Diagnostic approach and treatment of Zenker's diverticulum

Pharyngoesophageal diverticulum have many subtypes, Zenker's diverticulum being the most common of them. Accounting from 70 to 75% of all esophageal diverticula. The 50% of these occur between the seventh and eighth decade of life. The most common symptom is dysphagia. The predominant symptom of ZD is dysphagia and the most serious is pulmonary aspiration. A 68-year-old female attended a general surgery consultation with progressive dysphagia, weight loss, regurgitation and halitosis. Laboratory studies showed normal, while the upper gastrointestinal series (UGI) showed stasis in the upper part of the esophagus. Digestive panendoscopy revealed Zenker's diverticulum, diverticulectomy and cricopharyngeal myotomy were performed. Zenker's diverticulum is diagnosed through radiological studies and endoscopy. Surgical management is necessary due to the list of complications if left untreated.

Trans and postoperative endoscopic assistance in an esophageal gastro anastomosis: case report

Esophageal anastomosis leak has an average incidence of 10% and three times the risk of mortality. Use should be made of all available tools to reduce the risk of anastomotic leak. Endoscopy could be useful during the trans and postoperative period to reduce morbidity and mortality in high-risk esophageal anastomoses. We present this case as proof of this.

Rare presentation of esophageal atresia with supra-esophageal atresia: a case report and management challenges

Esophageal atresia (EA), often regarded as 'the epitome of modern surgery', typically presents with tracheoesophageal fistula (TEF) and occurs in about 1 in 2400 to 1 in 3000 newborns, frequently accompanied by other congenital malformations. Rarely, EA is associated with congenital esophageal stenosis (CES), a condition first identified by Spitz. EA and TEF result from the incomplete development of the esophagus and trachea, with polyhydramnios in the third trimester being a potential indicator. This case study described a 43-year-old multiparous woman who, during an antenatal care examination, was found to have a fetus with abnormalities and excessive amniotic fluid, necessitating two amnioreduction procedures. Despite the interventions, the fetus exhibited signs of supra-esophageal atresia, leading to an elective cesarean section. The newborn, a girl with a birth weight of 3200 grams and an Apgar score of 5/6, could not be fitted with an orogastric tube, although karyotyping showed no chromosomal abnormalities. The discussion highlights the association of EA with various tracheobronchial anomalies and emphasizes the need for preserving the native esophagus in cases of CES. Gastroesophageal reflux disease (GERD) is common in EA patients, often requiring long-term follow-up and possible antireflux surgery. The case underscores the importance of diligent monitoring and intervention in high-risk pregnancies, with regular ANC examinations and accurate diagnoses being crucial for effective management.

Prediction of esophageal varices in cirrhosis by using splenic stiffness measurement

Background: Predicting esophageal varices in cirrhosis using the measurement of splenic stiffness is an exciting area of study. Vein enlargement in the lower esophagus, known as varices, is a common symptom of cirrhosis caused by portal hypertension. These varicose veins are potentially fatal since they bleed easily. The present study aims to predict the OV in cirrhosis patients by splenic stiffness in and around this region. Methods: After receiving permission from the Institutional Ethics Committee, the study was performed. The present study authors measured splenic stiffness and liver stiffness by using FibroScan in 112 consecutive cirrhotic patients who met the inclusion criteria. Patients were also assessed by hepatic venous pressure gradient (HVPG), upper gastrointestinal endoscopy, liver stiffness, liver spleen diameter to platelet ratio score, and platelet count to spleen diameter ratio. Results: Among 112 patients enrolled, 64 patients had valid liver stiffness and splenic stiffness measurement, and 64 patients had EV (small, n=23 and large n=42). There was a significant difference in median liver stiffness (54.2 vs. 21.3 kPa, p<0.05), splenic stiffness (56.1 vs. 30 kPa, p<0.05), liver spleen diameter to platelet ratio score (6.3 vs. 2.7, p<0.05), and platelet count to spleen diameter ratio (798 vs 1,241, p<0.05) between patients with OV and those without OV. Conclusions: Non-invasive markers, such as splenic stiffness, may help identify individuals with cirrhosis who are at risk of having esophageal varices, especially large ones, and who are at risk of bleeding, the study's authors conclude.

