Gastroscopy Research Articles

IL-8, TNF-α, and IL-17 in the Development of Erosive Esophagitis and Symptom Perception in Gastroesophageal Reflux Disease (GERD)

Background: The diverse clinical characteristics of erosive esophagitis (EE) and symptom perception in patients with gastroesophageal reflux disease (GERD) remain a major challenge in understanding their underlying pathogenesis. This study aimed to investigate the association between the levels of IL-8, TNF-α, and IL-17 in serum and the presence of erosive esophagitis and symptoms related to GERD. Method: We enrolled 65 subjects presenting with GERD symptoms. Based on the findings of upper endoscopy, the subjects were categorized into two groups: (1) erosive esophagitis (EE LA grades B-D) and (2) non-erosive esophagitis (normal-EE LA grade A). Symptom perception was assessed via GERD questionnaire (GERD-Q) and the frequency scale for the symptoms of GERD (FSSG). The enzyme-linked immunosorbent assay (ELISA) method was used to analyze serum levels of IL-8, TNF-α, and IL-17. Analysis of cytokine levels between different symptoms severity was performed using the Kruskal-Wallis H test. Results: Median serum IL-8 levels were significantly higher in the erosive esophagitis group compared to those with non-erosive esophagitis (20.2 (IQR 16.9–32.2) vs. 17.7 (IQR 15.2–19.6), p < 0.05). The study found a significant association between IL-8 levels and the presence of globus symptoms (median IL8 level 46.961 (38.622–92.644) in subjects with globus vs. 18.06 (16.68–20.49) in those without globus; p < 0.05). Similarly, TNF-α levels were associated with the frequency of regurgitation symptoms (H index = 10.748; dr = 3; p < 0.05). We observed a significant correlation between IL-17 levels and the frequency of heartburn and early satiety symptoms. Conclusions: IL-8 may play a role in the development of mucosal erosion in GERD. IL-8, TNF- α, and IL-17 might be involved in the development of globus symptoms, the frequency of regurgitation, and the frequency of heartburn and early satiety, respectively. The diverse symptom phenotypes observed in patients with GERD symptoms may be mediated by distinct profiles of proinflammatory cytokines.

PCR-based RFLP and ERIC-PCR patterns of Helicobacter pylori strains linked to multidrug resistance in Egypt.

H. pylori infects approximately 50% of the world's population that causes chronic gastritis, and may lead to peptic ulcer disease (PUD). H. pylori-induced chronic infections are associated with gastric adenocarcinoma and low-grade gastric lymphoma. In Egypt, H. pylori strains are widespread and became resistant to antimicrobial agents, thus advanced typing methods are needed to differentiate infectious strains that are resistant to antibiotics, and therefore earlier prognosis and infection control. The main objectives were (i) to determine susceptibility of infectious H. pylori strains to some antimicrobial agents that are currently used in eradication therapy in Egypt; (ii) to identify diverse strains commonly detected in the gastrointestinal (GIT) endoscopy units in Egypt through phenotypic and genotypic analyses. In this observational study we isolated 167 isolates from 232 gastric biopsies (antrum and corpus) of patients who were admitted to the upper GIT endoscopy units in five governmental Egyptian hospitals. Antimicrobial susceptibility patterns were investigated using Kirby Bauer disc diffusion and agar dilution Minimum Inhibitory Concentrations (MICs) methods. Phenotypic characterization was based on biotyping and antibiogram typing techniques. Genotypic characterization was carried out using PCR-based Restriction Fragment Length Polymorphism (RFLP) and Enterobacterial Repetitive Intergenic Consensus (ERIC)-PCR analyses. H. pylori isolates were highly resistant to diverse antimicrobial agents including Metronidazole, Fluoroquinolones, Macrolides, Amoxycillin, Tetracycline and Gentamicin. Two factors contributed to the increased resistance of H. pylori to the conventional therapy seen in Egypt: (i) Metronidazole and Amoxycillin are inexpensive and available drugs being abused by patients; (ii) the regional prescribing practice of Macrolids commonly used to treat upper respiratory and urinary tract infections. Five different biotypes were identified depending on the ability of the isolates to synthesize different enzymes. Nine antibiogram types were identified. PCR-RFLP analysis revealed fifteen different fingerprints while ERIC-PCR revealed 22 fingerprints. Biotyping alone or in combination with antibiogram typing are highly useful molecular tools in the prognosis of strain relatedness. PCR-RFLP and ERIC-PCR acquired good discriminatory power for identifying H. pylori infectious sub-types.

