Endoscopic Grading System Research Articles

Navigating COVID-19-associated mucormycosis: endoscopic grading, radiological correlations, and treatment outcomes

BackgroundThe global COVID-19 pandemic has brought forth multifaceted healthcare challenges, including the emergence of COVID-19-associated mucormycosis (CAM). This study investigates demographics, clinical presentation, endoscopic grading, radiological correlations, treatment modalities, and outcomes of CAM in Central India.MethodsA retrospective analysis of 312 CAM patients (April-June 2021). Data included demographics, clinical profiles, endoscopic and radiological findings, laboratory results, and treatments. A novel endoscopic grading system was utilized to assess the severity of mucormycosis lesions. Statistical analysis, including chi-squared tests, was performed.ResultsAmong 312 patients, 65% were male, 82% had comorbidities, and 84% presented with facial swelling. Endoscopic grading correlated with radiological manifestations (p < 0.05) and intraoperative findings. Surgical debridement and antifungal therapy were common treatments, yielding varied clinical outcomes. Mortality was 13% in advanced grades.ConclusionThis study underscores the role of endoscopic grading in risk stratification and prognosis. Findings contribute to CAM management knowledge, underscoring tailored interventions’ significance.

Effect of bile reflux on gastric juice microbiota in patients with different histology phenotypes

Background/aimsBile reflux (BR) can influence the gastric environment by altering gastric acidity and possibly the gastric microbiota composition. This study investigated the correlation between bile acids and microbial compositions in the gastric juice of 50 subjects with differing gastric pathologies.MethodsThis study included 50 subjects, which were categorized into three groups based on the endoscopic BR grading system. The primary and secondary bile acid concentrations in gastric juice samples were measured, and microbiota profiling was conducted using 16 S rRNA gene sequencing.ResultsSignificant differences were observed in each bile acid level in the three endoscopic BR groups (P < 0.05). The Shannon index demonstrated a significant decrease in the higher BR groups (P < 0.05). Analysis of the β-diversity revealed that BR significantly altered the gastric microbiota composition. The presence of neoplastic lesions and the presence of H. pylori infection impacted the β-diversity of the gastric juice microbiota. The abundance of the Streptococcus and Lancefielfdella genera exhibited positive correlations for almost all bile acid components(P < 0.05). In addition, the abundance of Slobacterium, Veillonella, and Schaalia showed positive correlations with primary unconjugated bile acids (P < 0.05).ConclusionChanges in microbial diversity in the gastric juice were associated with BR presence in the stomach. This result suggests that the degree of BR should be considered when studying the gastric juice microbiome.

Thyroarytenoid botulinum toxin injection for refractory laryngeal contact granuloma

BackgroundAlthough there are many treatments for laryngeal contact granuloma (LCG), some patients still fail treatment. Botulinum toxin A injection vocal cords may be a salvage therapy. ObjectivesTo study the efficacy of thyroarytenoid botulinum toxin A injection for the treatment of refractory LCG. Material and methodsFrom May 2021 to March 2022, 23 male patients with refractory idiopathic LCG were treated by injection of botulinum toxin A into the thyroarytenoid muscle via the thyrohyoid membrane approach. Inspiratory-phase laryngoscopy images were collected before treatment and 3 months after injection treatment. The lesion size was evaluated with the Farwell granuloma endoscopic grading system and Image J software. ResultsThe average age of 23 patients was 49 years. The dose of botulinum toxin injection ranged from 2.5 to 5 units. Three months after injection, 17 patients were cured, 2 patients showed marked improvement, and 4 patients did not experience any effect. The total efficacy rate was 82.61% (19/23), and no serious complications occurred. Almost all patients experienced hoarseness within one week after injection; they gradually recovered after one month, and their voice returned to baseline at 3 months. ConclusionsThyroarytenoid botulinum toxin injection is an effective method for resolving refractory LCG.

