Foreign body ingestion in children is considered an emergency. The most common ingested foreign bodies are coins;however, the ingestion of disc batteries is on the rise requiring urgent rigid esophagoscopy. In the lit...Foreign body ingestion in children is considered an emergency. The most common ingested foreign bodies are coins;however, the ingestion of disc batteries is on the rise requiring urgent rigid esophagoscopy. In the literature, multiple foreign body ingestion is very rare and only a few cases of multiple coins and multiple battery ingestion have been reported in the past. Herein, a case of simultaneous coin and battery ingestion requiring foreign bodies removal on two sequential endoscopies due to improper initial evaluation in a pediatric patient is reported which, to our knowledge, is the first reported case.展开更多
Pneumatic dilation(PD) is considered to be the first line nonsurgical therapy for achalasia.The principle of the procedure is to weaken the lower esophageal sphincter by tearing its muscle fibers by generating radial ...Pneumatic dilation(PD) is considered to be the first line nonsurgical therapy for achalasia.The principle of the procedure is to weaken the lower esophageal sphincter by tearing its muscle fibers by generating radial force.The endoscope-guided procedure is done without fluoroscopic control.Clinicians usually use a lowcompliance balloon such as Rigiflex dilator to perform endoscope-guided PD for the treatment of esophageal achalasia.It has the advantage of determining mucosal injury during the dilation process,so that a repeat endoscopy is not needed to assess the mucosal tearing.Previous studies have shown that endoscope-guided PD is an efficient and safe nonsurgical therapy with results that compare well with other treatment modalities.Although the results may be promising,long-term follow-up is required in the near future.展开更多
The authors present the clinical case of an 87-year-old Caucasian male admitted to the emergency room with hematemesis. He had a history of intermittent dys-phagia during the previous month. Endoscopic evaluation reve...The authors present the clinical case of an 87-year-old Caucasian male admitted to the emergency room with hematemesis. He had a history of intermittent dys-phagia during the previous month. Endoscopic evaluation revealed an eccentric,soft esophageal lesionlocated 25-35 cm from the incisors,which appeared asa protrusion of the esophagus wall,with active bleeding. Biopsies were acquired. Tissue evaluation wascompatible with a melanoma. After excluding other sites of primary neoplasm,the definitive diagnosis of Primary Malignant Melanoma of the Esophagus(PMME) was made. The patient developed a hospital-acquired respiratory infection and died before tumor-directed treatment could begin. Primary malignant melanoma represents only 0.1% to 0.2% of all esophageal ma-lignant tumors. Risk factors for PMME are not defined.A higher incidence of PMME has been described in Japan. Dysphagia,predominantly for solids,is the most frequent symptom at presentation. Retrosternal orepigastric discom fort or pain,melena or hemate mesishave also been described. The characteristic endoscopic finding of PMME is as a polypoid lesion,with variablesize,usually pigmented. The neoplasm occurs in thelower two-thirds of the esophagus in 86% of cases.PMME metastasizes via hematogenic and lymphatic pathways. At diagnosis,50% of the patients present with distant metastases to the liver,the mediastinum,the lungs and the brain. When possible,surgery(curative or palliative) ,is the preferential method of treatment. There are some reports in the literature where chemotherapy,chemohormon otherapy,radiotherapy and immunotherapy,with or without surgery,wereused with variable efficacy. The prognosis is poor;themean survival after surgery is less than 15 mo.展开更多
AIM： Although most patients with achalasia respond to pneumatic dilation, one-third experienced recurrence, and prolonged follow-up studies on parameters associated with various outcomes are scanty. In this retrospec...AIM： Although most patients with achalasia respond to pneumatic dilation, one-third experienced recurrence, and prolonged follow-up studies on parameters associated with various outcomes are scanty. In this retrospective study, we reported a 15-years＇ experience with pneumatic dilation treatment in patients with primary achalasia, and determined whether previously described predictors of outcome remain significant after endoscopic dilation. METHODS： Between September 1989 and September 2004, 39 consecutive patients with primary symptomatic achalasia （diagnosed by clinical presentation, esophagoscopy, barium esophagogram, and manometry） who received balloon dilation were followed up at regular intervals in person or by phone interview. Remission was assessed by a structured interview and a previous symptoms score. The median dysphagia-free duration was calculated by Kaplan-Meier analysis. RESULTS： Symptoms were dysphagia （n = 39, 100%）, regurgitation （n = 23, 58.7%）, chest pain （n = 4, 10.2%）, and