Esophageal Stricture Research Articles

Malnutrition and Refeeding Syndrome: Report of Three Patients on Jejunostomy Feeding Following Corrosive Oesophageal Injury

Abstract Patients with alternative enteral access for corrosive oesophageal stricture are a particularly sensitive group of patients requiring dedicated nutritional care. The COVID-19 pandemic and the resulting lockdown, restrictions, financial constraints and delayed surgeries have resulted in nutritional deprivation. Many of these patients present late to healthcare institutions with severe malnutrition. Refeeding should be done carefully in them to prevent refeeding syndrome. Here, we describe the clinical course of three patients who were on jejunostomy feeds for corrosive injury of the oesophagus, developed feeding tube-related complications and presented with severe malnutrition during the COVID-19 pandemic.

FACTORS ASSOCIATED WITH A HIGHER NUMBER OF ESOPHAGEAL DILATIONS IN CHILDREN WITH A HISTORY OF ALKALINE INGESTION.

Children who experience alkaline injury are at risk for the development of esophageal strictures and the need for esophageal dilations. We aimed to assess predictors for a higher number of esophageal dilatations in children following alkali ingestion. Single-center retrospective cohort study including children who underwent esophagogastroduodenoscopy (EGD) after alkali ingestion. Possible predictive factors for the need for esophageal dilatations were evaluated. A total of 34 patients were included, and 19 were female (55.9%). The median age at the time of the accidents was 20.6 months (IQR 15-30.7). All alkali ingestions were accidental, in all cases involving liquid products, and most (24/34; 70%) occurred at the child's home. Homemade liquid soap was the agent in half of the cases. The most frequently reported symptom at presentation was vomiting (22/34, 64.7%). The median follow-up time was 3.2 years (IQR 1.1-7.4). On follow-up, the median number of esophageal dilatations required for these patients was 12.5 (IQR 0-34). Among demographic factors, male gender (P=0.04), ingestion of homemade products (P<0.01), and accidents happening outside of the household environment (P=0.02) were associated with a greater number of esophageal dilations on follow-up. An endoscopic classification Zargar of 2B or higher (P=0.03), the presence of stricture at the time of the second EGD (P=0.01), and gastroesophageal reflux disease (GERD) as a late complication (P=0.01) were also associated with a greater number of esophageal dilations on long term follow-up. Beyond the endoscopic classification severity - a well-known risk factor for the strictures after alkali ingestions, we found that male gender, accidents with homemade products, and accidents occurring outside the household environment were significantly associated with a greater number of esophageal dilatations in the long-term follow-up of children following alkali ingestion.

Clinical evaluation and treatment outcomes of caustic ingestion injuries in Syrian pediatric patients: A retrospective study: Short title: High-dose steroids for pediatric caustic ingestions in Syria.

Accidental ingestion of caustic agents poses a significant concern in pediatric emergency departments globally. It is a growing public health concern in low-to-middle income countries, which often lack comprehensive data reporting. This study examines high doses of corticosteroid treatment outcomes of caustic ingestion injuries in Syrian pediatric patients, addressing clinical features, and associated variables. A retrospective observational study was conducted at University Pediatric Hospital from January 2016 to January 2019. Medical records were reviewed for patients aged <10 years with esophagoscopy-confirmed grade IIa, IIb, or III burns. Data collected included sociodemographics, esophagoscopy results, treatment details, and outcomes. Among 114 pediatric patients, 76 (67%) were males and 38 (33%) were females. Age groups included <1 year (11%), 1-3 years (39%), 3-5 years (29%), 5-7 years (11%), and >7 years (11%). Alkaline burns accounted for 54% of injuries, acidic for 32%, and other substances for 13%. Complications included bleeding (19%) and psychomotor disability (7%). The most common burn site was the entire esophagus (62%), with 81% having grade II burns. Healing was achieved in 71% of patients with high doses of corticosteroids treatment, and 29% required dilation, with final 92% healing rate. The use of corticosteroids for esophageal strictures remains inconclusive, demanding further robust research with larger sample sizes and control groups. While our study revealed that high doses of corticosteroids treatment followed by esophageal dilation had a 92% success rate. However, our study demonstrates promising results, methodological limitations and absence of a control group underscore the need for more definitive evidence. Both alkali and acidic ingestion contribute to stricture development.

