Endoscopic Findings In Patients Research Articles

ThP6.6 - Enhancing Management Strategies: Exploring the Expansion of Low-Risk Criteria in Glasgow-Blatchford Scoring for Acute Upper Gastrointestinal Bleeding – A Retrospective Cohort Study

Abstract Aims Glasgow-Blatchford Scoring (GBS) determines the need for further interventions in patients presenting with acute upper gastrointestinal bleeding (AUGIB). We aimed to study whether we can safely expand low-risk criteria to patients with GBS 2 and manage them as urgent outpatient. Methods A retrospective study of consecutive adult patients who had inpatient endoscopy for AUGIB in a single surgical unit from September 2021 to September 2022. Patient demographics, clinical and laboratory findings, GBS and endoscopic findings was analysed. Low-risk was defined as GBS 0-1 and high-risk as GBS ≥3. Results 150 patients were identified; 79 (58.7%) were male and median age of 63 years (IQR 53-76). Median total length-of-stay was 3.7 days (IQR 1.9=7.8). Similar to the low-risk group, patients with GBS 2 presented with lower range and frequency of symptoms as the high-risk group (p=0.0002). Severity correlated with admission haemoglobin (p=0.001) and urea count (p<0.0001) but not relevant comorbidities (p=0.560) and admission observations (p=0.456). The frequency of benign endoscopic findings in patients with GBS 2 were similar to the low-risk group with no malignant findings noted. This group also had similar rates of past and re-attendances for AUGIB and 30-day mortality of 0% to the low-risk group. Conclusion While our study has a small sample size, it suggests promising prospect that patients with GBS 2 may not need inpatient endoscopy. Future multi-centre studies are crucial to validate and strengthen this proposition. The potential advantages include decreased inpatient admissions, reduced healthcare costs, and alleviating pressures on emergency endoscopy unit.

Predictive factors of portal hypertensive enteropathy exacerbations based on long-term outcomes

BackgroundPortal hypertensive enteropathy (PHE) is a small-bowel lesion observed in patients with portal hypertension. The clinical significance of endoscopic findings in PHE remains unclear. We aimed to clarify the clinical significance and predictive factors of capsule endoscopic findings in patients with PHE based on long-term outcomes.MethodsThis retrospective study enrolled 55 patients with PHE (33 males and 22 females; median age, 64 years; range, 23–87) followed for > 3 years using capsule endoscopy (CE) between February 2009 and May 2023. We evaluated the clinical factors affecting PHE exacerbations and the effects of PHE exacerbations on gastrointestinal bleeding by comparing exacerbated and unchanged PHE groups.ResultsOverall, 3 (5%) patients showed improvement, 33 (60%) remained unchanged, and 19 (35%) showed exacerbation on follow-up CE. In the exacerbated group, the rates of worsened fibrosis-4 index, exacerbated esophageal varices, and exacerbated portal hypertensive gastropathy were significantly higher than those in the unchanged group (21%, 32%, and 42% vs. 3%, 6%, and 12%, respectively; P < 0.05), and the rate of splenectomy was significantly lower in the exacerbated group than in the unchanged group (5% vs. 39%, respectively; P < 0.01). In multivariate analysis, exacerbation of esophageal varices and absence of splenectomy were significantly associated with PHE exacerbation. The rate of gastrointestinal bleeding after follow-up CE was significantly high in the exacerbated group (log-rank, P = 0.037).ConclusionsExacerbation of esophageal varices and splenectomy were significantly associated with exacerbation of PHE. Exacerbated PHE requires specific attention to prevent gastrointestinal bleeding.