weight loss （n = 26, 66.6%）. A total of 74 dilations were performed in 39 patients; 13 patients （28%） underwent a single dilation, 17 patients （48.7%） required a second procedure within a median of 26.7 mo （range 5-97mo）, and 9 patients （23.3%） underwent a third procedure within a median of 47.8 mo （range 37-120 mo）. Post-dilation lower esophageal sphincter （LES） pressure, assessed in 35 patients, has decreased from a baseline of 35.8±10.4- 10.0±7.1 mmHg after the procedure. The median follow-up period was 9.3 years （range 0.5-15 years）. The dysphagia- free duration by Kaplan-Neier analysis was 78%, 61% and 58.3% after 5, 10 and 15 years respectively. CONCLUSION： Balloon dilation is a safe and effective treatment for primary achalasia. Post-dilation LES pressure estimation may be useful in assessing response. 2005 The W.IG Press and Elsevier Inc. All rights reserved.展开更多
Capsule endoscopy is now considered as the first imaging tool for small bowel examination. Recently, new capsule endoscopy applications have been developed, such as esophageal capsule endoscopy and colon capsule endos...Capsule endoscopy is now considered as the first imaging tool for small bowel examination. Recently, new capsule endoscopy applications have been developed, such as esophageal capsule endoscopy and colon capsule endoscopy. Esophageal capsule endoscopy in patients with suspected esophageal disorders is feasible and safe, and could be also an alternative procedure in those patients refusing upper endoscopy. Although large-scale studies are needed to confirm its utility in GERD and cirrhotic patients, current results are encouraging and open a new era in esophageal examination.展开更多
AIM: To assess feasibility of unsedated esophagoscopy using a small-caliber disposable transnasal esophagosco-py and to compare its accuracy with standard endoscopy.METHODS: We prospectively included subjects who were...AIM: To assess feasibility of unsedated esophagoscopy using a small-caliber disposable transnasal esophagosco-py and to compare its accuracy with standard endoscopy.METHODS: We prospectively included subjects who were referred for upper endoscopy. All subjects un-derwent transnasal endoscopy with E.G. Scan^(TM). The disposable probe has a 3.6 mm gauge and at its distal end there is a 6 mm optical capsule, with a viewing angle of 125°. Patients underwent conventional endos-copy after the completion of E.G. Scan^(TM). We describe the findings detected by the E.G. Scan^(TM) and calculate the diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa index for esophageal diagnosis.RESULTS: A total of 96 patients(54 women), mean age of 50.12 years(14 to 79), were evaluated. In all cases we were able to perform esophagoscopy with E.G.Scan^(TM). The average realization time was 5 min. A total of 58 alterations were detected in the esophagus, 49 gastric abnormalities and 13 duodenal abnormalities. We found that for esophageal varices, E.G. Scan^(TM) has sensitivity, specificity and diagnostic accuracy of 95%, 97% and 97%, respectively. Kappa coefficients were 0.32 for hiatal hernia, 0.409 for erosive gastroesopha-geal reflux disease, 0.617 for Barrett's esophagus, and 0.909 for esophageal varices.CONCLUSION: Esophagoscopy with E.G. Scan? is a well-tolerated, fast and safe procedure. It has an ap-propriate diagnostic accuracy for esophageal varices when compared with conventional endoscopy.展开更多
BACKGROUND Esophageal granular cell tumor(eGCT)is a relatively rare,usually benign neoplasm of the neuroectoderm.It is derived from Schwann cells.Clinical symptoms of this disease are non-specific.However,the most com...BACKGROUND Esophageal granular cell tumor(eGCT)is a relatively rare,usually benign neoplasm of the neuroectoderm.It is derived from Schwann cells.Clinical symptoms of this disease are non-specific.However,the most common presenting symptom is dysphagia,which is mostly misdiagnosed as esophageal polyps under gastroscopy,yet it has a 2%chance of forming cancers.We report the case of a 52-year-old woman with solitary eGCT,then analysed retrospectivelyanalyze the clinical features and elucidate on the reduction of misdiagnosis and missed diagnosis.CASE SUMMARY A 52-year-old woman was diagnosed with“esophageal granulossoma”after esophagoscopy,which was mistaken for eGCT.CONCLUSION eGCT diagnosis depends on characteristic pathomorphologies and detection of the S-100 protein.Endoscopic mucosal resection is the preferred therapeutic method.展开更多
文摘Foreign body ingestion in children is considered an emergency. The most common ingested foreign bodies are coins;however, the ingestion of disc batteries is on the rise requiring urgent rigid esophagoscopy. In the literature, multiple foreign body ingestion is very rare and only a few cases of multiple coins and multiple battery ingestion have been reported in the past. Herein, a case of simultaneous coin and battery ingestion requiring foreign bodies removal on two sequential endoscopies due to improper initial evaluation in a pediatric patient is reported which, to our knowledge, is the first reported case.
