Esophagogastroduodenoscopy Findings Research Articles

Upper Gastrointestinal Endoscopic Screening in Bariatric Surgery Candidates: Correlating the Findings with GERD symptoms.

The role of routine preoperative esophagogastroduodenoscopy (EGD) in bariatric surgery candidates is controversial. This study compares preoperative EGD outcomes with patient-reported gastroesophageal reflux disease (GERD) symptoms to determine if a case-based EGD is appropriate. A prospective cohort study was conducted from April 2022 through September 2023 in Mashhad, Iran. All patients underwent EGD. To assess GERD symptoms, we used the GERD-Health Related Quality of Life questionnaire. Patients were categorized into two groups: the asymptomatic group (GERD-HRQL = 0) and the symptomatic group (GERD-HRQL > 0). A total of 165 patients were included, out of which 133 (80.6%) were in the symptomatic group and 32 (19.4%) were in the asymptomatic group. Esophagitis was present in 41 (24.8%) patients. There was no significant difference in the frequency of esophagitis (18.8% vs. 26.3%, p-value = 0.37), hiatal hernia (18.8% vs. 18.8%, p-value = 1.00), gastritis (56.3% vs. 63.9%, p-value = 0.42), and H. pylori infection (9.4% vs. 12.0%, p-value = 1.00) between the asymptomatic and symptomatic groups, respectively. None of the demographic factors or comorbidities of asymptomatic patients were associated with esophagitis, except for hiatal hernia (OR = 7.67, 95% CI 3.01-19.53, p-value < 0.001). Receiver operating characteristic (ROC) analysis showed that the GERD-HRQL total scores, as well as the heartburn and regurgitation subscales, were poor predictors of esophagitis (AUC 0.57, 0.51, and 0.56, respectively). EGD findings were not associated with GERD symptoms in candidates for bariatric surgery.

Clinical and endoscopic characteristics of patients undergoing gastrointestinal endoscopic procedures in Egypt: a nationwide multicenter study

BackgroundEgypt faces a significant public health burden due to chronic liver diseases (CLD) and peptic ulcer disease. CLD, primarily caused by Hepatitis C virus (HCV) infection, affects over 2.9% of the population nationwide, with regional variations. Steatotic liver disease is rapidly emerging as a significant contributor to CLD, especially in urban areas. Acid-related disorders are another widespread condition that can significantly impact the quality of life. These factors and others significantly influence the indications and findings of gastrointestinal endoscopic procedures performed in Egypt.AimWe aimed to evaluate the clinico-demographic data, indications, and endoscopic findings in Egyptian patients undergoing gastrointestinal endoscopic procedures in various regions of Egypt.MethodsThis study employed a retrospective multicenter cross-sectional design. Data was collected from patients referred for gastrointestinal endoscopy across 15 tertiary gastrointestinal endoscopy units in various governorates throughout Egypt.Results5910 patients aged 38–63 were enrolled in the study; 75% underwent esophagogastroduodenoscopy (EGD), while 25% underwent a colonoscopy. In all studied patients, the most frequent indications for EGD were dyspepsia (19.5%), followed by hematemesis (19.06%), and melena (17.07%). The final EGD diagnoses for the recruited patients were portal hypertension-related sequelae (60.3%), followed by acid-related diseases (55%), while 10.44% of patients had a normally apparent endoscopy. Male gender, old age, and the presence of chronic liver diseases were more common in patients from upper than lower Egypt governorates. Hematochezia (38.11%) was the most reported indication for colonoscopy, followed by anemia of unknown origin (25.11%). IBD and hemorrhoids (22.34% and 21.86%, respectively) were the most prevalent diagnoses among studied patients, while normal colonoscopy findings were encountered in 18.21% of them.ConclusionThis is the largest study describing the situation of endoscopic procedures in Egypt. our study highlights the significant impact of regional variations in disease burden on the utilization and outcomes of GI endoscopy in Egypt. The high prevalence of chronic liver disease is reflected in the EGD findings, while the colonoscopy results suggest a potential need for increased awareness of colorectal diseases.