Baveno VII Criteria for the Exclusion of Esophageal Varices in a Peruvian Population: Cross-Sectional Study / Criterios de Baveno VII para la exclusión de várices esofágicas en una población peruana: estudio transversal

Abstract Introduction: Esophageal varices represent one of the main complications in patients with liver cirrhosis. The main objective was to determine the diagnostic performance of the new Baveno VII criteria to exclude the presence of esophageal varices in compensated advanced chronic liver disease (cACLD), in an independent Peruvian population. Materials and methods: A cross-sectional study, including patients with cACLD, upper digestive endoscopy, and transient hepatic elastography from January 2017 to December 2019. Results: The mean age was 59.4 (12.9) years, while the mean measurement of liver stiffness was 27.21 (14.6) kPa. The prevalence of esophageal varices was 85.6%; non-alcoholic fatty liver disease (NAFLD) (63.6%) was the most prevalent etiology, followed by viral hepatitis (14.4%). For esophageal varices exclusion, Baveno VII criteria for all etiologies demonstrated adequate sensitivity and negative predictive value (sensitivity: 96.7%; 95% confidence interval [CI]: 92.3%-98.8%; negative predictive value: 76.9%, 95% CI: 56.4% -91%). However, better diagnostic performance was found when applying the Baveno VII criteria without considering NAFLD patients (sensitivity: 98.4%, 95% CI: 79.2% -99.2%; negative predictive value: 90.9%, 95% CI: 79.2% -99.2%). This would prevent 14% of endoscopic studies with a 9% risk of failing to detect esophageal varices. Conclusions: The Baveno VII criteria present good diagnostic performance for the exclusion of esophageal varices, especially in patients with cACLD without NAFLD, in an independent Peruvian population.

Resumen Introducción: Las várices esofágicas representan una de las principales complicaciones en pacientes con cirrosis hepática. El objetivo principal fue determinar el rendimiento diagnóstico de los nuevos criterios de Baveno VII para excluir la presencia de várices esofágicas en la enfermedad hepática crónica compensada (cACLD), en una población peruana independiente. Materiales y métodos: Estudio transversal que incluyó a pacientes con cACLD, endoscopia digestiva alta y elastografía hepática transitoria desde enero de 2017 hasta diciembre de 2019. Resultados: La edad media fue de 59,4 (12,9) años, mientras que la medición media de rigidez hepática fue de 27,21 (14,6) kPa. La prevalencia de várices esofágicas fue del 85,6%; la enfermedad metabólica asociada al hígado graso (MASLD) (63,6%) fue la etiología más prevalente, seguida de la hepatitis viral (14,4%). Para la exclusión de várices esofágicas, los criterios de Baveno VII para todas las etiologías demostraron una sensibilidad y un valor predictivo negativo adecuados (sensibilidad: 96,7%; intervalo de confianza [IC] del 95%: 92,3%-98,8%; valor predictivo negativo: 76,9%, IC 95%: 56,4%-91%). Sin embargo, se encontró un mejor rendimiento diagnóstico al aplicar los criterios de Baveno VII sin considerar a los pacientes con MASLD (sensibilidad: 98,4%, IC 95%: 79,2%-99,2%; valor predictivo negativo: 90,9%, IC 95%: 79,2%-99,2%). Se evitaría el 14% de estudios endoscópicos con un riesgo del 9% de no detectar várices esofágicas. Conclusiones: Los criterios de Baveno VII presentan buen rendimiento diagnóstico para la exclusión de várices esofágicas, especialmente en pacientes con cACLD sin MASLD, en una población peruana independiente.

