Peptic Esophageal Stricture Research Articles

S2352 No Soup for You: The Case of an Intramucosal Hematoma Found During Endoscopy for an Esophageal Food Impaction

Introduction: Esophageal food impaction (EFI) is third most common gastrointestinal emergency, which is commonly associated with obstructive lesions such as peptic strictures and Schatzki rings, eosinophilic esophagitis and rarely motility disorders. Endoscopic therapy is the mainstay option for the management of EFI if medical therapy fails. The most commonly impacted foods include beef, chicken, pork, and undercooked vegetables with liquids rarely causing an impaction. Complications from a prolonged EFI can result in mucosal disruption to an esophageal perforation. We present an unusual case of an esophageal intramucosal hematoma found in a during endoscopic retrieval of an esophageal impaction. Case Description/Methods: An 80-year-old male presented with a 2-hour history of foreign body sensation in his throat that began while eating hamburger meat and soup with potatoes. He began coughing up a large amount of mucus at symptom onset and was unable to finish his meal. He has been unable to swallow solids or liquids. History was significant for esophageal peptic strictures in the past requiring dilations. After 2 doses of glucagon failed to help pass the bolus, the patient underwent endoscopic removal of the esophageal food impaction. During the procedure, food was found in the middle and lower thirds of the esophagus and was subsequently removed with suction cap and rat toothed forceps. The esophagus was tortious and was noted to have decreased and abnormal movement throughout with a moderate stenosis found at the gastroesophageal junction. The middle and lower third of the esophagus had localized severe erythema, suspicious for the presence of intramucosal hemorrhage (Figure). The patient tolerated a diet after endoscopy and discharged home. Discussion: Esophageal food impactions are uncommon and are commonly associated with stricture and rings. Complications from a prolonged food impaction include mucosal disruption however findings of an intramucosal hematoma are rare. Intramucosal hematoma present with chest pain, dysphagia, and hematemesis. This patient presented with dysphagia however had no other pain or episodes of hematemesis. In this patient it is unclear whether his presentation was due to an acute EFI causing an intramucosal hematoma or whether the ingestion of soup caused an intramucosal hematoma resulting in an EFI. Nevertheless, one should take caution during endoscopic evaluation for patients who presented with an EFI.Figure 1.: Localized severe erythema suspicious for intramucosal hemorrhage. (1a., 1b., 1c.), Lower third of the esophagus. (1d.)- Gastroesophageal junction.

530. LAPAROSCOPIC REPAIR OF ESOPHAGEAL PERFORATION

Abstract Esophageal perforation is associated with high morbidity and mortality. Early detection and treatment are vital as delays substantially increases mortality risk. Management options include surgical repair, drainage, diversion, endoscopic stenting/clipping and conservative management. Treatment of choice depends on etiology, location and duration between perforation and detection. Surgical repair remains as the mainstay of treatment if perforation is diagnosed <24 hours. However, for perforation detected > 24 hours, management is controversial with many advocating non-operative therapy. We present the case of a 68-year-old gentleman who underwent laparoscopic repair of an iatrogenic esophageal perforation. He first presented with dysphagia secondary to esophageal peptic stricture, initial biopsy showing no signs of malignancy. Patient underwent serial endoscopic dilatations, which was complicated with an iatrogenic esophageal perforation during his second dilatation. He underwent an urgent laparoscopic distal esophagectomy and proximal gastrectomy to resect the diseased part of the esophagus- intraoperatively noted a 1cm perforation over distal esophagus. A double tract reconstruction was then performed to restore continuity of the gastrointestinal tract and reduce gastric reflux to the esophagus. Patient was started on clear feeds on post-operative day 1 with gradual escalation of feeding to soft diet on post-operative day 4. His post-operative recovery was largely uneventful and he was discharged on post-operative day 7. Histological examination however returned as a pT3N1a moderately differentiated oesophageal squamous cell carcinoma. A PET-CT scan and repeat gastroscopy done showed no residual or distant disease. His condition was discussed in multidisciplinary meeting and patient then underwent definitive chemotherapy and radiotherapy. Although early recognition, detection and treatment of esophageal perforation are important for good outcomes, delays in diagnosis and treatment are usually due to rarity of this condition and lack of familiarity with management. Our video aims to showcase the surgical repair of a distal esophageal perforation and reconstruction in a minimally invasive fashion. Aim of surgery should include repair of perforation, cleaning up contamination, restoring gastrointestinal continuity and resolution of any underlying etiology.

