Peptic Stricture Research Articles

429. BARRETT'S ESOPHAGUS IN CHILDREN

Abstract Background In children, Barrett's esophagus (BE) is much less common than in adults and has its own characteristics. If in adult practice the treatment tactics are quite restrained, then in childhood they are, on the contrary, as radical as possible. Barrett's esophagus is a consequence of pathological gastroesophageal reflux disease, which is considered an obligate precancerous disease, which determines the relevance of research in this direction. Material and research methods 345 children with GERD were examined over 10 years. BE was detected in 52 children, which accounted for 14% of cases. Of these, 20 children had peptic stricture of the esophagus. They were included in the 2nd group of the study. The first group - 32 children without peptic stenosis of the esophagus. The treatment tactics for patients in the first group are fundoplication, after 3 months eradication of BE (electrodestruction or cryodestruction). In the second group - a course of bougienage, fundoplication, with destruction BE, or extirpation of the esophagus for extended peptic strictures of the esophagus. Results Of the 52 children, boys predominated (71%). The average age was 10.2 years In all cases in the first group, antireflux surgery produced a positive result, although it did not affect the regression of metaplasia in the category of patients with an endoscopically negative form. In all patients of the second group, a positive result was obtained, GER was stopped, stenosis and metaplasia of the esophagus were eliminated. Eradication of metaplasia in 45% (9 children) of cases was achieved by extirpation of the esophagus due to extensive peptic stenosis (4-6 cm), and in 55% (11 children) - postoperative endoscopic destruction BE. Conclusions BE detected in childhood is subject to eradication upon its detection, regardless of the absence of signs of high-grade dysplasia, which is more likely to occur in adulthood. Patients with an endoscopically negative form of BE require clinical observation with morphological control once a year. Extirpation of the esophagus with simultaneous coloesophagoplasty is indicated in children with peptic strictures (4-6 cm) that are not amenable to balloon dilatation against the background of fundoplication for 6 months or more.

Efficacy and safety of self-expandable metallic stents for management of benign gastric outlet obstruction-A prospective study.

We aimed at evaluating the safety and efficacy of self-expandable metallic stent (SEMS) insertion for managing patients with benign gastric outlet obstruction (GOO). This prospective interventional study included 23 patients. All consecutive treatment-naïve symptomatic patients with benign GOO were recruited. Fully covered SEMS were deployed across the stricture under fluoroscopic and endoscopic guidance. Technical success, clinical success and sustained treatment response (STR) were assessed. Technical success was defined as the successful deployment of SEMS at the desired anatomic location. Clinical success was defined as the resolution of symptoms and an increase in Gastric Outlet Obstruction Scoring System (GOOSS) of at least 1 point from the baseline score on Day 7. STR was assessed at four and eightweeks post stent removal in patients who had a response at week four. Factors associated with stent migration and non-response at week four were also assessed. The median age of the study population was 30years (range 19-65years). Males constituted 65.22%. Most patients presented with vomiting (100%) and abdominal pain (95.65%). Peptic stricture was most common etiology for GOO (60.9%) followed by tubercular (26.1%) and corrosive (13%). Most common site of obstruction was junction of first and second part of duodenum (69.57%) followed by pyloric (30.43%). Median length of stricture was 2cm (range 1.5-4). Technical success was achieved in all 23 patients (100%). Clinical success was achieved in 21 patients (91.3%). Response at Day 28 was seen in 20 patients (86.95%). Eighteen of 20 (90%) patients who had a response at week four had STR at week four and week eight after stent removal. Stent migration occurred in five (21.7%) patients. On univariate analysis, stricture length, calibre and stent length were found to predict migration. Fully covered SEMS was an effective and safe management modality in patients with benign GOO. Stent migration remains a troublesome disadvantage.

