Retrosternal Discomfort Research Articles

ThP3.6 - Long Term Surgical Outcome of Complete Intrathoracic Stomach (CIS)

Abstract Background & Aims Surgery is required for medically fit symptomatic CIS patients to avoid complications (volvulus, obstruction & strangulation) that have high morbidity & mortality. To assess the long term outcome including QOL (quality of life) for patients who underwent laparoscopic biological hiatal mesh reconstruction for CIS (100%). Methods Retrospective analysis of a prospectively collected of 34 CIS of 154 consecutive GPEH(Giant Para-Esophageal Hernia) patients intervened between March 2008- December 2023 in a large DGH. Data collected included demographics, BMI, ASA, Preoperative investigations (OGD & Computerised Tomography), operative details including complications, & standardised GERD-Health Related Quality of Life Questionnaire(GERD-QOL) scores of 0-5, 6-10, 11-15 & more than 15 as excellent, good, fair & poor respectively (pre-operatively, 6-month post-operative & long-term), postoperative diet, SOB (shortness of breath) & patient satisfaction. Results 34 included M:F 11: 23, age 72*(45-83) years, BMI 29 *(20-43), ASA III *(II-III). 20(59%), 20(59%), 18(53%), 14(41%), 14(41%) & 12(35%) had heartburn, dysphagia, retrosternal discomfort, vomiting, weight loss and SOB respectively. 6 (18%) emergencies, 22 (65%) incomplete OGDs, operative time 210* (150-510) mins, 1(3%) conversion, 3*(9%) surgical mortality & PO stay 3*(2-27) days. Pre and 6-month post surgery GERD-QOL poor (≥15) & excellent (<5) in 21(62%) & 32(94%) respectively with 32(94%) excellent satisfaction. Follow up at 102*(16-190) months had 2 more unrelated deaths, 21(72%) contacted with GERD-QOL excellent (<5) in 14(67%), poor 1(5%), 19(90%) solid diet, 2(10%) SOB with 19(90%) excellent satisfaction. Conclusion Favourable long term outcome achieved here supports complex surgery for this debilitating condition in the medically fit symptomatic elderly patients. * Median

A Case Report of Brain Metastases after Neoadjuvant Chemo and Radiotherapy for Esophagogastric Junction Adenocarcinoma in an Adult Male Patient

Background: Treatment given as a first step to shrink a tumor before the main treatment, which is usually surgery, is given. Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy. It is a type of induction therapy. The most common pattern of esophageal cancer metastases (ECM) is to the lymph nodes, lung, liver, bones, adrenal glands, and brain.
 Case Presentation: A male patient, 47 years old, was admitted to the hospital on July 31, 2020, mainly due to "progressive dysphagia. Two months ago, the patient had difficulty eating without obvious incentives, especially when eating hard food such as rice. The liquid diet was acceptable, accompanied by retrosternal pain and discomfort, heartburn, and obvious weight loss. The symptoms gradually aggravated without obvious relief.
 Conclusion: In summary, there are few international investigations and an absence of relevant information and literature on the environment in which tumor cells survive after radiotherapy. Clinicians can't ignore the issue of whether radiotherapy will alter the tumor cells' natural environment, leading to tumor cell escape and an increase in brain metastases.

High-grade large cell neuroendocrine carcinoma of the esophagus: a case report and review of the literature

BackgroundNeuroendocrine carcinomas are extremely rare in the esophagus as they represent less than 0.04% of all neuroendocrine tumors. To date, only 14 cases of poorly differentiated, high-grade esophageal NEC have been described in the literature. The majority of these patients presented with typical dysphagia symptoms. Due to its rarity, no standardized guidelines have been proposed to treat esophageal neuroendocrine carcinoma, although general recommendations suggest surgery with adjuvant chemoradiotherapy as the treatment of choice.Case presentationA 67-year-old previously healthy White male presented with a year-long intermittent nonspecific retrosternal discomfort, with the absence of any other symptoms. Esophagogastroduodenoscopy revealed an ulcerative mass in his lower esophagus, with concern of malignancy. Endoscopic ultrasound-guided biopsy revealed poorly differentiated neuroendocrine carcinoma of the esophagus with metastasis to a diaphragmatic lymph node. He was treated with neoadjuvant chemoradiation followed by surgery, and he has been in remission for over 5 years.ConclusionHere, we review the literature and report a unique case of a patient with a vague presentation of esophageal neuroendocrine carcinoma as he enters his sixth year of survival following neoadjuvant chemoradiotherapy.