THERAPEUTIC TACTICS FOR PEPTIC STRICTURES OF THE ESOPHAGUS. LITERATURE REVIEW

The work is based on the analysis of literature data devoted to the choice of treatment for peptic esophageal strictures. The main goal of this review is to identify treatment tactics for patients with stenosing reflux esophagitis. Researchers point out that the main causes of GERD are a decrease in pressure in the lower esophageal sphincter, the action of the damaging properties of the refluctant. Untimely treatment of GERD can lead to complications such as peptic stricture, Barrett's esophagus. The appearance of GERD stricture is most often promoted by: persistent heartburn after bougienage, erosion of the lower third of the esophagus, shortening of the II degree esophagus, and inadequate antisecretory therapy.Various methods of treatment at all stages of the appearance of peptic stricture are presented, depending on the degree of dysphagia and the length of the stricture, the use of adequate conservative therapy regimens for PPIs, bougienage, as well as a description of various methods of antireflux operations. Endoscopic dilation is the first treatment option for all symptomatic benign esophageal strictures. There are treatments for benign refractory esophageal strictures such as endoscopic dilatation with intraluminal steroid injection, endoscopic postoperative therapy or stricturoplasty, esophageal stenting, self-bougienage, as well as surgery - antireflux surgery, esophagectomy with replacement of the esophagus by the stomach or colon [1].The main goal in the treatment of peptic esophageal strictures, according to most authors, is to eliminate the progression of GERD, conduct bougienage or balloon dilatation, and select the optimal antireflux surgery. Treatment for peptic strictures should minimize the risk of re-stricture of the esophagus.

Spontaneous Perforation of a Peptic Esophageal Stricture

Abstract Surgical interventions for intractable and unamenable for dilatation peptic esophageal strictures could sometimes be difficult and challenging. Esophageal perforation management depends on many factors such as underlying esophageal disease, location and cause of perforation, age, overall condition, comorbidities, and time from perforation to presentation. Of great importance for the selection of technique is whether the esophagus is normal and it is worthwhile trying not to remove it or whether it is pathologically changed and it is reasonable to proceed with resection during the initial intervention. We present a patient who has undergone surgery several times in another hospital for perforation of peptic stricture in the distal part of the esophagus and esophageal diversion in its proximal part. Three months later, he was admitted to the Thoracic Surgery Department and resection of the excluded esophagus followed by thoracic duct ligation for chylothorax was performed. After another three months, retrosternal colon replacement and subsequent removal of the gastrostomy were performed.

Roux-en-Y Gastrojejunostomy to a Gastric Pull-Up Transhiatal Esophagectomy for a Concurrent Esophageal and Duodenal Peptic Stricture—a Rare Case

Esophageal strictures are usually benign with the most common cause being reflux from acid peptic disease. The concurrent strictures of the esophagus and duodenum are a rarity and such concurrent strictures secondary to acid peptic disease have not been reported in the literature so far. These strictures are managed endoscopically and the role of surgery is reserved for refractory strictures. Here, we present a case of concurrent esophageal and duodenal peptic strictures which was managed surgically by performing a transhiatal esophagectomy and a Roux-en-Y gastrojejunal anastomosis to the gastric tube. The patient recovered well and is currently on 2 years follow-up. Surgery for benign esophageal strictures is to be considered when endoscopic procedures cannot be performed or have failed. Concurrent duodenal and esophageal strictures are very rare. Gastric tube pull-up with Roux-en-Y bypass performed when there is an adequate intra-abdominal stomach tube is a safe and feasible option.