Esophagoplasty Using a Jejunum Segment on a Vascular Pedicle

Aim: to substantiate the expediency of using a segment of the jejunum on a vascular pedicle in esophagoplasty. Materials and methods. At the National Medical Research Center of Surgery named after A.V. Vishnevsky, 12 patients underwent esophagoplasty with a combined visceral transplant, of which 9 (75.0 %) received a gastrointestinal graft and 3 (25.0 %) — a colon-jejunum one. Esophagectomy with simultaneous esophageal plastic surgery was performed in 10 (83.3 %) patients, in 4 (40 %) of them — in combination with distal gastric resection. The indication for surgery in 3 patients was cicatricial stricture of the esophagus and stenosis of the pylorus, in 2 — achalasia of the cardia of the terminal stage (in one patient — with ulcerative stenosis of the pylorus). Three more patients underwent esophagectomy due to peptic strictures: esophagogastroanastomosis (n = 1), esophagoenteroanastomosis (n = 1) and esophagus after Nissen surgery (n = 1). Cancer recurrence after proximal gastric resection and gastrectomy in 2 patients was an indication for esophagectomy. Also, 2 (16.7 %) patients were hospitalized in the National Medical Research Center of Surgery named after A.V. Vishnevsky with incomplete esophagoplasty: one person — after Dobromyslov — Torek surgery for spontaneous rupture of the esophagus, and one patient — after the unsuccessful Lewis surgery for esophageal cancer performed in other hospitals. Results. The average duration of post-operative stay was 12.7 ± 6.3 days. The postoperative period was smooth in 10 (83.3 %) patients. The failure of the cervical anastomosis was revealed in 1 (8.3 %) patient on day 5 after esophageal plastic surgery with colon-jejunum graft, which was resolved conservatively without repeated surgery. Relaparotomy was required in one patient on day 7 after surgery for bile peritonitis, the cause of which was destructive acalculous cholecystitis with perforation. All 12 patients were discharged from the clinic with full nutrition through the mouth. In the long-term period, 11 (91.7 %) patients remained under observation, 1 (9.1 %) developed an esophagogastroanastomosis stricture 1.5 months after esophageal plastic surgery, which was resolved by 4 courses of bougation during the first 9 months after surgery. No other complications were noted. Conclusion. The segment of the jejunum on the vascular pedicle, used for esophagoplasty, in the condition of a shortage of plastic material, allows not only to complete the reconstruction at once, but also to restore the natural passage of food and prevent bile reflux.

Toupet fundoplication to prevent progression of scleroderma-associated interstitial lung damage: a study protocol

Summary Background Systemic sclerosis (SSc) is a rare autoimmune and multiorgan disorder. Hallmarks of the disease include inflammation, endothelial dysfunction, and dysregulation of fibroblasts leading to fibrosis of the skin and internal organs. The esophagus is often involved, with up to 80% of patients developing gastroesophageal reflux disease (GERD). Reflux can be associated with hiatal hernia and several complications such as erosive esophagitis, peptic stricture, Barrett’s esophagus, aspiration pneumonia, and chronic microaspiration. Silent aspiration can lead to interstitial lung disease (ILD) in up to 50% of patients with scleroderma and accounts for up to 40% of mortality. Treatment of GERD in patients with SSc is challenging. Proton pump inhibitors (PPI) have been shown effective in relieving typical GERD symptoms, but up to 40% of patients are non-responders. Various antireflux surgical procedures have been proposed to treat GERD and to modify the natural course of the disease by preventing lung damage in these patients. However, current algorithms consider only the degree of esophageal dilation as a marker of disease severity/progression, and results of antireflux surgery remain controversial. Methods We propose a feasibility, observational, multicenter, single-arm trial including adult patients diagnosed with SSc. Criteria for inclusion are individuals with GERD symptoms refractory to PPI, absence of peptic stricture at baseline endoscopy, high-resolution computed tomography (HRCT) scan showing no or less than 10% lung fibrosis, forced vital capacity at least 40% of the predicted value, and diffusing capacity of lung for carbon monoxide 30–89% of the predicted value. A laparoscopic partial posterior fundoplication according to the Toupet technique will be performed. Primary study outcome is the efficacy of fundoplication to reduce reflux exposure measured with a pH-impedance study or 4‑day wireless pH recording. Secondary outcomes include endoscopic, HRCT, and respiratory function tests findings as well as quality of life at 12-month follow-up. Conclusions The expected reduction of reflux burden in SSc patients selected for Toupet fundoplication may improve GERD symptoms/complications, pulmonary function, and quality of life, and may be associated with a reduced risk for lung transplant.

Esophageal food bolus impaction in pediatric age.