The Gastroscopy RAte of Cleanliness Evaluation (GRACE) Scale: an international reliability and validation study.

mucosal visualization during upper gastrointestinal (UGI) endoscopy can be impaired by the presence of foam, bubbles, and mucus. Some UGI endoscopy visibility scales were proposed but without a multicenter validation. This study aimed to develop and validate the Gastroscopy RAte of Cleanliness Evaluation (GRACE) scale. a multicenter international cross-sectional study was conducted. The GRACE scale is based on a score from 0-worst to 3-excellent of esophagus, stomach, and duodenum, for a total ranging from 0 to 9. In the first phase, four expert endoscopists evaluated 60 selected images twice with a two-week interval; in the second phase, the same 60 images were scored twice by one expert and one non-expert endoscopist from 27 different Endoscopy Departments worldwide. For reproducibility assessment and clinical validation, a real-time scale application was performed on consecutive patients undergoing gastroscopy in each center. in the internal validation, the interobserver agreement was 0.81 (95%CI[0.73-0.87]) and 0.80 (95%CI[0.72-0.86]), with a reliability of 0.73 (95%CI[0.63-0.82]) and 0.72 (95%CI[0.63-0.81]), in the two rounds, respectively. In the external validation, the overall interobserver agreement was 0.85 (95%CI[0.82-0.88]) with a reliability of 0.79 (95%CI[0.73-0.84]). In the real-time evaluation phase, the overall percentage of correct classifications was 0.80 (95%CI[0.77-0.82]). the GRACE scale showed good interobserver agreement and reliability and good validity. The spread of this scale could enhance the quality and standardize the cleanliness of the mucosa assessment during UGI endoscopy, pushing endoscopists to obtain excellent visibility and reducing the risk of missing lesions.

Efficacy of Upper Gastrointestinal Endoscopy In Cholelithiasis Before Laparoscopic Cholecystectomy

Background: The most prevalent condition affecting the gallbladder and biliary tree is cholelithiasis. Presence of gall stones is discovered commonly during imaging tests for other pathologies. Laparoscopic cholecystectomy is a preferred modality for the treatment of gallstone disease. Objective: The primary aim of the study is to determine the efficacy of upper gastrointestinal endoscopy as a routine investigative modality in symptomatic presentation of cholelithiasis prior to laparoscopic cholecystectomy. Methods: A total 50 participants having single or multiple stones in the gall bladder found on ultrasound were included in the study. Enrolled patients underwent routine investigations. The baseline demographic details like patient name, age, gender, clinical presentation, and upper endoscopy findings were documented. The intensity of the pain was measured by visual analogue scale. Results: A total of 36% patients were in the age-group of < 30 years. The highest incidence of cholelithiasis was observed in female gender. Abdominal pain was the most common symptom. The most common upper gastrointestinal endoscopy findings were gastritis followed by gastritis erosion. A significant reduction of pain was noted in group I as compared to group II at first- and fourth-week time durations. Conclusion: Cholelithiasis has common clinical presentations in similarity to other upper gastrointestinal diseases. Upper gastrointestinal endoscopy can be recommended for patients with atypical presentation to prevent post-surgical adverse outcomes.

Evaluating the discrepancies between evidence-based and community standard practices in the endoscopic diagnosis of esophageal squamous cell carcinoma: a survey study.

The practice of endoscopic diagnosis of esophageal squamous cell carcinoma (ESCC) often diverges from evidence-based standards due to various factors, including inadequate dissemination of evidence or a mismatch between evidence and real-world contexts. This survey aimed to identify discrepancies between evidence-based standard practices and community standard practices for ESCC among endoscopists. An online survey targeting endoscopists who perform upper gastrointestinal endoscopy at least weekly was conducted to collect data on clinical practices related to ESCC diagnosis. The survey, comprising 20 questions, was disseminated through multiple professional networks. Descriptive statistical analysis and logistic regression were performed to analyze the data. Data from 819 endoscopists were included in the analyses. Notably, a significant proportion employed narrow-band imaging/blue-laser imaging over iodine staining, and preferences varied based on risk assessment for ESCC. In total, 64.0% of endoscopists primarily used iodine solution at a concentration of 1% or less, while 96.5% of endoscopists performed an observation of the oral cavity and the pharynx when conducting upper gastrointestinal endoscopies on individuals at high risk of ESCC. The surveillance interval for metachronous multiple ESCCs was most commonly every 6months, followed by every 12months. In addition, most physicians conducted surveillance of metastatic recurrence at 6-month intervals. This survey highlights significant gaps between evidence-based and community standard practices in the endoscopic diagnosis of ESCC. These findings underscore the need for enhanced dissemination of evidence-based guidelines and consideration of real-world clinical contexts to bridge these gaps and optimize patient care.