Recommendations of the Russian Gastroenterological Association in Diagnosis and Treatment of Gastroesophageal Reflux Disease

Aim . Current recommendations of the Russian Gastroenterological Association are developed to acquaint medical practitioners with modern diagnostics, treatment and trends in rational drug therapy for gastroesophageal reflux disease (GERD). General provisions . Incidence rate of GERD in the Russian Federation varies from 11.3 to 23.6%. GERD is diagnosed with medical history and laboratory examination evidence. Esophagogastroduodenoscopy (EGDS) allows detection of reflux esophagitis of various severity and cylindrical epithelial metaplasia of esophagus. The refractory form of disease (lack of conclusive clinical and endoscopic remission during 4-8 weeks of standard-dose PPI therapy), presence of strictures and Barrett's esophagus require EGDS with esophageal biopsy and bioptic histological examination. Patients should be conclusively performed esophageal 24-hour pH-metry or pH-impedance monitoring, high-resolution manometry to thoroughly examine functionality of esophagus, esophagogastric junction and assess disease prognosis and therapy outcomes. Treatment of GERD should be personalised accounting for clinical manifestations and severity, as well as aimed at symptom improvement, lesion healing in erosive esophagitis, averting complications, Barrett's esophagus progression, dysplasia and esophageal adenocarcinoma. Proton pump inhibitors (PPIs) are most effective agents in primary (4-8 weeks) and maintenance anti-GERD therapy. Antacids are recommended in monotherapy for occasional nonerosive heartburn and complex anti-GERD settings for fast symptom improvement. Prokinetics can be used in combination with PPIs for their properties to recover normal functionality of esophagus through affecting pathogenetic mechanisms of GERD. Complicated patients (repeated bleedings, peptic esophageal strictures) are recommended anti-reflux surgery with prior examination of esophageal functionality using pH-impedance and high-resolution manometry. Conclusion . Current recommendations provide an up-to-date evidential medicial review of GERD and guidelines to advance special medical care and timely preventive measures.

A Case of Zenker’s Diverticulum in a Patient with Tight Esophageal Peptic Stricture

AbstractZenker’s diverticulum (ZD) is a posterior Sac like outpouching of the hypopharyngeal mucosa and submucosa through Killian’s triangle, which is an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor muscle. ZD usually presents with swallowing difficulties, regurgitation of undigested food, choking, halitosis, weight loss, and respiratory symptoms due to chronic aspiration. Several esophageal pathologies have been reported in association with ZD. These include cervical esophageal webs, upper esophageal stenosis, and hiatus hernia. Herein, we report a case of ZD in association with severe gastroesophageal reflux disease and tight lower esophageal peptic stricture.

“Peptic Esophageal Stricture In A Patient With Parkinson’s Disease”

Benign esophageal strictures are uncommon and their management remains challenging. Herein, we present a rare both functional and organic esophageal stricture in a patient with Parkinson’s disease and reflux esophagitis. The patient was diagnosed with severe complex stricture in the distal part of the esophagus, requiring surgical treatment. We performed subtotal esophageal resection and Ivor-Lewis gastroesophagoplasty. The successful management of antiparkinsonian drug therapy with adequate parenteral substitution in the early postoperative period is of great importance to avoid any further complications.