Esophageal food impaction (EFI) is the sudden onset of dysphagia that occurs when a food bolus becomes lodged in the esophagus, requiring endoscopic removal. Scientific data on the prevalence and causes of EFI in children is lacking. The aim of this study was to provide further insights into EFI episodes in children. We have prospectively enrolled all children admitted for a first episode of EFI between March 2018 and March 2023. A fluoroscopic contrast study was performed in all patients to confirm the boluses and assess their position. Boluses were extracted by esophagogastroduodenoscopies, and esophageal biopsies were routinely obtained for histologic evaluation. Over the study period, 41 children were admitted for a first episode of food impaction. Drooling was the most commonly reported symptom. Half children experiencing a first episode of food bolus were diagnosed with EoE (20/41, 48.8%). Almost a fourth of the episodes subtended a different condition, such as esophageal anastomotic, peptic or congenital strictures, stricturing caustic esophagitis, esophageal duplication,and achalasia. In the last fourth of patients the cause of EFI was not identified and thus probably related to quick eating and inadequate chewing of food. Our study represents the largest known series of pediatric patients evaluated for food bolus impaction. Our main finding is the high frequency of EoE, which accounts for a half of EFI episodes in pediatric age, especially in older children. This finding highlights the importance of obtaining esophageal biopsies after the endoscopic bolus removal in children with EFI to provide a complete diagnostic evaluation.

Long-term results of operations for hernias of the esophageal orifice of the diaphragm depending on the performance of vagotomy

Introduction. Hernia of the esophageal orifice of the diaphragm, complicated by reflux esophagitis, is one of the most common gastroenterological diseases, occupying the first place among all benign pathology of the cardiofundal zone. Typical complications of this pathology are esophagitis of varying severity, bleeding from the esophagus, peptic stricture and shortening of the esophagus, Barette's esophagus, ulcer and cancer of the esophagus. Indications for surgery include severe reflux esophagitis, the development of complications, and the failure of conservative therapy.Objective: to evaluate the effect of stem vagotomy on the long-term results of surgical treatment of patients with hiatal hernia complicated by reflux esophagitis.Object and methods. The long-term treatment outcomes of 130 patients were studied. All patients had increased acid production. The patients were divided into two groups: group I – 77 patients who underwent correction of hiatal hernia in isolation; group II – 53 patients who had correction of hiatal hernia supplemented by stem vagotomy. In group I, anatomical recurrence of hiatal hernia was diagnosed in 14 patients (18.2%), and in group II – in 1 (1.9%) patient. In the long-term postoperative period, none of the patients who underwent stem vagotomy were diagnosed with severe reflux esophagitis. While in patients who did not undergo stem vagotomy, a severe form of reflux esophagitis was found in 10.3% of patients.Conclusion. In patients with hiatal hernia with increased acid production complicated by reflux esophagitis, it is advisable to supplement the correction operation with a stem vagotomy. This tactic leads to a statistically significant decrease in the number of relapses in the long-term period.

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.

Factors influencing the quality of life of GERD patients in the Aseer Region, Saudi Arabia.

To assess the factors influencing the QoL of GERD patients in the Aseer region of Saudi Arabia. This descriptive cross-sectional study used self-administered questionnaires in a study population of patients aged ≥18 years from Aseer, Saudi Arabia, between January 15, 2023-February 15, 2023. A previously validated GERD health-related QoL (GERD-HRQoL) questionnaire was used to assess the patients' sociodemographic data, GERD, and GERD-HRQoL. Descriptive analysis included describing the frequency distribution and percentage for study variables, including demographic data, GERD-related QoL symptoms, and QoL, which were graphed. Cross-tabulation presented the distribution of GERD-HRQoL scores by their personal data and other factors using the Pearson Chi-square and exact probability tests. Overall, 502 participants previously diagnosed with GERD completed the questionnaire. Participants' were aged 18-65 years (mean age of 31.5 ± 14.6 years), and 384 (76.5%) were male. The most frequent symptom affecting QoL was heartburn (85.9%), followed by postprandial heartburn (84.3%), heartburn while lying down (82.7%), bloating or gassy feelings (79.9%), and heartburn while standing up (77.3%). Our study showed that patients with GERD had a poor QoL due to GERD-related symptoms, mainly heartburn. Younger age, male sex, and lower educational status were associated with lower GERD-HRQoL scores.