Reflux, eosinophilic esophagitis, and celiac disease - the blurred lines.

Gastroesophageal reflux disease (GERD) is a commonly recognized cause of dysphagia. Conversely, eosinophilic esophagitis (EoE) and celiac disease are rarer and often overlooked as dysphagia culprits. Overlap between these conditions complicates diagnosis and delays appropriate treatment. This review aims to clarify the distinctive dysphagia characteristics in each condition, explore potential overlaps, and offer guidance on differentiation. Recent studies have advanced our understanding of dysphagia mechanisms in GERD, EoE, and celiac disease, particularly in characterizing disordered motility and dysphagia's natural history. While upper endoscopy, biopsies, and manometry remain crucial in dysphagia assessment, novel diagnostic tools are emerging. New insights highlight the significance of cytokine-induced mucosal injury in all three conditions, revealing potential connections where mucosal damage in one disorder may contribute to the development of others. GERD, EoE, and celiac disease can coexist and present with similar symptoms. Distinguishing between them often entails upper endoscopy, esophageal biopsies, pH testing, and celiac serologies. EoE should be considered when GERD patients fail proton pump inhibitor therapy or when celiac patients have persistent esophageal symptoms despite a gluten-free diet. Consider celiac disease if dysphagia accompanies iron deficiency anemia, malabsorptive diarrhea, or osteoporosis. Recognizing the potential overlap between these conditions is crucial for guiding clinical evaluation and therapy.

Applications of Artificial Intelligence-Based Systems in the Management of Esophageal Varices.

Esophageal varices, dilated submucosal veins in the lower esophagus, are commonly associated with portal hypertension, particularly due to liver cirrhosis. The high morbidity and mortality linked to variceal hemorrhage underscore the need for accurate diagnosis and effective management. The traditional method of assessing esophageal varices is esophagogastroduodenoscopy (EGD), which, despite its diagnostic and therapeutic capabilities, presents limitations such as interobserver variability and invasiveness. This review aims to explore the role of artificial intelligence (AI) in enhancing the management of esophageal varices, focusing on its applications in diagnosis, risk stratification, and treatment optimization. This systematic review focuses on the capabilities of AI algorithms to analyze clinical scores, laboratory data, endoscopic images, and imaging modalities like CT scans. AI-based systems, particularly machine learning (ML) and deep learning (DL) algorithms, have demonstrated the ability to improve risk stratification and diagnosis of esophageal varices, analyzing vast amounts of data, identifying patterns, and providing individualized recommendations. However, despite these advancements, clinical scores based on laboratory data still show low specificity for esophageal varices, often requiring confirmatory endoscopic or imaging studies. AI integration in managing esophageal varices offers significant potential for advancing diagnosis, risk assessment, and treatment strategies. While promising, AI systems should complement rather than replace traditional methods, ensuring comprehensive patient evaluation. Further research is needed to refine these technologies and validate their efficacy in clinical practice.

Endoscopic Outcomes Before and Five Years After Laparoscopic Sleeve Gastrectomy: Is There a Significant Impact?

Laparoscopic sleeve gastrectomy (LSG) is a popular bariatric procedure with significant effects on weight and metabolic health. However, its impact on gastroesophageal reflux disease (GERD) and esophageal symptoms remains debated. This study aims to evaluate the endoscopic changes five years post-LSG. We conducted a retrospective analysis of patients who underwent LSG at our center between June 2017 and June 2019. Inclusion criteria included preoperative and at least five-year follow-up esophagogastroduodenoscopy (EGD). We analyzed demographic factors, esophageal symptoms, and endoscopic findings. Out of 118 patients who underwent LSG, 24 met the inclusion criteria. Two patients were excluded due to conversion to Roux-en-Y gastric bypass (RYGB). The final cohort included 22 patients with a mean age of 42 ± 10 years and a mean BMI of 45 ± 7 kg/m². Preoperative EGD showed no GERD in 21 patients (95.5%) and GERD in 1 patient (4.5%). At five-year follow-up, 14 patients (63.6%) had no GERD, 7 (31.8%) had GERD A, and 1 (4.5%) had GERD B. Esophageal symptoms included heartburn (54.5%), nausea (36.4%), regurgitation (31.8%), and epigastric pain (22.7%). PPI or antacid use was reported in 10 patients (45.5%). Extra-esophageal symptoms were rare. BMI was significantly higher in patients with GERD (34.5 ± 6.3 kg/m²) compared to those without GERD (30.2 ± 5.1 kg/m², p = 0.04). LSG may lead to the development or worsening of GERD in a subset of patients, despite the majority showing no significant GERD changes over five years. Continuous monitoring and tailored management strategies are essential for optimizing outcomes.