Rare Coexisting Pyloric Stenosis, Oesophageal Peptic Stricture and Hiatal Hernia

Introduction: Our purpose is to report the clinical presentation of a rare coexistence of pyloric stenosis, peptic esophageal stricture associated with hiatal hernia, and discuss the therapeutic strategy decided with criterion of decision-making and outcome. Presentation of Case: We experienced a case of 67-year-old man with history of duodenal ulcer presenting a co-existing pyloric stenosis, peptic esophageal stricture and hiatal hernia. Clinical presentation consisted of an evolving gastrooesophageal reflux disease GERD symptoms along with gastric discomfort. Further exploration characterized a benign stricture between middle and lower esophagus with sliding hiatal hernia, a stasis stomach attaining pelvic area, and a second post-bulbar stenosis with double bubble aspect. The therapeutic strategy decided was medical preparation with subsequent endoscopic esophageal dilatation, followed by a Roux-en-Y diversion with antrectomy surgery and bilateral vagotomy. Evolution was uneventful. Conclusion: To our knowledge we report the first case of duodenal ulcer with pyloric stenosis associated with esophageal peptic stenosis and hiatal hernia reviewed in literature. The condition can be arguably considered as a complication of gastric emptying delay due to pyloric stenosis, and triggered by the duodenal ulcer disease in addition to hiatal hernia. Association of endoscopic dilation and Roux-Y gastrojejunostomy diversion after antrectomy and bivagotomy in our case meets all the requirements. Indeed the approach enables further exploration of the stomach comforting the histological diagnosis of benign strictures, treat the surgical stricture, reduce volume of toneless dilated stomach, and treat GERD. Nissen fundoplication is not indicated.

2636 Brunner's Gland Hyperplasia: A Massive Duodenal Lesion

INTRODUCTION: Brunner’s glands are alkaline-fluid secreting duodenal glands in the proximal duodenum submucosa. Brunner’s gland hyperplasia is a rare entity that accounts for 10% of all benign duodenal tumors, with an estimated incidence of 0.008%. Underlying etiology is postulated to be secondary to excessive acid secretion, H. pylori infection or inflammation. CASE DESCRIPTION/METHODS: A 57-year-old male with PMH of Myasthenia Gravis, GERD and esophageal strictures with prior dilations, presented with melena and intermittent abdominal pain for a few weeks and labs notable for iron deficiency anemia. EGD showed a large 5 cm polypoid mass in the proximal duodenal bulb with shallow surface ulcerations and a thick stalk causing ball-valve like obstruction of the pyloric channel. CT abdomen showed an elongated tubular mass arising from the proximal duodenum projecting antegrade within the duodenal lumen, measuring 5.3 × 1.7 × 1.5 cm, with no evidence of metastasis. Endoscopic ultrasound (EUS) showed the lesion appeared to be arising from the submucosal layer, with a large blood vessel feeding the lesion. A fine needle biopsy revealed benign histology. Due to its large size, the lesion was not amenable to endoscopic removal. He underwent laparotomy with pyloroplasty, duodenotomy and partial duodenal resection due to concern for premalignant potential. Surgical pathology showed Brunner’s gland hyperplasia and hamartoma that was negative for malignancy. The patient is doing well with resolution of abdominal pain. DISCUSSION: Brunner’s gland hyperplasia is usually an incidental finding during endoscopy. Symptomatic presentations include gastrointestinal bleeding and intestinal obstruction. Literature search shows reports of Brunner’s hyperplasia usually 1–2 cm in size, there are few reported that are larger than 5 cm. Diagnosis requires histological examination of the mass, usually by endoscopy with excision or biopsy. CT scan and EUS can demonstrate the submucosal origin of the mass. Mode of excision depends on the size, location and presentation of the lesion. Upper gastrointestinal endoscopy with polypectomy is preferred. Laparoscopic polypectomy is also an option. Laparotomy is reserved for large, sessile tumors, failure of endoscopic approach or unstable bleeding patients. Few cases reported in literature have been managed with laparotomy. The potential cause of our patient’s large Brunner’s gland mass could be gastric acid hypersecretion as he had severe GERD with peptic esophageal strictures.