Mediastinal teratoma with double malignant transformation

We report a case of a 65-year-old woman with retrosternal discomfort, dyspnea, and weight loss in whom the computed tomography showed a multicystic mass with fat content and calcified wall in the anterior mediastinum. After surgical resection, pathological examination revealed synchronous primary colorectal adenocarcinoma and primary carcinoid tumor arising in a mediastinal mature cystic teratoma. Treatment with oxaliplatin and capecitabine was instituted, and subsequent checkups showed no evidence of recurrence. Malignant transformation of mature cystic teratoma is a rare complication that occurs in 1–3% of these tumors and consists of a nongerm cell malignant tumor arising from a preexisting mature teratoma. Any of the constituent tissues of a teratoma has the potential to undergo malignant transformation. In case of limited disease, treatment should be surgical. There is no consensus regarding adjuvant treatment, and the existence of a double neoplastic lineage may complicate the choice of chemotherapy treatment.

Gastrointestinal conditions related to tooth wear

Gastro-oesophageal reflux disease (GORD) is a relatively common condition that occurs in adults and less commonly in children. It develops when the reflux of stomach contents into the oesophagus causes troublesome symptoms and/or complications. Signs and symptoms include heartburn, retrosternal discomfort, epigastric pain and hoarseness, dental erosion, chronic cough, burning mouth syndrome, halitosis and laryngitis. A proportion of patients will, however, have silent reflux. Strongly associated risk factors include family history, age, hiatus hernia, obesity and neurological conditions, such as cerebral palsy. There are different treatment options which may be considered for GORD, consisting of conservative, medical and surgical therapy. Dentists should be aware of the symptoms of GORD and dental signs of intrinsic erosion indicative of possible GORD so that they can question patients about this and, if appropriate, initiate a referral to a general medical practitioner.

Tetracycline-, Doxycycline-, Minocycline-Induced Pseudotumor Cerebri and Esophageal Perforation.

Tetracyclines are a class of broad-spectrum bacteriostatic antibiotics used to treat many infections, including methicillin-resistant Staphylococcus aureus (MRSA), acne, pelvic inflammatory disease, chlamydial infections, and a host of zoonotic infections. These drugs work by inhibiting protein synthesis in bacterial ribosomes, specifically by disallowing aminoacyl-tRNA molecules from binding to the ribosomal acceptor sites. While rare, tetracycline antibiotics, particularly minocycline and doxycycline, are associated with an increased risk of developing esophageal perforation and pseudotumor cerebri (PTC, or idiopathic intracranial hypertension). Since tetracyclines are a commonly prescribed class of medications, especially in adolescents for acne treatment, it is important for clinicians to appreciate significant side effects that can result in morbidity and mortality. This paper aims to consolidate and to emphasize current research on the association between tetracycline antibiotics and the development of esophageal perforation, and PTC. PTC is a neurological syndrome consisting of increased intracranial pressure, headache, and vision changes without evidence of the contributing source, such as mass lesion, infection, stroke, or malignancy. Esophageal perforation, while rare, can be the result of pill esophagitis. Pill-induced injuries occur when caustic medicinal pills dissolve in the esophagus rather than in the stomach. Most patients experience only self-limited pain (retrosternal burning discomfort, heartburn, dysphagia, or odynophagia), but hemorrhage, stricture, and perforation may occur. Tetracycline use can lead to pill esophagitis. In summary, clinicians should appreciate the potential risks of tetracycline compounds in clinical practice.

Endoscopic resection of a huge Vanek's tumor (inflammatory fibroid polyp).

A 43-year-old man vomited a “sausage-like” mass into the mouth after drinking a bottle of beer; the mass was then re-swallowed. He subsequently experienced intermittent retrosternal discomfort. Esophagogastroduodenoscopy (EGD) at the local hospital showed a huge esophageal tumor. The patient was transferred to our hospital for further endoscopic resection.

Balloon-Occluded Esophageal Variceal Obliteration Procedure: A Novel Technique Report from Three Centers.

