Experience in Peroral Endoscopic Myotomy in a Center in Bogotá, Colombia, Between 2018 and 2022 / Experiencia en miotomía endoscópica peroral en un centro de Bogotá, Colombia, entre 2018 y 2022

Abstract Background: Achalasia is a low-incidence disease, but it significantly affects the life quality of patients. Before 2010, peroral endoscopic myotomy (POEM) was the preferred course of treatment. However, due to its effectiveness and safety, POEM has been widely used since then. Objective: To describe the results of the largest cohort of patients with achalasia-treated with endoscopic surgery-with the poem technique to date in Colombia. Methods: Observational cohort study that included patients treated with peroral endoscopic myotomy in the city of Bogota, Colombia, between 2018 and 2022. Information from medical records was collected and analyzed retrospectively, with subsequent telephone follow-up prospectively. The presurgical and follow-up Eckardt scale was used to establish clinical success. Results: Between 2018 and 2022, 31 patients were intervened, 61% of which were men. The mean age was 47 years. Technical and clinical success was obtained in 97% of cases, with an Eckardt score less than or equal to three, in 93%, at two months of follow-up. Forty-five percent of the procedures were outpatient. The complication rate was 10%. Conclusion: Our study shows that peroral endoscopic myotomy for achalasia management is an effective, low complication rate, and safe technique to perform on an outpatient basis.

Resumen Antecedentes: La acalasia es una enfermedad de baja incidencia, pero que afecta significativamente la calidad de vida de los pacientes. El tratamiento de elección ha sido la miotomía de Heller, pero en 2010 se describió la miotomía endoscópica peroral (POEM) y desde entonces ha tenido amplia difusión por su efectividad y seguridad. Objetivo: Describir los resultados de la cohorte más grande hasta la fecha en Colombia, en pacientes con acalasia tratados con cirugía endoscópica, con la técnica POEM. Métodos: Estudio observacional de cohorte que incluyó pacientes manejados con miotomía endoscópica peroral en la ciudad de Bogotá, Colombia, entre 2018 y 2022. Se recolectó y analizó retrospectivamente la información de las historias clínicas, y prospectivamente el posterior seguimiento telefónico. Se utilizó la escala de Eckardt prequirúrgica y en los seguimientos para establecer el éxito clínico. Resultados: Entre 2018 y 2022 se intervino a 31 pacientes, de los cuales el 61% eran hombres, y la media de edad fue de 47 años. Se obtuvo éxito técnico en el 97% de los casos y éxito clínico, con un puntaje de Eckardt menor o igual a tres, en el 93% a los dos meses de seguimiento. El 45% de los procedimientos fueron ambulatorios y la tasa de complicaciones fue del 10%. Conclusión: Nuestro estudio muestra que la miotomía endoscópica peroral para manejo de acalasia es una técnica efectiva, con baja tasa de complicaciones y segura para realizarse ambulatoriamente.

Esophageal diverticulum: a case report

Esophagic diverticulum抯 are a rare entity. The prevalence in the world population is reported to be less than 1%. They are generally diagnosed incidentally, have a higher peak of prevalence in the fifth decade of life, affecting men and women equally. The most common esophageal diverticula are epiphrenic and the main symptom is usually dysphagia. A case of a 74-year-old female with diagnosis of epiphrenic esophageal diverticulum is reported, which is treated with conservative management. The objective of this study was to describe a clinical case of esophageal diverticulum, as well as its etiology, clinical presentation, and therapeutic conduct. The screening of these patients must be focused on what the literature indicates, symptomatic patients with long-term evolution, the treatment will be surgical and with minimally invasive techniques so clinical evolution will be more favorable, reducing possible complications.

Experiencia con sonda luminal funcional endoluminal (EndoFLIP) en Hospital Universitario San Ignacio, Bogotá, Colombia / Experience with endoluminal functional luminal probe (EndoFLIP) at San Ignacio University Hospital, Bogota, Colombia

RESUMEN Introducción: La EndoFLIP (por sus siglas en inglés: sonda luminal funcional endoluminal) es un sistema que mide en tiempo real el índice de la distensibilidad de la unión esofagogástrica y el peristaltismo esofágico secundario, basándose en el principio de planimetría de impedancia. Aunque esta tecnología es relativamente nueva y su utilidad diagnóstica aún se encuentra en evaluación, cada vez se reconoce más su uso en la práctica clínica, fundamentalmente en aquellos pacientes donde no hay un diagnóstico manométrico conclusivo de un trastorno motor esofágico, principalmente obstrucción al tracto de salida y acalasia. Objetivo: El objetivo del presente estudio es describir la experiencia con la EndoFLIP en el Hospital Universitario San Ignacio en Bogotá, Colombia. Materiales y métodos: Estudio observacional descriptivo tipo serie de casos, donde se incluyeron pacientes mayores de 18 años a quienes se les realizó EndoFLIP en el Hospital Universitario San Ignacio desde el año 2021 hasta el 2022, bien sea de forma intrahospitalaria como ambulatoria, con indicación clara de realización del estudio, previamente discutida en Junta multidisciplinaria de Gastroenterología. Resultados: Se incluyeron un total de 27 pacientes en el estudio con promedio de 55,6 años de edad, de los cuales 20 eran mujeres (74%) y 7 hombres (26%). La indicación más frecuente del estudio fue diagnóstico no conclusivo de obstrucción al tracto de salida identificado en manometría esofágica de alta resolución de acuerdo a los criterios de la clasificación de Chicago 4.0 (14 pacientes), seguido de esófago hipercontráctil (4 pacientes) y motilidad esofágica inefectiva (3 pacientes). Al evaluar la respuesta contráctil, se encontró que 9 pacientes con diagnóstico no conclusivo de obstrucción al tracto de salida tenían respuesta normal, 3 ausente y una alterada; y en los pacientes con diagnóstico no conclusivo de acalasia uno de ellos tenía respuesta contráctil limítrofe y dos ausente. La totalidad de los pacientes con diagnóstico previo de contractilidad ausente, tenían respuesta contráctil igualmente ausente en la EndoFLIP. Conclusiones: La imagen luminal funcional endoluminal es una técnica que evalúa las propiedades biomecánicas como la distensibilidad, volumen, presión e inclusive diámetros de regiones esfinterianas como la unión esofagogástrica, píloro y ano. Se ha destacado su utilidad para varias indicaciones, siendo las más importantes los diagnósticos manométricamente no conclusivos de trastornos motores esofágicos como la acalasia y la obstrucción del tracto de salida, patologías que tienen un impacto importante en la calidad de vida de los pacientes y cuyo diagnóstico es esencial para poder brindar la mejor opción terapéutica.