Dysphagia

Dysphagia may be oropharyngeal or esophageal. Evaluation is described, including a thorough dysphagia history of associated painful swallowing, location, solids versus liquids, intermittent versus progressive, acute versus gradual onset, and associated symptoms such as weight loss. Physical examination and key diagnostic tests are also reviewed. The evidence-based management of various etiologies of esophageal dysphagia are summarized. Motor disorders described include achalasia, the other primary esophageal motility disorders, and the most common secondary esophageal motility disorders. Esophageal diverticulae are also reviewed in this section. Mechanical esophageal obstruction is presented, including discussions of esophageal webs, rings, peptic stricture, and cancer. Important inflammatory and infectious causes of dysphagia are described, including caustic ingestion, eosinophilic esophagitis, and esophageal infections. The oral phases of liquid and solid swallowing are presented, as are the pharyngeal and esophageal phases of swallowing. Figures show the results of several diagnostic tests and other conditions, including pharyngeoesophageal diverticulum, giant epiphrenic diverticulum, Schatzki ring, and midesophageal squamous cell carcinoma. A flowchart outlines evaluation and management of dysphagia. This review contains 13 figures, 12 tables, and 68 references. Keyword: Esophageal cancer, Achalasia, Diffuse esophageal spasm, Esophageal ring, Peptic esophagitis, Eosinophilic esophagitis, Scleroderma, Esophageal stricture, Chagas disease, Stroke

Dysphagia

Dysphagia may be oropharyngeal or esophageal. Evaluation is described, including a thorough dysphagia history of associated painful swallowing, location, solids versus liquids, intermittent versus progressive, acute versus gradual onset, and associated symptoms such as weight loss. Physical examination and key diagnostic tests are also reviewed. The evidence-based management of various etiologies of esophageal dysphagia are summarized. Motor disorders described include achalasia, the other primary esophageal motility disorders, and the most common secondary esophageal motility disorders. Esophageal diverticulae are also reviewed in this section. Mechanical esophageal obstruction is presented, including discussions of esophageal webs, rings, peptic stricture, and cancer. Important inflammatory and infectious causes of dysphagia are described, including caustic ingestion, eosinophilic esophagitis, and esophageal infections. The oral phases of liquid and solid swallowing are presented, as are the pharyngeal and esophageal phases of swallowing. Figures show the results of several diagnostic tests and other conditions, including pharyngeoesophageal diverticulum, giant epiphrenic diverticulum, Schatzki ring, and midesophageal squamous cell carcinoma. A flowchart outlines evaluation and management of dysphagia. This review contains 13 figures, 12 tables, and 68 references. Keyword: Esophageal cancer, Achalasia, Diffuse esophageal spasm, Esophageal ring, Peptic esophagitis, Eosinophilic esophagitis, Scleroderma, Esophageal stricture, Chagas disease, Stroke

Proximal third esophageal peptic stricture in an elderly patient: a case report and review

Proximal third esophageal peptic stricture in an elderly patient: a case report and review

Biodegradable Stents in Resistant Peptic Oesophageal Stricture: Is It the Right Way to Go?

Peptic oesophageal stricture can be considered as the end result of prolonged gastro-oesophageal reflux. The ‘gold standard’ treatment for peptic stricture is endoscopic dilatation with balloon or bougie. It is predicted that up to 40% of patients remain symptomatic with dysphagia due to refractory (resistant to treatment) or recurrent strictures, needing frequent interventions at short intervals. Such patients have poor nutritional status due to the primary disease and are susceptible to complications related to repeated endoscopic dilatation such as bleeding and perforation. This general review aims to analyse existing published evidence and address the role of biodegradable stents in resistant peptic strictures as an alternative treatment to provide long-term dysphagia-free intervals.