Proposal for Simplified Endoscopic Standardized Grading of Central Airway Complications After Lung Transplantation According to the Long-Term Prognosis Value of the Current MDS Classification

<h3>Purpose</h3> The MDS classification (<i>i.e.</i> Macroscopic aspect, Diameter, Suture) allows an endoscopic grading of bronchial complications after lung transplantation. We aimed to determine the long-term prognosis value of the MDS airway evaluation after lung transplant and to propose a new organization in prognostic stage of the MDS classification. <h3>Methods</h3> We performed a retrospective monocentric cohort study of the consecutive patients who underwent a single or double lung transplant between the January 2015 and December 2021. We analyzed the prospectively evaluated MDS status at day 7, 28 and 90 after transplantation and the long term follow-up. Analyzed outomes were overall survival (OS), chronic lung allograft dysfunction (CLAD) and airways complications (AC) defined by reoperation or rigid bronchoscopy requirement. <h3>Results</h3> During the study period 221 lung transplants were performed. 437 bronchial anastomoses were analyzed at day 7, 378 at day 28 and 336 at day 90. At day 7, patients with extremely severe and extensive necrosis of the bronchial mucosa (M3d) presented worse OS (p<0.01); While extensive ischemic or necrosis bronchial mucosa (M3c) was associated with AC (p<0.01). At day 28, patients with bronchial mucosa necrosis distal to the anastomosis (M3b, 3c and 3d) presented a worse OS (all p≤0.01) and AC (all p<0,01). At day 90, patients who still presented M3c presented worsened OS (p<0.01) and increased risk of AC (p<0.01). Separate analysis of patients with M3b, c and d (at day 28 and 90) showed similar relationship with OS, CLAD and AC (all p<0.01); as far as patients with M0 and M1 had the same prognosis in terms of OS (all p=NS), CLAD and AC (all p=NS), it was the same for M2 and M3a (all p=NS). Therefore, we have reorganized the MDS classification in 3 stages: G1 for M0/M1 a, b, c, d; G2 for M2 a, d, c, d/M3 a; G3 for M3b, c, d. We have compared the 3 groups of patients with G1 as reference. Stage G3 at day 7 was associated with AC (p<0.05) while at days 28 and 90 it was associated with OS, AC and CLAD (all p<0.05) <h3>Conclusion</h3> The endoscopic MDS grading system can be simplified into 3 groups providing prognostic risk stratification of OS, AC and CLAD development after lung transplantation.

Anastomotic leakage following resection of the esophagus\u2014introduction of an endoscopic grading system

BackgroundMalignant tumors of the esophagus are the sixth leading cause of cancer-related deaths worldwide. Postoperative leakage of the esophago-gastrostomy leads to mediastinal sepsis, which is still associated with a high morbidity and mortality rate. The aim of this study was to describe the endoscopic view of the different severity grades of an anastomotic leakage.MethodsPatientsBetween June 2016 and September 2018, 144 patients were operated upon in the Department of Surgery, University of Munich, Germany.Among these patients, 34 (23.6%) presented with a leakage of the anastomosis.EndoscopyIn this retrospective analysis, the focus is to describe different patterns of leakage of the anastomosis.ResultsWe studied 34 patients in whom post-esophagectomy leakage of the anastomosis was detected and treated with an endoluminal vacuum sponge system. The leakage healed in 26 of 29 patients (success rate 89.7%).With the increasing severity of leakage, the treatment time and the in-hospital mortality correspondingly increased. Furthermore, the incidence of the development of a fistula to the tracheobronchial system increased with higher grades of leakage.ConclusionsExact descriptions of leakage are necessary to compare the cases and to prove post-treatment improvement. This is, to our knowledge, the first publication to present a leakage grading score in patients after esophagectomy including reconstruction with a gastric tube.This new grading system needs to be tested in further analyses, with a special focus on prospective analysis.