Gastric antral web presenting with esophageal stricture and severe malnutrition

Gastric antral web is a rare cause of gastric outlet obstruction in children. Common complaints include intermittent non-bilious vomiting, bloating, pain, loss of appetite, and weight loss. Herein, we report a case of gastric antral web presenting with esophageal stricture and malnutrition, which was followed for many years with a misdiagnosis. An 8-year-old African boy was referred to our pediatric gastroenterology clinic due to recurrent vomiting and severe malnutrition. According to his medical history, the patient began experiencing non-bilious vomiting at 40 days of age and a diagnosis of gastroesophageal reflux was made. He was hospitalized multiple times and received nasogastric tube feedings in the following 4 years. He was re-evaluated for growth retardation and malnutrition at 4 years of age. He had been diagnosed with gluten enteropathy and was fed a gluten-free diet. Recently, he developed difficulty swallowing solid food and was only able to consume liquid meals. Esophagography revealed segmental stenosis in the distal portion of the esophagus. After stricture excision with thoracotomy, upper gastrointestinal series with a radiopaque substance indicated normal esophageal passage; however, prolonged gastric emptying time was also noted. Upon examination during laparotomy, a congenital web was detected in the antral region and was excised. Esophageal and gastric pathologies were consistent with stricture caused by reflux esophagitis and gastric antral web. Today, gastric antral web is mostly diagnosed and treated in infancy. Near total obstruction is relatively easy to diagnose; however, many patients with partial obstruction are followed-up for years with an incorrect diagnosis. Therefore, it should be considered in such cases, persistent vomiting and gastroesophageal reflux may be associated with esophageal stricture.

Hipertensión portal no cirrótica por enfermedad vascular porto-sinusoidal: presentación de un caso y revisión de la literatura / Non-cirrhotic portal hypertension due to porto-sinusoidal vascular disease: Case presentation and literature review

La enfermedad vascular porto-sinusoidal es una causa infrecuente de hipertensión portal no cirrótica, fue descrita recientemente y es poco diagnosticada por el desconocimiento entre los médicos. Se considera en casos de hipertensión portal clínicamente significativa, en ausencia de cirrosis. El diagnóstico se basa en los hallazgos de la biopsia. El pronóstico de la enfermedad es mejor que el de los pacientes cirróticos, y el tratamiento es similar al de la hipertensión portal y al de las complicaciones que presentan los pacientes con cirrosis. Se presenta el caso de una paciente con várices esofágicas con estudios de imágenes no compatibles con cirrosis y hallazgos específicos en la biopsia de enfermedad vascular porto-sinusoidal. Este caso muestra el ejercicio diagnóstico en un caso de enfermedad vascular porto-sinusoidal de una paciente de Colombia, así como el resultado de las intervenciones terapéuticas y la evolución en el tiempo.

Porto-sinusoidal vascular disease is an uncommon cause of non-cirrhotic portal hypertension. It was recently described and is rarely diagnosed due to lack of knowledge among doctors. It is considered in cases of clinically significant portal hypertension in the absence of cirrhosis, and the diagnosis is based on biopsy findings. The prognosis of the disease is better than that of cirrhotic patients, and the treatment is similar to that of portal hypertension, including the management of complications associated with cirrhosis. We present the case of a patient with esophageal varices, whose imaging studies were not compatible with cirrhosis, alongside specific biopsy findings of porto-sinusoidal vascular disease. This case illustrates the diagnostic process in a patient from Colombia with portosinusoidal vascular disease, as well as the outcomes of therapeutic interventions and the patient´s evolution over time.

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.

Delayed Esophageal Perforation after Anterior Cervical Spine Fixation: Case Report and Literature Review / Perforación esofágica tardía posterior a la fijación de columna cervical por vía anterior: reporte de caso y revisión de la literatura

Abstract The anterior approach to cervical spine surgery can cause esophageal injuries; however, it is an infrequent complication with a 0.02-0.25% prevalence. It usually appears in two high-risk areas: Killian's dehiscence and the thyrohyoid membrane. Delayed esophageal perforations typically occur due to chronic friction and usually have a benign course. Most cases of late migration occur in the first 18 months of the surgical procedure, and the clinical manifestation varies between asymptomatic patients in the case of delayed perforations and patients with dysphagia, subcutaneous emphysema, and sepsis in the case of acute perforations.

Resumen El abordaje quirúrgico de la columna cervical por vía anterior puede generar lesiones esofágicas; sin embargo, es una complicación muy infrecuente con una prevalencia que varía entre el 0,02% y el 0,25%. Suelen presentarse en dos zonas de mayor riesgo: el triángulo de Killian y la membrana tirohioidea. Las perforaciones esofágicas tardías usualmente se presentan debido a fricción crónica y suelen tener un curso benigno. La mayoría de los casos de migración tardía se presentan en los primeros 18 meses del procedimiento quirúrgico y la presentación clínica varía entre pacientes asintomáticos en caso de perforaciones tardías y pacientes con disfagia, enfisema subcutáneo y sepsis en caso de perforaciones agudas.