Introduction: Esophageal variceal bleeding (EVB) is a potentially fatal complication of cirrhosis. The purpose of the present study was to evaluate the safety and efficacy of a novel technique of balloon-occluded esophageal varices (EVs) obliteration (BEVO) for EVs classified as F2 (medium size, F2-EVs) and F3 (large size, F3-EVs). Materials and Methods: Between December 2020 and December 2021, a total of 73 consecutive patients with EVs were treated using BEVO. An injection of sclerosant was administered via direct puncture of the varices during balloon occlusion. Immediate postprocedural Doppler endoscopic ultrasonography (EUS) was conducted to evaluate the blood flow in the EVs. Several factors, including the technical success, controlling of acute bleeding, intraoperative bleeding at the injection site, variceal eradication, variceal recurrence, and BEVO-related complications, were assessed. Results: BEVO was successfully performed in all patients. Immediate hemostasis was achieved in 100% (25/25) of patients with active EVB. The incidence of injection site intraoperative bleeding presenting as oozing and spurting bleeding was 76.71% (56/73) and 8.22% (6/73), respectively. Based on Doppler EUS and endoscopic examination, EVs were completely eradicated in 71 out of 73 patients (97.26%) after three sessions. A total of 3 (4.11%) patients were diagnosed with EV recurrence during follow-up after complete EV eradication. Retrosternal chest discomfort (13.70%; 10/73) and abdominal bloating (2.74%; 2/73) were spontaneously relieved after a few days. No serious BEVO-related complications were observed. Discussion: BEVO is a convenient and effective treatment for obliterating F2 and F3 EVs. Clinical Trial Registration No. ChiCTR2000039974.

An Unusual Cause of Esophagitis

An Unusual Cause of Esophagitis

Man With Back Pain

A healthy 46-year–old man presented to the emergency department (ED) with a dull back pain for 2 weeks and a foreign body sensation, along with retrosternal discomfort after ingesting food. He also complained of decreased appetite and unspecified weight loss over previous months. On physical examination, the patient had a blood pressure of 114/78 mm Hg and a pulse rate of 99 beats/minute. Percussion tenderness was noted over the epigastric area and bilaterally at the costovertebral angles. Laboratory test results were unremarkable.

Novel balloon compression-assisted endoscopic injection sclerotherapy and endoscopic variceal ligation in the treatment of esophageal varices: a prospective randomized study

BackgroundHerein, our group designed a novel technology, termed balloon compression-assisted endoscopic injection sclerotherapy (bc-EIS), which was applied to improve the efficiency of eradicating esophageal varices (EVs). The present study aimed to compare the rate of eradication and efficacy between bc-EIS and endoscopic variceal ligation (EVL) in the management of EVs.MethodsNinety-five patients with esophageal variceal bleeding (EVB) were randomly assigned to receive bc-EIS or ligation alone. Additional treatment sessions were held 1 month later and then at 3-month intervals until eradication of the varices was achieved. Endoscopic follow-up examinations were carried out at 6-month intervals in the absence of recurrence or immediately if there was any recurrent bleeding.ResultsThe mean physical injection points per session were 2.89 ± 0.79, and the mean volume of lauromacrogol used per session was 17.74 ± 7.09 ml in the bc-EIS group. The mean band per session was 6.13 ± 0.86. The rate of eradication after one to three rounds of bc-EIS was obviously higher than that of the EVL group (89.36%, 97.87%, and 100% vs. 37.5%, 43.75%, and 47.92%, respectively). Retrosternal pain or discomfort in the bc-EIS group was slightly lower than that in the EVL group (23.4%, 11/47 vs. 31.25%, 15/48). Two and five patients showed mild abdominal bloating and distension between the bc-EIS and EVL groups, respectively (2/47, 4.26% vs. 5/48, 10.42% P > 0.05). Nausea and vomiting were reported in one patient (1/47, 2.13%) in the bc-EIS group and three patients (3/48, 6.25%) in the EVL group. However, there were no statistically significant differences between the two groups (P > 0.05). No fatal or severe complications, such as esophageal perforation, esophageal stricture or ectopic embolism, were observed.ConclusionThe bc-EIS method was effective in eradicating EVs and was accompanied by fewer complications.

PULMONARY MICRONODULES OF PROBABLE VARICELLA ETIOLOGY

Often, during consultations, elements pertaining to the patient’s history are omitted, leading to a diagnostic suspicion far from the truth and to unrequired medical investigations. Herein, we describe the case of a 36-year-old patient who presented himself for a post-COVID evaluation and a second medical opinion regarding the appearance of pulmonary micronodules during the control chest Computed Tomography (CT) scan. From the patient's history, we note that he had a SARS-CoV-2 infection in May 2021 and because he had persistent symptoms of retrosternal discomfort and the feeling of having a "knot in his throat", the patient presented himself for a consultation that recommended CT scan, performed in July 2021. In this CT examination (Fig. 1, A and D), several pulmonary micronodules of uncertain etiology were observed, but according to their appearance, they are most likely sequelae; no other pathological changes were observed. Routine blood tests were normal. The patient was advised to undergo a new CT scan after 6 months, in order to monitor the evolution of the nodules.