ABSTRACT Introduction: The EndoFLIP (for its acronym in English: endoluminal functional luminal probe) is a system that measures in real time the compliance index of the gastroesophageal junction and secondary esophageal peristalsis, based on the principle of impedance planimetry. Although this technology is relatively new and its diagnostic usefulness is still being evaluated, its use in clinical practice is increasingly recognized, fundamentally in those patients where there is no conclusive manometric diagnosis of esophageal motor pathology, mainly esophagogastric junction outflow obstruction and achalasia. Objective: The aim of the present study is to describe the experience with EndoFLIP at the San Ignacio University Hospital in Bogotá, Colombia. Material and methods: Descriptive observational case series study, which included patients over 18 years of age who had undergone EndoFLIP at the San Ignacio University Hospital from 2021 to 2022, either in-hospital or outpatient, with a clear indication of performance of the study, previously discussed in the multidisciplinary Gastroenterology Board. Results: A total of 27 patients with an average age of 55 years were included in the study, of which 20 were women (74%) and 7 men (26%). The most frequent indication of the study was an inconclusive diagnosis of outflow tract obstruction identified in high-resolution esophageal manometry according to Chicago 4.0 criteria (14 patients), followed by hypercontractile esophagus (4 patients) and ineffective esophageal motility (3 patients). When evaluating the contractile response, it was found that 9 patients with an inconclusive diagnosis of outflow tract obstruction had a normal response, 3 absent and one altered; and in the patients with an inconclusive diagnosis of achalasia, one of them had a borderline contractile response and two had no response. All patients with a previous diagnosis of absent contractility had an equally absent contractile response in EndoFLIP. Conclusion: Endoluminal functional luminal imaging is a technique that evaluates biomechanical properties such as distensibility, volume, pressure and even diameters of sphincter regions such as the gastroesophageal junction, pylorus and anus. Its usefulness has been highlighted for several indications, the most important being manometrically inconclusive diagnoses of esophageal motor disorders such as achalasia and outflow tract obstruction, pathologies that have a significant impact on the quality of life of patients and whose diagnosis is essential to be able to provide the best treatment option.

The Variation of the Fetal Esophageal Mucosa at the End of Gestation may be a Possible Etiopathogenic Factor for Barrett's Esophagus / La Variación de la Mucosa Esofágica Identificada al Final de la Gestación Puede ser un Posible Factor Etiopatogénico para el Esófago de Barrett

SUMMARY: Barrett's esophagus is a condition where the distal third of the esophagus changes its epithelial lining from non- keratinized stratified squamous to simple columnar. This cross-sectional descriptive study was conducted to characterize the esophageal mucosa in the third trimester of pregnancy and determine possible variants in its development and was carried out in the Morphology Laboratory of the Health Faculty of the Industrial University of Santander, Colombia, with 45 human fetuses in the third trimester of gestation (weeks 25-40). A section of the distal esophagus and the first portion of the cardial region of the stomach were obtained, and the histological sections were subjected to a fixation process with 5 % formaldehyde solution. The sections were stained with hematoxylin and eosin and were evaluated for the presence of epithelial change or glands in the esophageal lamina propria. The change from non- keratinized stratified squamous epithelium to simple columnar epithelium was observed in the esophageal mucosa in five fetuses (11.1 %). In 15 cases (33.3 %), the presence of mucous glands underlying the epithelium was determined. In two fetuses, simple columnar epithelium was observed in the esophageal mucosa and underlying submucosal glands (4.4 %). The lack of replacement of the columnar epithelium by squamous epithelium in the distal third of the esophagus and the presence of mucous glands in the last third of gestation may suggest the presentation of Barret's esophagus in adulthood and thus, a predisposition to develop esophageal adenocarcinoma.

El esófago de Barrett es una afección en la que el tercio distal del esófago cambia su revestimiento epitelial de escamoso estratificado no queratinizado a columnar simple. Este estudio descriptivo de corte transversal tiene como objetivo caracterizar la mucosa esofágica en el tercer trimestre del embarazo y determinar posibles variantes en su desarrollo y se realizó en el laboratorio de Morfología de la Facultad de Salud de la Universidad Industrial de Santander-Colombia, con 45 fetos humanos en el tercer trimestre de gestación (semanas 25-40). Se obtuvo una sección del esófago distal y la primera porción de la región cardial del estómago y las secciones histológicas se sometieron a un proceso de fijación con solución de formaldehído al 5 %. Los cortes se tiñeron con hematoxilina y eosina y se evaluaron determinando la presencia de cambio epitelial y glándulas en la lámina propia del esófago. El cambio de epitelio escamoso estratificado no queratinizado a epitelio cilíndrico simple se observó en la mucosa esofágica en cinco fetos (11,1 %). En 15 casos (33,3 %) se determinó la presencia de glándulas mucosas subyacentes al epitelio. En dos fetos se observó epitelio cilíndrico simple en la mucosa esofágica y glándulas submucosas subyacentes (4,4 %). La falta de reemplazo del epitelio cilíndrico por epitelio escamoso en el tercio distal del esófago y la presencia de glándulas mucosas en el último tercio de la gestación pueden sugerir la presentación de esófago de Barrett en la edad adulta y una predisposición a desarrollar adenocarcinoma de esófago.

