Endoscopic Grading Research Articles

From part to whole, operative link on to endoscopic grading of gastric intestinal metaplasia, pathology to endoscopy: gastric intestinal metaplasia graded by endoscopy.

Objective: To conduct a systematic review and meta-analysis on the prediction of severity of gastric intestinal metaplasia (GIM) in localized and entire gastric mucosa using endoscopy. Methods: The authors searched Web of Science, PubMed, Embase and Cochrane Central Register of Controlled Trials and performed systematic searches on endoscopic grading of GIM of the entire stomach using Meta-DiSc and Stata. Results: Sensitivity and specificity for the stratified prediction of overall GIM were 0.91 (95% CI: 0.85-0.95) and 0.91 (95% CI: 0.88-0.93), respectively. Sensitivity in predicting the different grades of GIM was higher in operative link on GIM assessment grades 0, III and IV but lower in grades I and II. Conclusion: Digital chromoendoscopy is well suited to predicting the severity of localized and overall GIM.

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.

Caustic Ingestion

Caustic ingestions are rare, life-threatening injuries with life-long consequences. Injury can occur anywhere from the lips to stomach but tends to be most severe in the esophagus. Aspiration of caustic substances can lead to laryngeal or tracheobronchial injury and airway compromise. Caustic injuries come in two main varieties: acidic and alkaline-induced injuries. The type and state of agent determines in part the location of injury and depth of injury. Management consists of comprehensive evaluation and stabilization and must consider airway safety. Endoscopic evaluation and staging of the esophagus should be done within 24 hours of ingestion but not before 6 hours. Nasogastric tube placement should be considered based on the stage of the injury. Antibiotics, acid-suppressants, and corticosteroids may have a roll for certain patients but must be determined on an individual basis. Long-term follow up is required to monitor for strictures and patients with caustic esophageal injury are at increased risk of esophageal carcinoma. This review will help both junior and senior Otolaryngology residents recognize, evaluate and manage causing ingestions in pediatric patients. This review contains figures, tables, and references Keywords: Caustic ingestion, acid, alkali, endoscopic grading, strictures, mitomycin C, balloon dilatation

Correlation of Ultrasonographically Measured Splenic Size with Endoscopic Grading of Esophageal Varices in Cirrhosis of Liver

Background: Cirrhosis is the end stage of chronic liver disease, resulting in formation of fibrous tissue, derangement of liver architecture and ultimately results in portal hypertension and its complication. Objective: To find out the correlation between splenic size and endoscopic grading of esophageal varices in diagnosed cases of cirrhosis of liver. Methods: This prospective observational cross-sectional study was carried out in the Department of Radiology and Imaging in collaboration with GHPD, BIRDEM, Dhaka. 110 liver cirrhosis patients with or without esophageal varices diagnosed by endoscopy of UGIT referred to the department of Radiology and Imaging were included in this study on the basis of selection criteria. Result: The following observations and results were obtained in this study the mean age was 44.81 (±14.42) years, minimum age was 18 years and maximum age was 65 years. Majority 69% were male and 31% were female. Esophageal variceal grading of the study population majority 47(42.73%) were grade I, 24(21.82%) were grade II, 16(14.55%) were grade III, 12(10.91%) were grade IV and 11(10%) were no varices. Splenic size by ultrasonography, majority 66(60%) were 12-14.9 cm, 37(33.64%) were ≥15 cm and 07(6.36%) were < 12 cm. In splenic size ≤ 15 cm, grading of esophageal varices, 15.07% had no varices, 60.27% had grade I, 20.55% had grade II, 2.74% had grade III and 1.37% had grade IV. In splenic size ≥ 15 cm grading of esophageal varices, 8.11% had grade I, 24.32% had grade II, 37.84% had grade III and 29.73% had grade IV. That means there is a positive correlation between ultrasonographically measured splenic size and endoscopic grading of esophageal varices in liver cirrhosis patients. Conclusion: Positive correlation was found between ultrasonographically measured splenic size with endoscopic grading of esophageal varices. Bangladesh Crit Care J March 2022; 10 (1): 57-61

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.

Endoscopic diagnosis of gastric intestinal metaplasia in patients with autoimmune gastritis using narrow-band imaging: does pseudopyloric metaplasia muddy the waters?

