoring and white light endoscopy. Minimal mucosal changes were assessed by HRE with i-scan imaging.ResultsTotal of 156 consecutive patients with heartburn but without esophageal mucosal erosions were studied. Forty-eight of these subjects had NERD, with increased acid exposure time (AET) and positive SAP and/or SI. Eighteen had FH with normal AET and negative SAP and SI. When compared to FH patients and healthy controls, NERD patients had significantly increased number of total acid reflux episodes, as well as increased number of weakly acidic reflux episodes (p<0.01). The rate of proximal reflux episodes in NERD patients was higher than that of FH patients and healthy controls (p<0.01). Irregular or blurring of the Z-line (58.3%) and white mucosal turbidity (47.9%) were the most common endoscopic findings of minimal mucosal changes observed in this study. NERD patients had more prevalent minimal changes than FH patients and the controls (87.5%vs. 66.6%vs. 61.9%; p = 0.004) with sensitivity of 87.5%. Histopathological evaluation showed that NERD patients had significantly higher average scores of intercellular spaces dilation (2.82±0.9 vs. 1.2±0.6, p = 0.005) and papillae elongation (2.65±1.0 vs. 1.5±0.8, p = 0.014), but not for basal cell proliferation (1.6±1.3 vs. 1.0±0.9, p = 0.070). The histological scores of the NERD patients were 7.1±1.2, which were higher than those of FH patients (3.4±1.0, p = 0.004).ConclusionsMinimal mucosal changes could be useful markers to support clinical diagnosis of NERD. Combination of 24-h MII-pH monitoring and i-scan high resolution endoscopy can distinguish patients with NERD from those with FH.

Early versus late bedside endoscopy for gastrointestinal bleeding in critically ill patients

Background/AimsGastrointestinal (GI) bleeding is a life-threatening complication in critically ill patients. The aim of this study was to determine the efficacy of bedside endoscopy in an intensive care unit (ICU) setting, and to compare the outcomes of early endoscopy (within 24 hours of detecting GI bleeding) with late endoscopy (after 24 hours).MethodsWe retrospectively reviewed the medical records of patients who underwent bedside endoscopy for nonvariceal upper GI bleeding and lower GI bleeding that occurred after ICU admission at Seoul National University Hospital from January 2010 to May 2015.ResultsTwo hundred and fifty-three patients underwent bedside esophagogastroduodenoscopy (EGD) for upper GI bleeding (early, 187; late, 66) and 69 underwent bedside colonoscopy (CS) for lower GI bleeding (early, 36; late, 33). Common endoscopic findings were peptic ulcer, and acute gastric mucosal lesion in the EGD group, as well as ischemic colitis and acute hemorrhagic rectal ulcers in the CS group. Early EGD significantly increased the rate of finding the bleeding focus (82% vs. 73%, p = 0.003) and endoscopic hemostasis (32% vs. 12%, p = 0.002) compared with late EGD. However, early CS significantly decreased the rate of identifying the bleeding focus (58% vs. 82%, p = 0.008) and hemostasis (19% vs. 49%, p = 0.011) compared with late CS due to its higher rate of poor bowel preparation and blood interference (38.9% vs. 6.1%, p = 0.035).ConclusionsEarly EGD may be effective for diagnosis and hemostatic treatment in ICU patients with GI bleeding. However, early CS should be carefully performed after adequate bowel preparation.