Endoscopic Management of Sharp Force Injury in the Esophagus: Case Report / Manejo endoscópico de herida por arma cortopunzante en el esófago: reporte de caso

Abstract Introduction: Esophageal trauma is a challenge because it may go unnoticed. These injuries are associated with high morbidity and mortality due to the increased risk of local or systemic infections that progress to sepsis and, finally, death. Objective: To describe a case of endoscopic management of a sharp force injury in the esophagus, which was corrected with hemostatic clips. Case description: A 28-year-old male patient with no significant history was referred due to a penetrating injury caused by a sharp weapon in region I of the neck at the sternal fork level. He had imaging findings suggestive of pneumomediastinum, so we opted for an endoscopic intervention with the initial plan of placing a fully covered esophageal prosthesis. However, given the location of the lesion and other risk factors, endoscopic management with hemostatic clips was performed, the evolution of which was satisfactory, and the patient was discharged without any complications. Conclusions: Esophageal perforation due to trauma continues to be a clinical situation that requires a high index of suspicion, so all tools for early diagnosis must be exhausted. Systemic complications such as mediastinitis must be avoided, given the high morbidity and mortality with which it is associated. Besides, each patient must be individualized according to their hemodynamic stability to determine the most appropriate intervention and reduce hospital stay. Endoscopy is an excellent alternative.

Resumen Introducción: El trauma de esófago resulta un reto porque puede pasar desapercibido. Estas lesiones se asocian a una alta morbimortalidad por el alto riesgo de infecciones locales o sistémicas que evolucionan a sepsis y, finalmente, a la muerte. Objetivo: Describir un caso de manejo endoscópico en una herida causada por arma cortopunzante en el esófago, la cual se corrigió con clips hemostáticos. Descripción del caso: Paciente masculino de 28 años sin antecedentes de importancia; remitido por una lesión penetrante por arma cortopunzante en la región I del cuello a nivel de la horquilla esternal. Tuvo hallazgos imagenológicos sugestivos de neumomediastino, por lo que se decidió intervenir por vía endoscópica con el plan inicial de colocación de prótesis esofágica completamente recubierta. Sin embargo, dada la localización de la lesión y otros factores de riesgo, se realizó un manejo endoscópico con clips hemostáticos, cuya evolución fue satisfactoria y el egreso del paciente se dio sin ninguna complicación. Conclusiones: La perforación esofágica por trauma sigue siendo una situación clínica que requiere un alto índice de sospecha, por lo que se deben agotar todas las herramientas para un diagnóstico temprano y evitar complicaciones sistémicas como la mediastinitis, dada la alta morbimortalidad a la que se asocia. Así mismo, cada paciente debe ser individualizado, según su estabilidad hemodinámica, para poder determinar la intervención más adecuada, con el fin de disminuir la estancia hospitalaria, y la endoscopia es una excelente alternativa.

Esophageal Melanocytosis

ABSTRACT Esophageal melanocytosis is a rare entity defined by the proliferation of a melanocytic basal layer of the esophageal squamous lining and deposition of melanin in the esophageal mucosa. Esophageal melanocytosis is considered a benign entity of unknown etiology; however, it has been reported as a melanoma precursor. We report a case of esophageal melanocytosis in a diabetic and hypertensive 67-year-old male with recurrent dizziness and syncope for the past 6 months. Given his complaint of dyspepsia, he underwent an upper gastrointestinal endoscopy, in which an esophageal biopsy revealed the diagnosis of esophageal melanocytosis. The definitive diagnosis of esophageal melanocytosis can only be made by histological analysis. The histologic differential diagnoses include melanocytic nevi and malignant melanoma. Therefore, they need to be ruled out.

Predictive value of esophageal deviation index for clinical outcomes of patients with left-sided congenital diaphragmatic hernia / 中华围产医学杂志

Objective:To evaluate the predictive value of postnatal esophageal deviation index for clinical outcomes of fetuses with left-sided congenital diaphragmatic hernia (L-CDH).Methods:This retrospective study analyzed the clinical data of 103 neonates with prenatally diagnosed L-CDH who were admitted to Guangzhou Women and Children's Medical Center from January 2016 to February 2023. These patients were divided into the survival group ( n=82) and the death group ( n=21) according to the outcomes, and the extracorporeal membrane oxygenation (ECMO) group ( n=25) and the non-ECMO group ( n=78) according to whether ECMO support was required. Thoracoabdominal X-ray screening was performed on all neonates within 24 h after admission and the esophageal deviation index and cardiac deviation index were calculated. Independent sample t-test or Fisher's exact probability test were used to analyze the differences in general condition and postnatal imaging features between different groups. Receiver operating characteristic (ROC) curve was used to evaluate the value of postnatal imaging features in predicting the prognosis of L-CDH. Results:The esophageal deviation index and the cardiac deviation index of neonates in the survival group were lower than those in the death group [(10.5±5.3)% vs. (18.0±4.5)%, t=－5.47; (37.7±7.1)% vs. (42.8±8.2)%, t=－2.62; both P<0.05], while that were both higher in the ECMO group compared with the non-ECMO group [(18.0±4.3)% vs. (10.1±5.2)%, t=6.34; (42.4±7.9)% vs. (37.6±7.1)%, t=2.63; both P<0.05]. ROC curve showed that the area under the curve (AUC) for predicting the need for ECMO support was 0.879 (95% CI: 0.805-0.953) for esophageal deviation index and 0.712 (95% CI: 0.570-0.854) for cardiac deviation index, with the optimal cut-off values of 11.7% and 41.7%, respectively. The AUC for predicting the survival rate in patients with L-CDH by esophageal deviation index and cardiac deviation index were 0.854 (95% CI: 0.761-0.947) and 0.735 (95% CI: 0.582-0.887), respectively, with the corresponding optimal cut-off values of 15.8% and 41.7%. Conclusion:Postnatal esophageal deviation index is of value in predicting the need for ECMO support and survival rate in patients with L-CDH.