Esophageal achalasia, an unexpected complication of COVID-19 post palatoplasty: a case report and literature review

The COVID-19 pandemic, caused by SARS-COV-2, has led to significant mortality worldwide. Despite the declaration in May, 2023 by the World Health Organization (WHO), that the COVID-19 pandemic in no longer a public health emergency of international concern, some survivors are experiencing post-infection complications, including esophageal achalasia. Esophageal achalasia is a rare neurodegenerative disorder characterized by impaired esophageal motility and lower esophageal sphincter dysfunction. This study reviews the literature to explore the association between COVID-19 and achalasia and also presents a case of a 9-month-old child diagnosed with achalasia following COVID-19 infection; a unique occurrence in a young child. This study comprises a case report and a literature review. Clinical data for the case report was collected from medical records, while the literature review included a search of electronic databases from January 2020 to October 2023. Keywords related to COVID-19 and esophageal achalasia were utilized to conduct a search in electronic databases resulting in 9 selected articles. This study underscores the emerging concern of esophageal achalasia as a post-infection complication of COVID-19. It provides a unique case of a young child developing achalasia after COVID-19 infection and reviews the limited literature on this association. Further research is needed to understand the underlying mechanisms and potential preventative measures for this rare complication in COVID-19 survivors.

Overexpression SPRY2 Suppresses Esophageal Squamous Cell Carcinoma Progression Via Inactivation of ERK/AKT Signaling / La Sobreexpresión SPRY2 Suprime la Evolución del Carcinoma de Células Escamosas de Esófago Mediante la Inactivación de la Señalización ERK/AKT

SUMMARY: Esophageal cancer is one of the most aggressive gastrointestinal cancers. Invasion and metastasis are the main causes of poor prognosis of esophageal cancer. SPRY2 has been reported to exert promoting effects in human cancers, which controls signal pathways including PI3K/AKT and MAPKs. However, the expression of SPRY2 in esophageal squamous cell carcinoma (ESCC) and its underlying mechanism remain unclear. In the present study, we aimed to investigate the detailed role of SPRY2 in the regulation of cell proliferation, invasion and ERK/AKT signaling pathway in ESCC. It was identified that the expression level of SPRY2 in ESCC was remarkably decreased compared with normal tissues, and it was related to clinicopathologic features and prognosis ESCC patients. The upregulation of SPRY2 expression notably inhibited the proliferation, migration and invasion of Eca-109 cells. In addition, the activity of ERK /AKT signaling was also suppressed by the SPRY2 upregulation in Eca-109 cells. Our study suggests that overexpression of SPRY2 suppress cancer cell proliferation and invasion of by through suppression of the ERK/AKT signaling pathways in ESCC. Therefore, SPRY2 may be a promising prognostic marker and therapeutic target for ESCC.

El cáncer de esófago es uno de los cánceres gastrointestinales más agresivos. La invasión y la metástasis son las principales causas de mal pronóstico del cáncer de esófago. Se ha informado que SPRY2 ejerce efectos promotores en los cánceres humanos, que controla las vías de señales, incluidas PI3K/AKT y MAPK. Sin embargo, la expresión de SPRY2 en el carcinoma de células escamosas de esófago (ESCC) y su mecanismo subyacente aún no están claros. En el presente estudio, nuestro objetivo fue investigar el papel detallado de SPRY2 en la regulación de la proliferación celular, la invasión y la vía de señalización ERK/AKT en ESCC. Se identificó que el nivel de expresión de SPRY2 en ESCC estaba notablemente disminuido en comparación con los tejidos normales, y estaba relacionado con las características clínico-patológicas y el pronóstico de los pacientes con ESCC. La regulación positiva de la expresión de SPRY2 inhibió notablemente la proliferación, migración e invasión de células Eca-109. Además, la actividad de la señalización de ERK/AKT también fue suprimida por la regulación positiva de SPRY2 en las células Eca-109. Nuestro estudio sugiere que la sobreexpresión de SPRY2 suprime la proliferación y la invasión de células cancerosas mediante la supresión de las vías de señalización ERK/AKT en ESCC. Por lo tanto, SPRY2 puede ser un marcador de pronóstico prometedor y un objetivo terapéutico para la ESCC.