Post-endoscopy Esophageal Neoplasia in Barrett’s Esophagus: Consensus Statements From an International Expert Panel

Post-endoscopy Esophageal Neoplasia in Barrett’s Esophagus: Consensus Statements From an International Expert Panel

S78 Retracted Major Papilla in Primary Sclerosing Cholangitis: Creating an Endoscopic Grading System

S78 Retracted Major Papilla in Primary Sclerosing Cholangitis: Creating an Endoscopic Grading System

Preemptive Endoluminal Vacuum Therapy to Reduce Morbidity After Minimally Invasive Ivor Lewis Esophagectomy: Including a Novel Grading System for Postoperative Endoscopic Assessment of GI-Anastomoses.

Preemptive endoluminal vacuum therapy (pEVT) is a novel concept to reduce postoperative morbidity and has the potential to disrupt current treatment paradigms for patients undergoing esophagectomy. Endoluminal vacuum therapy is an accepted treatment for AL after esophagectomy. Retrospective analysis of patients undergoing minimally invasive Ivor Lewis esophagectomy with pEVT between 11/2017 and 10/2020. The sponge was removed endoscopically after 4-6 days, and anastomosis and gastric conduit were assessed according to a novel endoscopic grading system. Further management was customized according to endoscopic appearance and clinical course. Endpoints were postoperative morbidity and AL rate, defined according to the Clavien-Dindo (CD) and International Esodata Study Group classifications. PEVT was performed in 67 consecutive patients, 57 (85%) were high-risk patients with an ASA score >2, WHO/ECOG score >1, age >65 years, or BMI >29 kg/m2. Thirty patients experienced textbook outcome, and overall minor (≤CD IIIa) and major (≥CD IIIb) morbidity was 40.3% and 14.9% respectively. 30-day-mortality was 0%. Forty-nine patients (73%) had uneventful anastomotic healing after pEVT without further endoscopic treatment. The remaining 18 patients (27%) underwent prolonged EVT with uneventful anastomotic healing in 13 patients (19%), contained AL in 4 patients (6%), and 1 uncontained leakage (1.5%) in a case with proximal gastric conduit necrosis, resulting in an overall AL rate of 7.5%. PEVT is an innovative and safe procedure with a promising potential to reduce postoperative morbidity after minimally invasive Ivor Lewis esophagectomy and may be particularly valuable in highly comorbid cases.

Esophagogastric Junction Morphology on Hill's Classification Predicts Gastroesophageal Reflux with Good Accuracy and Consistency.

Hill's classification provides a reproducible endoscopic grading system for esophagogastric junction morphology and competence, specifically whether the gastroesophageal flap valve (GEFV) is normal (grade I/II) or abnormal (grades III/IV). However, it is not routinely used in clinical practice. We report a systematic review and meta-analysis to determine association between abnormal GEFV and gastroesophageal reflux disorder (GERD). A comprehensive literature search of MEDLINE and Scopus databases was conducted to identify studies that reported the association between abnormal GEFV and GERD. The search and quality assessment were performed independently by two authors. Fixed- and random-effects meta-analyses were conducted using symptomatic GERD and erosive esophagitis as outcomes. A total of 11 studies met inclusion criteria that included a total of 5054 patients. In the general population, patients with abnormal GEFV had greater risk of symptomatic GERD compared to patients with a normal GEFV (risk ratio [RR] 1.88, 95% CI 1.57-2.24). Further, in patients with symptomatic GERD, patients with abnormal GEFV had greater risk of erosive esophagitis compared to patients with normal GEFV (RR 2.17, 95% CI 1.40-3.36). Finally, the specificity of abnormal GEFV for symptomatic GERD was 73.3% (95% CI 69.3-77.0%) and 75.7% (95% CI 65.9-83.4%) for erosive esophagitis in symptomatic GERD. Our systematic review and meta-analysis showed consistent association between abnormal GEFV indicated by Hill's classification III/IV and symptomatic GERD and erosive esophagitis. Our recommendation is to include Hill's classification in routine endoscopy reports and workup for GERD.