Research progress on esophageal squamous intraepithelial neoplasia / 实用医学杂志

China is a country with a high incidence of esophageal cancer.The pathological type is mainly squamous cell carcinoma.Squamous intraepithelial neoplasia is the most recognized precancerous lesion of esopha-geal squamous cell carcinoma,and its monitoring and intervention is an effective method to reduce the incidence of esophageal squamous cell carcinoma and improve the quality of life of patients.Understanding the etiology,clinical features,diagnosis and treatment of esophageal squamous cell carcinoma plays a crucial role in the prevention and early diagnosis and treatment of esophageal squamous cell carcinoma.At present,the clinical research related to esophageal squamous intraepithelial neoplasia is still insufficient,and there are some differences in clinical treat-ment.This review summarizes the risk factors,clinical features,diagnosis,prognosis and treatment of esophageal squamous intraepithelial neoplasia,hoping to provide ideas for the clinical management of esophageal squamous intraepithelial neoplasia.

Análise crítica do vigor contrátil de ondas hipercontráteis para definer a doença esôfago hipercontrátil / Critical analysis of hypercontractile waves vigor to define hypercontractile esophagus disease

ABSTRACT Background: The current definition for hypercontractile esophagus was arbitrarily set at the uppermost range in volunteers for a specific equipment. Objective: This study aims to critically analyze the concept of hypercontractile waves to redefine hypercontractile esophagus parameters. Methods: We reviewed 500 unselected and consecutive HRM tests (5000 waves) performed in a water -perfused system. Results: Mean distal contractility integral (DCI) was 825±1492 (0-42775) mmHg.cm.s, two standard deviations above average = 3810; 95th percentile = 2798 mmHg.cm.s. Conclusion: In healthy volunteers, two standard deviations above average is 4000 mmHg.cm.s, we thus suggest this value to define hypercontractile waves and define hypercontractile esophagus in a water-perfused HRM system.

Esophageal replacement in children - 27 years of experience in a University Hospital / Substituição esofágica em crianças - 27 anos de experiência em um Hospital Universitário

ABSTRACT Introduction: esophageal replacement in children is indicated when it is impossible to maintain the native esophagus, which in the pediatric population includes patients with esophageal atresia and esophageal caustic stenosis. The objective of this communication is to report the experience of a university service with two techniques of esophageal replacement. Methods: this is a retrospective study based on the revision of hospital files. The study population consisted of patients who underwent esophageal replacement from 1995 to 2022, at the Hospital de Clínicas of the State University of Campinas. The analyzed data were age, sex, underlying disease, technical aspects, complications, and long-term results. Results: during the study period, 30 patients underwent esophageal replacement. The most common underlying diseases were esophageal atresia (73.33%) and caustic stenosis (26.67%). Twenty-one patients underwent gastric transposition (70%), and nine underwent esophagocoloplasty (30%). The most frequent postoperative complication was fistula of the proximal anastomosis, which occurred in 14 patients. Most of the patients with fistulas had a spontaneous recovery. There were three deaths. Of the 27 survivors, 24 can feed exclusively by mouth. Conclusion: esophageal replacement in children is a procedure with high morbidity and mortality. Esophagocoloplasty and gastric transposition have similar results and complications, with the exception of proximal anastomotic fistulas, which are generally self-resolving and are more common in esophagocoloplasty. The choice of the best surgical technique must be individualized according to the patients characteristics and the surgeons experience, as both techniques offer the ability to feed orally in the short or medium term.

RESUMO Introdução: a substituição esofágica em crianças está indicada quando não é possível manter o esôfago nativo, o que inclui principalmente pacientes com atresia esofágica e estenose cáustica esofágica. O objetivo deste trabalho é relatar a experiência de um serviço universitário com duas técnicas de substituição esofágica, a transposição gástrica e a esofagocoloplastia. Métodos: Estudo retrospectivo baseado na revisão de arquivos hospitalares. A população do estudo foi de 30 pacientes com idade entre 6 meses e quatorze anos, submetidos à substituição esofágica, no período de 1995 a 2022, no Hospital de Clínicas da Universidade Estadual de Campinas. Os dados analisados foram idade, sexo, doença de base, aspectos técnicos, complicações e resultados a longo prazo. Resultados: As doenças de base mais comuns foram atresia de esôfago (73,33%) e estenose cáustica (26,67%). Vinte e um pacientes foram submetidos à transposição gástrica (70%) e nove à esofagocoloplastia (30%). A complicação pós-operatória mais frequente foi fístula da anastomose proximal, que ocorreu em 14 pacientes. A maioria dos pacientes com fístula teve recuperação espontânea. Houve três mortes no total. Dos 27 sobreviventes, 24 conseguem se alimentar exclusivamente por via oral. Conclusão: A substituição esofágica em crianças é um procedimento com alta morbimortalidade. Esofagocoloplastia e transposição gástrica têm resultados e complicações semelhantes, com exceção de fístulas da anastomose proximal, que são em geral auto-resolutivas e mais comuns na esofagocoloplastia. A escolha da melhor técnica cirúrgica deve ser individualizada, sendo que ambas as técnicas oferecem a capacidade de alimentação via oral a curto ou médio prazo.