Background and study aims In autoimmune atrophic gastritis (AAG), associated with intestinal (IM) and/or pseudopyloric metaplasia (PPM), endoscopic surveillance is recommended for gastric cancer risk mainly linked to IM. Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM) reliably identifies IM, but has not been assessed in AAG. We aimed to assess the performance of EGGIM (index test) versus histology (reference test) of corpus IM in AAG. Patients and methods This was a cross-sectional study of 210 AAG patients undergoing surveillance gastroscopy with narrow-band imaging (NBI): corpus IM scored according to EGGIM, histology according to updated Sydney system, and morphological criteria. Results NBI identified corpus IM in 88.6 % of AAG patients: EGGIM were 0, 1, 2, 3, 4 in 11.4 %, 0.5 %, 33.3 %, 1.9 %, and 52.9 %, respectively. Histology identified corpus IM in 78.1 % and PPM in 79.5 % of patients. PPM was present with IM in 57.6 % and without IM in 21.9 % patients, 20.5 % had IM without PPM. EGGIM, compared to histology, correctly classified 76.2 % of patients, showing high sensitivity (91.5 %, 95 %CI 86.1–95.3). EGGIM correctly classified 93 % of patients with IM without PPM, 90.9 % with both metaplasias, and 21.7 % with PPM without IM yielding low specificity (21.7 %, 95 %CI 10.9–36.4). Conclusions In AAG, EGGIM showed high accuracy and sensitivity identifying > 90 % of patients with histological corpus IM. EGGIM overestimated IM when PPM without IM was present, yielding low specificity. These findings raise the question of whether in AAG, PPM and IM may display similar endoscopic features on NBI.

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.

Correlation between Serum Ascites Albumin Gradient and Endoscopic Grading of Esophageal Varices in patients with cirrhosis

Introduction: The serum-ascites albumin gradient (SAAG) is a medical calculation that can help determine the cause of your ascites. The SAAG may be a more effective discriminator than the usual method of dividing ascites fluid into transudates and exudates. Objective: The objective of this study was to see if there was a link between the serum ascites albumin gradient and the endoscopic grading of esophageal varices in cirrhotic individuals. Materials and Methods: This Cross-sectional study was conducted in Unit II, Department of Medicine, Lahore General Hospital, Lahore during 3-10-2018 to 3-4-2019. A total of 60 patients who met the study's inclusion criteria were included. Blood sample was taken and sent to the laboratory of the hospital for assessment of serum albumin level and SAAG was calculated. Results: Results of this study showed positive moderate correlation between grades of varices and SAAG i.e. r= 0.661, p-value=0.000. Esophageal varices appear to be directly linked to the severity of SAAG. Conclusion: In individuals with cirrhosis, there is a moderately strong significant association between the SAAG and the endoscopic grading of esophageal varices. In cirrhotic individuals, SAAG may be a useful biomarker for EV development. Key words: Correlation, Serum ascites, Albumin, Gradient, Endoscopic, Esophageal, Varices, Cirrhosis

Relevance of pepsinogen, gastrin, and endoscopic atrophy in the diagnosis of autoimmune gastritis

Simple objective modalities are required for evaluating suspected autoimmune gastritis (AIG). This cross-sectional study aimed to examine whether pepsinogen, gastrin, and endoscopic findings can predict AIG. The diagnostic performance of endoscopic findings and serology in distinguishing AIG was evaluated. AIG was diagnosed in patients (N = 31) with anti-parietal cell antibody and/or intrinsic factor antibody positivity and histological findings consistent with AIG. Non-AIG patients (N = 301) were seronegative for anti-parietal cell antibodies. Receiver operating characteristic curve analysis of the entire cohort (N = 332) identified an endoscopic atrophic grade cutoff point of O3 on the Kimura–Takemoto classification (area under the curve [AUC]: 0.909), while those of pepsinogen-I, I/II ratio, and gastrin were 20.1 ng/mL (AUC: 0.932), 1.8 (AUC: 0.913), and 355 pg/mL (AUC: 0.912), respectively. In severe atrophy cases (≥ O3, N = 58, AIG/control; 27/31), the cutoff values of pepsinogen-I, I/II ratio, and gastrin were 9.8 ng/mL (AUC: 0.895), 1.8 (AUC: 0.86), and 355 pg/mL (AUC: 0.897), respectively. In conclusion, endoscopic atrophy is a predictor of AIG. High serum gastrin and low pepsinogen-I and I/II ratio are predictors even in the case of severe atrophy, suggesting their usefulness when the diagnosis of AIG is difficult or as serological screening tests.