Analysis of survival and prognostic factors of thymic neuroendocrine tumors.

e20622 Background: To investigate the clinical characteristics of thymic neuroendocrine tumors and the relationship between treatment and survival prognosis. Methods: 69 patients, including 54 males and 15 females, who were diagnosed with NETT by puncture or surgical pathology in the First Affiliated Hospital of Zhengzhou University from September 2011 to October 2021 were retrospectively analyzed for initial symptoms, Pathological type, lesion size, treatment and prognosis of survival. Results: The median age of the 69 patients was 53 years old (28-83 years old), the median maximum diameter of the primary lesion was 6.85 cm (1.1-14.9 cm), and the clinical manifestations were not specific. The most common initial symptom was chest tightness and chest pain for 20 cases, 19 cases with hidden disease, found during physical examination. The manifestations of local invasion and metastasis included cough (6 cases), neck and face swelling (9 cases), retrosternal discomfort (3 cases), and low back pain (4 cases). There were 6 cases with systemic manifestations (anorexia, fatigue and fever). Only one case showed ectopic ACTH syndrome. The pathological types included 46 cases of well-differentiated neuroendocrine tumors (5 cases of typical carcinoid tumors, 41 cases of atypical carcinoid tumors), 23 cases of poorly differentiated neuroendocrine tumors (13 cases of small cell carcinomas, 3 cases of large cell neuroendocrine carcinomas, and high-grade neuroendocrine carcinomas). 7 cases of endocrine carcinoma). Masaoka-Koga staging: 2 cases of stage I, 10 cases of stage II, 20 cases of stage III, and 37 cases of stage IV. Thirty patients received surgical treatment, and 19 received postoperative adjuvant therapy. Long-term follow-up results showed a median overall survival time of 49.5 months. Univariate analysis showed that surgery could improve PFS (P = 0.009), while postoperative comprehensive treatment had no effect on PFS (P = 0.724). Pathological grade (P < 0.001), Masaoka-Koga stage (P = 0.004), and surgery (P = 0.014) were associated with OS. Multivariate analysis showed that pathological grade was an independent factor affecting OS (HR: 7.133; 95%CI: 2.183-23.306; P = 0.001). Conclusions: Thymic neuroendocrine tumor is a rare malignant tumor, and pathological grade is an independent risk factor for prognosis. Surgery can improve the patient's PFS.

Secondary antiphospholipid syndrome at a young male

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by recurring venous and/or arterial thrombosis and the presence of circulating antiphospholipid antibodies. APS occurs as a primary condition or secondary to other autoimmune disorders, mainly systemic lupus erythematosus (SLE). The diagnosis of APS is made on the basis of suggestive clinical findings and the presence of one or more of the following antiphospholipid antibodies (LAC, aCL antibody or aβ2GPI antibody present on two or more occasions, at least 12 weeks a part). A clinically significant aPL profile has been detected in approximately 30 % of patients with SLE. Case presentation: We are presenting a rare case of a 23 years old male with complaints of dyspnea, retrosternal discomfort, fatigue, general weakness, joint pain over a period of 3 months. The patient reported a single syncopal episode, 3 months prior to admission as his first clinical manifestation. He was at first diagnosed with Thrombocytopenia in 2007 and Systemic Lupus Erythematosus (SLE) in 2020. During his hospitalization, the patient experienced recurrent headaches, dizziness and episodes of elevated blood pressure (170/100 mmHg), as well. Moreover, laboratory and imaging examinations showed bilateral pulmonary thromboembolism and positive Anticardiolipin antibodies, positive ANA, positive SSA & SSB. Conclusion: Given the lack of typical clinical findings in the early stages of the disease, establishing a diagnosis of APS can be challenging. Although APS is one of the most common thrombocytophilias, unfortunately, it remains underdiagnosed. Clinicians should investigate for the presence of antiphospholipid antibodies, as early diagnosis may influence the course of the disease.