Acalasia esofágica de presentación inespecífica: a propósito de un caso clínico / Esophageal achalasia of nonspecific presentation: clinical case study / Acalasia esofágica apresentação inespecífica: relato de caso

Introducción: la acalasia es una entidad poco frecuente en pediatría. Es un desorden de la motilidad esofágica de tipo neurovegetativo, idiopático; aunque también puede ser secundario a infecciones, neoplasias y enfermedades autoinmunes. Se caracteriza por síntomas como disfagia, regurgitaciones, dolor y descenso ponderal. En adultos la manometría de alta resolución es el gold standard. En niños las dificultades técnicas complejizan su realización. En la actualidad la asociación de la impedanciometría intraesofágica con la manometría es el método diagnóstico más eficaz. El objetivo del tratamiento es mejorar el vaciamiento esofágico mediante la disminución del tono del esfínter esofágico inferior por métodos farmacológicos, endoscópicos o quirúrgicos. Actualmente la miotomía de Heller es de elección. Caso clínico: escolar de 6 años, previamente sano, ingresado por regurgitaciones, dolor abdominal y adelgazamiento. Estudio radiográfico con bario con hallazgos compatibles con acalasia esofágica. Se descartaron causas secundarias. El tratamiento definitivo fue la miotomía de Heller con funduplicatura anterior de Dorr, presentando buena evolución clínica. Discusión: si bien la disfagia es el síntoma clave y en general guía el diagnóstico, es importante estar alertas a las formas clínicas atípicas con presentaciones inespecíficas, como en el caso clínico presentado, esto permite establecer un diagnóstico oportuno, evitando el impacto nutricional y psicosocial del niño y su familia.

Introduction: achalasia is a rare entity in pe-diatrics. It is an idiopathic neurovegetative esophageal motility disorder; although it can also be secondary to infections, neoplasias and autoimmune diseases. It is characterized by symptoms such as dysphagia, regurgitation, pain, and weight loss. In adults, high-resolution manometry is the gold standard. In children, technical difficulties complicate its realization. Currently, the association of intraesophageal impedance measurement with manometry is the most effective diagnostic method. The goal of treatment is to improve esophageal emptying by reducing the tone of the lower esophageal sphincter by pharmacological, en-doscopic, or surgical methods. Heller's myotomy is currently the treatment of choice. Clinical case: a 6-year-old schoolboy, previous-ly healthy, admitted for regurgitation, abdomi-nal pain, and weight loss. Barium radiographic study with findings compatible with esopha-geal achalasia. Secondary causes were ruled out. The definitive treatment was Heller's myotomy with Dorr's anterior fundoplication, presenting good clinical evolution. Discussion: although dysphagia is the key symptom and in general it leads the diagnosis, it is important to be aware of atypical clinical forms with non-specific presentations as in the clinical case presented, which allows timely diagnosis, preventing the nutritional and psychosocial impact of the child and his family.

Introdução: a acalasia é uma entidade rara em pediatria. É um distúrbio neurovegetativo da motilidade esofágica idiopática; embora também possa ser secundária a infecções, neoplasias e doenças autoimunes. É caracterizada por sintomas como disfagia, regurgitação, dor e perda de peso. Em adultos, a manometria de alta resolução é o padrão ouro. Nas crianças, as dificuldades técnicas tornam a sua implementação mais complexa. Atualmente, a associação da impedanciometria intraesofágica com a manometria é o método diagnóstico mais eficaz. O objetivo do tratamento é melhorar o esvaziamento esofágico, reduzindo o tônus do esfíncter esofágico inferior por métodos farmacológicos, endoscópicos ou cirúrgicos. Atualmente a miotomia de Heller é de escolha. Caso clínico: escolar de 6 anos, previamente hígido, internado por regurgitação, dor abdominal e emagrecimento. Estudo radiográfico com bário com achados compatíveis com acalasia esofágica. As causas secundárias foram descartadas. O tratamento definitivo foi miotomia de Heller com fundoplicatura anterior de Dorr, com boa evolução clínica. Discussão: embora a disfagia seja o sintoma chave e geralmente oriente o diagnóstico, é importante estar atento às formas clínicas atípicas e com apresentações inespecíficas, como no caso clínico apresentado, isso permite estabelecer um diagnóstico oportuno, evitando o impacto nutricional e psicossocial da criança e de sua família.

Cuerpos extraños en esófago: revisión de 84 casos

La presencia de cuerpo extraño esofágico (CEE) es una urgencia habitual en gastroenterología. El protocolo en el manejo y la intervención endoscópica puede ser variable entre las instituciones. Objetivo: Definir características clínicas del CEE en adultos, su diagnóstico radiológico y endoscópico, y complicaciones a partir de una muestra de pacientes en un centro de gastroenterología. Materiales y métodos: serie de casos de pacientes que ingresaron desde urgencias y fueron interconsultados al servicio de gastroenterología con diagnóstico presuntivo de CEE. Se recolectaron variables clínicas, así como características, comorbilidades, tiempo de evolución y oportunidad diagnóstica, estudios confirmatorios, y complicaciones. Resultados: 84 sujetos, 70% hombres, promedio de edad 45 (rango:17-87; SD 12,5) años. En 98,8% de los pacientes se realizó endoscopía digestiva alta de modo urgente, con estancia intrahospitalaria promedio de 2,5 días. 93% sin patología de base asociada, en 6/84 (7,14%) pacientes se documentó patología esofágica estructural o funcional. 59/84 70,2%) pacientes consultaron en las primeras 24 horas, en 57,6% se confirmó endoscópicamente presencia de cuerpo extraño. En 67/84 (79,76%) pacientes se realizó radiografía previa a endoscopia, de los cuales, 62/67 (92,5%) con resultado anormal. 70% de los CEE confirmados fueron espinas de pescado. El sitio más frecuente de localización fue en región cricofaringea en el 90% de los casos. En 66/84 (78,6%) sujetos hubo ausencia de complicaciones, seguido de laceración profunda en 10/84 (11,9%) casos. En 3/84 (3,6%) casos se identificaron complicaciones con requerimiento quirúrgico. Conclusiones: La intervención endoscópica en las primeras 24 horas es un momento oportuno para identificación de complicaciones y brindar el tratamiento indicado.

