Routine Endoscopic Examination Research Articles

Isolation of Malassezia yeasts from dogs with gastrointestinal disease undergoing duodenal endoscopy.

To culture Malassezia and other fungi from the duodenum of dogs with gastrointestinal signs undergoing routine endoscopic examination. Quantitative microbial culture was performed on duodenal juice aspirated from dogs with suspected enteropathy during routine upper gastrointestinal endoscopy; samples were cultured on Sabouraud's dextrose agar (30, 32 and 37°C) and modified Dixon agar (32°C) for 14 days. Isolates were identified phenotypically and by matrix-assisted laser desorption ionisation-time of flight, and internal transcribed spacer sequencing. Yeast presence was also evaluated by cytological and histopathological examination of smears and biopsy specimens. Forty-five dogs were recruited with chronic inflammatory enteropathy (n=38), granulomatous colitis (n=2), gastric adenocarcinoma (n=2), duodenal small cell lymphoma (n=1) and idiopathic severe gastrointestinal haemorrhage (n=2). Fungi were cultured from 14 dogs: Malassezia pachydermatis was isolated from eight [chronic inflammatory enteropathy (n=7) (along with Candida albicans n=1); granulomatous colitis (n=1)] and Malassezia sympodialis from another (gastric adenocarcinoma). Five dogs with chronic inflammatory enteropathy yielded other yeasts (C. albicans, Candida glabrata, Kazachstania slooffiae, Kazachstania telluris, Pichia kudriavzevii [syn. C. krusei]). Yeasts were never observed in histopathological specimens. Fluorescent microscopical examination of cytological specimens showed yeast in only one case, from which K. slooffiae was subsequently isolated. Based on a literature search, this is the first report of isolation of M. pachydermatis, M. sympodialis, K. slooffiae and K. telluris from the canine duodenum. Further studies are needed to determine whether these are resident or transient fungi in the canine duodenum and whether their presence has a pathogenic effect on the host.

Is upper gastrointestinal system screening necessary in kidney transplant candidates?

BACKGROUND
 The aim of this study is to present and discuss upper gastrointestinal tract endoscopy findings in renal transplant candidates with a high incidence of gastrointestinal system diseases.
 METHODS
 Between January 2014 and December 2019, patients over the age of 18 who were on dialysis for chronic renal failure and renal transplant candidates at xxx University xxx Hospital were included in the study. Upper gastrointestinal endoscopic findings and pathology results (atrophy, helicobacter pylori and intestinal metaplasia) of the patients were retrospectively evaluated by scanning from the electronic archive system of the hospital.
 RESULTS
 The study included 105 patients. 53 (50.5%) of the patients were male. The mean age of the patients was 44.09 ± 14.16 years and there was no statistically significant difference between male and female sexes (p=0.961). The most common endoscopic findings were pangastritis (44.8%), antral gastritis (27.6%) and esophagitis (16.2%). Only 4 (3.8%) patients had duodenal ulcer. Atrophy was positive in 3 (13%) of 23 patients, HP was positive in 19 (27.1%) of 67 patients and IM was positive in 17 (24.3%) of 56 patients.
 CONCLUSIONS
 Patients who are renal transplant candidates should be reviewed for indication of routine upper endoscopic examination before transplantation to prevent upper GI tract complications that may develop after transplantation.

Ectopic Olfactory Neuroblastoma: Systematic Review of a Rare Clinical Entity among Sinonasal Tumors.

Objectives Ectopic olfactory neuroblastoma is an uncommon manifestation of an already rare neoplasm. We aimed to systematically review the literature for cases of ectopic olfactory neuroblastoma to better characterize this rare disease entity and to present two new case reports. Methods A search of the PubMed and Embase databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify English-language articles reporting cases of ectopic olfactory neuroblastoma, published from 1955 through November 2021. Results Sixty-six cases of ectopic olfactory neuroblastoma were identified in 62 articles including the current review. Ectopic olfactory neuroblastoma arose in a wide age range (2-89 years) without significant sex predilection. It occurred most commonly in the ethmoid (25%), maxillary (25%), and sphenoid (16%) sinuses. Seventy-three percent of cases presented with low Hyams grade (I and II). The most common symptoms were nasal obstruction (32%) and epistaxis (32%). Paraneoplastic syndromes were observed in 27% of patients. The most common treatment was surgical resection followed by adjuvant radiotherapy. Overall, 76% of all patients were disease-free at the time of last follow-up. Locoregional recurrences and distant metastases were found in 19 and 5% of cases, respectively. Conclusion This systematic review describes previously reported cases of ectopic olfactory neuroblastoma, a disease entity with poorly understood characteristics. Physicians should consider olfactory neuroblastoma in the differential diagnosis for sinonasal masses, as their ectopic presentation may present considerable diagnostic and therapeutic difficulties. Patients with olfactory neuroblastoma may benefit from long-term follow-up and routine endoscopic examinations for surveillance of ectopic recurrences.