Combined Detection of RUNX3 and EZH2 in Evaluating Efficacy of Neoadjuvant Therapy and Prognostic Value of Middle and Low Locally Advanced Rectal Cancer.

ObjectiveThis article investigated whether Runt-Related Transcription Factor 3 (RUNX3) and enhancer of zeste homolog 2 (EZH2) can be used to evaluate the clinical efficacy of neoadjuvant therapy and prognosis of locally advanced rectal cancer (LARC). MethodsEighty LARC patients admitted to the Tianjin Medical University Cancer Institute/Hospital and First Affiliated Hospital of Hebei North University from Jan 2015 to Jan 2016 were enrolled. The patients were followed up for 60 months through hospital visits. All patients received neoadjuvant chemoradiotherapy (long range radiotherapy + oral capecitabine) + total mesorecta excision (TME) surgery. The clinical efficacy of the treatments was evaluated through endoscopic, radiography, and tumor regression grade (TRG). In addition, expression level of RUNX3 and EZH2 was quantified via immunohistochemistry. The association of RUNX3 and EZH2 with clinicopathological characteristics of advanced tumors and efficacy of neoadjuvant therapy was explored. Logistic regression analysis was performed to identify predictors of efficacy of neoadjuvant chemoradiotherapy. Survival curve was used to evaluate the impact of RUNX3 and EZH2 on the prognosis of LARC patients.ResultsA total of 80 patients diagnosed with LARC were enrolled in the study. Expression of RUNX3 was elevated in 25 (31.25%) patients, whereas expression of EZH2 was upregulated in 44 (55.00%) patients. Analysis of tumor regression identified 10 cases with TRG grade 0 (pathologic complete response, PCR), 24 cases with TRG grade 1, 35 cases with TRG grade 2, and 11 cases with TRG grade 3. Furthermore, 38 cases had significant down-staging, and 42 cases showed no significant down-staging as revealed by endoscopy and imaging. Patients with high expression of RUNX3 showed better tumor regression response and down-staging compared with those with low expression of RUNX3 (P < 0.001, P < 0.001). Moreover, patients with low EZH2 expression achieved TRG grade 0 and 1 response and down-staging effect compared with those with high expression of EZH2 (P < 0.001, P < 0.001). Logistic regression analysis showed that high expression of RUNX3, low expression of EZH2, and clinical N (cN) stage were good predictors of tumor regression response and down-staging. The 5-year disease free survival (DFS) and overall survival (OS) were 48.75 (39/80) and 58.75% (47/80), respectively. The 5-year DFS and OS of patients with high RUNX3 expression were significantly higher than low RUNX3 expression, whereas the 5-year DFS and OS of patients with high EZH2 expression were significantly lower than low EZH2 expression (P < 0.001). Univariate survival analysis showed that RUNX3 expression, EZH2 expression, cN, clinical T (cT), pathological T (pT) and pathological N (pN) were significantly correlated with the 5-year DFS and 5-year OS. Multivariate survival analysis showed that EZH2 expression and PN were good predictors of 5-year DFS and 5-year OS, whereas RUNX3 was a good predictor of 5-year DFS but not 5-year OS.ConclusionsExpression level of RUNX3 and EZH2 accurately predicts clinical efficacy of neoadjuvant chemoradiotherapy and the prognosis of LARC patients, suggesting that RUNX3 and EZH2 can be used as pivotal clinical predictors for LARC.