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

Unveiling the hidden pathologies: preoperative endoscopic findings in patients with obesity undergoing bariatric surgery

BackgroundObesity is closely associated with upper gastrointestinal disorders. The recommendations for routine preoperative esophagogastroduodenoscopy (EGD) before bariatric surgery remains a topic of debate. This study aimed to describe the pathological endoscopic findings in individuals qualified for bariatric surgery.MethodsRetrospective analysis was conducted on preoperative gastroscopy reports of patients who underwent bariatric surgery at our hospital between October 2022 and October 2023.ResultsA total of 405 patients were included in the study. The two most prevalent endoscopic findings during EGD in this patient cohort were chronic superficial gastritis (326/405, 80.5%) and reflux esophagitis (82/405, 20.2%). Some patients exhibited two or more abnormalities. Patients with reflux esophagitis were older, had a higher proportion of men, higher BMI, higher rates of smoking and drinking compared to those without it (P = 0.033, P < 0.001, P = 0.003, P = 0.001, and P = 0.003, respectively). Morbid obesity (P = 0.037), smoking habits (P = 0.012), and H. pylori infection (P = 0.023) were significant risk factors for reflux esophagitis in male patients, while age (P = 0.007) was the sole risk factor in female patients. No statistically significant differences were observed in surgical procedures between LA-A and B groups (P = 0.382), but statistically significant differences were noted between the nondiabetic and diabetic groups (P < 0.001).ConclusionsPreoperative EGD can unveil a broad spectrum of pathologies in patients with obesity, suggesting the need for routine examination before bariatric surgery. The findings of this study can guide bariatric surgeons in developing tailored treatments and procedures, thus significantly enhancing prognosis. Gastroscopy should be performed routinely in Chinese patients planning to undergo bariatric surgery.

Endotype and Phenotype Related Postoperative Effects of Bacterial Lysate in Chronic Rhinosinusitis.

Chronic rhinosinusitis (CRS) endotypes have demonstrated clinical value in guiding treatment decisions. Bacterial lysates are immunomodulators that have shown beneficial effects in various respiratory inflammatory diseases. This study aimed to evaluate the effect of postoperative bacterial lysate therapy on different CRS endotypes. Patients diagnosed with CRS who underwent endoscopic sinus surgery were recruited. Bacterial lysates were administered postoperatively for 10 days per month for 3 months to the experimental group comprising patients with a history of frequent upper respiratory infections without adverse reactions. The remaining participants were allocated to the control group. The results of the postoperative 3-, 6-, and 12-month assessments, including the modified Lund-Kennedy (mLK) endoscopic and Sinonasal Outcome Test (SNOT) 22 scores, for the groups were compared. The tissue samples obtained from the participants were evaluated to detect the presence of relevant inflammatory mediators. Among the 92 participants, 47 started bacterial lysate therapy 2 weeks after the surgery. The tissue cytokine profiles and clinical parameters, such as the disease severity and blood eosinophil percentage, of the bacterial lysate and control groups were comparable before treatment. The mLK endoscopic and SNOT-22 scores did not differ after 3, 6, and 12 months of follow-up. The subgroup analysis revealed that the bacterial lysate group had significantly lower mLK endoscopic scores than the control group for CRS without nasal polyps, while there was a tendency toward significance for the interleukin (IL)-5 negative group after 6 months. Postoperative bacterial lysate therapy has some beneficial effects on the endoscopic findings of patients with CRS without nasal polyps or those who are negative for IL-5.

Analysis of Risk Factors and Predictors of Endoscopic Findings in Patients with Gastrointestinal Disorders: A Single Center Observational Study at Sanjiwani General Hospital, Gianyar, Bali, Indonesia

Background: Gastrointestinal disorders are a common health problem in Indonesia. Endoscopy is an important procedure in diagnosing and managing this disorder. This study aims to analyze risk factors and predictors of endoscopic findings in patients with gastrointestinal disorders at regional hospitals in Bali. Methods: This research is an analytical observational study with a cross-sectional design. The research subjects were patients with gastrointestinal disorders who underwent endoscopy at regional hospitals in Bali during the period January 2022 to December 2023. Data was collected through medical records and interviews. Data analysis was carried out using the Chi-square test and logistic regression. Results: A total of 1074 patients were included in this study. The mean age of patients was 45.3 years (SD 15.2). The most common endoscopic finding was gastritis (35.2%), followed by gastric ulcer (15.8%) and esophagitis (12.4%). Risk factors that were significantly associated with endoscopic findings were age &gt; 45 years (OR 1.78; 95% CI 1.23-2.57), male gender (OR 1.54; 95% CI 1.11- 2.14), history of smoking (OR 2.31; 95% CI 1.65-3.24), and history of use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR 1.98; 95% CI 1.39-2.82). Conclusion: Age &gt; 45 years, male gender, smoking history, and history of NSAID use are risk factors that are significantly associated with endoscopic findings in patients with gastrointestinal disorders at regional hospitals in Bali.