Screening for exclusion of high-risk bleeding features of esophageal varices in cirrhosis through CT and MRI

Background & aimEsophageal varices (EV) screening guidelines have evolved with improved risk stratification to avoid unnecessary esophagogastroduodenoscopy (EGD) in individuals with low bleeding risks. However, uncertainties persist in the recommendations for certain patient groups, particularly those with hepatocellular carcinoma (HCC) and/or receiving non-selective beta-blockers (NSBB) without prior endoscopy. This study assessed the efficacy of imaging in ruling out EVs and their high-risk features associated with bleeding in patients with cirrhosis and with HCC. We also evaluated the impact of NSBB on the detection of these characteristics. MethodsA total of 119 patients undergoing EGD with CT and/or MRI within 90 days of the procedure were included. 87 patients had HCC. A new imaging grading system was developed utilizing the size of EVs and the extent of their protrusion into the esophagus lumen. The negative predictive value (NPV) of EVimaging(−) versus EVimaging (+) (grades 1–3) in ruling out the presence of EV and/or high-risk features by EGD was calculated. The predictive performance of imaging was determined by logistic regression. ResultsThe NPV of imaging for detecting EV and high-risk features was 81 % and 92 %, respectively. Among HCC patients, the NPV for EV and high-risk features was 80 % and 64 %, respectively. Being on NSBB didn't statistically impact the imaging detection of EV. Imaging was a better predictor of high-risk EGD findings than Child-Turcotte-Pugh scores. ConclusionsOur results suggest that imaging can effectively rule out the presence of EV and high-risk features during EGD, even in patients with HCC and/or receiving NSBB.

Esophagogastroduodenoscopy findings that do no not explain dysphagia are associated with underutilization of high-resolution manometry.

In patients with dysphagia that is not explained by upper endoscopy, high-resolution esophageal manometry (HRM) is the next logical step in diagnostic testing. This study investigated predictors of failure to refer for HRM after an upper endoscopy that was performed for but did not explain dysphagia. This was a retrospective cohort study of patients >18 years of age who underwent esophagogastroduodenoscopy (EGD) for dysphagia from 2015 to 2021. Patients with EGD findings that explained dysphagia (e.g. esophageal mass, eosinophilic esophagitis, Schatzki ring, etc.) were excluded from the main analyses. The primary outcome was failure to refer for HRM within 1 year of the index non-diagnostic EGD. We also investigated delayed referral for HRM, defined as HRM performed after the median. Multivariable logistic regression modeling was used to identify risk factors that independently predicted failure to refer for HRM, conditioned on the providing endoscopist. Among 2132 patients who underwent EGD for dysphagia, 1240 (58.2%) did not have findings to explain dysphagia on the index EGD. Of these 1240 patients, 148 (11.9%) underwent HRM within 1 year of index EGD. Endoscopic findings (e.g. hiatal hernia, tortuous esophagus, Barrett's esophagus, surgically altered anatomy not involving the gastroesophageal junction, and esophageal varices) perceived to explain dysphagia were independently associated with failure to refer for HRM (adjusted odds ratio 0.45, 95% confidence interval 0.25-0.80). Of the 148 patients who underwent HRM within 1 year of index EGD, 29.7% were diagnosed with a disorder of esophagogastric junction outflow, 17.6% with a disorder of peristalsis, and 2.0% with both disorders of esophagogastric outflow and peristalsis. The diagnosis made by HRM was similar among those who had incidental EGD findings that were non-diagnostic for dysphagia compared with those who had completely normal EGD findings. Demographic factors including race/ethnicity, insurance type, and income were not associated with failure to refer for HRM or delayed HRM. Patients with dysphagia and endoscopic findings unrelated to dysphagia have a similar prevalence of esophageal motility disorders to those with normal endoscopic examinations, yet these patients are less likely to undergo HRM. Provider education is indicated to increase HRM referral in these patients.

