A Case of an Esophageal Foreign Body with Iatrogenic Esophageal Perforation Caused by the Gag Reflex / 대한내과학회지

Esophageal foreign bodies are a common clinical problem; they can be removed via endoscopic intervention. However, sharp foreign bodies, such as fish bones, stuck in a physiological or pathological stenosis of the esophagus can sometimes lead to esophageal perforation. This can even lead to fatal complications, such as empyema, mediastinitis, esophago-tracheal fistula, and peritonitis. Consequently, during an endoscopic procedure, special precautions and protective devices are required. Here, we report the case of a 56-year-old woman who presented with an esophageal impacted fish bone with iatrogenic esophageal perforation caused by the gag reflex during endoscopic removal. She was treated successfully with surgery and antibiotics. The case highlights the need for sufficient sedation of the patient and attention by clinicians to achieve successful treatment without complications.

Prediction of Helicobacter pylori Infection Status via Close Observation of Gastric Mucosal Pattern by Standard Endoscopy

BACKGROUND/AIMS: Common endoscopic findings in stomachs with Helicobacter pylori infections include antral nodularity, thickened gastric folds, and visible submucosal vessels. These findings are suggestive but not diagnostic of H. pylori infection. Magnifying endoscopy can reveal more precisely the abnormal mucosal patterns in an H. pylori-infected stomach; however, it requires more training, expertise, and time. We aimed to establish a new classification for predicting H. pylori-infected stomachs by non-magnifying standard endoscopy alone. MATERIALS AND METHODS: A total of 617 participants who underwent gastroscopy were prospectively enrolled from August 2011 to January 2012. We performed a careful close examination of the corpus at the greater curvature maintaining a distance < or =10 mm between the endoscope tip and the mucosal surface. We classified gastric mucosal patterns into four categories: normal regular arrangement of collecting venules (numerous minute red dots), mosaic-like appearance (type A; swollen areae gastricae or snakeskin appearance), diffuse homogenous redness (type B), and mixed pattern (type C; irregular redness with groove) to predict H. pylori infection status. RESULTS: The frequencies of H. pylori infection in patients with a normal regular arrangement of collecting venules pattern and types A, B, and C patterns were 9.4%, 87.7%, 98.1%, and 90.9%, respectively. The sensitivity, specificity, and positive and negative predictive values of all abnormal patterns for prediction of H. pylori infection were 93.3%, 89.1%, 92.3%, and 90.6%, respectively. The overall accuracy was 91.6%. CONCLUSIONS: Careful close observation of the gastric mucosal pattern with standard endoscopy can predict H. pylori infection status.