Clinical study on microscopic syndrome differentiation and traditional Chinese medicine treatment for liver stomach disharmony in chronic gastritis.

Chronic gastritis (CG) is a common gastrointestinal disorder characterized by inflammation of the stomach lining. Liver-stomach disharmony (LSD) syndrome is believed to contribute to CG symptoms. To evaluate the efficacy and safety of microcosmic syndrome differentiation and Chinese herbal medicine (CHM) treatment in patients with CG and LSD syndrome. Sixty-four patients with CG and LSD syndrome were randomly divided into two groups: The treatment group received CHM based on microcosmic syndrome differentiation and the control group received conventional Western medicine. The treatment course lasted 12 wk. The primary outcome was improvement in dyspeptic symptoms, measured using the Nepean Dyspepsia Index. The secondary outcomes included the improvement rate of endoscopic findings, histopathological findings, and microcosmic syndrome scores and the incidence of adverse events. After 12 wk of treatment, the treatment group showed significantly greater improvement in dyspeptic symptoms than the control group (93.75% vs 65.63%, P < 0.01). The treatment group also showed a significantly higher improvement rate in endoscopic findings than the control group (81.25% vs 53.13%, P < 0.05). The improvement rates of histopathological findings and microcosmic syndrome scores were not significantly different between the two groups (P > 0.05). No serious adverse events were observed in either group. Microcosmic syndrome differentiation and CHM treatment can effectively improve dyspeptic symptoms and endoscopic findings in patients with CG and LSD syndrome and have a good safety profile. Further studies with larger sample sizes and longer follow-up periods are required to confirm the long-term efficacy and mechanism of action of this treatment.

Frequency of Clinically Significant Findings in the Surgical Pathology Specimen Following Laparoscopic Sleeve Gastrectomy and Concordance with Preoperative Endoscopy: Insights from a Large Single-Center Experience.

Endoscopy prior to bariatric surgery is not always performed, and in sleeve gastrectomy (SG), the surgical specimen is not always sent for pathological examination. There is limited data on the frequency of clinically significant findings in SG specimens or correlation with preoperative endoscopy. We reviewed 426 consecutive SG patients to determine the concordance of preoperative endoscopy findings in patients with clinically significant postoperative pathology. Preoperative endoscopy was performed on 397 patients (93.2%). Three hundred seventy-three patients had preoperative endoscopy and surgical pathology results available. Then, 20/373 (5.4%) patients had potentially significant postoperative pathology, including intestinal metaplasia, autoimmune metaplastic atrophic gastritis (AMAG), gastrointestinal stromal tumors, and/or gastric cancer. The overall incidence of AMAG in the entire cohort was 2.3%. Preoperative gastric biopsies (to include gastric body) identified AMAG in nearly 1/2 of patients. Patients with clinically significant postoperative pathology results had a median [interquartile range] of 3 [3-5] tissue blocks examined as compared to 3 [1-3] for the remainder of the cohort (p < 0.001). This is one of the largest studies describing clinically significant postoperative pathology after SG. AMAG, in particular, is of particular importance as it is associated with a 3-fivefold increase in risk for gastric cancer. The incidence of significant postoperative pathology in this population is small but potentially clinically significant and requires validation in larger studies. We recommend wider sampling in preoperative endoscopy (body and antrum), especially in patients being planned for gastric bypass, consideration for routine pathological examination of SG surgical specimens, with careful gross examination and targeted sampling.

When It's Not Allergic Rhinitis: Clinical Signs to Raise a Patient's Suspicion for Chronic Rhinosinusitis.