The presence of esophageal foreign body (EFB) is a common emergency in gastroenterology. The protocol for management and endoscopic intervention can be variable among institutions. Objective: to define the clinical characteristics of EFB in adults, its radiological and endoscopic diagnosis, and complications based on a sample of patients in a gastroenterology center. Materials and methods: case series of patients admitted from the emergency department and referred to the gastroenterology department with a presumptive diagnosis of EFB. Clinical variables were collected, as well as characteristics, comorbidities, time of evolution and diagnostic opportunity, confirmatory studies, and complications. Results: 84 subjects, 70% men, mean age 45 (range: 17-87; SD 12.5) years. Urgent upper endoscopy was performed in 98.8% of the patients, with an average in-hospital stay of 2.5 days. 93% had no associated underlying pathology, in 6/84 (7.14%) patients structural or functional esophageal pathology was documented. 59/84 (70.2%) patients consulted in the first 24 hours, in 57.6% the presence of foreign body was confirmed endoscopically. In 67/84 (79.76%) patients radiography was performed prior to endoscopy, of which 62/67 (92.5%) had an abnormal result. Seventy percent of confirmed EFB were fish bones. The most frequent site of localization was in the cricopharyngeal region in 90% of the cases. In 66/84 (78.6%) subjects there was absence of complications, followed by deep laceration in 10/84 (11.9%) cases. In 3/84 (3.6%) cases complications requiring surgery were identified. Conclusions: Endoscopic intervention in the first 24 hours is an opportune moment to identify complications and provide the indicated treatment.

Dolor torácico severo tras retención de cápsula inalámbrica de pH

La cápsula inalámbrica para medir el reflujo gastroesofágico o tambien conocida como cápsula de pHmetría, es una técnica utilizada en la monitorización ambulatoria del reflujo. Esta cápsula es introducida mediante una guía al esofágo y se coloca mediante un sistema de succión y anclaje a la mucosa esofágica. De alli, se comunica con un dispositivo externo mediante señales de radio para registrar la actividad del ácido gástrico en el esófago durante un período determinado de tiempo. A diferencia de la técnica convencional, que implica la inserción de un tubo a través de la nariz hasta el esófago, la cápsula inalámbrica puede ser una alternativa más cómoda y tolerable para los pacientes, lo que podría mejorar la adherencia al procedimiento. Sin embargo, algunos pacientes pueden presentar dolor torácico tras la colocación de la cápsula de pHmetría. Presentamos el caso de una mujer con cuadro clínico de reflujo gastroesofágico, con colocación capsula de pHmetría inalámbrica, lo cual generó dolor torácico severo que precisó la retirada de la cápsula vía endoscópica.

The wireless capsule to measure gastroesophageal reflux, also known as pH monitoring capsule, is a technique used in ambulatory reflux monitoring. This capsule is introduced through a guide into the esophagus and is placed using a suction system and anchored to the esophageal mucosa. From there, it communicates with an external device using radio signals to record the activity of gastric acid in the esophagus over a specified period of time. Unlike the conventional technique, which involves inserting a tube through the nose into the esophagus, the wireless capsule may be a more comfortable and tolerable alternative for patients, potentially improving adherence to the procedure. In some cases, patients may present chest pain after placement of the pH monitoring capsule, however there is little evidence about the etiology and management. We present the case of a woman with a clinical picture of gastroesophageal reflux, with pH monitoring capsule placement, which resulted in severe chest pain that required endoscopic capsule removal.

The Comparative Anatomy of the Upper Digestive System in 26 Species of Zoophagous-Polyphagous Palearctic Birds / Anatomía Comparada del Sistema Digestivo Superior en 26 Especies de Aves Paleárticas Zoófagas-Polífagas

SUMMARY: Birds are the most diversified organisms on Earth, with species covering various niches in each major biome, being essential to understand the modern ecosystem. This study concentrates on the diversification of the anatomical structure of the upper digestive tract for 26 species of zoophage-polyphagous birds and the anatomical differences in the digestive system to reveal aspects related to their evolution and diversification. The trophic spectrum of the selected birds includes several categories of food, or, as in the case of strictly carnivorous birds, to a single food category. After performing the dissections, the digestive tract was separated from the carcass and each digestive segment was measured and analysed. In this study, it was demonstrated that the birds' feeding behaviour influence the macroscopic particularities of the digestive system, more visible in the cranial portion (oropharyngeal cavity, esophagus, proventriculus and gizzard), with little descriptive information in the literature. The tongue is poorly developed and immobile in piscivorous birds, while the tongue of insectivorous birds is long and moves considerably away from the tip of the bill. The esophagus was stretchable and presents longitudinal folds on its entire surface in piscivorous species and not extensible in insectivorous birds.