Real-Time Gastric Juice Analysis in Cirrhotic Patients: Can We Avoid Unrewarding Gastric Biopsies?

Background: To search for H. pylori infection and gastric precancerous lesions in cirrhotic patients is worthwhile when considering the high incidence of peptic ulcers and gastric cancer in these patients. We tested if gastric juice analysis allows to avoid unrewarding gastric biopsies. Methods: This prospective study enrolled consecutive patients with liver cirrhosis who underwent upper endoscopy with standard gastric biopsies. Real-time gastric juice analysis was performed with a specific device (EndoFaster®) that test ammonium concentration for H. pylori diagnosis, and pH values to suspect extensive atrophy/metaplasia involving gastric body mucosa. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), the overall accuracy, and the likelihood ratio were calculated for both H. pylori infection and extensive precancerous lesions on gastric mucosa. Results: A total of 78 cirrhotic patients (males: 55; mean age: 66 ± 12 years) were enrolled. When considering as positive EndoFaster® results when at least one of two (ammonium and pH levels) tests were positive, the NPVs were as high as 89% and 86%, respectively, to rule out H. pylori and extensive precancerous lesions on gastric mucosa, with an overall accuracy of 83% and 74%. Conclusions: This study supports the evidence that real-time gastric juice analysis allows to avoid clinically unrewarding and potentially unsafe gastric biopsies in a definite portion of cirrhotic patients, but more data are needed.

Surgical and Endoscopic Approaches to Management of Submucosal Tumors of the Gastroesophageal Junction: Technical Considerations and Systematic Review of the Literature

Background: Gastroesophageal junction (GEJ) submucosal tumors are comprised predominantly of leiomyomas, followed by gastrointestinal stromal tumors. Methods: Herein we provide a comprehensive review of GEJ submucosal tumors including a systematic review of the literature. Results: Computed tomography, esophagogastroduodenoscopy, and endoscopic ultrasound are the most commonly used diagnostic imaging modalities. Surgical resection via laparoscopy is the most common treatment approach, with simultaneous upper endoscopy utilized in approximately half of the cases. Concomitant fundoplication is performed by certain groups to minimize risk for postoperative leak, gastroesophageal reflux, and esophagitis. Conclusions: Prospective studies evaluating long-term outcomes are needed to help guide treatment.

Image J as the quantification tool in endosonography strain elastography may be reflected in the disturbance of endocrine pancreatic dysfunction.

Pancreatic fibrosis is one of the main pathological features of chronic pancreatitis (CP), suggesting a strong relationship between CP and pancreatic ductal cancer. There was no available data about pancreatic fibrosis and pancreatic dysfunction in the early CP (ECP) using endosonography (EUS). Asymptomatic patients with pancreatic enzyme abnormalities (AP-P; n = 56) and patients with ECP (n = 21) were determined by the absence of abnormal findings on upper gastrointestinal endoscopy, abdominal ultrasonography, and abdominal computed tomography. An Olympus EUS (GF-UCT 260; Olympus) was used to perform EUS. Open software "Image J", developed by NIH, was used to measure the surface area fraction of the designated elastic blue region. The maximum value among the pancreatic head, pancreatic body, and pancreatic tail was defined as the ELST-blue score. The exocrine and endocrine pancreatic functions were evaluated using the N-benzoyl-l-tyrosyl-p-aminobenzoic acid (BT-PABA) test and homeostasis model assessment of β-cell function (HOMA-β) value, respectively. EUS score, lobularity, and hyperechoic foci/strands in patients with ECP were significantly (p < 0.001) higher than those in patients with AP-P. In addition, there were no significant differences in the BT-PABA test (73.1 ± 25.5, 68.5 ± 15.6) and HOMA-β (93.1 ± 67.4, 73.5 ± 139.7) between patients with ECP and AP-P. The ELST-blue score measured by image J as the quantification tool in EUS strain elastography in patients with ECP was significantly higher (p = 0.002) than that in patients with AP-P. Interestingly, the ELST-blue score was significantly associated with HOMA-β in patients with ECP. The ELST-blue score may be a useful tool for the evaluation of endocrine pancreatic dysfunction in the ECP.