2010 The scope of CT in investigating iron deficiency anaemia in the context of frailty

Abstract Introduction Iron Deficiency Anaemia (IDA) is a highly prevalent co-morbidity in older patients with advanced frailty. It’s associated with adverse outcomes and heightened all-cause mortality. IDA is frequently multifactorial and can stem from various gastrointestinal causes. The British Society of Gastroenterology and National Institute for Health and Care Excellence advocate a combination of endoscopy and computerised tomography (CT) as the gold standard investigations for IDA. The aim of this review was to evaluate oesophagogastroduodenoscopy (OGD) findings and management outcomes of clinically frail patients with IDA. Methods We review notes for patients referred for OGD to investigate IDA without additional symptoms over a six-month period. The inclusion criteria were IDA, age of 65 years or greater and a clinical frailty score of 5 or greater. Results 53 patients met the inclusion criteria. A single case (1.8%) UGI malignancy using OGD was identified prior to CT. Thus, demonstrating low yield of OGD in malignancy. 35.6% of patients underwent CT scanning 3 months prior to OGD. Approximately 90% of OGD findings were benign. 23% of patients died within 90 days of OGD. No significant adverse events during OGD or significant complications were recorded in our cohort. It is therefore highly unlikely that the undergoing of an OGD had a direct impact on mortality. Conclusion This review shows there is a low yield of UGI malignancy on OGD following a negative CT. Benign upper GI condition is the most common finding. Thus, CT imaging alone may be an adequate investigation to rule out UGI malignancy in this group. Considering there is a high mortality rate in older patients with frailty, following an OGD, we suggest considering starting empirical treatment with PPI and iron replacement as a suitable and less invasive alternative to OGD after a negative CT in frail patients.

Esophagogastroduodenoscopy at a Tertiary Care Hospital: Common Indications, Endoscopic Findings and Interventional Approach

Objective: Esophagogastroduodenoscopy (EGD) is frequently performed as a screening, diagnostic and therapeutic procedure in patients presenting to gastroenterology department. No data documentation of EGD with demographics, indications, findings and intervention performed is available for our tertiary care setup in recent years. The aim of this study is to assess the common indications, esophagogastroduodenoscopy (EGD) findings and therapeutic procedures performed in patients undergoing EGD for various gastrointestinal (GI) symptoms.&#x0D; Methodology: A cross sectional study was conducted on 127 patients in department of Gastroenterology, Pakistan Institute of Medical Sciences Hospital. Duration of study was six months. Collected data included name, age, gender, indications for EGD, mode of presentation, EGD findings and therapeutic procedures that were performed. Statistical package for social sciences version 23 was used to analyze the data.&#x0D; Results: Mean age was 47.85 ± 6.74 years with male to female ratio of 1.04. Most common indications for EGD included upper GI bleed 25.19% and dyspepsia 22.83%. The three most common EGD findings were esophageal varices (34.64%), portal gastropathy (24.4%) and mild gastritis (14.96%). Variceal banding was the most common procedure performed.&#x0D; Conclusion: In our tertiary care hospital, upper GI bleed is the most common indication for EGD. Esophageal varices is the most common EGD finding encountered and variceal banding is the commonest procedure performed.&#x0D; Key words: Esophagogastroduodenoscopy; EGD; Upper gastrointestinal endoscopy; Upper gastrointestinal bleed; Varices; Gastritis; Gastropathy; variceal banding

Comparing Pre- and Post-Operative Findings in Patients Who Underwent Laparoscopic Proximal Gastrectomy With a Double-Flap Technique: A Study on High-Resolution Manometry, Impedance pH Monitoring, and Esophagogastroduodenoscopy Findings.

Laparoscopic proximal gastrectomy (LPG) is a viable choice for treating proximal gastric lesions. However, the occurrence of severe reflux has limited its widespread adoption. To address this issue, the double flap technique (DFT), which incorporates artificial lower esophageal sphincteroplasty, has been developed to prevent reflux problems after proximal gastrectomy. In this study, we aimed to investigate the usefulness of this technique using high-resolution manometry (HRM), impedance pH monitoring, and esophagogastroduodenoscopy (EGD). The findings of pre- and postoperative 6-month HRM, pH monitoring, and EGD were compared for 9 patients who underwent LPG with DFT for various proximal gastric lesions at Incheon St. Mary's Hospital from January 2021 to December. A total of 9 patients underwent proximal gastrectomy. Approximately half of the patients had Hill's grade under II preoperatively, whereas all patients had Hill's grades I and II in EGD findings. In the HRM test, there was no significant difference between distal contractile integral (1,412.46±1,168.51 vs. 852.66±495.62 mmHg·cm·s, P=0.087) and integrated relaxation pressure (12.54±8.97 vs. 8.33±11.30 mmHg, P=0.27). The average lower esophageal sphincter (LES) pressure was 29.19±14.51 mmHg preoperatively, which did not differ from 19.97±18.03 mmHg after the surgery (P=0.17). DeMeester score (7.02±6.36 vs. 21.92±36.17, P=0.21) and total acid exposure time (1.49±1.48 vs. 5.61±10.17, P=0.24) were slightly higher, but the differences were not statistically significant. There is no significant functional difference in HRM and impedance pH monitoring tests after DFT. DFT appears to be useful in preserving LES function following proximal gastrectomy.

