Gastroenterology & Endoscopy最新文献

Extraskeletal mesenchymal chondrosarcoma (ESMC) metastasizing to the pancreas in isolation is a rare entity. We present a case of a 30-year-old gentleman who underwent surgery for chondrosarcoma of the left temporal region (2017) and was detected to have a space-occupying a lesion of the pancreas 6 years post-surgery. Distal pancreatectomy was performed, and the histopathological examination revealed features suggestive of an extraskeletal mesenchymal chondrosarcoma. ESMC have a long latency period before presentation and these patients have a good survival following surgery. We present this case owing to its rarity.

Objective

Radiofrequency (RF) therapy is a minimally invasive procedure used to treat gastroesophageal reflux disease (GERD). During the procedure, electrodes are meticulously inserted into the lower esophageal sphincter and cardiac muscle through a gastroscope. By applying heat at various layers and sites around the gastroesophageal junction, the treatment intends to augment the junction's pressure and reduce tissue compliance. This process may also desensitize the esophagus, thereby preventing reflux and relieving symptoms. RF therapy boasts a high success rate and a low risk of adverse effects, making it an increasingly popular choice. However, there is a lack of consensus regarding its indications, contraindications, and the evaluation processes for pre- and postoperative care. To enhance the precision of patient selection and the technical execution of RF therapy, it is imperative to consolidate and standardize its clinical application in China. This will ensure the therapy's safety and efficacy are optimized.

Methods

Between December 2022 and April 2024, a group of 25 Chinese endoscopists, each with experience in over 50 radiotherapy procedures, engaged in six rounds of consensus discussions. The discussions focused on several key aspects of the procedure. During these discussions, each item was put to a vote among the experts. A consensus was reached when an item received agreement from at least 80 ​% of the participants.

Results

The expert group, comprising 25 specialists from 22 different institutions, had an average experience of over 50 RF procedures. These experts engaged in comprehensive discussions on a total of eight critical items, covering the full spectrum of the procedure, including indications, contraindications, basic working conditions and preparation, preoperative preparation, surgical process and technical skills, postoperative management, therapeutic effects, complications and prevention. The group successfully reached a consensus on all these items, ensuring a standardized approach to RF procedures.

Conclusion

This consensus summarized and standardized the clinical application of anti-reflux RF therapy in China. Adoption of this consensus will improve the precision of patient selection and technical implementation, thereby enhancing the safety and effectiveness of anti-reflux radiofrequency therapy.

Atrial fibrillation (AF) affects a significant proportion of older individuals, with prevalence rates of 3.8 ​% in those over 60 and 9.0 ​% in those over 80 years old, posing a considerable risk of stroke. Radiofrequency ablation (RFA) has emerged as a popular treatment option. However, RFA is not without risks, with esophageal injury being a notable complication, as illustrated by our case study of a 67-year-old patient who developed an atrial-esophageal fistula post-RFA. Timely diagnosis is imperative due to the rarity and severe consequences such as esophageal perforation. While treatment strategies remain somewhat uncertain, initial stenting has given way to surgical intervention for improved outcomes. Our study emphasizes the critical importance of vigilance, early identification, and a multidisciplinary approach in managing this challenging complication.

Esophageal squamous cell carcinoma (ESCC) is the most dangerous variant of esophageal cancer, and the most common in developing countries. Its ever-increasing incidence, due to cell resistance to available drugs and side effects, is prompting the scientific community to find new solutions. Alternatively, alkaloids are a large group of secondary metabolites found in plants and characterized by the presence of at least one nitrogen group in their structure. Thus, the aim of the research of is to thoroughly examine alkaloids that may offer an alternate course of treatment for esophageal squamous cell carcinoma. To achieve this, literature searches were conducted in databases such as Web of Science, PubMed/Medline, and Scopus to identify articles that explored the effect of alkaloids on esophageal squamous cell carcinoma as a primary or secondary objective. This methodology enabled us to obtain 7 studies and 6 alkaloids (neferine, matrine, tetrandine, d-dicentrine, synephrine, and 8-(4-(trifluoromethyl)benzyloxy)-1,2,3,4-tetrahydro-2-methylquin-oline or (83b1)). d-dicentrine (0.40 ​μM ​< ​IC50 ​< ​4.932 ​μM), and Matrine (1.50 ​mg/mL ​< ​IC50 ​< ​1.94 ​mg/mL) have significant activities on ESCC. They act by arresting cell cycle at the G2/M and G1/G0 phases respectively. Tetrandrine produces a synergistic effect when combined with cisplatin (IC₅₀ ​= ​4.57 ​μg/mL) and reverses the resistance of cisplatin-resistant ESCC cells by inhibiting MRP1. The others molecules have a moderate anti-ESCC effect. In conclusion, d-dicentrine, matrine and tetrandrine represent an important therapeutic avenue in the fight against esophageal squamous cell carcinoma. However, future research should focus on determining the toxicological potential of d-dicentrine.