Correlation of gastrointestinal symptom rating scale and frequency scale for the symptoms of gastroesophageal reflux disease with endoscopic findings

Background Gastroesophageal Reflux Disease (GERD) is caused by the reflux of gastric contents into the esophagus and has a 13% global prevalence that is increasing. GERD symptoms negatively impact physical, social, and emotional quality of life. The Frequency Scale for the Symptoms of GERD (FSSG) and the Gastrointestinal Symptom Rating Scale (GSRS) determine the efficacy of treatment but may not correlate with endoscopically estimated esophageal mucosal injury severity. We aimed to probe the correlation between FSSG, GSRS, and esophageal injury severity to evaluate whether these scores can predict GERD severity. Methods A total of 2962 patients who underwent physical examinations, including upper gastrointestinal endoscopy, at the Kyoto Kuramaguchi Medical Center, Japan, were enrolled in this study. Upper gastrointestinal endoscopy was used to diagnose fundic mucosal atrophy, reflux esophagitis based on the Los Angeles (LA) classification, gastroesophageal flap value function (GEFV) based on Hill’s classification, and Barrett’s esophagus. Endoscopic diagnoses were examined for correlations with FSSG and GSRS scores. Results In reflux esophagitis, FSSG and GSRS scores correlated with LA-B and LA-C endoscopic diagnosis but not with LA-M and LA-A endoscopic findings. Multiple regression analysis results were similar. FSSG scores reflected advanced fundic gland mucosal atrophy, while GSRS scores associated with high grade of GEFV. Conclusions This is the first report to examine the correlation between FSSG and GSRS scores and endoscopic findings in a relatively large patient population. Our findings suggest that these scores can diagnose the severity of reflux esophagitis.

Hemorragia digestiva grave debido a ectasia vascular de yeyuno

Introduction: bleeding from the small bowel represents 5% of all cases of gastrointestinal (GI) bleeding and is mainly due to vascular malformations. Diagnosis is made by capsule endoscopy, although it depends on the patient´s condition as well as capsule endoscopy availability. Case report: a 22-year-old female patient presenting with hematochezia leading to hypovolemic shock and cardiorespiratory arrest, with negative upper and lower GI endoscopies. Given the impossibility of accessing capsule endoscopy, a surgical intervention was performed which identified jejunal vascular ectasia.

Compromiso gástrico por enfermedad relacionada con IgG4

Introduction: IgG4-related disease (IgG4-RD) is a recently described entity, characterized by IgG4+ infiltration of plasma cells and storiform pattern sclerosis mediated by CD4+ lymphocytes and follicular helper T-cells (Tfhs). Most patients present with adenopathy and weight loss. Among the most affected sites are the pancreas, salivary and lacrimal glands, aorta, and retroperitoneum. Gastric involvement is rare. Diagnosis is based on histopathological examination of the involved organ, clinical manifestations, and serological results. Glucocorticoid therapy is the first line management. Case report: a 38-year-old male patient with symptoms suggestive of upper gastrointestinal (GI) bleeding, upper GI endoscopy revealed a gastric corpus ulcer, suspicious of an ulcerated gastric subepithelial lesion, possibly a gastrointestinal stromal tumor (GIST). Consequently, laparoscopic subtotal gastrectomy was performed. Histology was compatible with an ulcerated IgG4-related fibrosclerosing tumor. Glucocorticoid therapy was started with patient´s favorable response. Conclusion: in this paper, we will review the cases of IgG4-RD with gastric involvement reported in the literature to describe the most important features of this condition.

Timing of Endoscopic Intervention for Esophageal Food Impaction and Its Impact on Patient Outcomes.