Man Presenting After Hydrochloric Acid Ingestion.

We describe a case of a man who developed severe caustic injury of his upper gastrointestinal tract after ingestion of a commercially available 9.5% hydrochloric acidic cleaning solution. He rapidly deteriorated and required endotracheal intubation. He underwent several imaging modalities demonstrating his injuries and ultimately succumbed to his injuries. Acidic caustic ingestions may range in severity and uncommonly result in death. Diagnosis is most often achieved by esophagogastroduodenoscopy, although computed tomography may increasingly play a role in defining the extent of injury. Esophagogastroduodenoscopy findings are often assigned a Zargar grade, which guides management. Medical management of acidic caustic ingestion may include bowel rest, steroids, antibiotics, and proton pump inhibitors depending on the extent of injury, although surgery may be required if esophageal perforation occurs.

Development and validation of a scoring system to predict esophagogastroduodenoscopy necessity.

This study aimed to develop and validate a scoring system for predicting the need for esophagogastroduodenoscopy (EGD) in clinical practice to enhance accuracy and reduce misapplications. From February 2021 to April 2022, outpatients scheduled for EGD at the Department of Gastroenterology in our hospital were recruited. Patients completed the system evaluation by providing clinical symptoms, relevant medical history, and endoscopic findings. Patients were randomly divided into the training and validation cohorts (at 2:1 ratio). The optimal algorithm was selected from five alternatives including a parallel test. Six physicians participated in a human-computer comparative validation. Sensitivity and negative likelihood ratio (-LR) were used as the primary indicators. Altogether 865 patients were enrolled, with 578 in the training cohort and 287 in the validation cohort. The scoring system comprised 21 variables, including age, 13 typical clinical symptoms, and seven medical history variables. The parallel test was selected as the finalalgorithm. Positive EGD findings were reported in 54.5% ofthe training cohort and 62.7% of the validation cohort. The scoring system demonstrated a sensitivity of 79.0% in the training cohort and 83.9% in the validation cohort, with -LR being 0.627 and 0.615, respectively. Compared to physicians, the scoring system exhibited higher sensitivity (84.0% vs 68.7%, P = 0.02) and a lower -LR (1.11 vs 2.41, P = 0.439). We developed a scoring system to predict the necessity of EGD using a parallel test algorithm, which was user-friendly andeffective, as evidenced by single-center validation.

Forty years of Helicobacter pylori infection and changes in findings at esophagogastroduodenoscopy.

It is 40 years since the discovery of Helicobacter pylori infection. Over that time major changes have occurred in esophagogastroduodenoscopy (EGD) findings. The aim of this review is to describe these changes, and the important role H. pylori infection has played in their evolution. References were identified through searches of PubMed using the search terms-endoscopy time trends, peptic ulcer disease, gastroesophageal reflux disease, upper gastrointestinal cancer, gastric polyps, H. pylori, eosinophilic gastrointestinal disorders, and celiac disease, from 1970 through December 2021. The prevalence of H. pylori infection has fallen and consequently, H. pylori-positive peptic ulcer disease has become rare. Gastroesophageal reflux disease is now the commonest disorder diagnosed at EGD, and Barrett's esophagus has increased in parallel. Cancer of the distal stomach has fallen while esophageal adenocarcinoma and reflux-related cardia cancer have risen. Gastric polyps have changed from hyperplastic and adenomas to sporadic fundic gland polyps. Antimicrobial resistance has made H. pylori infection more difficult to eradicate. Eosinophilic gastrointestinal disorders, particularly eosinophilic esophagitis, have emerged as important new allergic disorders. Celiac disease has changed and increased. EGD findings appear to have changed from features suggesting a H. pylori-positive "phenotype" 40 years ago to a H. pylori-negative "phenotype" today. These changes have major implications for the management of gastrointestinal disorders.