Las aves son los organismos más diversificados de la Tierra, con especies que cubren varios nichos en cada bioma principal, siendo esenciales para comprender el ecosistema moderno. Este estudio se concentra en la diversificación de la estructura anatómica del tracto digestivo superior para 26 especies de aves zoófago-polífagas y las diferencias anatómicas en el sistema digestivo para revelar aspectos relacionados con su evolución y diversificación. El espectro trófico de las aves seleccionadas incluye varias categorías de alimentos o, como en el caso de las aves estrictamente carnívoras, una sola categoría de alimentos. Después de realizar las disecciones, se separó el tracto digestivo de la canal y se midió y analizó cada segmento digestivo. En este estudio se demostró que el comportamiento alimentario de las aves influye en las particularidades macroscópicas del sistema digestivo, más visibles en la porción craneal (cavidad orofaríngea, esófago, proventrículo y molleja), con poca información descriptiva en la literatura. En las aves piscívoras, la lengua está poco desarrollada e inmóvil, mientras que la lengua de las aves insectívoras es larga y se aleja considerablemente de la punta del pico. El esófago era estirable y presentaba pliegues longitudinales en toda su superficie en especies piscívoras y no extensible en aves insectívoras.

Esófago de Barrett: Actualización en el diagnóstico y tratamiento / Barrett's Esophagus: Update on the Diagnosis and Treatment. Review

El esófago de Barrett (EB) se define como la condición en la cual una mucosa columnar metaplásica predispuesta a neoplasia reemplaza la mucosa escamosa del esófago distal. La guías actuales recomiendan que el diagnóstico requiere el hallazgo de metaplasia intestinal (MI) con células caliciformes de al menos 1 cm de longitud. El EB afecta aproximadamente al 1% de la población general y hasta en 14% de los pacientes con enfermedad por reflujo gastroesofágico (ERGE). El EB es precursor del adenocarcinoma esofágico (ACE), neoplasia en aumento en países occidentales. Los principales factores de riesgo descritos para ACE asociado a EB son: sexo masculino, edad > 50 años, obesidad central y tabaquismo. El riesgo anual de ACE en EB sin displasia, displasia de bajo (DBG) y alto grado es 0,1-0,3%, 0,5% y 5-8%, respectivamente. El tratamiento del EB no displásico consiste en un cambio de estilo de vida saludable, quimioprevención mediante inhibidores de la bomba de protones y vigilancia endoscópica cada 3 a 5 años. Se recomienda que a partir de la presencia de DBG los pacientes sean referidos a un centro experto para la confirmación del diagnóstico, estadio y así definir su manejo. En pacientes con EB y displasia o cáncer incipiente, el tratamiento endoscópico consiste en la resección y ablación, con un éxito cercano al 90%. El principal evento adverso es la estenosis esofágica que es manejada endoscópicamente.

Barrett's esophagus (BE) is the condition in which a metaplastic columnar mucosa predisposed to neoplasia replaces the squamous mucosa of the distal esophagus. The current guidelines recommends that diagnosis requires the finding of intestinal metaplasia (IM) with goblet cells of at least 1 cm in length. BE affects approximately 1% of the general population and up to 14% of patients with gastroesophageal reflux disease (GERD). BE is a precursor of esophageal adenocarcinoma (EAC), which has increased in western countries. The main risk factors described for EAC associated with BE are male sex, age > 50 years, central obesity and tobacco use. Annual risk of EAC in patients with BE without dysplasia, low grade (LGD) and high-grade dysplasia is 0,1-0,3%, 0,5% y 5-8%, respectively. Treatment of non-dysplastic BE consists mainly of a healthy lifestyle change, chemoprevention with proton pump inhibitors and surveillance endoscopy every 3 to 5 years. It is recommended that from the presence of LGD patients are referred to an expert center for confirmation of the diagnosis, stage and thus define their management. In patients with BE and dysplasia or early-stage cancer, endoscopic therapy with resection and ablation is successful in about 90% of the patients. The main adverse event is esophageal stricture, which is managed endoscopically.

Reemplazo esofágico mínimamente invasivo con tubo de Akiyama en un paciente pediátrico con quemadura esofágica / Minimally invasive esophageal replacement with Akiyama tube in a pediatric patient with esophageal burn

Introducción. La ingesta de cáusticos continúa siendo un problema de salud pública en los países en vía de desarrollo, por lo que a veces es necesario realizar un reemplazo esofágico en estos pacientes. Aún no existe una técnica estandarizada para este procedimiento. Caso clínico. Masculino de 10 años con estenosis esofágica por ingesta de cáusticos, quien no mejoró con las dilataciones endoscópicas. Se realizó un ascenso gástrico transhiatal por vía ortotópica mediante cirugía mínimamente invasiva como manejo quirúrgico definitivo .Discusión. Actualmente existen varios tipos de injertos usados en el reemplazo esofágico. La interposición colónica y gástrica son las que cuentan con mayores estudios, mostrando resultados similares. Conclusiones. La elección del tipo y posición del injerto debe ser individualizada, tomando en cuenta las características de las lesiones y la anatomía de cada paciente para aumentar la tasa de éxito.

Introduction. The ingestion of caustics continues to be a public health problem in developing countries, which is why sometimes is necessary to perform an esophageal replacement in these patients. There is still no standardized technique for this procedure. Clinical case. A 10-year-old male with esophageal stricture due to caustic ingestion, who did not improve with endoscopic dilations. A laparoscopic transhiatal gastric lift was performed orthotopically as definitive surgical management using minimally invasive surgery. Discussion. Currently there are several types of grafts used in esophageal replacement. Colonic and gastric interposition are the ones that have the most studies, showing similar results. Conclusions. Choice of type and position of the graft must be individualized, taking into account the characteristics of the lesions and anatomy of each patient, in order to increase the success rate.