Incidence of Aberrant Right Subclavian Artery in General Population

Objective: The existence of an anomalous right subclavian artery is the most significant aortic arch defect. Dysphagia, wheezing, stridor, and other symptoms may occur if this vessel pressures the neighbouring structures. The goal of this study is to find out how common ARSA is based on CT scans of the thorax and neck (plain and contrast).
 Method: Between January 1st and December 31st, 2020, 1122 patients had CT Thorax/neck scans, and the data were evaluated. The origin of the ARSA, the vessel's path, and the Kommerell diverticulum were all assessed. We looked at the literature to see how important ARSA is in clinical practise.
 Results: ARSA was found in eight of 1122 patients. All of the ARSAs in these eight individuals began at the posterior part of the aortic arch and travelled via the retroesophageal path to the thoracic outlet. All eight ARSA were found in the front part of the thoracic vertebral bodies, from the first to the fourth.
 Conclusion: Other clinical symptoms such as dysphagia, dyspnea, retrosternal discomfort, cough, and weight loss must be differentiated from compression of surrounding tissues by an abnormal right subclavian artery.

The Impact of Gastrointestinal Symptoms on Patients’ Well-Being: Best–Worst Scaling (BWS) to Prioritize Symptoms of the Gastrointestinal Symptom Score (GIS)

Background: The gastrointestinal symptom score (GIS) is used in a standardized form to ascertain dyspeptic symptoms in patients with functional dyspepsia in clinical practice. As a criterion for evaluating the effectiveness of a treatment, the change in the summed total point value is used. The total score ranges from 0 to 40 points, in which a higher score represents a more serious manifestation of the disease. Each symptom is included with equal importance in the overall evaluation. The objective of this study was to test this assumption from a patients’ perspective. Our aim was to measure the priorities of patients for the ten gastrointestinal symptoms by using best–worst scaling. Method: A best–worst scaling (BWS) object scaling (Case 1) was applied. Therefore, the symptoms of the GIS were included in a questionnaire using a fractional factorial design (BIBD—balanced incomplete block design). In each choice set, the patients selected the component that had the most and the least impact on their well-being. The BIB design generated a total of 15 choice sets, which each included four attributes. Results: In this study, 1096 affected patients were asked for their priorities regarding a treatment of functional dyspepsia and motility disorder. Based on the data analysis, the symptoms abdominal cramps (SQRT (B/W): −1.27), vomiting (SQRT (B/W): −1.07) and epigastric pain (SQRT (B/W): −0.76) were most important and thus have the greatest influence on the well-being of patients with functional dyspepsia and motility disorders. In the middle range are the symptoms nausea (SQRT (B/W): −0.69), acid reflux/indigestion (SQRT (B/W): −0.29), sickness (SQRT (B/W): −0.26) and retrosternal discomfort (SQRT (B/W): 0.26), whereas the symptoms causing the least impact are the feeling of fullness (SQRT (B/W): 0.80), early satiety (SQRT (B/W): 1.54) and loss of appetite (SQRT(B/W): 1.95). Discussion: Unlike the underlying assumption of the GIS, the BWS indicated that patients did not weight the 10 symptoms equally. The results of the survey show that the three symptoms of vomiting, abdominal cramps and epigastric pain are weighted considerably higher than symptoms such as early satiety, loss of appetite and the feeling of fullness. The evaluation of the BWS data has illustrated, however, that the restrictive assumption of GIS does not reflect the reality of dyspeptic patients. Conclusions: In conclusion, a preference-based GIS is necessary to make valid information about the real burden of illness and to improve the burden of symptoms in the indication of gastrointestinal conditions. The findings of the BWS demonstrate that the common GIS is not applicable to represent the real burden of disease. The results suggest the potential modification of the established GIS by future research using a stated preference study.

A case series of sublingual immunotherapy-induced eosinophilic esophagitis: stop or spit.

We experienced six cases with eosinophilic esophagitis (EoE). They complained of dysphagia, heartburn, or retrosternal discomfort. Endoscopy revealed typical findings of EoE and biopsy examination showed significant eosinophil infiltration in the esophageal epithelium. They received sublingual immunotherapy (SLIT) for allergic rhinitis. Discontinuation or spit method during SLIT resulted in improvement of symptoms, and endoscopic and histological remission. Previously six cases with SLIT-induced EoE has been reported. Our case series suggest that SLIT is clearly associated with the development of EoE by entering of aeroallergens from the luminal side of the esophagus and spit method during SLIT might be one of the therapeutic options for SLIT-induced EoE.

Acute coronary syndrome in a patient with single coronary artery and double left anterior descending artery coexistence: a case report of an extremely rare congenital coronary artery anomaly

We report a case of a 57-year-old male patient, who presented at the Emergency Department due to an episode of retrosternal discomfort, provoked by mild exertion. Upon admittance, he was asymptomat...

Effects of aerospace environments on the cardiovascular system.