Anaesthesia and Airway Challenges in Patients with Corrosive Pharyngo-oesophageal Stricture: Experience of a Tertiary Care Centre

Background: Ingestion of corrosive substances causes necrosis of the tissues of the upper airway and upper gastrointestinal tract resulting not only in acute airway injuries but also long-term sequelae like strictures. Medical and surgical management of these strictures has been discussed extensively; however, there is little literature available on the anaesthetic management of pharyngo-oesophageal strictures. We hereby discuss our experience in managing these patients undergoing surgical correction. Methods: Out of a total of 57 cases of corrosive ingestion injuries between 2008 and 2016, medical records of 15 patients with complex pharyngeal or high oesophageal strictures undergoing surgical intervention were reviewed. The preoperative findings, the extent of airway involvement and any airway intervention done were noted. Based on the surgical intervention, patients were divided into two groups; Group A included patients undergoing repeated string dilatation and Group B included those undergoing coloplasty. Type of anaesthesia given, details of airway management, intraoperative and postoperative course and complications were noted. Results: Group A consisted of 10 patients who underwent endless string dilatation, and Group B consisted of five patients who underwent coloplasty. In Group A, general anaesthesia with endotracheal intubation was given to all patients except for one patient who was tracheostomised. Two patients had significant glottic narrowing and required a smaller size tube. In Group B, four out of five patients were tracheostomised, while one had a normal glottic opening. General anaesthesia with epidural analgesia was given to all patients. Severe haemodynamic changes were seen during tunnelling through the posterior mediastinum for colonic interposition. All patients were extubated on the table. None of the patients required postoperative ventilatory or inotropic support. Conclusion: Management of corrosive pharyngo-oesophageal strictures is challenging and requires a multidisciplinary approach. Careful assessment and management of the airway, vigilant intraoperative haemodynamic monitoring and good pain management are the key contributions of anaesthesia care.

Dilation of benign esophageal strictures with balloon/bougie; a single center experience

Objective: Narrowing in the esophagus caused by benign conditions such as peptic injury, surgical anastomosis, radiation therapy, Schatzki rings, esophageal webs, erosive injury and eosinophilic esophagitis are called benign esophageal strictures. In the treatment of benign esophageal stricture, endoscopic dilation with balloon or bougie is the first priority. Method: The study included a total of 96 patients who were diagnosed with a benign stricture at the gastroenterology clinic of our university from May 2009 to October 2023. All patients were symptomatic, and their main complaint was dysphagia. The benign stricture was diagnosed through clinical examination, radiological imaging and endoscopy. Patient data were scanned retrospectively. The dilation method (bougie, balloon), the number of times the procedure was permormed and any potential complications were recorded. Stents were applied to patients who did not provide adequate dilatation. Results: A total of 96 patients were included in the study. 47 (49%) of them were women and 49 (51%) were men. The average age was 48±17 years (the youngest was 18, the oldest was 81). A total of 198 dilation procedures were performed on 96 patients. The average follow-up period was 79±54 (1-179) months. Srictures were divided into 4 groups according to etiology as anastomotic stricture, peptic stricture, caustic stricture and post-radiotherapy stricture. Of the cases with stricture, 76 (79.2%) underwent bougie dilation, 26 (27.1%) underwent balloon dilation, 5 (5.2%) underwent bougie and then balloon dilation, and in 5 (5.2%) cases, metallic stent was placed due to failed dilations. Conclusion: This study shows the effectiveness of bougie and/or balloon dilation in treating most of the patients with benign esophageal strictures, with a low complication rate. It is less invasive, comfortable and cost-effective than the alternative surgical approach.

Plummer-Vinson syndrome: is the immune system the missing piece?