Gastric Electrical Stimulation is an Effective Treatment Modality for Symptoms of GERD in Patients With Gastroparesis and VACTERL Association

Patients with VACTERL Association have multiple gastrointestinal comorbidities extending into adulthood. The term VACTERL stands for vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula (TEF) with or without esophageal atresia (EA), renal anomalies, and limb abnormalities. Symptoms of gastroesophageal reflux disease (GERD), such as heartburn and acid regurgitation, are common in this population, and patients with EA have a higher risk. Multiple therapies have been suggested to treat symptoms of GERD in patients with gastroparesis and VACTERL Association, including acid suppression therapy and treating the underlying gastroparesis. If left untreated, patients who had EA can experience severe complications, including erosive esophagitis, Barrett’s esophagus (BE), peptic strictures, esophageal cancer, and decrease in quality of life. We present 2 cases of patients with VACTERL Association with prior EA, gastroparesis and underlying symptoms of GERD that were successfully treated with gastric electrical stimulation (GES).

Esophageal Dilation: Pearls and Pitfalls

Esophageal dilation is an important part of endoscopic practice. Proper preparation and technique can optimize outcomes. Techniques include wire guided per oral dilation, blind bougienage and balloon dilation. Fluoroscopy and steroid injections may also be part of endoscopic practice. Diseases that are often and addressed with esophageal dilation include peptic strictures, lower esophageal rings, eosinophilic esophagitis, achalasia and other motility disorders, postoperative dysphagia, radiation induced strictures and malignant strictures. The techniques and approach to all of these disorders will be discussed in this review.

RISK FACTORS FOR REFRACTORY BENIGN ESOPHAGEAL STRICTURES

Background: The management of patients with refractory benign esophageal stricture is time-consuming and challenging. Dilation is the classic treatment for esophageal strictures, expressed primarily as dysphagia, which can significantly impair quality of life.Our objective is to report the results of dilatation, as well as the different risk factors of refractory benign esophageal strictures. Methods: This is a single-center retrospective study. Thirty-three patients with benign esophageal strictures were treated by dilation between 2016 and 2021. Refractory stenosis was defined as the inability to maintain esophageal caliber at 14 mm diameter over 5 dilatation sessions, or the inability to maintain satisfactory luminal diameter for 4 weeks once a 14 mm diameter was achieved. Results: 12 patients had refractory strictures. All patients had dysphagia.After univariate analysis, refractory strictures were associated with the presence of a peptic stenosis (p=0.002) and dilatations of caliber less than 16 mm (p=0.012), after multivariate analysis only peptic stenosis was associated with refractory stenosis (p=0.034). Conclusion: In our series, refractory stenosis was present in 38.7%. Peptic stenosis was statistically significantly associated with refractory esophageal stenosis.

Biochemical and Physiological Effects of Food-Induced Gastro-Esophageal Reflux Disease (GERD) in our Population. A Comparative Clinical Study

Background: Gastroesophageal reflux disease (GERD) can lead to significant medical complications such as esophageal ulcerations, peptic stenosis and esophageal adenocarcinoma. Aims and Objectives: The aims and objectives of current study was to evaluate the biochemical and physiological parameters associated with daily food which caused gastroesophageal reflux disease in population of Pakistan. Study Design: This was a comparative clinical study designed to investigate the effect of different dietary interventions on the symptoms of gastroesophageal reflux disease (GERD). Place and Duration: Current study was conducted medical units of Jinnah Hospital Lahore and Jinnah Hospital Karachi from June 2022 to February 2023 comparatively. Statistical analysis: Raw data was analyzed by using SPSS software (version 26.0). Descriptive statistics were used to summarize demographic and clinical characteristics of the study population. Methodology: A total of 100 adult patients with confirmed GERD diagnosis were randomized to either a standard GERD diet. The primary outcome measure was the change in GERD symptom severity, as assessed by the Gastroesophageal Reflux Disease Questionnaire (GERDQ) score after 12 weeks of dietary intervention. Secondary outcome measures included changes in esophageal inflammation, measured by endoscopy, and patient-reported improvement in quality of life. Practical Implications: Current study focuses on evaluation of the biochemical and physiological parameters associated with daily food which caused gastroesophageal reflux disease in population of Pakistan which will spread awareness among community for the prevention of GERD. Results: Demographic characteristics of the study population are presented in Table 1. The mean age of the patients was 48.7 years, and there were slightly more females (60%) than males (40%). The majority of patients (60%) reported a history of smoking, and 10% reported regular alcohol consumption. There was a significant (P≤0.05) difference between the two groups with respect to age, sex, smoking history and alcohol consumption. The findings of this study suggest that dietary interventions, particularly a modified Mediterranean diet, can significantly improve the symptoms and quality of life of patients with GERD. Conclusion: In conclusion, our study found that a modified Mediterranean diet may be more effective than a standard GERD diet in reducing the severity of GERD symptoms and improving quality of life in patients with GERD. This was evidenced by a significantly greater reduction in GERD score in Group B compared to Group A, as well as a higher proportion of patients reporting improved quality of life in Group B. In addition, the incidence of esophageal inflammation was lower in Group B, although this difference was not statistically significant. Keywords: dietary intervention, Mediterranean diet, symptom severity, quality of life, esophageal inflammation,