How to Manage a Patient With Gastric Intestinal Metaplasia: An International Perspective

How to Manage a Patient With Gastric Intestinal Metaplasia: An International Perspective

내시경적 아데노이드 등급과 소아 폐쇄성 수면무호흡증 중증도의 상관관계

Background and Objectives: Hypertrophy of adenoids was recognized as one of the main causes of snoring and obstructive sleep apnea (OSA) in pediatric patients. Recently, two endoscopic adenoid grading system was proposed, Parikh grade (P-G) and ACE grade (ACE-G). The aim of this study is to evaluate the correlation between obstructive sleep apnea severity and these two endoscopic adenoid grading systems. Materials and Methods: We retrospectively reviewed the medical records of 52 patients who underwent a polysomnography and endoscopic nasal endoscopy in the secondary referral hospital from 2008 to 2017. Adenoid exam was performed with nasal endoscopy after nasal packing soaked with lidocaine and xylometazoline in out-patient clinic. It was evaluated the correlation between each adenoid grading system and apnea-hypopnea index, adjusted by sex, age, tonsil grade, body mass index, and presence of allergic rhinitis. Results: Mean age was 7.6 year (range : 2-15, SD : 2.57) and 75% of the patient had obstructive sleep apnea (AHI≥1). P-G was statistically correlated with OSA severity. (OR=11.8, 95% CI : 1.5-92.2, p=0.02) Only subgrade E of ACE-G has meaningful correlation with OSA severity (OR=2.07, 95% CI : 0.91-4.81 p=0.03). Conclusion: P-G and subgrade E of ACE-G were statistically related to sleep apnea severity in pediatric patients. Endoscopic adenoid grading system can be useful tool to evaluate adenoid hypertrophy and upper airway in pediatric OSA patients. (J Clinical Otolaryngol 2019;30:204-208)

Reliability and accuracy of blue light imaging for staging of intestinal metaplasia in the stomach

Background and aims: An endoscopic grading system (EGGIM) using narrow-band-imaging (NBI) has shown to accurately identify patients with extensive gastric intestinal metaplasia (GIM). However, description with alternative systems such as blue-light-imaging (BLI) is limited. The aim of this study is to determine the reliability and accuracy of BLI-bright regarding diagnosis and staging of GIM.Methods: Reliability of WLE (white-light-endoscopy) and BLI among 6 observers was assessed using a standard classification based on endoscopic images. Afterward, 37 patients were submitted to gastroscopy using FujifilmEG-760Z and endoscopists had to determine EGGIM score using BLI-bright and to perform gastric biopsies for operative-link-of-gastric-intestinal-metaplasia (OLGIM) calculation. BLI-bright accuracy was determined by comparing results with prior EGGIM scores with NBI and current OLGIM.Results: Compared with WLE, the interobserver reliability between observers was substantially better with BLI (Weighted Kappa: 0.8 vs 0.41). There was an 84% agreement between BLI and NBI assessing EGGIM intervals (EGGIM 0-4vs5-10). The area under the ROC curve was 0.90 (95%CI: 0.79–1.0) using the cut-off of EGGIM > 4 to determine advanced GIM, with a sensitivity of 100% (95%CI: 88–100%).Discussion: BLI-bright is reliable for the diagnosis of gastric intestinal metaplasia and agrees significantly with NBI evaluation. Preliminary data suggests high sensitivity for identifying patients with increased risk of gastric cancer.

A Case-Control Study on the Association Between Endoscopic ACE Grade of Adenoid Hypertrophy and Hearing Loss in Children and Its Impact on Speech and Language Development.