Esophageal food impaction (EFI) is a common complaint of patients presenting to the emergency department. EFI requires urgent evaluation by the gastroenterology service and often necessitates esophagogastroduodenoscopy (EGD) for management. Timing of EGD in patients with EFI that does not improve with medical management remains a point of contention. We aim to evaluate outcomes of EFI in the context of time to intervention. A retrospective cohort study was performed among patients who presented to a multicenter health system with EFI between 2018 and 2022. Patients with EFI that did not resolve after medical management and required EGD were included. Outcome analysis evaluated rates of complications and hospitalizations. Two hundred eighty sis unique patient presentations were included. 175 (61.2%) of patients underwent EGD within six hours of presentation, 59 (20.6%) underwent EGD six to twelve hours after presentation, and 52 (18.2%) underwent EGD beyond twelve hours after presentation. Complication rates did not differ between patients depending on timing of EGD (p = 1.000). Admission rates were higher among patients in whom EGD was performed longer after presentation (p = 0.003). Complication rates were higher among patients with advanced age (p = 0.037), prior impaction (p = 0.004), and those who have not received glucagon (p = 0.007). Timing of EGD after presentation in patients with EFI was not associated with a difference in complication rates. Delayed intervention was associated with a higher rate of hospitalization which should be taken into consideration when assessing the cost of EFI to the healthcare system.

Narrow band imaging: Important tool for early diagnosis, management, and improved outcomes in gastrointestinal lesions.

Narrow band imaging-magnifying endoscopy (NBI-ME) is used to identify changes in mucosal or vascular pattern observed on GI endoscopy in real time on the basis of optical image enhancement.It has a significant role in early detection of dysplasia, premalignant, and Malignant lesions along with its depth of invasion. Upper and lower GI endoscopy performed in 1742 patients who presented with gastrointestinal symptoms at this tertiary center over 5years out of which 1623 were evaluated with both NBI-ME and histopathology. Real time endoscopic assessment was performed. Targeted biopsies were taken for comparative analysis. Of the 1742 patients, 119 were excluded from the study. 807 underwent upper GI endoscopy and 816 underwent lower GI endoscopy. Mean age of presentation was 38 +/- 2.7years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of NBI-ME for neoplastic esophageal lesions were 96.3%, 90.6%, 91.1%, 96.03%, respectively. For Barrett's esophagus it was 95.4%, 90.7%, 86.1%, and 90.7%; For gastric neoplastic lesions the values were 96.1%, 91.04%, 83.8%, and 97.9%. For colorectal it was 96.7%, 91.3%, 88.0%, and 97.7%. Overall sensitivity, specificity, PPV, andNPVof NBI-ME for neoplastic lesions (both upper and lower GI) were 96.2%, 91.0%, 96.2%, and 97.2%. Of the 1623 patients, 951 received medical management with regular surveillance and 672 patients with high-grade dysplasia, premalignant, and malignant conditions underwent interventions in form of either endoscopy or surgery. NBI-ME has a greater role and can be considered as an effective tool in making early diagnosis and guiding optimum treatment.

Evaluating the Necessity of Routine Histopathology in Sleeve Gastrectomy Specimens: A Five-Year Analysis.

Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric surgery that involves the removal of a portion of the stomach. Routinely, the resected gastric tissue is sent for histopathological examination to screen for malignancies or other significant pathological findings. However, the necessity of this routine practice remains uncertain. This study aims to evaluate the histopathological outcomes of LSG specimens over a five-year period at our institution. We conducted a retrospective analysis of 203 patients who underwent LSG between January 2017 and December 2022 at Heartlands Hospital, University Hospitals Birmingham. Data collected included patient demographics, body mass index (BMI), use of preoperative oesophagogastroduodenoscopy (OGD), and histopathological findings. Patients with incomplete records or those who underwent Roux-en-Y gastric bypass were excluded from the study. Data were extracted for 310 patients, of whom 107 were excluded. The majority of the 203 patients analyzed were female (83%), with a mean age of 45.7 years and a mean BMI of 45.4 ± 7.3. Preoperative OGD was performed in only 0.5% of cases. Histopathological examination revealed that 81.3% (n=165) of patients had normal gastric mucosa, while 14.3% (n=29) had chronic gastritis. Clinically significant findings were rare, with only 1% (n=2) of patients showing gastrointestinal stromal tumors (GISTs) or focal intestinal metaplasia. None of the patients required additional treatment or follow-up based on these histopathological findings. Most LSG specimens in our study showed normal or non-significant histopathological findings, raising questions about the routine use of histopathological examination in LSG procedures. It remains unclear whether histopathology is necessary following sleeve gastrectomy. While no patients in our cohort required further treatment or surveillance, there are reports in the literature where surveillance or further treatment was necessary, though the incidence remains low. Given the low incidence of clinically significant pathology, further studies with larger sample sizes and multi-center data are needed to establish clear guidelines on this issue.