To identify predictors of chronic rhinosinusitis (CRS) in patients presenting with the chief complaint of nasal allergies. Cross-sectional study. Tertiary care, academic center. Clinical and demographic characteristics were collected from participants who were patients presenting with the chief complaint of nasal allergies. From all participants, a 22-item Sinonasal Outcome Test (SNOT-22) was collected, and a modified Lund-Kennedy endoscopy score was calculated from nasal endoscopy. Association was sought between having CRS and variables of clinical and demographic characteristics, SNOT-22, and endoscopy score. A total of 219 patients were recruited and 91.3% were diagnosed with allergic rhinitis; 45.2% were also diagnosed with CRS. Approximately half of the patients with CRS reported no intranasal corticosteroid usage. Having CRS was associated with male sex (odds ratio [OR] = 2.29, 95% confidence interval [CI]: 1.30-4.04, P = .004), endoscopy score (OR = 1.96, 95% CI: 1.59-2.42, P < .001), and the SNOT-22 nasal subdomain score (OR = 1.07, 95% CI: 1.03-1.11, P = .001) related to SNOT-22 items: "need to blow nose,""thick nasal discharge,""sense of taste/smell,"and "blockage/congestion of nose."At least moderate (item score ≥3) "blockage/congestion of nose" or "thick nasal discharge,"mild "need to blow nose" (item score ≥2) or very mild decreased "sense of taste/smell" (item score ≥1), and any nasal endoscopy findings (endoscopy score ≥1) were statistically significant predictors of CRS. Moderate or more severe nasal obstruction or discharge symptoms, any decreased sense of smell/taste, or positive nasal endoscopy findings in patients believing they have allergic rhinitis should prompt further evaluation of CRS to avoid delays in treatment.

Endoscopic and clinical features of gastric emphysema

Gastric emphysema is characterized by the presence of intramural gas in the stomach without bacterial infection. Due to its rarity, most reports on gastric emphysema have been limited to single-case studies, and this condition’s clinical and endoscopic features have not been thoroughly investigated. In this study, we analyzed 45 patients with gastric emphysema from 10 institutions and examined their characteristics, endoscopic features, and outcomes. The mean age at diagnosis of gastric emphysema in our study population (35 males and 10 females) was 68.6 years (range, 14–95 years). The top five underlying conditions associated with gastric emphysema were the placement of a nasogastric tube (26.7%), diabetes mellitus (20.0%), post-percutaneous endoscopic gastrostomy (17.8%), malignant neoplasms (17.8%), and renal failure (15.6%). Among the 45 patients, 42 were managed conservatively with fasting and administration of proton pump inhibitors. Unfortunately, seven patients died within 30 days of diagnosis, and 35 patients experienced favorable recoveries. The resolution of gastric emphysema was confirmed in 30 patients through computed tomography (CT) scans, with a mean duration of 17.1 ± 34.9 days (mean ± standard deviation [SD], range: 1–180 days) from the time of diagnosis to the disappearance of the gastric intramural gas. There were no instances of recurrence. Endoscopic evaluation was possible in 18 patients and revealed that gastric emphysema presented with features such as redness, erosion, coarse mucosa, and ulcers, with fewer mucosal injuries on the anterior wall (72.2%), a clear demarcation between areas of mucosal injury and intact mucosa (61.1%), and predominantly longitudinal mucosal injuries on the stomach folds (50.0%). This study is the first English-language report to analyze endoscopic findings in patients with gastric emphysema.

Peptic ulcer characteristics in oral opium and non-opium user patients with upper gastrointestinal bleeding

