A168 PROSPECTIVE EVALUATION OF THE USE OF BIOPSY FORCEPS FOR THE ENDOSCOPIC TREATMENT OF SCHATZKI RINGS
Bibliographic record
Abstract
A Schatzki ring is a circumferential fibrotic thickening of the esophageal submucosa located at the gastroesophageal junction (GEJ), which typically presents with dysphagia or food impaction. Current recommendations for the treatment of Schatzki rings are largely anecdotal and lack supporting clinical data. Commonly used procedures for the treatment of Schatzki rings include dilation procedures using bougie or balloon dilators. Unfortunately these techniques are plagued with high recurrence rates (63–89% after 5 years). Despite being a simple and effective alternative, ring disruption using biopsy forceps is a much less frequently employed technique. The functional lumen-imaging probe (endoFLIP) is a commercially available device, which employs impedance planimetry to measure luminal diameters and pressures and reporting as a combined measurement known as the distensibility index (DI). This study utilizes endoFLIP to objectively measure changes in the DI at the GEJ. Pairing endoFLIP with the MDQ30 dysphagia score provides a means of assessing the effectiveness of Schatzki ring disruption using biopsy forceps. The aim of this study was to demonstrate that both dysphagia and the DI at the GEJ are improved by obliterating Schatzki rings with biopsy forceps and that DI at the GEJ correlates with symptoms of dysphagia in patients with Schatzki rings. Thirty-five patients with dysphagia were identified as having Schatzki rings on upper GI series in the absence of exclusion criteria. Participants completed the MDQ30 prior to, and 30 days after the procedure. Endoscopies were performed under conscious sedation and using the EndoFLIP catheter, the DI was measured before and after the intervention. Biopsies were collected to assess for the presence of EoE and the ring was obliterated using forceps. All data was analyzed. Of the 35 patients recruited, 7 were found to have either a peptic stricture or no ring. The remaining 26 patients underwent treatment for their Schatzki ring. The distensibility index and MDQ30 scores were evenly distributed and pairwise student t-tests were carried out, comparing pre & post treatment scores. Six patients in the population had endoscopic features suggestive of EoE however only 4 had biopsy confirming EoE. Nine of the patients had reflux esophagitis ranging from LA grade A to C. Student t-tests comparing both the pre and post treatment DI and pre and post MDQ30 scores show statistically significant difference (p=0.01 and p<0.01 respectively). There was no statistically meaningful correlation between MDQ30 and distensibility index (DI) scores. Biopsy forceps disruption of Schatzki rings results in improvement in dysphagia scores and the DI at the GEJ. There was no correlation between the two metrics. None
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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 | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".