Prevalence of gastroesophageal reflux disease among patients with dyspepsia undergoing endoscopy in a tertiary hospital in Nigeria

Background: Dyspepsia is a symptom complex rather than a specific disease entity. It can be caused by various diseases that could be organic or functional dyspepsia. Gastro-esophageal reflux disease (GORD) now accounts for the majority of upper gastrointestinal symptoms. Clinical judgment alone is unsatisfactory and unreliable in confirming the etiology due to the overlap which exists between the clinical presentations of the disease conditions causing dyspepsia. This study aimed to determine the burden of GORD among patients with dyspepsia. Materials and Methods: The study was carried out between May and August 2009. A total of 170 dyspeptic patients were recruited consecutively as they were referred to the Gastroenterology Unit of Aminu Kano Teaching Hospital for upper gastrointestinal endoscopy. After obtaining a signed written informed consent from each patient a prepared questionnaire on relevant demographic, and clinical history relating to GORD was administered. Upper gastrointestinal endoscopy was then performed on each subject after an overnight fast of at least 8 h. GORD was defined as symptoms of heartburn and/or regurgitation lasting longer than 6 months with or without erosive esophagitis, Barrett's esophagus, esophageal peptic stricture, ulcer or adenocarcinoma on endoscopy. Results: The prevalence of GORD was found to be 24.1% among the dyspeptic patients in this study Endoscopy positive accounted for 16 (9.4%) while endoscopy negative accounted for 25 (14.7%) of GORD. Reflux symptoms were observed in 63 (37.1%) of the patients studied. Heartburn had a high specificity (92.3%) and negative predictive value (77.3%) with low sensitivity (14.6%) and positive predictive value (37.5%), while for regurgitation specificity was 91.6%, negative predictive value of 63.6%, sensitivity of 11.1% and positive predictive value of 43.8% for endoscopy positive GORD. Conclusion: Gastroesophageal reflux disease is a common disease for which patients are referred for upper gastrointestinal endoscopy.

PTH-014 Food Bolus Obstruction: An Experience from A Large Teaching Hospital

Introduction Food bolus obstruction is a common problem encountered by endoscopists with an annual incidence estimated to be around 13 per 100,000.1 Several means of endoscopic management have been proposed including extraction, using a snare or a roth net, or pushing, occasionally with dilatation. The aim of this audit was to determine the common types of foodstuffs causing food bolus obstruction (FBO), the prevalence of eosinophilic oesophagitis (EO) among those cases and how different endoscopists in St. James’ University Hospital, Leeds handle FBO cases in terms of treatment and subsequent endoscopy follow up. Methods Two years’ data (2014 and 2015) was retrieved from the endoscopy data base in St. James’ University Hospital and a total of 33 cases of endoscopy for food bolus obstruction within the specified period were generated and analysed. Excel was used to construct graphs and tables and draw the descriptive statistics (mean, standard deviation, mode and median) of variables. Results Younger males are found to be more likely affected than females or elderly patients. In 8 cases no food bolus was seen at endoscopy, leaving 25 cases for analysis. In 10 cases (40%) the type of food causing the bolus was not documented. Among the others in 11 cases meat was the cause, 3 times fish and only once vegetables. In 13 cases (52%) the bolus was retrieved with either a snare or Roth net. In 12 cases (48%) it was pushed through, having first been crushed in 5 of these cases. All attempts were successful with no serious adverse events. EO was diagnosed in 24% (n = 6). Reflux was present in 28% (n = 7). One patient had an oesophageal cancer. 4 patients had a pre-existing diagnosis of oesophageal cancer, 1 had a peptic oesophageal stricture and another had a radiation induced stricture. Paired biopsies from upper and lower oesophagus were taken in 68% (n = 17) of cases, of the other 8 five had already been given a histologic diagnosis for their oesophageal stricture (4 malignant, 1 benign) and biopsies were not judged to be needed. Eosinophilic oesophagitis was suspected endoscopically in five cases and confirmed histologically in four of those. In two cases, endoscopic appearances were normal and random paired biopsies identified eosinophilic oesophagitis. Conclusion FBO is a relatively uncommon presentation even in a large acute unit. The majority of cases are due to benign disease. Endoscopic treatment modalities vary and pushing and removal methods seem to be of equally of good efficacy and safety. Meat bolus is the commonest cause of food bolus obstruction. There is a good diagnostic yield from biopsy. Reference 1 Longstreth GF, Longstreth KJ, Yao JF. Esophageal food impaction: epidemiology and therapy. A retrospective, observational study. Gastrointest Endosc. 2001 Feb; 53(2):193–8 Disclosure of Interest None Declared