Background/AimsUpper gastrointestinal bleeding (UGIB) is a frequent medical issue. The primary risk factors for bleeding peptic ulcers are Helicobacter pylori infection and non-steroidal anti-inflammatory drugs. The association between acute gastric/duodenal ulcer and opium use has been previously proposed; however, there is no available data on endoscopic findings of patients with acute UGIB who use opium.Materials and methodsIn the present descriptive cross-sectional study, endoscopic data of 50 consecutive patients with oral opium use and 50 consecutive patients without any opium use who were admitted for UGIB were recorded. The size (5–10 mm, 11–20 mm, or more than 20 mm), number (single, double, or multiple), and location of the ulcers (esophagus, gastric corpus including the fundus and body, antrum, angulus, or duodenum) were examined by endoscopy in both groups.ResultsThree or more ulcers were observed in 46% and 16% of patients with oral opium use and without opium use, respectively (P-value = 0.001). The rate of giant ulcers (> 20 mm) was significantly higher in patients who used oral opium (40% vs. 12%; P-value = 0.007). Esophageal ulcers were also more common in oral opium users (30%) than non-users (8%) with UGIB (P-value = 0.01). Nevertheless, the location of the ulcers between the two groups generally was not statistically different.ConclusionsThis study has demonstrated that multiple, large peptic ulcers in GIB are potential complications of oral opium use. This could aid the needed modifications in the treatment protocol for these patients.

Differences Between Patients With Chronic Epipharyngitis With and Without Previous COVID-19 Infection.

Objective Epipharyngeal abrasive therapy (EAT) is effective in patients with chronic epipharyngitis who previously had coronavirus disease 2019 (COVID-19). The study aimed to evaluate differences between patients with chronic epipharyngitis with (long COVID) or without a history of COVID-19 (non-long COVID). Methods This is a retrospective study based on the analysis of medical records of patients who visited the Mogitate ENT Clinic in Kawasaki, Japan,for six months from March 2022. Results Patients with long COVIDwere significantly younger (p=0.018). Fatigueand brain fogwere prevalent in patients with long COVID, whereas throat discomfort,postnasal drip,and sputumwere more common in those with non-long COVID. Epipharyngeal endoscopic findings in patients with long COVID showed significantly higher scores (p<0.001) compared with patients with non-long COVID. Conclusions The primary differences between patients with long COVID and non-long COVID were age, symptoms, and severity scores of endoscopic findings. The EAT should be aggressively implemented in patients with chronic epipharyngitis with or without COVID-19 infection, as there is no reason not to treat a patient with a condition caused by COVID-19 infection.

Histologic features and predicting prognosis in ulcerative colitis patients with mild endoscopic activity.

We aimed to evaluate the histologic features predictive of prognosis and correlate them with endoscopic findings in patients with ulcerative colitis (UC) having complete or partial mucosal healing (MH). We prospectively collected and reviewed data from patients with UC who underwent colonoscopy or sigmoidoscopy with biopsy. Complete and partial MH were defined as Mayo endoscopic subscores (MESs) of 0 and 1, respectively. Histologic variables, including the Nancy index (NI), predicting disease progression (defined as the need for medication upgrade or hospitalization/surgery), were evaluated and correlated with endoscopic findings. Overall, 441 biopsy specimens were collected from 194 patients. The average follow-up duration was 14.7 ± 7.4 months. There were 49 (25.3%) and 68 (35.1%) patients with MESs of 0 and 1, respectively. Disease progression occurred only in patients with an MES of 1. NI ≥ 3 was significantly correlated with disease progression during follow-up. Mucosal friability on endoscopy was significantly correlated with NI ≥ 3 (61.1% in NI < 3 vs. 88.0% in NI ≥ 3; p = 0.013). Histological activity can help predict the prognosis of patients with UC with mild endoscopic activity. Mucosal friability observed on endoscopy may reflect a more severe histological status, which can be a risk factor for disease progression.

Endoscopic findings in patients with dyspepsia without alarming symptoms

Endoscopic findings in patients with dyspepsia without alarming symptoms

The Relation Between Endoscopic and Subjective Laryngopharyngeal Reflux Signs, Vocal Tract Discomfort, Voice Handicap, and Voice Disorder Type: Same Yet Different?