文摘Pneumatic dilation(PD) is considered to be the first line nonsurgical therapy for achalasia.The principle of the procedure is to weaken the lower esophageal sphincter by tearing its muscle fibers by generating radial force.The endoscope-guided procedure is done without fluoroscopic control.Clinicians usually use a lowcompliance balloon such as Rigiflex dilator to perform endoscope-guided PD for the treatment of esophageal achalasia.It has the advantage of determining mucosal injury during the dilation process,so that a repeat endoscopy is not needed to assess the mucosal tearing.Previous studies have shown that endoscope-guided PD is an efficient and safe nonsurgical therapy with results that compare well with other treatment modalities.Although the results may be promising,long-term follow-up is required in the near future.
文摘The authors present the clinical case of an 87-year-old Caucasian male admitted to the emergency room with hematemesis. He had a history of intermittent dys-phagia during the previous month. Endoscopic evaluation revealed an eccentric,soft esophageal lesionlocated 25-35 cm from the incisors,which appeared asa protrusion of the esophagus wall,with active bleeding. Biopsies were acquired. Tissue evaluation wascompatible with a melanoma. After excluding other sites of primary neoplasm,the definitive diagnosis of Primary Malignant Melanoma of the Esophagus(PMME) was made. The patient developed a hospital-acquired respiratory infection and died before tumor-directed treatment could begin. Primary malignant melanoma represents only 0.1% to 0.2% of all esophageal ma-lignant tumors. Risk factors for PMME are not defined.A higher incidence of PMME has been described in Japan. Dysphagia,predominantly for solids,is the most frequent symptom at presentation. Retrosternal orepigastric discom fort or pain,melena or hemate mesishave also been described. The characteristic endoscopic finding of PMME is as a polypoid lesion,with variablesize,usually pigmented. The neoplasm occurs in thelower two-thirds of the esophagus in 86% of cases.PMME metastasizes via hematogenic and lymphatic pathways. At diagnosis,50% of the patients present with distant metastases to the liver,the mediastinum,the lungs and the brain. When possible,surgery(curative or palliative) ,is the preferential method of treatment. There are some reports in the literature where chemotherapy,chemohormon otherapy,radiotherapy and immunotherapy,with or without surgery,wereused with variable efficacy. The prognosis is poor;themean survival after surgery is less than 15 mo.