Bolus obstruction within the esophagus - an analysis over 5 years

The removal of bolus impaction within the esophagus is an indication for emergency endoscopy. The current guideline of the European Society of Gastrointestinal Endoscopy (ESGE) recommends gently pushing the bolus into the stomach. This view is discerned by many endoscopists because of the increased risk of complications. In addition, the use of an endoscopic cap for bolus removal is not mentioned. In a retrospective analysis from 2017 to 2021 we investigated 66 adults and 11 children with acute bolus impaction within the esophagus. Eosinophilic esophagitis, reflux esophagitic /peptic stenosis and Schatzki Ring caused 57.6%, esophageal and bronchial carcinoma 18%, esophageal motility disorders 4.5%, Zenkers diverticulum 1.5% and radiation esophagitis 1.5% of the bolus obstructions. The reason remained unclear in 16.7% of the cases. The spectrum was comparable in children with additional 2 cases with esophageal atresia and stenosis. The reason was unclear in 2 cases. Removal of bolus impaction was successful in 92.4% in adults and 100% in children. Bolus obstruction in adults was successfully removed solely by endoscopic cap in 57.6% and 75% in children. Pushing the bolus into the stomach without disintegration was possible in only 9% of cases. Flexible endoscopy is an effective ermergency intervention for removal of bolus obstruction within the esophagus. Uncontrolled pushing the bolus into the stomach without view cannot be recommended. An endoscopic cap is a good extension for safe bolus removal.

Complications of esophageal reconstruction

Esophageal cancer is the most common cause of esophageal resections. Esophageal replacement is still a significant challenge for surgeons, because complications can be expected in over 50% and death also occurs between 4-7%. Complications can be divided into early and late categories and into general and specific complications. From a surgical point of view, early and late specific complications are the most important aspects. Between 1993 and 2012, 540 esophageal resections were performed due to malignant tumors at the Department of Surgery, Medical Center of the University of Pécs. Stomach was used for replacement in 445 cases, colon in 38 cases, and jejunum in 57 cases. The anastomosis with stomach replacement was located to the neck in 275 cases and to the thorax in 170 cases. The colon was pulled up to the neck in each case. There were 29 cases of free jejunal replacements located to the neck, and 28 cases with a Roux-loop reconstruction located to the thorax. In the case of gastric replacement, anastomotic insufficiency developed in 55 cases, graft necrosis occurred in 8 cases, and early anastomosis stricture developed in 30 cases. These numbers are 3 conduit necrosis and 2 strictures in cases of colonic replacements. There was one anastomosis failure in the case of a thoracic jejunum replacement. Also one conduit necrosis was observed in the free jejunal neck transplantation group. Among late special complications, dysphagia is the most important, the causes of which were found in the order of frequency: anastomotic stricture, conduit obstruction, peptic and ischemic stricture, foreign body, local recurrence, functional causes, new malignant tumor in the esophageal remnant after resection and malignant tumor emerging in the replaced organ. Causes may overlap each other, and their treatment may be conservative, endoscopic or surgical. Surgical treatment is usually the last option to restore the ability to swallow and can present a significant challenge even to experienced centers. Orv Hetil. 2023; 164(7): 243-252.