An Unusual Case of Significant Cervical Esophageal Stricture

Question: A 65-year-old man was referred to our facility for solid-food dysphagia without other disease history. He lived a happy and healthy life without abuse of alcohol or tobacco. The symptom started about 2 years before, without accompanying heartburn and regurgitation, and did not progress significantly. A stricture at the upper orifice of the esophagus was found (Figure A) and hampered the routine endoscopic examination (GIF-Q260; Olympus). Instead, an ultrathin endoscope (GIF-XP290N; Olympus) was used, which revealed a well demarcated translucent white scaly lesion with shaggy surface distributed in a two-thirds circumferential arrangement from 15 cm to 25 cm of the esophagus distal to the incisors (Figure B, Video A). Narrow-band imaging endoscopy showed a distinct white irregular map-like area (Figure C, Video A). Computer tomography (CT) did not show any neck mass or thickness of the cervical esophageal wall (Figure D). Multiple biopsies were obtained from the proximal esophagus. No malignancy was confirmed pathologically (Figure E).

Advances in endoscopic resection techniques of small gastric tumors originating from the muscularis propria.

Gastrointestinal stromal tumors are common gastrointestinal tumors typically originating from the muscularis propria layer of the stomach. Small gastric stromal tumors are usually detected incidentally during routine endoscopic examination. Although they may have malignant potentially, controversies remain regarding the need for endoscopic resection of small gastric stromal tumors originating from the muscularis propria. According to the guidelines of the European Society of Medical Oncology, all gastrointestinal stromal tumors >2 cm in size should be resected with endoscopic surveillance recommended for tumors <2 cm. Endoscopic resection including endoscopic mucosal dissection (EMD), endoscopic submucosal dissection (ESD), submucosal tunneling endoscopic resection and snare assisted endoscopic resection. However, EMD and ESD procedures may be accompanied with serious complications including perforation, bleeding, and abdominal infection. Snare-assisted endoscopic resection is an alternative approach and has the advantages of a shorter procedure time and a low rate of perforation or bleeding. This study summarizes the safety and feasibility of a novel snare-assisted endoscopic resection technique and highlights the pros and cons of the different endoscopic approaches currently used for subepithelia small gastric tumors.

Preoperative Assessment of Patients Undergoing Bariatric Sleeve Gastrectomy: A Cross-Sectional Study.

Saudi Arabia (SA) is one of the top countries in the world when it comes to the number of bariatric procedures performed each year. There is still some debate on whether to do regular or selective upper endoscopy during the preoperative examination. The purpose of this study was to explore various endoscopic findings and Helicobacter pylori (HP) infection in symptomatic and asymptomatic patients having laparoscopic sleeve gastrectomy (LSG) prior to surgery. We investigated a cohort of 132 patients referred to the endoscopy unit from the bariatric surgery outpatient clinic for prebariatric esophagogastroduodenoscopy (EGD) as a part of preoperative LSG. Data extraction from medical records included clinical data such as body mass index (BMI), gastrointestinal symptoms (that include heartburn, regurgitation, epigastric pain, and nausea), medical comorbidities, and laboratory investigations. It included data about the endoscopic findings of EGD procedure as esophageal, gastric, and duodenal findings results as well as the results of biopsy specimens that were taken. Out of 132 patients, 29 (22%) had a BMI of less than 40 kg/m2 whereas 103 (78%) had a BMI of 40 kg/m2 or above, with an average of 44.4 ± 6.4 kg/m2. The average age of participants was 33.6 ± 10.4 years. HP was detected in 36 patients (35.0%) with a slightly greater prevalence in patients with a higher BMI (33.7%) than in patients with lower BMI (35.0%). Collectively, 73 patients (55.7%) had positive endoscopic findings of various grades, sites, and combinations. Incompetent cardia (35.6%) was the most often seen esophageal finding, antral gastritis (34.1%) was the most frequently encountered gastric finding, and duodenitis 1st part was the commonest duodenal endoscopic finding (7.8%). Among asymptomatic patients, incompetent cardia was detected in 33.3%, antral gastritis was found in 30.1%, and around one-quarter of them were positive on HP testing (26.6%). Additionally, 16.1% of them had signs of reflux esophagitis, 17.2% had hiatal hernia, and 14.0% had nodular gastritis. The current study revealed a high prevalence of positive endoscopic findings as well as HP infection upon routine endoscopic examination among patients undergoing bariatric surgery even those who were asymptomatic from any gastrointestinal symptoms.