Sandifer syndrome: the mis-interpretable disorder

Sandifer syndrome (SS), a movement disorder which is characterised by spasmodic torsional dystonia with back arching and rigid opisthotonic posturing, negatively impacting predominantly the neck, back, and upper extremities. Symptomatic gastro-esophageal reflux disease, esophagitis, or the presence of a hiatal hernia are all associated with Sandifer syndrome. The cause of Sandifer syndrome being uncertain, lifestyle adjustments and modifications highlights as the appropriate mode of treatment. To treat the condition and help relax the baby after feeding, dietary changes or medications can be administered. The case report of a patient with Sandifer Syndrome is considered for observation. Upon arrival, the child was stable, and an Electro-encephalogram (EEG) test revealed nothing abnormal. The child was taking several Anti-epileptic drugs (AED’s), which were stopped in favour of Sodium valproate and Pyridoxine. An opinion from a Gastro-enterologist was sought in light of the epilepsy and possible Gastro-esophageal reflux disease (GERD), and they suggested a milk scan. Rantac was then started, and breastfeeds were thickened. Milk can indicate mild GERD and a reduction in episode frequency. So, sodium valproate was discontinued. Haemodynamically stable child was discharged from the hospital with Pyridoxine and Carnisure. Studies shows most cases of SS improve over time, within the first 24 months in general.

Sandifer syndrome: the mis-interpretable disorder

Sandifer syndrome (SS), a movement disorder which is characterised by spasmodic torsional dystonia with back arching and rigid opisthotonic posturing, negatively impacting predominantly the neck, back, and upper extremities. Symptomatic gastro-esophageal reflux disease, esophagitis, or the presence of a hiatal hernia are all associated with Sandifer syndrome. The cause of Sandifer syndrome being uncertain, lifestyle adjustments and modifications highlights as the appropriate mode of treatment. To treat the condition and help relax the baby after feeding, dietary changes or medications can be administered. The case report of a patient with Sandifer Syndrome is considered for observation. Upon arrival, the child was stable, and an Electro-encephalogram (EEG) test revealed nothing abnormal. The child was taking several Anti-epileptic drugs (AED’s), which were stopped in favour of Sodium valproate and Pyridoxine. An opinion from a Gastro-enterologist was sought in light of the epilepsy and possible Gastro-esophageal reflux disease (GERD), and they suggested a milk scan. Rantac was then started, and breastfeeds were thickened. Milk can indicate mild GERD and a reduction in episode frequency. So, sodium valproate was discontinued. Haemodynamically stable child was discharged from the hospital with Pyridoxine and Carnisure. Studies shows most cases of SS improve over time, within the first 24 months in general.

Diagnóstico y manejo actual de la acalasia / Diagnosis and current management of achalasia

Introducción. La acalasia es un trastorno motor del esófago poco común, de etiología no clara, caracterizado por la pérdida de relajación del esfínter esofágico inferior, pérdida del peristaltismo normal, regurgitación y disfagia. Métodos. Se realizó una revisión narrativa de la literatura en revistas científicas y bases de datos en español e inglés, con el fin de presentar información actualizada en lo referente al diagnóstico y tratamiento de esta patología. Resultado. Se presenta la actualización de los criterios de los trastornos motores esofágicos según la clasificación de Chicago (CCv4.0) para el diagnóstico de acalasia y sus subtipos de acuerdo con los nuevos criterios, así como los tratamientos actuales. Conclusión. La acalasia es un trastorno esofágico multimodal, con manifestaciones de predominio gastrointestinal, por lo que su diagnóstico y abordaje terapéutico oportuno es esencial para mejorar la calidad de vida de los pacientes

Introduction. Achalasia is a rare motor disorder of the esophagus of unclear etiology, characterized by loss of lower esophageal sphincter relaxation, loss of normal peristalsis, regurgitation, and dysphagia. Methods. A narrative review of the literature in scientific journals and databases in Spanish and English was carried out, in order to present updated information regarding the diagnosis and treatment of this pathology. Result. The update of the Chicago esophageal motor disorders criteria (CCv4.0) is presented for the diagnosis of achalasia and its subtypes according to the new criteria, as well as current treatments. Conclusion. Achalasia is a multimodal esophageal disorder, with predominantly gastrointestinal manifestations, so its timely diagnosis and therapeutic approach is essential to improve the quality of life of patients.

Investigation of the histopathological level of Ki-67, caspase-3 expressions of the effects of hesperidin on wound healing in the rat esophagus

Purpose: The effects of hesperidin application on the wound caused by esophageal burns were investigated in this study. Methods: Wistar albino rats were divided into three groups: Control group: only 1 mL of 0.09% NaCl was administered i.p. for 28 days; Burn group: An alkaline esophageal burn model was created with 0.2 mL of 25% NaOH orally by gavage­1 mL of 0.09% NaCl was administered i.p. for 28 days; Burn+Hesperidin group: 1 mL of 50 mL/kg of hesperidin was given i.p. for 28 days to rats after burn injury. Blood samples were collected for biochemical analysis. Esophagus samples were processed for histochemical staining and immunohistochemistry. Results: Malondialdehyde (MDA) and myeloperoxidase (MPO) levels were significantly increased in Burn group. Glutathione (GSH) content and histological scores of epithelialization, collagen formation, neovascularization was decreased. After hesperidin treatment, these values were significantly improved in the Burn+Hesperidin group. In the Burn group, epithelial cells and muscular layers were degenerated. Hesperidin treatment restored these pathologies in Burn+Hesperidin group. Ki-67 and caspase-3 expressions were mainly negative in control group; however, the expression was increased in the Burn group. In the Burn+Hesperidin group, Ki-67 and caspase-3 immune activities were reduced. Conclusion: Hesperidin dosage and application methods can be developed as an alternative treatment for burn healing and treatment.