Introduction

Gastro-esophageal Reflux Disease (GERD) is a significant global health issue affecting millions and placing a substantial burden on healthcare systems. This study investigates the prevalence and influencing factors of GERD among the urban population in Saudi Arabia, amidst rapid urbanization and lifestyle changes. The goal is to provide insights for targeted interventions and improved public health strategies.

Methodology

A cross-sectional study was conducted using a comprehensive methodology. A validated, bilingual questionnaire was used to collect data on demographics, awareness, psychosocial aspects, symptoms, and medical history. The study included 493 participants, and data were collected through an online survey. Statistical analysis was performed using SPSS and Excel, maintaining a statistical power of 80 ​%.

Results

The survey included 493 participants, revealing the following key findings: Gender distribution: 41.37 ​% male, 58.62 ​% female (p ​= ​0.053). Age categories: 18–25 (25.35 ​%), 26–40 (18.05 ​%), 41–55 (26.97 ​%), 56 and above (29.61 ​%) (p ​= ​0.055). Nationality: 51.92 ​% Saudi, 48.07 ​% non-Saudi (p ​= ​0.058). Other notable demographics: marital status, education levels, smoking habits, nutritional habits, BMI categories, and prevalence of bariatric surgery. GERD symptoms and psychological factors showed significant associations. Treatment preferences and lifestyle modifications varied widely. The data provide essential insights for tailored interventions and healthcare strategies.

Conclusion

This study highlights the complex demographic patterns and lifestyle factors associated with GERD in Saudi Arabia's urban population. The findings emphasize the importance of tailored interventions and inform healthcare, research, and policy decisions for effective GERD management in urban settings.

Objective

Endoscopic injection is one of the simplest minimally invasive methods for the treatment of gastroesophageal diseases. However, the safety of injection material limits its clinical application. We investigated the feasibility, safety and efficacy of endoscopic autogenous fat transplantation (EAFT) in the lower part of esophagus in the treatment of gastroesophageal reflux disease in New Zealand albino rabbits.

Methods

Eight New Zealand albino rabbits were used for autogenous fat transplantation. The dynamic pH value of the lower esophagus was monitored before and one week after fat transplantation in two rabbits. The local retention of fat was observed by endoscopy, and the pathological analysis was made at the junction of esophagus and stomach after two weeks of fat transplantation in six albino rabbits. During the experiment, the weight, dietary habit and infection of albino rabbits were monitored.

Results

Endoscopic autogenous fat transplantation of the lower esophagus was successfully performed in 8 albino rabbits. The average pH value of the esophagus increased from 5.6 to 7.5 and 7.4 to 7.9, respectively in two rabbits one week after transplantation. The fat barrier of the lower esophagus was remained locally and observed by endoscopy two weeks after transplantation in six rabbits. Pathology showed that the adipocytes survived in the submucosa with neovascularization. No complications of bleeding, perforation and infection occurred. All albino rabbits kept normal dietary habit. No significant changes in weight were observed.

Conclusion

Endoscopic autogenous fat transplantation in lower esophagus is considered as a safe and feasible method by preliminary animal experiments, which can provide a new option in the treatment of gastroesophageal reflux disease (GERD) and is worth further study.

Introduction

There are several clinical manifestations of celiac disease, an autoimmune enteropathy caused by gluten intake, including extra-intestinal and gastrointestinal symptoms. Although it is linked to dilated cardiomyopathy and exocrine pancreatic insufficiency, it rare for children with celiac disease to have these disorders concurrently.