Follow-Up Clinico-Endoscopic Study among Young Patients with Peptic Ulcer Perforation: A Prospective Analysis

Background: One of the most common difficulties in the operation fatality is perforation peritonitis. The goal of this study was to identify risk factors for peptic ulcer disease (PUD) in young patients. Materials and method: In this study, 70 patients were evaluated and clinical examinations and endoscopies were performed at 8 weeks and 6 months. Place and Duration: A population‐based cohort study was conducted at the Gastroenterology department of Sharif Medical College, Lahore for one-year duration from January 2021 to December 2021. Result: Six patients died, and 4 patients were not followed up on, out of a total of 80 patients. There were 62 men and 8 women among the remaining 70 patients. The majority of the patients were between the ages of 35 and 40. After eight weeks, 34 (50%) had no infections on endoscopy, with 34 patients (48.6%) on treatment and 1 (1.4%) not on any therapies. The residual 35 patients (50%) had active ulcers and other positive endoscopic outcomes. Six months after surgery, 56 patients (80%) had no ulcers on endoscopy, with 34 on treatment and 12 without treatment. The rest 14 had some positive endoscopic findings. The study also revealed other factors linked with peptic ulcer perforation and impacting healing in the postoperative phase. Preoperative PUD symptoms, alcohol consumption, comorbidities, chronic drug consumption (NSAIDs/steroids), smoking, postoperative treatment given and H. pylori infection were all variables. Conclusion: All patients with peptic ulcer perforation should receive H2 blockers or proton pump inhibitors as a post - operative therapies, as well as an anti-Helicobacter pylori regimen. Postoperative follow-up should include routine endoscopic examinations of these patients to detect ulcer healing. Keywords: peptic ulcer disease, endoscopies, chronic drug consumption.

Convolutional neural network-based artificial intelligence for the diagnosis of early esophageal cancer based on endoscopic images: A meta-analysis.

Early screening and treatment of esophageal cancer (EC) is particularly important for the survival and prognosis of patients. However, early EC is difficult to diagnose by a routine endoscopic examination. Therefore, convolutional neural network (CNN)-based artificial intelligence (AI) has become a very promising method in the diagnosis of early EC using endoscopic images. The aim of this study was to evaluate the diagnostic performance of CNN-based AI for detecting early EC based on endoscopic images. A comprehensive search was performed to identify relevant English articles concerning CNN-based AI in the diagnosis of early EC based on endoscopic images (from the date of database establishment to April 2022). The pooled sensitivity (SEN), pooled specificity (SPE), positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR) with 95% confidence interval (CI), summary receiver operating characteristic (SROC) curve, and area under the curve (AUC) for the accuracy of CNN-based AI in the diagnosis of early EC based on endoscopic images were calculated. We used the I2 test to assess heterogeneity and investigated the source of heterogeneity by performing meta-regression analysis. Publication bias was assessed using Deeks' funnel plot asymmetry test. Seven studies met the eligibility criteria. The SEN and SPE were 0.90 (95% confidence interval [CI]: 0.82-0.94) and 0.91 (95% CI: 0.79-0.96), respectively. The LR+ of the malignant ultrasonic features was 9.8 (95% CI: 3.8-24.8) and the LR- was 0.11 (95% CI: 0.06-0.21), revealing that CNN-based AI exhibited an excellent ability to confirm or exclude early EC on endoscopic images. Additionally, SROC curves showed that the AUC of the CNN-based AI in the diagnosis of early EC based on endoscopic images was 0.95 (95% CI: 0.93-0.97), demonstrating that CNN-based AI has good diagnostic value for early EC based on endoscopic images. Based on our meta-analysis, CNN-based AI is an excellent diagnostic tool with high sensitivity, specificity, and AUC in the diagnosis of early EC based on endoscopic images.