Dysphagia After Esophageal Replacement and Its Treatment

Dysphagia occurs temporarily or permanently following esophageal replacement in at least half of the cases. Swallowing disorder, in addition to severe decline in the quality of life, can lead to a deterioration of the general condition, which may lead to death if left untreated. For this reason, their early detection and treatment are a matter of importance. Between 1993 and 2012, 540 esophageal resections were performed due to malignant tumors at the Department of Surgery, Medical Center of the University of Pécs. Stomach was used for replacement in 445 cases, colon in 38 cases, and jejunum in 57 cases. The anastomosis with a stomach replacement was located to the neck in 275 cases and to the thorax in 170 cases. The colon was pulled up to the neck in each case. There were 29 cases of free jejunal replacements located to the neck and 28 cases with a Roux loop reconstruction located to the thorax. Based on the literature data and own experience, the following were found to be the causes of dysphagia in the order of frequency: anastomotic stenosis, conduit obstruction, peptic and ischemic stricture, foreign body, local recurrence, functional causes, new malignant tumor in the esophageal remnant, and malignant tumor in the organ used for replacement. Causes may overlap each other, and their treatment may be conservative or surgical. The causes of many dysphagic complications might be prevented by improving the anastomosis technique, by better preservation the blood supply of the substitute organ, by consistently applying a functional approach, and by regular follow-up.

Barrett's Esophagus: An Updated Review.

Barrett's esophagus (BE) is a change in the distal esophageal mucosal lining, whereby metaplastic columnar epithelium replaces squamous epithelium of the esophagus. This change represents a pre-malignant mucosal transformation which has a known association with the development of esophageal adenocarcinoma. Gastroesophageal reflux disease is a risk factor for BE, other risk factors include patients who are Caucasian, age > 50 years, central obesity, tobacco use, history of peptic stricture and erosive gastritis. Screening for BE remains selective based on risk factors, a screening program in the general population is not routinely recommended. Diagnosis of BE is established with a combination of endoscopic recognition, targeted biopsies, and histologic confirmation of columnar metaplasia. We aim to provide a comprehensive review of the epidemiology, pathogenesis, screening and advanced techniques of detecting and eradicating Barrett's esophagus.

Clinical outcome of endoscopic balloon dilatations employed in benign paediatric oesophageal pathologies.

Oesophageal dilatations can be done either by bougies or balloons for differing aetiologies in children. We investigated the efficacy and safety of endoscopic balloon dilatations (EBDs) employed by a single surgeon. Relevant data over 12 years were retrospectively evaluated with an ethical committee approval. Ninety-seven children underwent 514 EBD with a median EBD of 3 (1-50). The primary diagnoses were oesophageal atresia (OA) in 51 children, corrosive ingestion in 21, peptic strictures in 13, achalasia in 8 and congenital oesophageal stenosis in 4. The balloon size varied between 3 and 30 mm. The EBD was successfully ended in 72 patients and unsuccessful in six patients. Six children are still under EBD and 13 are lost to follow-up. The overall success rate was 92%. The age at the time of first dilatation was the youngest in OA group followed by corrosive strictures. The balloon sizes differed regarding the age of the patients with larger balloons used as the patient age increased. The sizes of the balloons used at the first and the last EBD differed among diagnostic groups. The total number of dilatations or the time interval between the first and the last EBD dilatation did not show a statistically significant difference among groups. The anatomical type of OA or the height of corrosive stricture revealed no significant difference in any of the above parameters. A transmural oesophageal perforation occurred during 2 (0.4%) EBD sessions. EBD is an effective mean in relieving paediatric oesophageal pathologies with a variety of aetiologies and has a low complication rate.

