S3205 Electrosurgical Mucosotomy for Intramucosal Esophageal Dissection
Bibliographic record
Abstract
Introduction: Intramucosal esophageal dissection (IED) is a rare condition in which the mucosal and muscular layers of the esophageal wall are separated to form a false lumen. This separation occurs as a result of hematoma or abscess formation in the esophageal wall, which can occur spontaneously or following penetration of the esophageal mucosa. Management of IEDs is generally conservative, though endoscopic stenting and incision have been described in few case reports to date. In the current case, endoscopic electrosurgical mucosotomy was utilized for IED at the time of diagnosis. Case Description/Methods: A 47-year-old woman presented to hospital with retrosternal pleuritic chest pain and odynophagia after reportedly swallowing a fishbone 12 days earlier. Thoracic Surgery performed an urgent esophagoscopy for drainage of prevertebral and mediastinal collections, with 2 discrete perforations that were not transmural observed intra-operatively. The patient was intubated post-operatively and, after eventual extubation, reported new esophageal dysphagia. A fluoroscopic esophagram demonstrated a new false esophageal lumen. Esophagogastroduodenoscopy was completed on post-operative day 44 and a large mucosal septum with multiple small fenestrations between the true and false esophageal lumens was identified. This appearance was in keeping with an IED that was eighteen centimeters in length, with the muscularis layer visible and intact. An electrosurgical knife was used to completed a mucosotomy along the length of the septum and transection of several small bridges of musical tissue to deroof the clean and well-epithelialized cavity. Small areas of oozing on the transected flap were treated with hemostatic forceps and the esophagus was left to heal via secondary intention. The patient reported immediate improvement in esophageal dysphagia and was able to tolerate a regular diet within 24 hours of this procedure. Discussion: This case demonstrates the utility of mucosotomy in IED as evidenced by the rapid improvement in symptoms reported by the patient and the absence of procedural complications. While rare, patients who present with IED often undergo endoscopy and endoscopic mucosotomy should be considered as a first-line therapeutic intervention provided patients are appropriately stable to undergo this procedure. Watch the video: https://tinyurl.com/4w6zvw96
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| 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".