ObjectivesThis study aimed to investigate the relation between subjective voice-related symptoms and endoscopic findings in patients with different etiology of voice disorder and vocally healthy subjects with and without laryngopharyngeal reflux (LPR). Study designretrospective cross-sectional study MethodsThe study involved 149 participants (106 female, 43 male) including 125 with various voice disorders (functional, structural and neurogenic) and 24 vocally healthy individuals. For self-rating the German versions of the Voice Handicap Index (VHI), Vocal Tract Discomfort (VTD) Scale, and Reflux Symptom Index (RSI) were applied, while endoscopic evaluations utilized the Reflux Finding Score (RFS) and Reflux Sign Assessment (RSA).Statistical analyses incorporated ANOVA with Bonferroni post-hoc tests to identify group variations. Correlations between VTD Scale, VHI, RSI, RFS and RSA were evaluated using Pearson’s correlation coefficient. To examine test sensitivity and specificity for the VTD Scale and RSA, we performed a ROC analysis. Youden’s-Index was applied to determine the cut-off-value with best discriminatory abilities. The diagnosis of LPR was assumed when the criteria of RFS > 7 AND RSI > 13 was met. ResultsSignificant differences for all voice diagnosis groups and vocally healthy individuals for RFS and all three self-rating questionnaires were found. Moreover, there was significant correlation between VTD Scale and VHI and RSI as well as RSI and RFS, which was moderate, negative in the group of persons with LPR. However, there was no significant difference for RSA results between the vocally healthy or any diagnosis group. ConclusionThus, the RFS may be more suitable to predict reflux and voice related symptoms. The VTD Scale is a useful instrument in screening voice disorders but also LPR and can therefore be used as a tool for decision making when transferring to a specialist.

Discrepancy between Abdominal Symptoms and Endoscopic Findings in Patients with Gastro-duodenal Eosinophilia: A Case Series.

Some patients present gastro-duodenal eosinophilia without abdominal symptoms. Nine cases with gastro-duodenal eosinophilia were seen at the Tohoku University Hospital between January 2011 and June 2022. Seven (78%) patients had a background of allergic or hyper-eosinophilic disease. Esophagogastroduodenoscopy showed erosions (n=6), discoloration (n=4), ulcers (n=3), erythema (n=3), muskmelon-like appearance (n=2), and cracks (n=1). Two cases were asymptomatic with eosinophilic gastroenteritis (EGE)-like endoscopic findings, and two were symptomatic with normal endoscopic findings. The discrepancy between the abdominal symptoms and esophagogastroduodenoscopy findings suggests that clinicians should assess patients for background allergic disease, regardless of abdominal symptoms.

The Role of Nasal Endoscopy in the Preoperative Evaluation of Nasal Airway Obstruction.

To examine the prevalence and nature of nasal endoscopic findings in patients referred for structural nasal obstruction, and analyze how such findings influence the preoperative evaluation or operative plan. Cross-sectional study. University-based academic otolaryngology practice. Nasal endoscopy was performed by a single surgeon and the exam findings were documented. Patient demographics, variables in the patient history, Nasal Obstruction Symptom Evaluation scores, and an Ease-of-Breathing Likert Scale were tested for associations with findings on endoscopy. A total of 82 of 346 patients (23.7%) had findings on rigid nasal endoscopy not appreciable on anterior rhinoscopy. Prior nasal surgery (p = .001) and positive allergy testing (p = .013) were significantly associated with findings on nasal endoscopy. Endoscopic findings prompted additional preoperative studies in 50 (14.5%) patients, and a change in the operative plan in 26 (7.5%) patients. In patients referred for surgical management of nasal obstruction, findings on nasal endoscopy otherwise undetected with anterior rhinoscopy are most common in but certainly not limited to those with prior nasal surgery or allergic rhinitis. Routine nasal endoscopy should be considered for all patients being evaluated for nasal airway surgery. These results may benefit future updates of the clinical consensus statements regarding the role of nasal endoscopy in the evaluation of nasal valve compromise and septoplasty.