STENOSE PEPTIQUE: ETAT DES LIEUX

Oesophageal peptic stenosis (PS) is a benign and rare complication of chronic gastroesophageal reflux disease (GERD). Upper digestive endoscopy plays a crucial role in the diagnostic and therapeutic management of this pathology. The aim of this study is to describe the epidemiological, endoscopic and evolutionary aspects of PS in our context. Methods: This is a retrospective study realized over a period of 18 years [January 2002-August 2020], including all patients diagnosed as PS. The dilatation was performed by Savary-Gilliard candles or hydrostatic balloons. Results: We included 137 patients.The mean age was 50.2 years [16-88years] with a male predominance (sex ratio M/F of 1.15). one hundred and twenty-nine dilatation procedures were performed. A history of chronic GERD was present in 77% of the patients with a mean duration of 6 years [1-17 years]. The reason behind consultation of our patients was dysphagia in all cases regurgitation in 77% and pyrosis in 25%. The upper endoscopy showed an impassable stenosis in 74.5% and a surmountable stenosis in 25.5% of the cases. The stenosis located in the lower third of esophagus in 75% of the cases, with an average extent of stenosis of 3.5 cm. All our patients were put on proton pump inhibitor (PPI). Dilatation was made bycandles with progressive diameters in 63% and by balloons in 37.2%. The evolution was marked by a clinical improvement in 64.7% of the patients with recurrence in 30% requiring other endoscopic dilatation sessions. No complications were reported. Conclusion: Peptic stenosis is a benign complication of GERD. Endoscopic dilatation associated with PPI is the optimal treatment with good functional results.

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.

S402 Voice Enabled Artificial Intelligence for Detection of Pathologic Gastroesophageal Reflux Disease and Barrett’s Esophagus

Introduction: Gastroesophageal reflux disease (GERD) can lead to voice alterations, including hoarseness. The study aim was to identify specific voice biomarkers associated with pathologic GERD using advanced machine learning tools. Detection of pathologic GERD, including Barrett’s esophagus (BE), with voice biomarkers can serve as a simple non-invasive screening tool. Methods: Voice recordings were obtained from patients undergoing clinically indicated esophagogastroduodenoscopy (EGD) and/or ambulatory pH monitoring studies. Patients were excluded if they had another condition (pulmonary, cardiac, neurologic, etc) associated with voice disturbance. Voice recording consisted of a 6-sentence standard script read over 25-45 seconds. GERD(+) patients were defined as those with erosive esophagitis (LA grade B-D) or peptic stricture or acid exposure time >6%. BE was defined as columnar mucosa >1 cm with confirmed specialized intestinal metaplasia. Patients without these findings were considered GERD(-). A vocally normal group consisting of individuals with normal voice as judged by speech pathology evaluation was used as an independent control group. Random forest models were trained using a balanced number of subjects per condition using random participant selection from the majority class. Using a 5-fold nested cross validation strategy, features were selected and ranked within fold, and a series of models were trained within each fold using recursive feature elimination. The average F1 score, a harmonic mean of precision and recall (range 0-100), across all folds was reported to assess performance. Results: The study sample consisted of 245 patients (vocally normal, n=98; GERD(-), n=78; GERD(+), n=34; BE, n=35) (Table). Feature rankings suggested voice quality differences between groups relating to voice signal periodicity. The model demonstrated excellent ability to discern BE and GERD(+) from the vocally normal group with F1 scores 82 (males) and 89 (females) and 80 (males) and 80 (females) for BE and GERD(+) respectively. There was also a good voice signal distinguishing BE and GERD(+) groups from GERD(-) with F1 scores ranging from 60-70. Figure shows model Receiver Operating Characteristics. Conclusion: These results suggest that voice biomarkers may be useful as a non-invasive tool in the detection of pathologic GERD/BE. A deep learning diagnostic model will be developed using the identified voice biomarkers.Figure 1.: Receiver Operating Characteristics for a Random Forest (RF) Model for males a) BE vs. Normal Voice b) BE vs. GERD(-) c) GERD(+) vs. Normal Voice d) GERD(+) vs. GERD(-); females e) BE vs. Normal Voice f) BE vs. GERD(-) g) GERD(+) vs. Normal Voice h) GERD(+) vs. GERD(-). Table 1. - Baseline patient characteristics in study subgroups Subgroup Sex Number of patients Mean age in years (SD) Barrett's esophagus FemaleMale 1322 65 (15)67 (9) Gastroesophageal reflux disease (+) FemaleMale 2311 51 (14)53 (19) Gastroesophageal reflux disease (-) FemaleMale 4830 55 (15)59 (15) Vocally normal FemaleMale 6434 28 (11)34 (15)