To establish an association between adenoid hypertrophy and hearing loss and its impact on speech and language in pediatric age group. A prospective case control study done in a tertiary hospital in South India. Twenty children with hearing loss were recruited in the study group and twenty-four children as controls. These groups underwent at detailed otorhinolaryngologic examination, hearing and speech evaluation. The size of the adenoids was graded endoscopically. Findings between the two groups were compared and analysed. Our study found statistically significant association between adenoid hypertrophy with choanal obstruction and abutment of eustachian tube opening seen on endoscopy with hearing loss (p = 0.025). The children with hearing loss also had speech and language delay (p = 0.004). Children with enlarged adenoids obstructing the > 50% of the choanae or abutting the eustachian tube opening are more likely to have hearing loss and may develop speech and language delay. The ACE endoscopic adenoid grading system is consistent and reliable in evaluation of adenoids.

The Development and Validation of an Endoscopic Grading System for Hiatal Hernia: The Houston Hiatal Criteria

Introduction: A hiatal hernia (HH) is frequently found during esophagogastroduodenoscopy (EGD). Length of the HH is routinely measured as the distance between the gastroesophageal junction (GEJ) and the diaphragmatic pinch. Although gastroenterologists routinely perform examination of the gastric fundus in retroflexion, the diaphragmatic diameter and Hill grade of the gastroesophageal flap valve are not routinely reported during EGD. Methods: A multidisciplinary GERD group at our institution developed the Houston Hiatal criteria, standardized criteria for endoscopic assessment and reporting of HH. These criteria include length (L), diaphragmatic diameter (D) and Hill grade (H). We retrospectively applied these criteria to a prospectively maintained database of patients undergoing 96-hour wireless pH evaluation, and compared the results between groups of patients with and without HH. Results: In our cohort of 257 consecutive patients (94 male, mean age 52.6 years (19-84 years)), 46 patients met the Houston Hiatal criteria for HH, defined as L > 1 cm, D > 1 cm and H ≥ 2. Patients with HH based on these criteria were twice as likely to have endoscopic evidence of esophagitis compared to patients without HH (40% vs 19%, p < 0.01). We also found a positive correlation between higher DeMeester scores and increasing Houston Hiatal criteria scores of HH on 96-hour wireless pH studies (p < 0.01). Patients with HH also had higher mean DeMeester scores (32.38 ± 28 vs 21.54 ± 22, p < 0.01). 96-hour pH study results were more frequently abnormal in patients with HH compared to patients without HH: Total time spent in reflux (91% patients with HH vs 78% patients without HH, p <0.01), upright reflux (96% vs 81%, p < 0.01), supine reflux (89% vs 62%, p < 0.01), and postprandial reflux (98% vs 81%, p < 0.01). Conclusion: The Houston Hiatal criteria for HH allowed accurate endoscopic assessment, description, and grading of HH. Patients with HH based on these criteria were more likely to have esophagitis and objective findings of GERD on 96-hour pH study.328 Figure 1. Houston Hiatal Hernia statistic report

A novel endoscopic grading system for prediction of disease-related outcomes in patients with diverticulosis

BackgroundWe describe a simple endoscopic grading system of diverticular disease for the assessment of disease severity and prediction of outcomes. MethodsA retrospective analysis of prospectively maintained colonoscopy database was conducted. A single endoscopist prospectively graded disease severity according to the number and size of diverticula, the degree of muscular hypertrophy and rigidity of the sigmoid colon. Results762 patients were included in the analysis. Mean patient age was 70 years (range 37–97). Endoscopic severity of diverticulosis was predictive of the need for surgery, with 2% in the mild-moderate, 12% in the severe and 33% in the acute group (p < 0001). Time to surgery showed correlation to severity grade, with mean periods of 107.5 months in the moderate group vs. 3 and 2.5 months in the severe and acute group (p < 0001). The mean follow up was 11 years. ConclusionSurgeons should consider using endoscopic grading as an adjunct to clinical management decisions.

Semirigid ureteroscopy prior retrograde intrarenal surgery (RIRS) helps to select the right ureteral access sheath.

