Band Ligation-Assisted Histologic Surveillance of Barrett's Esophagus in the Setting of Esophageal Varices
Notice bibliographique
Résumé
CASE REPORT Barrett's esophagus (BE) with esophageal varices (EV) presents a clinical conundrum. Endoscopists tend to refrain from sampling in such cases due to bleeding risk. We report a biopsy sampling method for the diagnosis and surveillance of BE in the setting EV. Case 1: a 67-year-old man with primary sclerosing cholangitis-related cirrhosis with known EV requiring band ligation, Crohn's disease, and histologically confirmed long-segment BE. Case 2: a 56-year-old man with alcoholic liver cirrhosis and a long-segment salmon-colored mucosa (not sampled during previous endoscopy). The salmon-colored mucosa was C10M12 and C8M9 in each patient, respectively, per the Prague criteria. Large columns of EV were seen in the mid and lower esophagus during endoscopy. A thorough high-definition white-light and narrow band imaging examination did not reveal any nodularity or visible abnormalities. Endoscopic band ligation was performed at the gastroesophageal junction and distal esophagus (3-4 bands were placed). After removing the band ligation kit, the endoscope was reinserted and mucosal samplings using pediatric forceps were obtained from the tip of banded areas (Video 1). There was no immediate or delayed bleeding complication. Pathological examination confirmed nondysplastic BE in both patients. The first and second patients underwent 1 and 2 further surveillance examinations, respectively, with biopsies obtained following the same methodology (to expand the surface area of histologic surveillance), with pathology revealing nondysplastic BE. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_cwxcaaod"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Implementing the Seattle biopsy protocol is challenging when EV are present due to bleeding risk, especially in long segment BE. As an alternative strategy, obtaining biopsies using pediatric forceps from banded areas of esophageal varices is reasonable, feasible, and likely safe for diagnosis and surveillance of BE, understanding the sampling surface area is much smaller. This is particularly important in cases of suspected dysplastic area in the setting of large varices since histologic dysplasia confirmation determines further management of BE. DISCLOSURES Author contributions: F. Hamo, H. Patel and S. Samo.—Study concept and design, acquisition, drafting the manuscript, and critical revision of the final manuscript. P. Nathani, N. Talaat—Critical revision of the final manuscript. S. Samo is the Guarantor of the article. Financial disclosure: None to report. Conflict of Interest: F. Hamo, H. Patel, P. Nathani, N. Talaat: none. S. Samo: Speaker's bureau- Castle Biosciences, Evoke, Medtronic, Merit, Phathom, Sanofi, Takeda. Advisory board- Castle Biosciences, Sanofi. Previous presentation: This submission was presented as a poster at the American College of Gastroenterology Annual Meeting in Vancouver, Canada in 2023. Informed consent was obtained for this case report.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 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 tête enseignante, 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 ».