Plummer-Vinson syndrome (PVS) is a rare disorder characterized by a triad of iron-deficiency anemia, cervical dysphagia, and post-cricoid esophageal webs. The exact relationship between anemia and web formation remains unclear, with current hypotheses lacking strong evidence. Although treating anemia generally resolves dysphagia, some cases require endoscopic intervention. PVS is considered a precancerous condition due to its association with squamous cell carcinoma of the hypopharynx or upper esophagus. We present the case of a 53-year-old woman with psoriatic arthritis who exhibited iron-deficiency anemia unresponsive to oral iron and persistent dysphagia. Gastroscopy revealed esophageal narrowing, and she underwent successful balloon dilation following iron therapy. The patient is now asymptomatic. While the etiopathogenesis of PVS remains unknown, autoimmune conditions may play a role. Due to its potential link to neoplastic lesions, recognizing and managing PVS is critical. Further research is required to improve understanding and identify those at risk.

L APPORT DE L ENDOSCOPIE DIGESTIVE HAUTE INTERVENTIONNELLE DANS LA PRISE EN CHARGE THERAPEUTIQUE DES URGENCES (A PROPOS DE 73 CAS)

The aim of our study is to report the contribution of interventional upper GI endoscopyinthe therapeutic management of emergencies, through a retrospective study, over a period of 3 years about 73 cases. The mean age of our patients was 35.73 years (extremes 2 years and 87 years), and the male sex was the most represented in 53%. The indications in our series were dominated by hematemesis in 24 (32.9%) cases. Endoscopic examination found: PH in 31(42.46%) cases with a predominance of VO, peptic ulcer in 6(8.2%) patients, foreign body in 25(34.2%) patients, tumor lesion in 4(5.5%) patients and benign esophageal stenosis in 13(17.8%) patients, however endoscopic examination was normal in 7(9.6%) patients 61 (84%) patients benefited from endoscopic management. The short-term evolution after endoscopic treatment was favorable in 72 (98.6%) patients.

Assessment of effective doses for fluoroscopy-guided balloon dilatation of benign esophageal strictures in pediatric medicine

Interventional examinations are associated with high levels of patient exposure per examination, which makes it particularly important to monitor individual patient doses and to assess radiation risks. The aim of this study was the assessment of effective doses for fluoroscopy-guided balloon dilatation of benign esophageal strictures, whichwasperformedonpediatricpatientsaged 1 to 2 yearsatthe Departmentof Radiosurgical Methodsof Diagnosis and Treatment of St. Petersburg State Pediatric Medical University. Patient exposure patterns were basedonourowndatacollection. Thecalculationofeffectiveandorgandosesofpatientsnormalizedbythevalue of the dose area product measured during the study was carried out using PCXMC 2.0 software. The conversion coefficients from the dose area product to the effective dose were calculated using tissue weighting coefficients from the ICRP Publications 60 and 103 their values were 10.7 and 11.7 µSv/cGy cm2, respectively. The results of verification of the method indicated that the use of inappropriate conversion coefficients leads to an almost double underestimation of children’s effective doses. Differences in the values of conversion coefficients are significant and are explained by differences in voltage, source to image distance, and irradiation field size. A simplified model of patient exposure was proposed, which is described by a single irradiation field. The assessment of effective doses using multi-field and single-field irradiation model shows comparable results, which allows using the differentiated approach to the assessment of radiation doses of patients.

New hope for esophageal stricture prevention: A prospective single-center trial on acellular dermal matrix.