Case presentation

We describe the case of a five-year-old boy with biopsy-confirmed celiac disease who had chronic diarrhea, vomiting, and failure to grow properly despite strictly following a gluten-free diet. Investigations revealed severe deficiency of pancreatic enzymes and dilated cardiomyopathy. Treatment with pancreatic enzyme supplement resulted in significant improvement on follow up.

Clinical discussion

Celiac disease is characterized by various clinical features which may involve cardiovascular problems. However, the occurrence of both exocrine pancreatic insufficiency and dilated cardiomyopathy in children with celiac disease is extremely uncommon. There is limited evidence regarding the use of pancreatic enzyme supplements in the treatment of such patients; however, our patient recovered with this treatment unexpectedly.

Conclusion

This case highlights the significance of considering uncommon coexisting conditions in children with celiac disease who display atypical symptoms, this is crucial because it can result in life-threatening situations. Consequently, it is essential to promptly identify and treat conditions such as exocrine pancreatic insufficiency and dilated cardiomyopathy and screen these patients for celiac disease in order to enhance patient outcomes.

Introduction

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths for the overall US population, with over 153,000 new cases annually. It is one the most diagnosed cancers in veterans and accounts for approximately 9 ​% of all cancers in this population.

Methods

This cross-sectional study used weighted data from the BRFSS 2021, a nationally representative US-telephone-based survey. We assessed the rate of endoscopic and stool-based colorectal cancer screening done in the VP compared to the NVP, stratified by age of screening, insurance, health status, primary care and marital status. We used backward stepwise multivariate logistic regression analyses to then assess for potentially predictive factors.

Results

A total of 117,227,096 adults were included in the study of which 11.64 ​% were veterans. We found that a higher proportion of veterans (78.44 ​%) had endoscopic CRC screening compared to non-veterans (68.62 ​%). VP were more likely to be screened compared to NVP (OR ​= ​1.32, (1.00–1.74). Only 26.45 ​% of VP in this study utilized military health coverage and are four-times likely to be screened (OR ​= ​3.64, (2.04–6.52). Lastly, both VP and NVP who were actively followed by their primary care provider (OR ​= ​2.80, (2.02–3.87) were more likely to be screened.

Conclusion

A higher proportion of VP had endoscopic colorectal cancer screening, but a screening gap still exists. Active engagement with PCPs is associated with more frequent endoscopic CRC screening in veterans. We recommend more grassroots efforts to get veterans engaged with their PCPs to significantly improve screening coverage.

Aims

To examine the features of foreign body ingestion and evaluate the effectiveness of endoscopic therapy for foreign body ingestion in Bangladeshi children.

Methods

I retrospectively reviewed the medical records of 97 children diagnosed with foreign body ingestion that required endoscopic removal from 2016 to 2023.

Results

The children were aged between 3 months and 15 years, with a mean age of 2.9 ​± ​4.9 years, with more than 80 ​% of the patients being under 5 years of age. Foreign body ingestion was observed at a high frequency (71.1 ​%) in children aged one to five years. Coins (67 ​%) and button batteries (5.2 ​%) were the most common foreign bodies swallowed by kids, and the majority of them were accidental (97.9 ​%). The majority of the foreign bodies were blunt (74.3 ​%), but some were sharp (18.6 ​%). Fifty-six percent of esophageal foreign bodies and 94 ​% of gastric foreign bodies were asymptomatic. Around 80 ​% of button batteries and 77.8 ​% of pointed objects were effectively removed from the body within 24 ​h of ingestion. Similarly, food impaction and blunt objects (98.6 ​% and 100 ​%, respectively) were successfully removed after the 24-h period. Endoscopic removal was successful in 99 ​% of cases, with minimal complications. When button batteries and sharp objects were consumed, the severity of erythema, erosion, bleeding, and ulceration increased along with the length of impaction.

Conclusions

Foreign body ingestion is a frequent occurrence in children under the age of five. Coin was the most common foreign body, with the majority of asymptomatic presentations. Prompt identification and timely extraction of swallowed foreign bodies may improve clinical outcomes.