Reliability and responsiveness of endoscopic disease activity assessment in eosinophilic esophagitis

Endoscopic outcomes have become important measures of eosinophilic esophagitis (EoE) disease activity, including as an endpoint in randomized controlled trials (RCTs). We evaluated the operating properties of endoscopic measures for use in EoE RCTs. Modified Research and Development/University of California Los Angeles appropriateness methods and a panel of 15 international EoE experts identified endoscopic items and definitions with face validity that were used in a 2-round voting process to define simplified (all items graded as absent or present) and expanded versions (additional grades for edema, furrows, and/or exudates) of the EoE Endoscopic Reference Score (EREFS). Inter- and intrarater reliability of these instruments (expressed as intraclass correlation coefficients [ICC]) were evaluated using paired endoscopy video assessments of 2 blinded central readers in patients before and after 8 weeks of proton pump inhibitors, swallowed topical corticosteroids, or dietary elimination. Responsiveness was measured using the standardized effect size (SES). The appropriateness of 41 statements relevant to EoE endoscopic activity (endoscopic items, item definitions and grading, and other considerations relevant for endoscopy) was considered. The original and expanded EREFS demonstrated moderate-to-substantial inter-rater reliability (ICCs of .472-.736 and .469-.763, respectively) and moderate-to-almost perfect intrarater reliability (ICCs of .580-.828 and .581-.828, respectively). Strictures were least reliably assessed (ICC, .072-.385). The original EREFS was highly responsive (SES, 1.126 [95%confidence interval {CI}, .757-1.534]), although both expanded versions of EREFS, scored based on worst affected area, were numerically most responsive to treatment (expanded furrows: SES, 1.229 [95% CI, .858-1.643]; all items expanded: SES, 1.252 [95% CI, .880-1.667]). The EREFS and its modifications were not more reliably scored by segment and also not more responsive when proximal and distal EREFSs were summed. EREFS and its modifications were reliable and responsive, and the original or expanded versions of the EREFS may be preferred in RCTs. Disease activity scored based on the worst affected area optimizes reliability and responsiveness.

CORRELATION OF PUCAI BETWEEN MAYO ENDOSCOPIC AND GEBOES PATHOLOGY SCORES IN ASSESSING DISEASE ACTIVITY OF PEDIATRIC PATIENTS WITH UC AMONG HISPANICS AND NON-HISPANICS

Abstract BACKGROUND Disease activity in ulcerative colitis (UC) has traditionally been assessed by clinical scoring systems, including the pediatric ulcerative colitis activity index (PUCAI), a non-invasive, reliable way to monitor disease severity and the therapeutic efficacy of interventions in pediatric UC. Practice guidelines have recommended the use of PUCAI in routine clinical pediatric care. Therefore, we aim to investigate the correlation of PUCAI with the endoscopic assessment of disease activity (Mayo endoscopic score) and histologic features of mucosal inflammation (Geboes pathology grading score) in a Hispanic pediatric UC population compared to a non-Hispanic pediatric population. METHODS We conducted a retrospective study in pediatric patients aged 7 - 21 with UC enrolled at Children’s Hospital of Los Angeles. We first assess the distribution of the PUCAI, the Mayo, and the Geboes grading scales of disease activity (0=remission, 1=mild, 2=moderate, 3=severe) of the Physician Global Assessment (PGA). Reviewed data was collected directly from the physician report or calculated retrospectively using clinic notes. Although different pathologists graded the samples, the Geboes score is used as a department-wide standard for grading UC. Spearman correlation coefficient was assessed to measure the degree of linear association between two order-valued variables. Bootstrap simulations were used to calculate 95% confidence intervals, and approximate permutation tests were applied to compare these correlations between Hispanics and Non-Hispanics. RESULTS In total, 172 patients fit our inclusion criteria. Overall, a modest correlation between PUCAI with the Mayo endoscopic and Geboes pathology grading scores was observed (0.72 and 0.68). The PUCAI-Endoscopic correlations were 0.65 and 0.79 for Hispanics and non-Hispanics, respectively (p-value of difference = 0.084). The correlations between Geboes pathology and PUCAI grading scores were weaker but still larger for non-Hispanics (0.73) than Hispanics (0.64). A linear relationship between PUCAI scores and the two gradings scores, Mayo endoscopy and Geboes pathology, is shown in Figure 1 (p for trend &amp;lt; 0.001). CONCLUSION Endoscopic/pathology disease severity generally correlates with clinical disease activity measured by PUCAI score. The PUCAI correlated well with the endoscopy/pathology scores in severe clinical disease, and an agreement was less robust in assessing UC patients’ mild to moderate disease activity. However, the strength of the association varies by ethnic background. Hence, caution should be exercised when using the PUCAI score to assess UC disease activity in Hispanic pediatric patients.