Prevalence of Raspberry-type Gastric Foveolar-type Tumor in Individuals Undergoing Medical Checkups.

Objective This study was performed to clarify the prevalence of raspberry-type gastric foveolar-type tumors, along with the time-course changes in the size and clinical course. Materials and Methods The subjects were 10,663 consecutive patients who underwent a medical checkup between April 2016 and March 2022, including an esophagogastroduodenoscopy (EGD) examination and determination of Helicobacter pylori infection status (uninfected, positive, post-eradication). The presence of characteristic reddish polypoid lesions in the stomach was investigated, and a diagnosis of raspberry-type gastric foveolar-type tumor was made based on histological findings. Results Thirty-eight cases had gastric polyps with a raspberry-like appearance on endoscopy, with 29 lesions in 28 cases endoscopically and histologically diagnosed as a raspberry-type gastric foveolar-type tumor. All of the affected subjects were determined to be H. pylori-uninfected. The prevalence of this type of lesion in all subjects was 0.26%, while that in the 6,635 H. pylori-uninfected subjects was 0.42%. An older age and the presence of a fundic gland polyp were found to be significant risk factors associated with the occurrence of the tumor. The mean size was 3.8±1.9 (range: 2-10) mm, and the location was in a fundic gland area in all affected subjects. Furthermore, examinations of previous EGD images revealed that two-thirds of the lesions had not changed in size, while follow-up EGD findings showed that lesions ≤5 mm in size had disappeared after a biopsy procedure. Conclusion The prevalence of raspberry-type gastric foveolar-type tumors was 0.42% in H. pylori-uninfected subjects. More than half of the lesions were too small to be removed by an endoscopic biopsy.

GERD-screening before bariatric surgery: the predictive value of the GERD-HRQL questionnaire score compared with preoperative EGD findings.

There is an ongoing debate on how to best identify patients with gastroesophageal reflux disease (GERD) before bariatric surgery. The value of routine preoperative esophagogastroduodenoscopy (EGD) is questioned, and patient reported symptoms are commonly used for screening. The goal of this study is to determine if patient reported symptoms using a validated questionnaire correlate with preoperative EGD findings. A prospective cohort study at a single institution was performed. Patients undergoing bariatric surgery between December 2020 and March 2023 were required to report symptoms of reflux by completing a preoperative GERD. Health-Related Quality of Life (GERD-HRQL) questionnaire and undergo a mandatory preoperative screening EGD. Patients were stratified into two cohorts: (group A) asymptomatic (score = 0) and (group B) symptomatic (score > 0). Statistical analysis was conducted using Pearson's chi-squared test and Wilcoxon rank-sum test in RStudio version 4.2.2. The predictive value of the GERD-HRQL score was analyzed using Areas Under the Curve (AUC; AUC = 0.5 not predictive, 0.5 < AUC ≥ 6 poor prediction & AUC > 0.9 excellent prediction) calculated from Receiver Operating Characteristic (ROC) curves. 200 patients were included; median age was 42.0years (IQR 36.0 to 49.2). There were 79 patients (39.5%) in Group A and 121 patients (60.5%) in Group B. There was no difference in the frequency esophagitis (27.8% vs 32.2%, p = 0.61) or hiatal hernias (49.4% vs 47.1%, p = 0. 867) between group A and group B, respectively. ROC analysis revealed that the total GERD HRQL scores, heartburn only scores and regurgitation only scores, were poor predictors of esophagitis found on EGD (AUC 0.52, 0.53, 0.52), respectively. In asymptomatic patients, higher BMI was significantly associated with esophagitis (OR 1.15, 95% CI 1.06-1.27, p = 0.002). Symptoms, identified through the GERD-HRQL questionnaire, are a poor indicator of esophagitis or its severity in patients undergoing workup for bariatric surgery. Therefore, liberal screening upper endoscopy is recommended for pre-bariatric surgery patients to guide appropriate procedure selection.