文摘AIM： Although most patients with achalasia respond to pneumatic dilation, one-third experienced recurrence, and prolonged follow-up studies on parameters associated with various outcomes are scanty. In this retrospective study, we reported a 15-years＇ experience with pneumatic dilation treatment in patients with primary achalasia, and determined whether previously described predictors of outcome remain significant after endoscopic dilation. METHODS： Between September 1989 and September 2004, 39 consecutive patients with primary symptomatic achalasia （diagnosed by clinical presentation, esophagoscopy, barium esophagogram, and manometry） who received balloon dilation were followed up at regular intervals in person or by phone interview. Remission was assessed by a structured interview and a previous symptoms score. The median dysphagia-free duration was calculated by Kaplan-Meier analysis. RESULTS： Symptoms were dysphagia （n = 39, 100%）, regurgitation （n = 23, 58.7%）, chest pain （n = 4, 10.2%）, and weight loss （n = 26, 66.6%）. A total of 74 dilations were performed in 39 patients; 13 patients （28%） underwent a single dilation, 17 patients （48.7%） required a second procedure within a median of 26.7 mo （range 5-97mo）, and 9 patients （23.3%） underwent a third procedure within a median of 47.8 mo （range 37-120 mo）. Post-dilation lower esophageal sphincter （LES） pressure, assessed in 35 patients, has decreased from a baseline of 35.8±10.4- 10.0±7.1 mmHg after the procedure. The median follow-up period was 9.3 years （range 0.5-15 years）. The dysphagia- free duration by Kaplan-Neier analysis was 78%, 61% and 58.3% after 5, 10 and 15 years respectively. CONCLUSION： Balloon dilation is a safe and effective treatment for primary achalasia. Post-dilation LES pressure estimation may be useful in assessing response. 2005 The W.IG Press and Elsevier Inc. All rights reserved.
文摘Capsule endoscopy is now considered as the first imaging tool for small bowel examination. Recently, new capsule endoscopy applications have been developed, such as esophageal capsule endoscopy and colon capsule endoscopy. Esophageal capsule endoscopy in patients with suspected esophageal disorders is feasible and safe, and could be also an alternative procedure in those patients refusing upper endoscopy. Although large-scale studies are needed to confirm its utility in GERD and cirrhotic patients, current results are encouraging and open a new era in esophageal examination.
文摘AIM: To assess feasibility of unsedated esophagoscopy using a small-caliber disposable transnasal esophagosco-py and to compare its accuracy with standard endoscopy.METHODS: We prospectively included subjects who were referred for upper endoscopy. All subjects un-derwent transnasal endoscopy with E.G. Scan^(TM). The disposable probe has a 3.6 mm gauge and at its distal end there is a 6 mm optical capsule, with a viewing angle of 125°. Patients underwent conventional endos-copy after the completion of E.G. Scan^(TM). We describe the findings detected by the E.G. Scan^(TM) and calculate the diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa index for esophageal diagnosis.RESULTS: A total of 96 patients(54 women), mean age of 50.12 years(14 to 79), were evaluated. In all cases we were able to perform esophagoscopy with E.G.Scan^(TM). The average realization time was 5 min. A total of 58 alterations were detected in the esophagus, 49 gastric abnormalities and 13 duodenal abnormalities. We found that for esophageal varices, E.G. Scan^(TM) has sensitivity, specificity and diagnostic accuracy of 95%, 97% and 97%, respectively. Kappa coefficients were 0.32 for hiatal hernia, 0.409 for erosive gastroesopha-geal reflux disease, 0.617 for Barrett's esophagus, and 0.909 for esophageal varices.CONCLUSION: Esophagoscopy with E.G. Scan? is a well-tolerated, fast and safe procedure. It has an ap-propriate diagnostic accuracy for esophageal varices when compared with conventional endoscopy.
文摘BACKGROUND Esophageal granular cell tumor(eGCT)is a relatively rare,usually benign neoplasm of the neuroectoderm.It is derived from Schwann cells.Clinical symptoms of this disease are non-specific.However,the most common presenting symptom is dysphagia,which is mostly misdiagnosed as esophageal polyps under gastroscopy,yet it has a 2%chance of forming cancers.We report the case of a 52-year-old woman with solitary eGCT,then analysed retrospectivelyanalyze the clinical features and elucidate on the reduction of misdiagnosis and missed diagnosis.CASE SUMMARY A 52-year-old woman was diagnosed with“esophageal granulossoma”after esophagoscopy,which was mistaken for eGCT.CONCLUSION eGCT diagnosis depends on characteristic pathomorphologies and detection of the S-100 protein.Endoscopic mucosal resection is the preferred therapeutic method.
