Resolution of dysphagia following endoscopic resection of a large, nodular, esophageal inlet patch with low grade dysplasia
Notice bibliographique
Résumé
A 44-year-old man was referred due to chronic dysphagia to solids and a persistent globus sensation. Esophagogastroduodenoscopy (EGD) revealed a nodular inlet patch with a hyperplastic polypoid appearance occupying 70% of the luminal circumference in the proximal esophagus from 18 to 20 cm. Narrow-band imaging did not reveal dysplastic features and biopsies confirmed gastric heterotopia without dysplasia. Further work-up with barium swallow, chest X-ray, esophageal manometry, and pH testing were normal. Medical therapy with twice-daily proton pump inhibitor did not improve his symptoms. As such, endoscopic resection was proposed. The procedure was performed under general anesthesia with endotracheal intubation ([ Video 1 ]). Piecemeal endoscopic mucosal resection (EMR) was performed using a Duette multiband mucosectomy device (Cook Medical, Limerick, Ireland) after submucosal lifting using normal saline with diluted methylene blue. The entire inlet patch was successfully removed using nine bands with minor bleeding controlled using hemostatic forceps. Diluted triamcinolone (34 mg) was injected into the EMR defect for stricture prophylaxis, followed by treatment with budesonide slurry and sucralfate suspension for 4 weeks. The pathology revealed gastric oxyntic mucosa with low grade dysplasia. Follow-up EGD at 1 year confirmed the absence of any residual inlet patch and no dysplastic findings. Crucially, the patient had complete resolution of his chronic symptoms. Download Video Successful endoscopic resection with multiband mucosectomy device of a large inlet patch with low grade dysphagia causing dysphagia.Video 1 The inlet patch is a congenital anomaly with a prevalence of up to 1% [ 1 ]. Most inlet patches are asymptomatic but occasionally may cause dysphagia or globus sensation [ 2 ]. They are usually ignored by most endoscopists due to small size, but the finding of low grade dysplasia in our case highlights the importance of close examination and consideration for endoscopic intervention when there are abnormal features. Small, symptomatic inlet patches can be treated by EMR or mucosal ablation [ 3 ] [ 4 ], whereas larger or polypoid inlet patches may be completely and safely removed by multiband mucosectomy, as demonstrated by our case. Endoscopy_UCTN_Code_CCL_1AB_2AC_3AD Endoscopy E-Videos https://eref.thieme.de/e-videos E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos . Publication History Article published online: 29 April 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».