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.

Triple endoscopy and recurrent croup in children: A single aerodigestive center experience

ObjectiveTo determine the utility of triple endoscopy (combined direct laryngoscopy, bronchoscopy (DLB), flexible bronchoscopy with bronchoalveolar lavage (FB + BAL), and esophagogastroduodenoscopy (EGD)) in the diagnosis and management of patients with recurrent croup (RC), and to identify predictors of endoscopic findings MethodsA retrospective chart review was performed of pediatric patients (age <18 years) with RC evaluated by triple endoscopy at a tertiary care pediatric hospital from 2010 to 2021. Data including presenting symptoms, airway findings, BAL and EGD with biopsy findings were collected. Results42 patients with RC underwent triple endoscopy were included. The mean age was 4.55±2.84 years old. The most common symptom was chronic cough among 19 (45%) patients, while 23 (55%) patients had gastrointestinal (GI) symptoms. Airway findings included tracheomalacia in 19, laryngeal cleft in 17, and subglottic stenosis in 11 patients. On EGD with biopsy, abnormal gross findings were present in 6 and abnormal microscopic findings in 18 patients, including 6 with histologic findings suggestive of gastroesophageal reflux and 5 with eosinophilic esophagitis. Seventeen (40%) patients had positive culture on BAL. No findings in patient histories significantly predicted presence of lower airway malacia, subglottic stenosis, or abnormal EGD findings. ConclusionsChildren with recurrent croup presenting to aerodigestive centers may not have any pertinent presenting symptoms that correlate with significant findings on triple endoscopy. Further work is needed to determine which children with recurrent croup may benefit from aerodigestive evaluation. Level of evidenceLevel 3

Esophageal Inlet Patch: Association with Barrett's Esophagus.

Esophageal inlet patch (IP) with heterotopic gastric mucosa is an incidental finding on esophagogastroduodenoscopy (EGD). Although IP is thought to be embryologic in nature, IP has been associated with Barrett's esophagus (BE). The aim of this study was to compare prevalence, symptoms, demographic factors, and esophageal testing in patients with IP and BE. We retrospectively analyzed endoscopic findings of EGDs, high-resolution esophageal manometry and esophageal pH impedance studies from January 2010 to January 2021 at a single academic medical center. Patients were grouped by presence or absence of IP and BE. Of 27,498 patients evaluated, 1.3% had endoscopic evidence of IP and 4.9% had BE. Of 362 patients with IP, 17.1% had BE; of 1356 patients with BE, 4.6% had IP. Both IP and BE patients presented primarily with heartburn and/or regurgitation. Patients with BE and/or IP were older and had higher BMI than those without (p < 0.001). Mean lower esophageal sphincter pressure was lower and mean acid exposure time (AET) was higher in patients with IP and/or BE than those without (p < 0.05). Our study reports an IP prevalence of 1.3%, with 17.1% patients having concomitant BE; and a BE prevalence of 4.9%, with 4.6% also having IP. Patients with IP alone presented with similar symptoms to patients with concomitant BE. Esophageal function testing showed that patients with either IP or BE had decreased LES pressures and increased esophageal AET. During endoscopy, patients found to have one of these findings should be carefully examined for the other.

