Mucosal Bridge as a Cause of Dysphagia After Surgery for Esophageal Atresia
Bibliographic record
Abstract
Division of Gastroenterology, Department of Pediatrics, CHU Ste-Justine, Montreal, Quebec Correspondence: Dr Christophe Faure, Division of Gastroenterology and Nutrition, Hopital Sainte-Justine, 3175 Cote Sainte-Catherine, Montreal, Quebec H3T 1C5. Telephone 514-345-4931 ext 2561, fax 514-345-4999, e-mail christophe.faure@umontreal.ca Received for publication May 16, 2014. Accepted June 16, 2014 CASE PRESENTATION Esophageal atresia (EA) is a congenital disorder that affects one in 2500 newborns (1). In the long-term follow-up of these patients, dysphagia is a frequent complication after EA repair. The authors describe three patients presenting with dysphagia after surgical repair of type C EA for whom a treatable cause was found. Two of these patients underwent surgical correction on the first day of life, which was complicated by an anastomotic leak. In the third patient, surgery was postponed to five months of life due to low birth weight and prematurity, rendering reanastomosis technically difficult. All three patients underwent a barium swallow due to persistent dysphagia at six, 13 and 15 years of age, respectively. Esophageal diverticulae were present in two patients, but none had esophageal strictures (Figure 1). Upper endoscopy revealed a mucosal bridge slightly above the anastomotic site (Figure 2). Two patients showed dramatic improvement of their dysphagia after resection of the mucosal bridge using argon plasma coagulation (Figure 3). The mucosal bridge was not excised in the third patient, whose dysphagia remained. DISCUSSION The etiology of these mucosal bridges is unclear, but may be a consequence of surgery, trauma from nasogastric tube placement (2) or gastroesophageal reflux disease (3). Alternatively, mucosal bridges may also be a consequence of inflammation (4) caused by chronic food stasis due to esophageal dysmotility, which was present in all three of our patients, as confirmed by manometric studies (5).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".