Resolution of dysphagia following endoscopic resection of a large, nodular, esophageal inlet patch with low grade dysplasia
Bibliographic record
Abstract
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
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".