Novel use of esophageal overtube and water flushes as a safety indicator and facilitator for the push technique in esophageal food impaction

Esophageal food impaction requires urgent endoscopic intervention either by extraction or pushing into the stomach.Due to risks of perforation,controversy exists between when to extract verses when to push the food bolus.There are no clear guidelines on when it is safe to push a food bolus;endoscopists rely on their subjective experiences and judgment.We present a case with a novel use of an esophageal overtube and water flushes to determine the safety of pushing a food bolus and facilitate passage into the stomach.

Esophageal intramural pseudodiverticulosis,a rare cause of food impaction:case report and review of the literature

Esophageal intramural pseudodiverticulosis(EIPD)is a rare,benign condition of uncertain etiology and pathogenesis,which usually presents with either progressive or intermittent dysphagia.Acute presentation with food impaction,requiring emergency esophago-gastroduodenoscopy(EGD),is rare.We report a case of EIPD presenting as food bolus impaction in an elderly black female.The patient had no previous history of dysphagia or odynophagia.Currently accepted risk factors,such as diabetes mellitus,chronic alcoholism,and reflux esophagitis,were not present in our patient.Emergency EGD established the diagnosis and also dislodged the food bolus.Histopathological evaluation of the mucosa diagnosed co-existent acute candidal infection.Medical treatment with proton pump inhibitor and azole antifungal led to resolution of her symptoms.Review of the literature revealed that stenosis,strictures,perforation,gastro-intestinal bleed,and fistula formation are potential complications of EIPD.Multiple motility abnormalities have been described but are not consistent.Treatment of the underlying inflammatory and or infectious condition is the mainstay of management of this unusual condition.

Genetically Modified Doubts Imported GM soybeans impact China’s local farmers and create food safety concerns

The cooking oil made from the imported soybeans does not contain transgenic proteins. So there will be no food safety threat.

Endoscopic removal of foreign bodies:A retrospective study in Japan

BACKGROUND The ingestion of foreign bodies(FBs)and food bolus impaction(FBI)in the digestive tract are commonly encountered clinical problems.Methods to handle such problems continue to evolve offering advantages,such as the avoidance of surgery,reduced cost,improved visualization,reduced morbidity,and high removal success rate.However,to date,no studies have evaluated the endoscopic management of FBs in Japan.AIM To elucidate level of safety and efficacy in the endoscopic management of FBs and FBI.METHODS A total of 215 procedures were performed at Keio University Hospital between November 2007 and August 2018.Data were collected from medical charts,and endoscopic details were collected from an endoscopic reporting system.Procedures performed with a flexible gastrointestinal endoscope were only taken into account.Patients who underwent a technique involving FB or FBI from the digestive tract were only included.Data on patient sex,patient age,outpatient,inpatient,FB type,FB location,procedure time,procedure type,removal device type,success,and technical complications were reviewed and analyzed retrospectively.RESULTS Among the 215 procedures,136(63.3%)were performed in old adults(≥60 years),180(83.7%)procedures were performed in outpatients.The most common type of FBs were press-through-pack(PTP)medications[72(33.5%)cases],FBI[47(21.9%)],Anisakis parasite(AP)[41(19.1%)cases].Most FBs were located in the esophagus[130(60.5%)cases]followed by the stomach[68(31.6%)cases].AP was commonly found in the stomach[39(57.4%)cases],and it was removed using biopsy forceps in 97.5%of the cases.The most common FBs according to anatomical location were PTP medications(40%)and dental prostheses(DP)(40%)in the laryngopharynx,PTP(48.5%)in the esophagus,AP(57.4%)in the stomach,DP(37.5%)in the small intestine and video capsule endoscopy device(75%)in the colon.A transparent cap with grasping forceps was the most commonly used device[82(38.1%)cases].The success rate of the procedure was 100%,and complication were observed in only one case(0.5%).CONCLUSION Endoscopic management of FBs and FBI in our Hospital is extremely safe and effective.

Complication rates in emergent endoscopy for foreign bodies under different sedation modalities:A large single-center retrospective review

BACKGROUND Foreign object ingestion(FOI)and food bolus impaction(FBI)are common causes of emergent endoscopic intervention.The choice of sedation used is often dictated by physician experience.Many endoscopists frequently prefer to use monitored anesthesia care(MAC)and general anesthesia(GA)as opposed to conscious sedation(CS)due to the concern for inadequate airway protection.However,there is insufficient data examining the safety of different sedation modalities in emergent endoscopic management of FOI and FBI.AIM To investigate the complication rates of emergent endoscopic extraction performed under different sedation modalities.METHODS We conducted a retrospective chart review of patients presenting with acute FBI and FOI between 2010 and 2018 in two hospitals.A standardized questionnaire was utilized to collect data on demographics,endoscopic details,sedation practices,hospital stay and adverse events.Complications recognized during and within 24 h of the procedure were considered early,whereas patients presenting with a procedure-related adverse event within two weeks of the index event were considered delayed complications.Complication rates of patients who underwent emergent endoscopic retrieval were compared based on sedation types,namely CS,MAC and GA.Chi-square analysis and multiple logistic regression were used to compare complication rate based on sedation type.RESULTS Among the 929 procedures analyzed,353 procedures(38.0%)were performed under CS,278 procedures(29.9%)under MAC and the rest(32.1%)under GA.The median age of the subjects was 52 years old,with 57.4%being male.The majority of the procedures(64.3%)were FBI with the rest being FOI(35.7%).A total of 132 subjects(14.2%)had chronic comorbidities while 29.0%had psychiatric disorders.The most commonly observed early complications were mucosal laceration(3.8%)and bleeding(2.6%).The most common delayed complication was aspiration pneumonia(1.8%).A total of 20 patients(5.6%)could not adequately be sedated with CS and had to be converted to MAC or GA.Patient sedated with MAC and GA were more likely to require hospitalization,P<0.0001.Analysis revealed no statistically significant difference in the complication rate between patients sedated under CS(14.7%),MAC(14.7%)and GA(19.5%),P=0.19.CONCLUSION For patients who present with FOI or FBI and undergo emergent endoscopic treatment,there is no significant difference in adverse event rates between CS,MAC and GA.

Contributions of climate, varieties, and agronomic management to rice yield change in the past three decades in China

The long-term field experiment data at four representative agro-meteorological stations, together with a crop simulation model, were used to disentangle the contributions of climate change, variety renewal, and fertilization management to rice yield change in the past three decades. We found that during 1981-2009 varieties renewal increased rice yield by 16%-52%, management improvement increased yield by 0-16%, and the contribu- tions of climate change to rice yield varied from - 16% to 10%. Varieties renewal and management improvement offset the negative impacts of climate change on rice production. Among the major climate variables, decreases in solar radiation reduced rice yield on average by 0.1% per year. The impact of temperature change had an explicit spatial pattern. It increased yield by 0.04%-0.4% per year for single rice at Xinbin and Ganyu station and for late rice at Tongcheng station, by contrast reduced yield by 0.2%- 0.4% per year for single rice at Mianyang station and early rice at Tongcheng station. During 1981-2009, rice varieties renewal was characterized by increases in thermal requirements, grain number per spike and harvest index. The new varieties were less sensitive to climate change than old ones. The development of high thermal require- ments, high yield potential and heat tolerant rice varieties, together with improvement of agronomic management, should be encouraged to meet the challenges of climate change and increasing food demand in future.