Melanosis coli as a factor in the development of colorectal cancer

Melanosis coli is characteristic of patients with a long history of constipation and the use of laxatives – anthraquinone derivatives, which are quite prescribed by doctors and patients independently. As a rule, melanosis develops after 4–9 months of taking drugs from this group and is most common in women in the older age group. Pathogenetically, melanosis is characterized by the deposition of pigment in the lamina propria of the mucous membrane, manifested by a pronounced dark coloration of the mucosa, depending on the degree of pigmentation of the colon, melanosis is divided into three degrees. The most common localization is in the right colon, but cases with the spread of pigmentation to the left colon and other parts have been described. Diagnosis does not cause difficulties, melanosis coli is detected during routine endoscopic examination, and is confirmed by pathomorphological examination. Melanosis is an actual problem in terms of the risk of developing colorectal cancer (CRC). There are already convincing data proving that the frequency of detection of adenomas increases not only due to the absence of pigment accumulation by them, but also the pathogenetic aspects of the influence of melanosis on the occurrence and development of adenomas have been described. Proteomic analysis allows to determine the expression of various proteins, which confirms the role of melanosis in the development of colorectal cancer. It is also interesting to note that sometimes there are some difficulties in the differential diagnosis of melanosis, for example, with ischemic lesions of the colon. Patients with melanosis coli require close attention, timely diagnosis and treatment.

English

Adenoid hypertrophy is a common cause of nasal obstruction in children but relatively uncommon in adults, however adenoid hypertrophy in young adults is thought to be a persistence of untreated adenoid hypertrophy of childhood. This case series also notes that adenoid hypertrophy can be associated with deviated nasal septum. Coblation assisted endoscopic adenoidectomy usually has good result in adenoid clearance. Hence, routine endoscopic examination of nasopharynx helps in early diagnosis of adenoid hypertrophy and subsequent better management in young adults with complaints of nasal blockage. Nasopharyngeal vegetations were earlier described by Wilhelm Meyer in 1870 as forming part of Waldeyer’s ring of lymphoid tissue and he coined the term ‘adenoid’ to describe the same. In younger children, it has been thought that the adenoids may have an important role in development of an immunological memory. Physiologically it has been considered that hypertrophy of adenoid tissue occurs during 6 - 10 years and tend to regress and atrophy at 16 years. Grading of adenoid hypertrophy as described by Clemens et al. is as follows.1  Grade I: adenoid tissue filling 1/3rd. of the vertical height of choana.  Grade II: adenoid tissue filling up to 2/3rd of the vertical height of choana.  Grade III: from 2/3rd to nearly all but not completely filling the choana.  Grade IV: complete choanal obstruction We present three cases of adenoid hypertrophy with deviated nasal septums in adults who visited ENT outpatient department (OPD) at National Institute of Medical Sciences, Jaipur during COVID era of January 2021 to April 2021.

Double-endoscope assisted endoscopic submucosal dissection for treating gastric neuroendocrine tumor.

A middle-aged man was found to have a solitary lesion about 5 mm in diameter on the greater curvature of the lower gastric body during routine endoscopic examination ([Fig. 1 a]). Biopsy pathology plus immunohistochemistry reported a neuroendocrine tumor G2. A double-endoscope assisted endoscopic submucosal dissection (ESD) procedure was used to remove the tumor ([Video 1]).

A case report of Abrikossoff`s tumor of cecum treated by endoscopic submucosal dissection