Given the high incidence of esophageal cancer in China, an increasing number of patients there are undergoing endoscopic mucosal dissection (ESD). Although the 5-year survival rate after ESD can exceed 95%, esophageal stricture, the most common and serious postoperative complication, affects the long-term prognosis of patients and the quality of life. Autologous mucosal grafts have proven to be successful in preventing stricture after ESD for early esophageal cancer. To examine the viability of acellular dermal matrix (ADM) as an alternative to autologous mucosa for the prevention of stricture after ESD. This is a prospective, single-center, controlled study. Consecutive patients who underwent ESD surgery and were willing to undergo autologous mucosal transplantation were recruited between January 1 and December 31, 2017. Consecutive patients who underwent ESD surgery and were willing to undergo ADM transplantation were recruited between January 1 to December 31, 2019. A final three-year follow-up of patients who received transplants was conducted. Based on the current incidence of esophageal stricture, the sample size required for both the autologous mucosal graft group and the ADM group was calculated to be 160 cases. Due to various factors, a total of 20 patients with autologous mucosal grafts and 25 with ADM grafts were recruited. Based on the inclusion exclusion and withdrawal criteria, 9 patients ultimately received autologous mucosal grafts and completed the follow-up, while 11 patients received ADM grafts and completed the follow-up. Finally, there were 2 cases of stenosis in the autologous mucosal transplantation group with a stenosis rate of 22.22% and 2 cases of stenosis in the ADM transplantation group with a stenosis rate of 18.18%, with no significant difference noted between the groups (P = 0.94). In this prospective, single-center, controlled trial, we compared the effectiveness of autologous mucosa transplantation and ADM for the prevention of esophageal stricture. Due to certain condition limitations, we were unable to recruit sufficient subjects meeting our target requirements. However, we implemented strict inclusion, exclusion, and withdrawal criteria and successfully completed three years of follow-up, resulting in valuable clinical insights. Based on our findings, we hypothesize that ADM may be similarly effective to autologous mucosal transplantation in the prevention of esophageal stricture, offering a comparable and alternative approach. This study provides a new therapeutic idea and direction for the prevention of esophageal stricture.

Clinical analysis of endoscopic esophageal dilation for the treatment of corrosive esophageal strictures in children

To investigate the clinical application of endoscopic esophageal dilation in the treatment of corrosive esophageal strictures in children. A retrospective analysis was performed on the clinical data of 15 children with corrosive esophageal strictures who underwent endoscopic esophageal dilation in Children's Hospital, Zhejiang University School of Medicine. The clinical features, treatment modality of endoscopic esophageal dilation, number of dilations, complications, and prognosis were reviewed. A total of 96 esophageal dilations were performed in the 15 children with corrosive esophageal strictures, with a median of 6 dilations per child. Among them, 9 children (60%) underwent 6 or more dilations. The children with a stricture length of >3 cm had a significantly higher number of dilations than those with a stricture length of ≤3 cm (P<0.05). The children with strictures in a single segment had a significantly better treatment outcome than those with strictures in multiple segments (P=0.005). No complication was observed during all sessions of dilation. The overall effective rate (including significant improvement and improvement) of endoscopic esophageal dilation treatment was 87%, with 2 cases of failure. Endoscopic esophageal dilation is an effective and relatively safe treatment method for corrosive esophageal strictures in children, and children with strictures in a single segment tend to have a better treatment outcome than those with strictures in multiple segments.

Broncho-esophageal fistula: When surgery and endoscopy fail, consider physiological lung exclusion

We discuss the case of an esophageal cancer patient treated by chemo and radiotherapy complicated by an esophageal stenosis and an iatrogenic broncho-esophageal fistula. This latter was managed with multiple palliative stenting procedures and colonic surgical bypass. Despite a long disease free survival but decreased quality of life and frailty, we came to the proposal of an extremely unusual form of treatment - physiological lung exclusion, with clinical benefit and so far without any drawbacks related to the procedure.

Innovative regenerative therapy for refractory postoperative esophageal anastomotic stenosis in children

Autologous oral mucosa-derived epithelial cell sheet transplantation was devised as a new treatment for refractory postoperative anastomotic stenosis in patients with congenital esophageal atresia (CEA) and congenital esophageal stenosis (CES). Transplantation therapy was performed on three patients with refractory postoperative anastomotic stenosis who had undergone endoscopic balloon dilatation (EBD) at least twice in one year and at least five times in total. Epithelial cell sheets were prepared from the patients' oral mucosa and transplanted over the esophageal wounds caused by EBD using a specially developed transplantation device. After transplantation, the patients were followed for 48 weeks. Subject 1 underwent two transplantations and showed temporary improvement in stenosis, but required periodic EBD and eventually had the stenotic area removed. Subject 2 did not require EBD for more than two years post-transplantation; Subject 3, until one year after transplantation. Both Subject 2 and Subject 3 experienced improvement in the passage of food and drink and were able to consume a regular diet as opposed to a full liquid diet. These results suggest that cell sheet transplantation therapy is effective in some cases.Trial registration: UMIN, UMIN000034566, registered 19 October 2018, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000039393.

Feasibility of a Percutaneous and Non-Fluoroscopic Procedure for Transcatheter Mitral Valve Edge-to-Edge Repair.