A vanished gastric gastrointestinal stromal tumor

BackgroundLocal resection is the standard treatment for gastrointestinal stromal tumors (GISTs). Laparoscopic and endoscopic cooperative surgery (LECS) is a minimally invasive surgery used to resect GISTs. Herein, we report an extremely rare case of a gastric GIST that grossly vanished during LECS.Case presentationA 50-year-old Japanese female was referred to our hospital after an abnormality was detected during an esophagogastroduodenoscopy (EGD) at her annual health checkup. Based on EGD, endoscopic ultrasound (EUS), and computer tomography (CT) findings, the patient was diagnosed with a 50-mm submucosal tumor (SMT) with intraluminal growth on the anterior wall of the lesser curvature of the upper body of the stomach. We routinely use LECS to treat the intraluminal growth type of GISTs. During the intraoperative endoscopy, the intraluminal submucosal tumor, which was detected preoperatively, had vanished. A red-white scar was observed in the regressed tumor region. LECS was performed by resecting at a distance away from the scar tissue and closing the gastric wall with intracavitary sutures. In the evaluation from the tumor section view of the original resected specimen, a 22 × 14 × 8 mm lobular neoplasm was observed that was predominantly located in the gastric submucosa to the muscularis propia. Pathological findings confirmed the diagnosis of GIST with intermediate risk indicated by the Fletcher classification. The patient continued postoperative adjuvant chemotherapy with imatinib and no recurrence was detected over 12 months after surgery.ConclusionLECS was performed on the vanished gastric GIST, providing the best surgical treatment and leading to an accurate diagnosis and optimal postoperative care.

Esophagogastroduodenoscopy in Patients With Dyspepsia: A Retrospective Study at a Tertiary Hospital.

Background Recurrent upper abdominal pain or dyspepsia is one of the patients' most common chief complaints. This study correlates the symptoms of dyspepsia to esophagogastroduodenoscopy findings among Sudanese patients attending Soba University Hospital. Methods A retrospective observational study was conducted at Soba University Hospital from April 2019 to April 2020. Patients were selected according to inclusion and exclusion criteria. Each patient filled out a standardized data collection form with data on their demographics, symptoms, and endoscopic findings.A P-value of < 0.05 was considered statistically significant. Results The study included 142 patients, where 57.7% (n=82) were females, and 59.9% (n=85) of the study participants were of normal body mass index. In contrast, 57% of the study participants had a symptomdurationof less than six months. Approximately 95.1% (n=135) suffered from heartburn, 80.3% (n=114) suffered from epigastric fullness, and 96.5% (n=137) suffered from epigastric pain. Seventy-eight point two percent (78.2%; n=111) who suffered from epigastric pain mentioned that it increased in intensity with food, 85.9% (n=121) who suffered from epigastric pain mentioned that it decreased in intensity with food, 54.2% (n=76) of the study participants suffered from regurgitation, 59.9% (n=85) of the study participants suffered from weight loss, 52.1% (n=73) of the study participants were using non-steroidal anti-inflammatory drugs (NSAIDs), 41.7% (n=59) of the study participants had normal esophagogastroduodenoscopy findings, followed by 35.9% (n=51) who had duodenitis or gastritis during the endoscopic assessment. Conclusion The study showed that esophagogastroduodenoscopy is not recommended in young patients without alarm symptoms who can be managed conservatively. However, every patient with alarming symptoms should have an esophagogastroduodenoscopy. Also, the study revealed that females and old-aged patients had higher rates of dyspeptic symptoms.

The Approach to Performance of Quality Upper Endoscopy in Lynch Syndrome (QUELS)

Strong evidence demonstrates the protective benefit of frequent colonoscopy surveillance for colorectal cancer prevention in Lynch Syndrome (LS) and is endorsed by many guidelines. Until recently, the evidence supporting the utility of upper endoscopy [esophagogastroduodenoscopy (EGD)] for upper gastrointestinal (UGI) cancer surveillance was limited. Over the last 3 years, multiple studies have demonstrated that EGD surveillance in LS is associated with the detection of both precancerous lesions and early-stage UGI cancers. On the basis of the emerging favorable evidence derived from EGD surveillance programs, the 2022 National Comprehensive Cancer Network (NCCN) Guidelines for LS recommend UGI surveillance with EGD starting between age 30 and 40 years with repeat EGDs every 2 to 4 years, preferably in conjunction with colonoscopy, in all patients with a germline pathogenic variant (PV) in MLH1, MSH2, EPCAM, and MSH6 and, because of the lack of data, consideration in PMS2. Standardization of the approach to performing EGD surveillance in LS and reporting clinically actionable findings is requisite for both improving quality and understanding the cost efficiency and outcomes of patients undergoing EGD as a surveillance tool. Accordingly, the primary objective of this Quality of Upper Endoscopy in Lynch Syndrome (QUELS) statement is to articulate a framework for standardizing the approach to performing and reporting EGD findings in patients with LS by introducing emerging quality metrics. The recommendations presented herein were developed from available evidence and consensus-based expert opinion and provide a practical approach for clinicians applying EGD surveillance in accordance with the most recent and existing LS guidelines.