Introduction. Granular cell tumor (GCT, synonym – Abrikossoff’s tumor) is a benign neoplasm of neuroectodermal differentiation from epithelioid cells originating from Schwann’s cells, with a characteristic sign of the presence of lysosomal granules in the cytoplasm. 5–10% of GCTs are found in the gastrointestinal tract, with the most frequent localization in the esophagus, large intestine (the right colon) and perianal zone. Most often, the tumor occurs at the age of 40–60 years, in women. As a rule, the tumor is single, but it can be multiple and associated with various hereditary syndromes, in particular, type 1 neurofibromatosis. A rare malignant variant of GCT with local spread and the possibility of metastasis has been described. At the moment, less than 100 clinical cases with tumor localization in the cecum have been described.Clinical case. A 36-year-old patient with nonspecific complaints of constipation and recurrent abdominal pain during diagnostic colonoscopy a submucosal formation in the cecum up to 1 cm in diameter, dense, fixed in the submucosa, with an unchanged mucous membrane above it was revealed. A biopsy was taken, in which a granular cell tumor was suspected. The tumor was removed by the endoscopic submucosal dissection, and the subsequent morphological and immunohistochemical studies, which confirmed a granular cell tumor (Abrikossoff’s tumor).Conclusion. Granular cell tumor of the colon is a rare, non-specific tumor that can be detected during routine diagnostic endoscopic examination. The diagnosis of GCT is established by morphological examination and immunophenotyping of the removed neoplasm. Removal of the tumor by the endoscopic submucosal dissection can be a radical method of treatment for patients with GCT in the colon.

CLINICO-ETIOLOGICAL SKETCH OF VOCAL CORD PALSY

OBJECTIVE: To determine clinical features and causesof vocal cord paralysis in our set up.MATERIALAND METHODS: This descriptive study was conducted in the department of ENT, Head &amp;Neck Surgery, Hayat Abad Medical complex, Peshawar from January 2010 to December 2012. All newlydiagnosed patients of any age and either gender included. After enrollment a detailed history was taken,thorough ENT and systemic examination was conducted especially focusing on the causes of vocal cordpalsy. After routine investigation endoscopic examination of the upper aero-digestive tract was carried outto establish the diagnosis and causes of vocal cord paralysis.All these patients were followed regularly.Thedata was collected on a pre-designed proforma and analyzed using SPSS version 15.RESULTS: We studied 90 patients over a period of 3 years (2010-2012). Males outnumbered (n-60) withmale to female ratio of 2:1. These patients were in age range of 6-85 years with mean age of 47.33 ± SD21.15 years. The commonest presentation was change of voice (100%). Majority of the patients (n-52,57.77%) were non smoker. Hoarseness was the dominant (94.44%) presentation of these patients. Thecommonest causes of vocal cord palsy was idiopathic (34.44%) followed by thyroid surgery (21.11%). Leftvocal cord palsy was the commonest finding.CONCLUSION: We concluded from this study that vocal cord paralysis is still a challenge for ENTsurgeon. Although in our study idiopathic cause of vocal cord palsy was on top but thyroidectomy has greatcontribution to vocal cord paralysis which can be further minimized if surgeon gives some time to identifythe recurrent laryngeal nerve during thyroid surgery.KEY WORDS: Vocal cord palsy, vocal fold paralysis, hoarseness, clinical feature, etiology

Аутоиммунный гастрит: нерешенные вопросы диагностики, значение внутрипросветной эндоскопии

Autoimmune gastritis remains an insufficiently studied disease with an unknown prevalence and nonspecific clinical picture. Autoimmune gastritis is associated with other autoimmune diseases and characterized by an increased risk of developing neuroendocrine and epithelial tumors of the stomach. The diagnostic criteria for autoimmune gastritis are not clearly defined, the diagnosis is based on the detection of specific antibodies and morphological verification, while the value of intraluminal endoscopy has not been established. The article describes the characteristic signs of autoimmune gastritis, detected during routine endoscopic examination and with the use of magnifying and narrow-spectrum imaging. The clinical observation is presented.