Prevalence of erosive esophagitis and peptic esophageal strictures

Gastroesophageal reflux disease is a widespread among population in economically developed countries including Russia. It was analyzed the results of 34 903 endoscopic examinations of upper gastrointestinal tract in ethnically and socially homogeneous population of Leningrad region with symptoms of gastric dispepsia. Procedures were performed for the period 2007-2013. Prevalence of erosive esophagitis was 4.9%. Peptic esophageal strictures due to chronic reflux-associated inflammation were revealed in 0.2% of examined patients (3.7% of patients with erosive esophagitis). Obtained data allow to considergastroesophageal reflux disease as a socially significant problem in Russia requiring close attention and further study.

Diagnostic Yield of Upper Endoscopy and Colonoscopy for Isolated Unintentional Weight Loss

Introduction: Unintentional weight loss is a symptom that concerns physicians because of its association with increased mortality.The diagnostic evaluation of unintentional weight loss (UWL) often includes endoscopic procedures when gastrointestinal symptoms are present. In the absence of alarm features such as vomiting, dysphagia and gastrointestinal bleeding, the diagnostic yield of endoscopic evaluation is poorly defined. AIMS: The primary aim of this study is to investigate the diagnostic yield of upper endoscopy and colonoscopy in patients with isolated, unintentional weight loss. The secondary aim of this study was to investigate the diagnostic yield of upper endoscopy and colonoscopy particularly in adults over age 65. Methods: A retrospective, cross-sectional analysis was performed using the electronic medical record at an academic gastroenterology practice from January 2009 to December 2013.The study sample included patients referred for endoscopic evaluation with an associated ICD-9 code for unintentional weight loss. Chart review was performed to abstract demographic and clinical data including age, sex, race, and clinical symptoms. The primary outcome was clinically significant abnormal endoscopic findings such as peptic ulcer, gastrointestinal malignancy, esophageal stricture, or colitis. Clinically significant weight loss was defined as greater than 5% of baseline body weight loss in kilograms in the 6 months preceding the endoscopic procedure.Statistical analysis was performed using Pearson’s chi-squared test in STATA IC 13.0 statistical software. Results: Of the 300 records initially identified, 140 where excluded. The final sample size was 160. The study sample was 63% female and 49% White. Median age was 61.2 years (SD 17.7). The mean percent baseline body weight loss was 9.69% (SD 6.19). The laboratory evaluation and imaging was normal in 98% (157) of patients. Upper endoscopy findings where clinically insignificant in 97% (155) of the study sample. Colonoscopy findings where clinically insignificant in 96% (153) of the study sample.In those > age 65 versus <65, there was no statistically significant difference in the frequency of clinically significant upper endoscopic (1.5% vs 1.63%; p=0.12) or colonoscopic findings (2.60.% vs 1.62%; p= 0.09). Conclusion: In this study, the diagnostic yield of upper endoscopy and colonoscopy was low in patients presenting with isolated unintentional weight loss in the setting of normal laboratory and imaging evaluation. Furthermore, individuals over age 65 did not have a significantly higher frequency of clinically significant endoscopic findings compared with those under age 65. This research was supported by an industry grant from “This project was supported by Grant Number UL1TR000003 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of NCATS or the NIH.

Effect of oral fluticasone on refractory peptic esophageal stricture – a new therapeutic method

Effect of oral fluticasone on refractory peptic esophageal stricture – a new therapeutic method

Peptic Esophageal Stricture in children: A Case report &amp; review of literature

Peptic Esophageal Stricture in children: A Case report &amp; review of literature