Role of Transcatheter Arterial Embolization in Acute Refractory Non-variceal Upper Gastrointestinal Bleeding Not Controlled by Endoscopy: A Single-Center Experience and a Literature Review.

Introduction Acute upper gastrointestinal bleeding (UGIB) is a medical emergency and a common cause of hospital admissions worldwide. It has traditionally been treated with resuscitation and endoscopic intervention as the first-line therapy. In this study, weassessed the adjunctive role of transcatheter arterial embolization (TAE) in patients with uncontrolled UGIB after an endoscopic intervention. Material and methods A retrospective chart review of patients requiring TAE of UGIB which was not controlled by endoscopic intervention in BronxCare Health System from 2018 to 2021 was done. Patients who were more than 18 years of age and required TAE during the time period of the study were included in the study. Patients' charts were reviewed for patients' demographics, comorbidities, hospital course, imaging findings, esophagogastroduodenoscopy findingsand intervention, and interventional radiology intervention and clinical outcome. Results A total of 10 patients were included in the study. A majority of the patients were male. Transcatheter atrial embolization was successful in all the 10 patients. Coils were used in seven patients while particulate polyvinyl alcohol 500 micronparticlewas used in two patients and vascular plug was used in two patients. Out of the 10 patients, four expired during the hospital course. None of the patients died secondary to UGIB. Three of the patients expired due to severe sepsis with septic shock secondary to pneumonia while one patient died because of respiratory failure due to lung collapse secondary to endobronchial lesion. Conclusion Refractory acute UGIB is associated with significant morbidity and mortality. TAE is a minimally invasive measure that should be considered early in the treatment of UGIB which is refractory to conventional endoscopic management. Our case highlights the importance of TAE in a patient with refractory UGIB after endoscopic intervention.

S624 Role of Esophagogastroduodenoscopy Before Transesophageal Echocardiography

Introduction: As per American Society of Echocardiography (ASE) guidelines, esophageal varices, dysphagia, thrombocytopenia, symptomatic hiatal hernia, active esophagitis, are relative contraindications to transesophageal echocardiography (TEE). It is not uncommon for gastroenterologists to get consulted to perform an esophagogastroduodenoscopy (EGD) to determine any lesions that will preclude performing a TEE. The evidence behind this recommendation is scant. We aim to determine whether an upper endoscopy before TEE changes patient management. Methods: This is a retrospective chart review of patients who underwent a diagnostic EGD to assess for clearance before TEE. All the EGDs were done 3 weeks prior to TEE. The primary outcome was preclusion of TEE based on EGD findings. Secondary outcomes were overt GI bleeding or drop in hemoglobin post TEE requiring endoscopic intervention. Results: A total of 26 patients met the inclusion criteria. Bacteremia and fungemia are the indications for TEE in 23 patients and cardioversion for Atrial fibrillation, mitral valve disease are the indications in the others. Variceal screening is the indication in 11 patients and anemia with overt GI bleeding is the indication in the rest. Of the 11 patients in the variceal screening group only 4 were known to have cirrhosis, and the rest were requested to have EGD for variceal screening due to elevated AST and thrombocytopenia with an APRI Score >1. All the consult requests are from cardiology team. 15 patients had EGD due to concerns for GI bleeding in the setting of anemia and overt GI bleeding. Of these 15, 2 patients had Grade D esophagitis and they underwent TEE 2-3 weeks after EGD (Figure). None of the patients experienced primary or secondary outcomes. Conclusion: Based on our findings upper GI endoscopy before TEE for risk stratification has limited utility. However, we agree with ASE guidelines of consulting gastroenterology when there is a question as to whether gastrointestinal symptoms or pathology present poses a risk for TEE. Our study is limited by small sample size, however, adds to the limited literature available on this subject.Figure 1.: Breakdown of indication for EGD and EGD findings.