Transcatheter edge-to-edge repair (TEER) of the mitral valve has emerged as an alternative treatment for mitral regurgitation (MR). However, the high radiation exposure during the process has been associated with multiple adverse effects for medical staff. In this study, we assessed the feasibility and safety of TEER performed solely under the echocardiographic (echo) guidance. Between April 2021 to August 2021, we retrospectively collected characteristics of 23 patients with MR who underwent TEER under echocardiographic guidance exclusively. Follow-up evaluations were performed at 1- , 3-months and 1-year post procedure. All 23 patients (mean age, 66.1 12.1 years; 65.2% males) successfully underwent echo-guided TEER, with 22 patients under transesophageal echo (TEE) guidance and 1 patient under transthoracic echo (TTE) guidance for severe esophageal stenosis. Of the patients, 60.9% received 1 implant and 39.1% received 2 implants. The median total procedural time was 130 (interquartile range, IQR: 90-150) min and the device procedure time was 73 (IQR: 58-100) min. The median length of stay was 6 (IQR: 5-9) days. At 3-months follow-up, 63.6% of patients had an MR 1+ and 90.9% had an MR 2+ (p 0.001 vs. baseline). Improvement in functional status was observed, with 40.9% of patients classified as New York Heart Association (NYHA) functional class I and 45.5% as NYHA functional class II (p 0.001 compared to baseline) at 3-months. At 1-year follow-up, 90.4% maintained MR reduction with MR 2+ (p 0.001 vs. baseline). Single leaflet device attachment (SLDA) occurred in one patient (4.3%) 1-week post procedure. This retrospective, single-center, and pilot study demonstrates the feasibility, safety, and low complication rates of TEER guided solely by echocardiography. Our findings support the systematic use of echocardiography as the sole guidance modality for TEER, highlighting its potential as an alternative to fluoroscopy-guided procedures. Further multicenter and comparative studies are warranted to confirm these results and provide a more comprehensive evaluation of this approach.

Post-radiation esophagitis with formation of esophageal stricture: a rare clinical observation

Post-radiation esophagitis occurs fairly rarely, affecting less than 1 % of the patients who underwent a course of radiation therapy. Non-specific complaints of dysphagia and/or painful swallowing are reported by at most 2 % post-radiation-therapy patients (with a total focal dose of ≤50 Gy) and by up to 15 % patients (&gt;60 Gy). Post-radiation esophagitis may develop after irradiation of the thorax for esophageal, pulmonary, breast cancer, lymphoma, or metastatic affection of bones. The prognosis and severity of esophagitis are evaluated according to the FARE criteria (Fukui Acute Radiation Esophagitis). In the event of strictures and symptoms of dysphagia, endoscopic balloon dilation is indicated.

Comprehensive review of materials, applications, and future innovations in biodegradable esophageal stents.

Esophageal stricture (ES) results from benign and malignant conditions, such as uncontrolled gastroesophageal reflux disease (GERD) and esophageal neoplasms. Upper gastrointestinal endoscopy is the preferred diagnostic approach for ES and its underlying causes. Stent insertion using an endoscope is a prevalent method for alleviating or treating ES. Nevertheless, the widely used self-expandable metal stents (SEMS) and self-expandable plastic stents (SEPS) can result in complications such as migration and restenosis. Furthermore, they necessitate secondary extraction in cases of benign esophageal stricture (BES), rendering them unsatisfactory for clinical requirements. Over the past 3decades, significant attention has been devoted to biodegradable materials, including synthetic polyester polymers and magnesium-based alloys, owing to their exceptional biocompatibility and biodegradability while addressing the challenges associated with recurring procedures after BES resolves. Novel esophageal stents have been developed and are undergoing experimental and clinical trials. Drug-eluting stents (DES) with drug-loading and drug-releasing capabilities are currently a research focal point, offering more efficient and precise ES treatments. Functional innovations have been investigated to optimize stent performance, including unidirectional drug-release and anti-migration features. Emerging manufacturing technologies such as three-dimensional (3D) printing and new biodegradable materials such as hydrogels have also contributed to the innovation of esophageal stents. The ultimate objective of the research and development of these materials is their clinical application in the treatment of ES and other benign conditions and the palliative treatment of malignant esophageal stricture (MES). This review aimed to offer a comprehensive overview of current biodegradable esophageal stent materials and their applications, highlight current research limitations and innovations, and offer insights into future development priorities and directions.