Comparative study for predictability of type 1 gastric variceal rebleeding after endoscopic variceal ligation: High-frequency intraluminal ultrasound study.

BACKGROUNDThe efficacy of endoscopic ultrasonography for the follow-up of gastric varices treated with endoscopic variceal ligation (EVL) has not been established. AIMTo evaluate the diagnostic correlation of esophagogastroduodenoscopy (EGD) and high-frequency intraluminal ultrasound (HFIUS) for type 1 gastric varices (GOV1) after EVL and to identify the predictability for rebleeding of EGD and HFIUS. METHODSIn liver cirrhosis patients with GOV1, we performed endoscopic follow-up using EGD and HFIUS synchronously after EVL for hemorrhage from GOV1. Endoscopic grading and red color signs were analyzed using EGD, and the largest variceal cross-sectional areas were measured using HFIUS. In addition, 1-year follow-up was performed. Variceal rebleeding was defined as the presence of hematemesis, hematochezia, or melena without other evidence of bleeding on endoscopic follow-up. RESULTSIn 26 patients with GOV1, variceal cross-sectional areas on HFIUS of GOV1 was poorly correlated with EGD grading of GOV1 (r = 0.36). In 17 patients who completed the 1-year follow-up, variceal cross-sectional areas on HFIUS was a good predictor of subsequent rebleeding, whereas EGD grading was not a predictor of subsequent rebleeding. CONCLUSIONHFIUS measurement is more predictive of GOV1 rebleeding than EGD grading, so HFIUS measurement may be necessary for endoscopic follow-up after EVL in patients with GOV1.

Positioning Infliximab and Vedolizumab in the Treatment of Moderate-to-Severe Ulcerative Colitis

Positioning Infliximab and Vedolizumab in the Treatment of Moderate-to-Severe Ulcerative Colitis

Evaluation of endoscopic assisted suction coagulation adenoidectomy versus traditional curettage technique

BackgroundAdenoidal hypertrophy is a common condition in children and can cause symptoms such as mouth breathing, nasal discharge, snoring, sleep apnea, and hyponasal speech. The curettage adenoidectomy has some disadvantages, especially the intranasal extension of the adenoid tissue that makes this technique inadequate. This study is conducted to evaluate and compare between assisted suction coagulation adenoidectomy and traditional curettage techniques.ResultsOne hundred twenty-two patients with symptomatic adenoid hypertrophy such as nasal obstruction, snoring, and mouth breathing were included in our study. Patients underwent adenoidectomy either traditional curettage adenoidectomy (60 patients as group A) or endoscopic assisted suction coagulation adenoidectomy (62 patients as group B). Patients were scheduled for follow-up visits with respect to operative time, operative and postoperative complications. The mean age of groups A and B were 6.57+2.8 and 7+2.8 ranging from 3 to12 years. There was a statistically significant difference between groups as regard intraoperative blood loss, trauma, postoperative complications as neck stiffness and bad odor plus postoperative endoscopic and radiological grading after the operation.ConclusionsSuction coagulation diathermy adenoidectomy is alternative to cold adenoidectomy with significantly fewer intraoperative complications such as blood loss and trauma of prevertebral muscle plus post-operative complications such as primary or secondary bleeding and rhinolalia aperta.

Severe acute ischemic colitis: What is the place of endoscopy in the management strategy?

Background and study aims Ischemic colitis (IC) is potentially lethal. Clinical and biology information and results of computed tomography (CT) scan and/or colonoscopy are used to assess its severity. However, decision-making about therapy remains a challenge. Patients and methods This was a retrospective, single-center study between 2006 and 2015. Patients with severe IC who underwent endoscopic evaluation were included. The aims were to determine outcomes depending on endoscopic findings and assess the role of endoscopy in the management. Results A total of 71 patients were included (men = 48 (68%), mean age = 71 ± 13 years). There was hemodynamic instability in 29 patients (41 %) and severity signs on CT scan in 18 (38 %). Twenty-nine patients (41 %) underwent surgery and 24 (34 %) died. The endoscopic grades were: 15 grade 1 (21 %), 32 grade 2 (45 %), and 24 grade 3 (34%). Regarding patients with grade 3 IC, 55 % had hemodynamic instability, 58 % had severity signs on CT scan, 68 % underwent surgery, and 55 % died. The decision to perform surgery was based on hemodynamic status in 62 % of cases, CT scan data in 14 %, endoscopic findings in 10 %, and other in 14 %. Colectomy was more frequent in patients with grade 3 IC ( P < 0.05). A mismatch between mucosal aspect (necrosis) and serous (normal) was observed in 13 patients (46 %). Risk factors for colectomy in univariate analysis were aortic aneurysm surgery, hemodynamic instability, no colic enhancement on CT scan, and endoscopic grade 3. Risk factors for mortality in multivariate analysis were hemodynamic instability, colectomy, and Charlson score > 5 ( P < 0.05). Conclusions This study suggests a low impact of endoscopy on surgical decision making. Hemodynamic instability was the first indication for colectomy. A discrepancy between endoscopic mucosal (necrosis) and surgical serous (normal) aspects was frequently noted.