To evaluate ureteral compliance through semirigid ureteroscopy (sURS) in order to select the proper ureteral access sheath (UAS) size for retrograde intrarenal surgery (RIRS). In a prospective study, 100 consecutive patients selected for elective sURS or RIRS were recruited. Each patient, initially underwent 9.5 Fr sURS with a safety guidewire 3Fr, in order to estimate ureteral compliance. If the ureter was compliant, a gently passage of a 12/14Fr UAS was attempted. If the ureter was not deemed compliant, passage of either a smaller UAS or a smaller semirigid 7Fr or a flexible 7.5Fr or a digital 8.5Fr scope with and without safety guidewire, was attempted. Age, gender, disease location, prestenting, previous RIRS and/or stone elimination, hydronephrosis, ureteral strictures, unsuccessful procedures, and complications, were analyzed as possible correlated factors of ureteral compliance. In 77 patients the ureter was deemed compliant ≥ 14Fr. Of the preoperative factors that were examined, stent placement before RIRS (P < 0.002), previous RIRS (P = 0.000) and previous stone elimination (P = 0.004), correlated with ureter ≥ 14Fr. Ureteral lithiasis (P < 0.001), ureteral strictures (P < 0.05), unsuccessful procedures (P < 0.005) and complications (P = 0.01) correlated with ureter < 14Fr. The complication rate was 10% (10 patients) with ureteral injuries grade I in 9 patients and grade III in 1 patient according to the endoscopic grading system. Age, gender, hydronephrosis and urothelial carcinoma (UC) had no influence. sURS performed before RIRS allows selection of the right ureteral access sheath (UAS) and avoidance of major complications. Pre-stenting, previous RIRS and stone elimination history are all factors correlating with a compliant ureter.

Powered endoscopic inferior turbinoplasty: clinical study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Nasal obstruction is a common complaint in ENT clinics and significantly affect the patient`s quality of life. Inferior turbinate hypertrophy is one of the common causes of nasal obstruction, surgical reduction of inferior turbinate is indicated in refractory cases not responding to conservative measures and the optimal surgical technique is controversial. The aim of the study was to evaluate the clinical outcomes of powered endoscopic inferior turbinoplasty in the management of inferior turbinate hypertrophy. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;An interventional study (single group clinical trial) was conducted and powered endoscopic inferior turbinoplasty was performed on 30 patients complaining of chronic nasal obstruction due to inferior turbinate hypertrophy and other causes of nasal obstruction were excluded. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Assessed preoperatively and 1&lt;sup&gt;st&lt;/sup&gt; week, 1&lt;sup&gt;st&lt;/sup&gt; month and 3&lt;sup&gt;rd&lt;/sup&gt; month postoperatively depending on subjective visual analogue scale scores for nasal obstruction, endoscopic grading system and complications. There was significant improvement in nasal obstruction and significant reduction in inferior turbinate size and mild complications that completely absent at the third month following the surgery. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Microdebrider-assisted inferior turbinoplasty as a safe, effective and reliable alternative method for inferior turbinate reduction.&lt;/span&gt;&lt;/p&gt;

Pediatric airway study: Endoscopic grading system for quantifying tonsillar size in comparison to standard adenotonsillar grading systems