Neuroendocrine carcinomas of the esophagus: clinicopathological and immunohistochemical features of 43 cases

BackgroundNeuroendocrine carcinomas (NECs) of the esophagus are extremely rare and poorly understood. This study aimed to delineate the clinicopathological and immunohistochemical features of esophageal NECs using a retrospective survey.MethodsPatients with histologically proven esophageal neuroendocrine carcinomas (NECs) were recruited from Zhongshan Hospital, Fudan University, China, between 2006 and 2016. Clinical, endoscopic, pathological, and immunohistochemical data were collected retrospectively.ResultsOf 43 patients with NEC, older male patients were predominant. In total, 93.0% of the tumor masses were located in the middle or lower esophagus. Twenty-nine (67.4%) and 22 (51.2%) cases showed ulceration and esophageal stenosis, respectively. The average index of Ki-67 staining was 67.1% ± 21.4% with positive immunostaining for CD56 (88.4%), chromogranin A (51.2%), and synaptophysin (72.1%). Small cell carcinomas accounted for 95.3% of cases, and 16.3% of patients had mixed components with adenocarcinoma or squamous cell carcinoma.ConclusionEsophageal NECs are rare and mainly affect men in their sixties or seventies. They show a similar endoscopic appearance to squamous cell carcinoma or adenocarcinoma and present with a proliferative mass with stenosis or ulcers. Therefore, esophageal NECs are difficult to diagnose by endoscopy. Esophageal NECs can be mixed with other subtypes of neoplasms, such as adenocarcinoma and squamous cell carcinoma. In addition to chromogranin A, synaptophysin, and CD56, NSE, S100, and CKpan might be candidate biomarkers to diagnose esophageal NECs. Overall, we provide new insights into the biology of esophageal NECs.

Efficacy and safety of endoscopic submucosal dissection with additional radiotherapy for T1a-MM/T1b-SM esophageal squamous cell carcinoma

Objective: To clarify the efficacy and safety of endoscopic submucosal dissection (ESD) with additional radiotherapy in T1a-MM/T1b-SM esophageal squamous cell carcinoma (ESCC). Methods: A retrospective analysis was conducted on 71 patients with T1a-MM/T1b-SM ESCC admitted to Southeast University Affiliated Zhongda Hospital from January 2015 to December 2019. The patients were divided into two groups based on the treatment method: the ESD group (ESD therapy alone) and the ESD-radiotherapy group (ESD combined radiotherapy). The follow-up duration after ESD was (44±17) months. The difference of disease-free survival (DFS) rate and overall survival (OS) rate between the two groups was compared by survival analysis, and the occurrence of complications was compared. Baseline variables of the two groups were compared and the influencing factors of DFS rate were analyzed by Cox proportional risk regression model. Results: There were 44 patients in the ESD-radiotherapy group [28 males, 16 females, aged (65±7) years] and 27 patients in the ESD group [18 males, 9 females, aged (67±9) years]. The results of survival analysis show that the 1, 3 and 5-year DFS rates of ESD-radiotherapy group were 95.5%, 92.9% and 77.4%, respectively, which were higher than those of ESD group 85.2%, 73.2% and 62.7% (all P<0.05). The 1, 3 and 5-year OS rates of the ESD-radiotherapy group were 100%, 94.7% and 94.7%, while those of the ESD group were 96.3%, 96.3% and 79.4%, respectively. The difference was not statistically significant (all P>0.05). Cox proportional hazard regression model analysis showed that ESD combined with radiotherapy (HR=0.19, 95%CI: 0.04-0.90, P=0.037), complete tumor resection (HR=0.25, 95%CI: 0.07-0.86, P=0.027), and vascular invasion (HR=12.06, 95%CI: 1.61-90.26, P=0.015) were the influencing factors of DFS rates. The most common complication of ESD was esophageal stenosis, and no grade 3 or higher radiation adverse reactions occurred after combined radiotherapy. Conclusion: ESD combined radiotherapy is an effective and safe therapeutic strategy for patients with T1a-MM/T1b-SM ESCC.

Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement.

This ESGE Position Statement provides structured and evidence-based guidance on the essential requirements and processes involved in training in basic gastrointestinal (GI) endoscopic procedures. The document outlines definitions; competencies required, and means to their assessment and maintenance; the structure and requirements of training programs; patient safety and medicolegal issues. 1: ESGE and ESGENA define basic endoscopic procedures as those procedures that are commonly indicated, generally accessible, and expected to be mastered (technically and cognitively) by the end of any core training program in gastrointestinal endoscopy. 2: ESGE and ESGENA consider the following as basic endoscopic procedures: diagnostic upper and lower GI endoscopy, as well as a limited range of interventions such as: tissue acquisition via cold biopsy forceps, polypectomy for lesions ≤ 10 mm, hemostasis techniques, enteral feeding tube placement, foreign body retrieval, dilation of simple esophageal strictures, and India ink tattooing of lesion location. 3: ESGE and ESGENA recommend that training in GI endoscopy should be subject to stringent formal requirements that ensure all ESGE key performance indicators (KPIs) are met. 4: Training in basic endoscopic procedures is a complex process and includes the development and acquisition of cognitive, technical/motor, and integrative skills. Therefore, ESGE and ESGENA recommend the use of validated tools to track the development of skills and assess competence. 5: ESGE and ESGENA recommend incorporating a multimodal approach to evaluating competence in basic GI endoscopic procedures, including procedural thresholds and the measurement and documentation of established ESGE KPIs. 7: ESGE and ESGENA recommend the continuous monitoring of ESGE KPIs during GI endoscopy training to ensure the trainee's maintenance of competence. 9: ESGE and ESGENA recommend that GI endoscopy training units fulfil the ESGE KPIs for endoscopy units and, furthermore, be capable of providing the dedicated personnel, infrastructure, and sufficient case volume required for successful training within a structured training program. 10: ESGE and ESGENA recommend that trainers in basic GI endoscopic procedures should be endoscopists with formal educational training in the teaching of endoscopy, which allows them to successfully and safely teach trainees.

Endoscopic esophageal cicatricotomy assisted by submucosal injection for the treatment of esophageal stenosis after endoscopic submucosal dissection

Endoscopic esophageal cicatricotomy assisted by submucosal injection for the treatment of esophageal stenosis after endoscopic submucosal dissection

Anatomic Considerations of esophageal button battery ingestion for outcomes and imaging

IntroductionButton batteries (BB) are a source of significant morbidity and mortality in young children. Little data is available regarding associations between esophageal impaction location and outcomes or need for surveillance imaging. MethodsAll patients treated at a single institution following BB ingestion between 2018 and 2022 were included for retrospective chart review. ResultsTwenty patients were treated at our institution BBs were located, or most significant damage observed, in the cervical esophagus (n = 10, 50 %), followed by thoracic esophagus (n = 6, 30 %), and abdominal esophagus (n = 4, 20 %). Patients with cervical esophageal impaction were younger (482 [370–866] days), than those with thoracic (1395 [871–2369] days) or abdominal esophageal impaction (2021.5 [1230.5–3419.5] days) (p = 0.003). Zargar Mucosal Injury Grade was significantly more severe in patients with cervical button battery impaction; 8/10 (80 %) had a ≥Grade IIIB injury, compared to 2/6 (33.3 %) thoracic impactions and 0/4 (0 %) abdominal impactions (p = 0.002). All patients who developed persistent esophageal stenosis (n = 6) had cervical battery impactions (6, 60 %, p = 0.015). Both TEFs (2/2) had anterior facing anode, while both (2/2) esophageal perforations had posterior. Only 1/20 (5 %) patients, and 1/7 (14.3 %) with serious complications, had a serious complication detected on routine, rather than clinically indicated follow-up surveillance. ConclusionsIn our population, cervical BB impaction occurred more frequently in younger children, was associated with more severe mucosal injury, and had higher risk of stenosis. Nearly all complications were detected on clinically indicated rather than postoperative surveillance imaging.