Endoscopic Evaluation and Management of Superficial Esophageal Squamous Cell Carcinoma

AbstractEsophageal squamous cell carcinoma (SCC) is the seventh most common malignancy and the sixth leading cause of cancer-related deaths globally, demanding precise diagnostic and individualized therapeutic interventions. This case study describes the diagnosis and treatment of esophageal SCC in a 54-year-old man initially detected during an upper gastrointestinal endoscopy. The lesion was identified using narrow-band imaging and magnifying endoscopy; after imaging studies, it was treated with endoscopic submucosal dissection (ESD). ESD is known for its minimal invasiveness and the definitive histopathological evaluation it facilitates.The management strategy described in this paper reiterates the criticality of extensive pretreatment evaluations, the indication of the application of ESD, and the importance of a multidisciplinary team. It underscores the significance of careful posttreatment monitoring and the informed selection of adjuvant therapies, particularly in areas like India, where such advanced endoscopic techniques are still on the rise.

Chronic Atrophic Gastritis and Intestinal Metaplasia: A Latin American Perspective

Gastric cancer (GC), a significant cause of mortality globally, is the leading cause of cancer-related deaths among Latin American men. GC is usually diagnosed at an advanced stage; therefore, therapeutic options are limited, and prognosis is poor. &lt;i&gt;Helicobacter pylori&lt;/i&gt; infection remains the primary risk factor for GC; therefore, primary prevention directed toward diagnosis and treatment (“test-and-treat” strategy) is important. Western medicine guidelines recommend esophagogastroduodenoscopy (EGD) for at-risk individuals aged &gt;40 years with regular surveillance in patients with gastric premalignant conditions (GPMC). However, limited availability of EGD in Latin America necessitates development of risk stratification tools to minimize the endoscopic burden. Results from the Chilean “Endoscopic Cohort and Histological Operative Link on Gastric Assessment (OLGA) Staging” (ECHOS study), propose endoscopic surveillance of advanced GPMC (OLGA/Operative Link for Gastric Intestinal Metaplasia [OLGIM] stages III–IV) with reliable risk stratification to facilitate early GC detection. Ensuring high-quality EGD and enhanced diagnostic yield of GPMC is essential. GPMC grading tools, such as the Kimura-Takemoto or Endoscopic Grading of Gastric Intestinal Metaplasia classification, should be incorporated into the regular risk assessment protocol. However, obtaining mapping gastric biopsies using standardized methods such as the updated Sydney System biopsy protocol, followed by grading of chronic atrophic gastritis with or without intestinal metaplasia using the OLGA and OLGIM staging systems are preferred for GC risk stratification. Recent GC prevention strategies recommended in Chile include a “test-and-treat” approach for &lt;i&gt;H. pylori&lt;/i&gt; in individuals aged 35–44 years and combined &lt;i&gt;H. pylori&lt;/i&gt;/pepsinogen I–II serology and EGD evaluation in patients aged &gt;45 years to optimize the limited preventive resources available in the region.

Concurrent Esophageal Leiomyoma and Helicobacter pylori Infection

Esophageal leiomyomas are rare benign tumors arising from smooth muscle cells in the esophagus. Despite their rarity, they present unique diagnostic and management challenges due to varied symptomatology and anatomical locations. Here, we present a case of a 40-year-old male with unresolved dysphagia and epigastric pain referred for esophagogastroduodenoscopy (EGD). EGD revealed a medium-sized submucosal mass at the gastroesophageal junction, partially obstructing the lumen. Concurrently, severe chronic active gastritis with Helicobacter pylori (H. pylori) infection was confirmed upon gastric biopsy. Subsequent evaluation included endoscopic ultrasound (EUS), which identified a likely benign esophageal leiomyoma. Although a surgical referral was recommended, the patient was deferred. This case highlights the importance of EGD in diagnosing esophageal leiomyomas and uncovering incidental findings that can significantly influence patient management. The rare presentation of this leiomyoma at the gastroesophageal junction, combined with the co-occurrence of severe H. pylori-induced gastritis and chronic GERD, introduces new considerations for understanding the pathophysiology of esophageal tumors. The rare combination of these factors highlights the need for further research into their interactions, providing novel insights that could influence future diagnostic strategies and therapeutic approaches for similar cases.