Clinical Profile and Upper Gastrointestinal Endoscopic Findings in Patients with Dysphagia and Its Relation to Alarm Symptoms

Dysphagia is derived from the Greek word dys (difficulty, disordered) and phagia (to eat). It refers to the sensation where food is hindered in its passage from the mouth to the stomach. It is of two types – Oropharyngeal and Esophageal. Esophageal dysphagia can be either motor or mechanical. Symptoms vary depending upon the degree of luminal obstruction, associated esophagitis and type of food taken.Study design: prospective cross sectional study . The study took place from November 2021 to December 2022 in Department of Gastroenterology, BSM Medical University, Dhaka Bangladesh with sample size of 125. Patients with dysphagia with or without alarm symptoms attending the outpatient clinic of Gastroenterology department during the period were selected for study. Results show that a total of 125 patients were included in the study, 63 males and 72 females. Majority of patients were seen in the age group of 41 – 60 yrs (43.7 %). Clinically significant weight loss and vomiting was seen in around 22.2 % of the patients. Endoscopy was done in all patients presented with dysphagia. The common cause of dysphagia among the malignant etiology was found to be Ca Oropharynx (12%), followed by Ca Esophagus (4.8%), Ca OG JN (2.4%). Among the benign causes the most common etiology was due to post cricoid web (12.8%), followed by esophageal strictures (12%). Endoscopy was found to be normal in 37 patients (29.6%). Malignant etiology was found to be more common among males. Normal endoscopy was predominant among females. In conclusion, Upper GI Endoscopy is virtually always needed in the evaluation of esophageal dysphagia, allows tissue sampling, and, in many cases, is therapeutic, obviating the need for further evaluation. It is a very effective and appropriate tool to diagnose the causes of dysphagia in both the young and especially the elderly. Alarm symptoms like anorexia, vomiting, wt loss, melena may be more suggestive of malignant cause. Upper GI endoscopy will help in making an early and definite diagnosis.

Endoscopic findings suggestive of a high risk of non-radical cure after definitive chemoradiotherapy for cT1bN0M0 esophageal squamous cell carcinoma.

Definitive chemoradiotherapy (DCRT) is a curative treatment option for cT1bN0M0 esophageal squamous cell carcinoma (ESCC); however, local residual disease and recurrence after complete remission may occur. We aimed to identify endoscopic findings associated with the risk of non-radical cure (local remnant or recurrence) after DCRT for cT1bN0M0 ESCC. We retrospectively analyzed 40 consecutive patients with cT1bN0M0 ESCC who had undergone DCRT between January 2007 and December 2017. We examined the endoscopic findings in patients with residual or recurrent (RR) disease (RR group) and those without RR disease [non-RR (NRR) group] after DCRT. We also evaluated outcomes after DCRT for each endoscopic finding. There were 10 patients in the RR group and 30 patients in the NRR group. The RR group had a significantly larger tumor size and a higher proportion of lesions with type 0-I. The 5-year relapse-free survival rate was significantly lower in type 0-I and in the presence of B3 vessels. Endoscopic findings in 15 patients with cT1bN0M0 ESCC, type 0-I, who underwent DCRT revealed significantly more reddish lesions in the RR group compared to the NRR group. cT1bN0M0 ESCC large size, with B3 vessels, and type 0-I has a high risk of non-radical cure after DCRT, especially the reddish type 0-I, which may need to be considered for treatment similar to advanced cancer, including surgery with preoperative DCRT.

Upper endoscopic findings in patients attending the endoscopy unit of al-azhar assiut university hospital: 2019–2020

Background and aim An endoscope is a visual instrument used to inspect the internal cavities of the human body. Upper endoscopy has effective diagnostic and therapeutic functions; it can be used in patients with signs or symptoms suggestive of upper gastrointestinal (GI) disease, surveillance for upper gastrointestinal tract (GIT) malignancy in high-risk population, and also stoppage of upper GIT bleeding. The work is aimed to document the demographic characteristics, indications, endoscopic findings, and interventions done among patients referred to Al-Azhar Assiut University Hospital in the last 2 years (2019–2020). Patients and methods The study was conducted at the endoscopy unit in from January 2019 to December 2020. Results Our study showed that the most prevalent age group was aged between 20 and 50 years (65.4%). There is a slight predominance of female patients (51%) versus 49% who were males and the most common indications, while peptic ulcer disease was the most common endoscopic finding. Conclusion The most common indications were epigastric pain and upper GIT bleeding, while the most common GI finding was peptic ulcer disease. Also, esophageal varices were common esophageal findings for which band ligation and injection sclerotherapy were done.