Outcomes of simultaneous endoscopic submucosal dissection for synchronous multiple gastric neoplastic lesions: a retrospective comparative study.

Simultaneous endoscopic submucosal dissection (ESD) is occasionally used in synchronous multiple gastric neoplastic lesions (SMGL). Therefore, we aim to evaluate the safety and efficacy of simultaneous ESD for SMGL compared with ESD for single lesions. A total of 1058 patients who received ESD from November 2006 to September 2019 were retrospectively evaluated in this study, including 997 single gastric epithelial lesions treated by single ESD (unifocal group) and 125 SMGL from 61 patients treated by simultaneous ESD (multifocal group). The mean procedure time was 49.2 ± 41.30min and 89.5 ± 66.33min in unifocal group and multifocal group, respectively (p < 0.001). There was no significant difference in postoperative stenosis rate (1.0% vs. 0.0%, p = 1.000), intraoperative bleeding (endoscopic resection bleeding-c3 grade) rate (0.5% vs. 1.6%, p = 0.696), postoperative bleeding rate (1.3% vs. 0.0%, p = 0.461), and perforation rate (0.9% vs. 1.6%, p = 0.449) between the two groups. In addition, en block resection rate (p = 0.825), complete resection rate (p = 0.856) and curative resection rate (p = 0.709) were comparable between the two groups. During the follow-up, the local recurrence rate per patient: p = 0.363; per lesion: p = 0.235) was not significantly different between the two groups, however, the cumulative incidence of metachronous lesions after treatment was significantly higher in the multifocal group than the other group (10.0% vs. 3.2%, p = 0.004). Simultaneous ESD is safe and effective in the treatment of SMGL. However, separate ESD is recommended for SMGL with longer procedure time. Besides, the metachronous gastric neoplastic lesions should be paid attention to during follow-up.

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

Comparative Study between Vitamin D and Placebo in Patients with Nasal Polyps

Background: Chronic rhino-sinusitis with nasal polyps [CRSwNP] is a prevalent disease that has an important influence on patient quality of life. Vitamin D3 [VD3] has been shown to suppress the proliferation of fibroblasts generated from nasal polyps.Aim of the work: The aim of this work is to evaluate the safety and efficacy of vitamin D3 in decreasing the severity and size of sino-nasal polyps in patients with vitamin D3 insufficiency.Methods: This study is a prospective cohort study conducted on 46 patients with chronic rhino-sinusitis with nasal polyps with vitamin D3 insufficiency [low levels of vitamin D3 < 30 ng/ml]. Included patients were divided into 2 groups, the first group were 22 patients given vitamin D3 [200,000 IU] intramuscular [IM], and the other control group included 20 patients were given placebo in the same manner as the first group. The two groups were assessed before vitamin D3 and placebo supplementation and after 3 months with endoscopic Meltzer grading score and CT scan.Results: Based on endoscopic Meltzer scores, there was improvement among 68.3% of vitamin D3 group vs. 20% of the placebo group; the severity of sino-nasal polyps was observed to be considerably reduced in vitamin D3 group in comparison to placebo group. CT finding reported 40.9% of vitamin D3 group improved vs. 10% of placebo group], the improvement of CT was changing of the affected sinuses from complete to partial opacification.Conclusion: Vitamin D3 has an effective way in lowering the severity of nasal polyps and alleviating their manifestations.

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