Certain physical and physiological changes occur in the atmospheric levels where flight and space activities take place. Air pressure decreases with increasing altitude and the partial pres¬sure of O2 decreases in parallel with the atmospheric pressure drop and creates hypoxia in the flight crew and in the passen¬gers. In case of acute hypobaric hypoxia, blood is redistributed to the brain and the heart, whereas blood supply to internal organs, such as kidney and skin is reduced. Peripheral cyanosis can be observed on the fingertips and the lips during hypoxia-induced blood redistribution. Tachycardia develops, but the stroke volume does not change. The coronary blood flow increases in parallel with the rise of cardiac output; however, the presence of severe hypoxia leads to myocardial depression. Coronary reflex vasoconstriction is followed by cardiac arrest. Another important pathology caused by low pressure is decompression sickness. In this disease, immediate reduction of the environmental pressure leads to the dissolved nitrogen transforms into gas, and nitrogen bubbles form in the tissue and in the blood. These bubbles interfere the perfusion of the blood and cause ischemia. Symptoms and signs of cardiac decompression sicknesses are dyspnea, tachypnea, chest pain, cough, hemoptysis, cyanosis, retrosternal discomfort, and rarely, shock. Air embolism of coronary vessels manifests as rhythm disturbances, myocardial infarction, and circulatory collapse. The physical forces that occur because of aircraft move¬ment and affect both the pilot and the aircraft, are called acceleration (G) forces. The basic physical effect of G forces is weight increments and motion restriction. During high +Gz, blood pressure decreases in the brain and increases in the lower extremities. Blood forced to move into the lower parts of the body and lower extremities. Thus, brain perfusion cannot be achieved, and loss of consciousness occurs at approximately +4 Gz acceleration levels. Earth also applies an acceleration force to the objects on or around the world. Therefore, gravitational force is also applied to orbiting spacecraft by Earth. The centrifugal force and the gravitational force are in an equilibrium, weightlessness is created inside the orbiting spacecraft, and this is called microgravity. Blood redistributed to the neck and head veins, and astronauts feel nasal fullness, and bulging around the eyes during space missions. As the time spent in the space progresses, a 22% decrease in plasma volume is observed in the cardiovascular system within 1 week owing to increased venous return, and this causes a temporary hemoconcentration. After staying one week in space, cardiac output increases by 22% whereas peripheral resistance decreases by 14%. Rhythm disturbances are also seen during activities performed in space is and thought to be caused by electrolyte imbalance or stress. There is an increasing demand for high altitude and space travel nowadays. These trips cause several physical and physiological effects on both passenger and flight crew. Therefore, it is necessary to take precautionary measures to carry out these activities safely.

Comparing N-acetylcysteine with sodium thiosulfate for relieving symptoms caused by Lugol’s iodine chromoendoscopy: a randomized, double-blind trial

Lugol's iodine chromoendoscopy is an important method to detect esophageal squamous cell carcinoma. Sodium thiosulfate solution (STS) has been used to neutralize iodine after Lugol's chromoendoscopy; however, it is not available in many medical centers. The aim of the current study was to assess the efficacy of N-acetylcysteine solution (NAC) for relieving symptoms caused by Lugol's iodine chromoendoscopy. Patients were randomized to receive either STS or NAC after spraying Lugol's iodine solution on the esophagus. The neutralizing effects for residual iodine in the esophagus and gastric mucous pool were observed. The primary endpoint was the intensity of retrosternal pain and/or heartburn measured by a visual analog scale (VAS) score 30 minutes after chromoendoscopy. Secondary endpoints were the rate of patients with any adverse symptom, rate of moderate to severe retrosternal discomfort occurring, and heart rate variability between time points before and after chromoendoscopy. The neutralization rates for residual iodine between the NAC and STS groups were not significantly different (P > .999). The difference of median VAS scores between the NAC and STS groups 30 minutes after chromoendoscopy was .0 (P= .719; 95% confidence interval, .0-.0), and the 95% confidence interval higher limit was .0, which was less than our prespecified margin of .5, concluding an noninferiority of NAC with regard to STS. There was no significant difference between the 2 groups regarding the rate of patients with any adverse symptom, rate of moderate to severe retrosternal discomfort, or heart rate variability at 5 minutes or 30 minutes after chromoendoscopy. As a very easily accessible reagent in clinical circumstances, NAC can also alleviate mucosal irritation symptoms induced by Lugol's chromoendoscopy at similar efficacy as STS and can be routinely recommended. (Clinical trial registration number: NCT04764643.).