SignificanceCurrent grading systems may not allow clinicians to reliably document and communicate adenotonsillar size in the clinical setting. A validated endoscopic grading system may be useful for reporting tonsillar size in future clinical outcome studies. This is especially important as tonsillar enlargement is the cause of a substantial health care burden on children. ObjectiveTo propose and validate an easy-to-use flexible fiberoptic endoscopic grading system that provides physicians with a more accurate sense of the three-dimensional relationship of the tonsillar fossa to the upper-airway. Methods50 consecutive pediatric patients were prospectively recruited between February 2015 and February 2016 at a pediatric otolaryngology outpatient clinic. The patients had no major craniofacial abnormalities and were aged 1 to 16years. Each patient had data regarding BMI, Friedman palate position, OSA-18 survey results collected. For each child, digital video clips of fiberoptic nasopharyngeal, oropharyngeal and laryngeal exams were presented to 2 examiners. Examiners were asked to independently use the proposed Endoscopic tonsillar grading system, the Brodsky tonsillar grading scale, the Modified Brodsky tonsillar grading scale with a tongue depressor, and the Parikh adenoid grading system to rate adenotonsillar hypertrophy. Cohen's Kappa and weighted Kappa scores were used to assess interrater reliability for each of the four grading scales. The Spearman correlation was used to test the associations between each scale and OSA-18 scores, as well as Body Mass Index (BMI). Results50 pediatric patients were included in this study (mean age 6.1years, range of 1year to 16years). The average BMI was 20. The average OSA-18 score was 61.7. The average Friedman palate position score was 1.34. Twelve percent of the patients had a Friedman palate position score≥3, which made traditional Brodsky grading of their tonsils impossible without a tongue depressor. All four scales showed strong agreement between the two raters. The weighted Kappa was 0.83 for the Modified Brodsky scale, 0.89 for the Brodsky scale, 0.94 for the Parikh scale to 0.98 for the Endoscopic scale (almost perfect agreement). The Endoscopic scale showed the most consistent agreement between the raters during the study. There was a moderate association between the Parikh adenoid grading system with OSA-18 scores (Spearman's ρ=0.58, p<0.001) compared to a low association of the tonsillar grading systems with OSA- 18 scores. None of the scales correlated with patient BMI. ConclusionsThe proposed Endoscopic tonsillar grading system is as reliable of a method of grading tonsillar size as conventional grading systems. It offers the advantage of allowing for critical evaluation of the tonsils without any anatomic distortion which may occur with the use of a tongue blade. This new validated endoscopic grading system provides a tool for communicating the degree of airway obstruction at the level of the oropharynx regardless of Friedman palate position and may be used in future outcomes projects.

An endoscopic mucosal grading system is predictive of leak in stapled rectal anastomoses.

Anastomotic leak is a devastating postoperative complication following rectal anastomoses associated with significant clinical and oncological implications. As a result, there is a need for novel intraoperative methods that will help predict anastomotic leak. From 2011 to 2014, patient undergoing rectal anastomoses by colorectal surgeons at our institution underwent prospective application of intraoperative flexible endoscopy with mucosal grading. Retrospective review of patient medical records was performed. After creation of the colorectal anastomosis, application of a three-tier endoscopic mucosal grading system occurred. Grade 1 was defined as circumferentially normal appearing peri-anastomotic mucosa. Grade 2 was defined as ischemia or congestion involving <30% of either the colon or rectal mucosa. Grade 3 was defined as ischemia or congestion involving >30% of the colon or rectal mucosa or ischemia/congestion involving both sides of the staple line. From 2011 to 2014, a total of 106 patients were reviewed. Grade 1 anastomoses were created in 92 (86.7%) patients and Grade 2 anastomoses were created in 10 (9.4%) patients. All 4 (3.8%) Grade 3 patients underwent immediate intraoperative anastomosis takedown and re-creation, with subsequent re-classification as Grade 1. Demographic and comorbidity data were similar between Grade 1 and Grade 2 patients. Anastomotic leak rate for the entire cohort was 12.2%. Grade 1 patients demonstrated a leak rate of 9.4% (9/96) and Grade 2 patients demonstrated a leak rate of 40% (4/10). Multivariate logistic regression associated Grade 2 classification with an increased risk of anastomotic leak (OR 4.09, 95% CI 1.21-13.63, P=0.023). Endoscopic mucosal grading is a feasible intraoperative technique that has a role following creation of a rectal anastomosis. Identification of a Grade 2 or Grade 3 anastomosis should provoke strong consideration for immediate intraoperative revision.

Tu1207 Development of an Endoscopic Grading System for Classification of Gastroesophageal Junction: Seoul HOF Criteria

Tu1207 Development of an Endoscopic Grading System for Classification of Gastroesophageal Junction: Seoul HOF Criteria