Polipose gástrica: relato de caso e revisão da literatura

Pólipos gastrointestinais são elevações da mucosa circundante do sistema digestório, encontradas frequentemente em exames endoscópicos de rotina. A grande maioria é achado acidental e alguns pólipos podem indicar doença ou síndrome associada. Este artigo tem como objetivo apresentar um caso de polipose gástrica manifestada como Síndrome de Peütz-Jeghers em uma paciente de 25 anos, do sexo feminino, com história de dor abdominal em região epigástrica há 12 dias da admissão hospitalar, que evoluiu com vômitos e hematêmese 3 dias antes do internamento. A paciente realizou endoscopia digestiva alta (EDA), que evidenciou múltiplas lesões polipoides, regulares e de superfície lisa. Tomografia computadorizada (TC) do abdômen visualizou volumosa lesão vegetante coraliforme, de 16,3 x 10,2 x 5,4cm. Optou-se por realizar uma gastrectomia total com reconstrução em Y-de-Roux. O tempo total da cirurgia foi de 150min e ocorreu sem complicações. Paciente evoluiu com boas condições clínicas, sem intercorrências e recebeu alta hospitalar no 9º dia de pós-operatório (DPO). Estudo histopatológico da peça cirúrgica (estômago) evidenciou múltiplos pólipos gástricos de padrão predominante hamartomatoso, com transformação adenomatosa focal, margens cirúrgicas livres, sugerindo síndrome de Peütz-Jeghers. Nossa paciente não demonstrou hiperpigmentação mucocutânea, corroborando o fato de que a hiperpigmentação não é condição “sine qua non” para a síndrome de Peütz-Jeghers.

Endoscopic diagnosis value of narrow band imaging Ni classification in vocal fold leukoplakia and early glottic cancer

ObjectivesTo explore the diagnostic value and the correlation between histological diagnosis and the Ni classification under narrow band imaging (NBI) for vocal fold leukoplakia (VFL) and early glottic cancer. MethodsA total of 91 patients with 119 vocal fold lesions were selected from January 2017 to May 2020. All these patients were subsequently examined by white light imaging (WLI) and NBI endoscopy, and then all lesions were classified by the Ni classification according to the characteristics of intraepithelial papillary capillary loop (IPCL) observed. The gold standard of diagnosis was histopathological results. Eventually, the chi-square and kappa test were applied, respectively, to evaluate the diagnostic value of NBI endoscopy and the consistency of Ni classification and pathological results. ResultsThe accuracy and sensitivity of NBI endoscopy were significantly higher than that of WLI endoscopy (P < 0.05). For the diagnosis of precancerous lesions under the NBI, the sensitivity, specificity, positive and negative predictive value were 69.6% (16/23), 90.6% (87/96), 64.0% (16/25) and 92.6% (87/94), which for malignant lesions were 84.4% (65/77), 92.9% (39/42), 95.6% (65/68) and 76.5% (39/51). Moreover, for patients with low-grade intraepithelial neoplasia (mild and moderate dysplasia), type IV lesions accounted for the most (69.6 vs 30.4%; χ2 = 36.961, P < 0.001). For high-grade intraepithelial neoplasia or carcinoma in situ, type Va lesions were predominant (χ2 = 30.526, P < 0.001), while type Vb and Vc lesions were dominant in invasive carcinoma (χ2 = 64.373, P < 0.001). Besides, the kappa test revealed that there was a high consistency between Ni classification and pathological diagnosis (Kappa = 0.667, P < 0.001). ConclusionsThe Ni classification can improve the diagnosis accuracy of vocal fold lesions which enables clear visualization of mucosal microvasculature. This is essential for the early diagnosis of VFL and early glottic cancer during routine endoscopic examination.

Prevalence of Gerlach tonsil: a mucosa associated lymphoid tissue aggregation in the nasopharynx

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The major aggregate of mucosa associated lymphoid tissue located in the nasopharynx is the adenoid. The minor aggregate located in the nasopharynx is the Gerlach tonsils or tubal tonsils. The Gerlach tonsils are well described in the text books. But unlike the adenoids they are rarely visualized during routine endoscopic examination. Several studies conducted in children for recurrence of adenoids or serous otitis media after surgery; have reported tubal tonsil hypertrophy widely. This study in adults aims to see the prevalence of Gerlach or tubal tonsils visible during nasal endoscopy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The case records of 155 adult patients, aged between 18-50 years, who underwent pre-operative diagnostic nasal endoscopy for the management of septal deviations, chronic Sinusitis, nasal polyposis or eustachian dysfunction between Jan. 2019 to March 2020 are retrospectively reviewed and the endoscopy findings analyzed and presented. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Gerlach tonsil hypertrophy is reported to be more prevalent in children than in adults. When hypertrophied, the Gerlach tonsils can cause symptoms in adults also and can be visualized during nasal endoscopy. In this adult study, we report a 0.6% incidence of Gerlach tonsil hypertrophy. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The possibility of a Gerlach tonsil hypertrophy is to be remembered during nasal endoscopy in adult patients presenting with symptoms of eustachian dysfunction and past history of allergic rhinitis and adeno tonsillectomy. Comparing the size of the contra lateral torus tubaris and the eustachian tube opening during the act of swallowing is helpful in diagnosis.&lt;/p&gt;

Effects of SARS-CoV-2 emergency measures on high-risk lesions detection: a multicentre cross-sectional study

COVID-19 pandemic enforced the interruption of routine endoscopic examinations raising the issue of potential delays in the diagnosis of high-risk lesions. We conducted a multicentre study to assess the decrease...

406 REVIEWING THE DYSPLASIA DURING LONG FU OF BARRETT’S ESOPHAGUS. SHOULD WE RELY ON THE DIAGNOSIS OF DYSPLASIA?

Abstract Barrett’ s esophagus (BE) is a complication of severe gastroesophageal reflux disease (GERD). The major concern aspect is its association to dysplasia and esophageal adenocarcinoma. The endoscopic treatment of the epithelium, as well as the follow-up (FU) period, should be guided according to the diagnosis and the worst degree of dysplasia found in the last endoscopies. However, we are aware of the great difficulty and variation among pathologists in diagnosing and grading dysplasia in BE. Methods Aim: Review new diagnoses of low- and high-grade dysplasia (LGD and HGD) in BE with specialized pathologists during long-term FU in clinical or surgical treatment for GERD From January 1980 to July 2019, 738 patients with BE were FU (average of 98 months), with routine endoscopic examination each 2 years with multiple biopsies, in patients with BE without dysplasia. 48 patients were diagnosed with any grade of dysplasia on FU endoscopic biopsies. The biopsies were reviewed by specialized pathologists and evaluated epidemiologic data, clinical or surgical treatment for the GERD and about the confirmation, downgrade or upgrade of dysplasia degree. Results 48 patients were reviewed, 32 males. The medium age was 61,9 YO (29 -93). Only 18 patients were in follow-up after surgical treatment for GERD. 9 patients had first diagnosis of in situ Adenocarcinoma, after review 8 were confirmed and treated and 1 were downgrade to HGD. 8 patients had first HGD and after review, 2 were upgrade to Adenocarcinoma, 4 were confirmed as HGD (endoscopic treatment) and 2 downgraded to no dysplasia BE. 31 patients had first LGD. 2 had upgrade to HGD/Adeno, 8 are in FU annually and 21 were downgrade to non dysplastic BE. Conclusion The diagnosis of dysplasia in BE remains a challenge. 23 of 48 (47%) of our patients once marked with any grade of dysplasia, were downgrade after pathological review and FU to non dysplasic BE. These difficulty of appropriate dysplasia degree diagnosis could make some mistakes in BE treatment and surveilance.

Association of residual gastric acid secretion with persistent symptoms in gastroesophageal reflux disease patients receiving standard-dose proton pump inhibitor therapy.

Although a third of gastroesophageal reflux disease (GERD) patients are refractory to proton pump inhibitor (PPI) therapy, the underlying mechanism of the refractoriness remains unclear. We compared the level of gastric acid suppression during PPI treatment between responders and non-responders by directly measuring gastric acid secretion in GERD patients taking PPIs. Seventy-five consecutive patients receiving standard-dose PPI therapy for GERD were prospectively recruited, irrespective of persistent GERD symptoms. They were asked about their GERD symptoms using a validated questionnaire, and simultaneously underwent both a routine endoscopic examination and a gastric acid secretory testing using an endoscopic gastrin test. Associations between residual gastric acid secretion during PPI treatment and persistent GERD symptoms were analyzed by a logistic regression analysis. Overall, 26 of 75 (34.7%) patients were judged to be positive for persistent GERD symptoms. The patients with and without persistent symptoms showed similar gastric acid secretion levels (1.3 [1.3]mEq/10min vs. 1.4 [2.0]mEq/10min). Sufficient gastric acid suppression, defined as < 0.6, was not significantly associated with persistent GERD symptoms (odds ratio 1.1, 95% confidence interval 0.40-3.5). This study provided solid evidence to support that the gastric acid suppression level during PPI treatment does not differ between patients with and without persistent GERD symptoms. The insignificant role of residual gastric acid in the persistent GERD symptoms suggests that the use of medications other than those that enhance gastric acid inhibitory effects would be an essential approach for the management of PPI-refractory GERD.