Cohorte descriptiva de pacientes adultos con hipertensión portal en una institución de tercer nivel en Colombia / Descriptive cohort of adult patients with portal hypertension at a tertiary care institution in Colombia

Introducción. La hipertensión portal (HTP) se define como una elevación anormal de la presión venosa en el sistema portal que lleva al desarrollo de vías colaterales para desviar el flujo sanguíneo de la zona. Dentro de su etiología están las relacionadas con la cirrosis hepática y otras causas denominadas no cirróticas. El objetivo de este estudio fue evaluar los principales hallazgos demográficos, clínicos y paraclínicos en un grupo de pacientes con HTP, y determinar el uso de ayudas invasivas y no invasivas, y su disponibilidad para el diagnóstico y seguimiento de los pacientes en los centros que no cuentan con laboratorio de hemodinamia hepática, reflejando la dinámica de múltiples escenarios en Colombia. Metodología. Se realizó un estudio descriptivo de corte transversal, retrospectivo, en pacientes atendidos en una institución de tercer nivel del sur de Colombia, entre enero del año 2015 y diciembre del año 2020. Resultados. Se obtuvo una muestra de 61 pacientes en donde la mayoría de casos correspondían a hombres en la séptima década de la vida, procedentes del área urbana. La principal causa de consulta fue el sangrado digestivo (39,3 %), asociado a la presencia de telangiectasias (arañas vasculares) en el 37,2 %, seguido de circulación colateral (31,3 %) e ictericia (19,7 %). En la ecografía abdominal (realizada en el 57,4 % de los pacientes) predominaron la cirrosis (68 %) y la presencia de esplenomegalia (14,2 %), y en lospacientes con Doppler portal (realizado en el 16,4 %) se encontró hígado cirrótico (80 %) y dilatación portal (40 %). Con respecto a los hallazgos en la esofagogastroduodenoscopia predominó la presencia de várices esofágicas y gastritis crónica. Conclusión. El principal motivo de consulta fue el sangrado digestivo, en tanto que la cirrosis fue el antecedente y el hallazgo imagenológico más frecuente, seguido de las várices esofágicas. Se encontró que el uso de paraclínicos, ecografía abdominal, ecografía con Doppler portal y esofagogastroduodenoscopia fueron los más utilizados en el contexto clínico de los pacientes con el diagnóstico de HTP.

Introduction. Portal hypertension (PHT) is defined as an abnormal elevation of venous pressure in the portal system that leads to the development of collateral pathways to divert blood flow from the area. Within its etiology are those related to liver cirrhosis and other so-called non cirrhotic causes. The aim of this study was to evaluate the main demographic, clinical and paraclinical findings in a group of patients with PHT, and to determine the use of invasive and non-invasive aids, and their availability for the diagnosis and follow-up of patients in centers that do not have a hepatic hemodynamics laboratory, reflecting the dynamics of multiple scenarios in Colombia. Methodology. A descriptive, retrospective, cross-sectional, retrospective study was conducted in patients attended in a third level institution in Southern Colombia, between January 2015 and December 2020. Results. A sample of 61 patients was obtained where the majority of cases corresponded to men in the seventh decade of life, from the urban area. The main cause of consultation was digestive bleeding (39.3%), associated with the presence of telangiectasias (spider veins) in 37.2%, followed by collateral circulation (31.3%) and jaundice (19.7%). In abdominal ultrasound (performed in 57.4% of the patients), cirrhosis (68%) and the presence of splenomegaly (14.2%) predominated, and in patients with portal Doppler (performed in 16.4%), cirrhotic liver (80%) and portal dilatation (40%) were found. With respect to the findings in the esophagogastroduodenoscopy, esophageal varices and chronic gastritis were predominant. Conclusion. The main reason for consultation was gastrointestinal bleeding, while cirrhosis was the most frequent history and imaging finding, followed by esophageal varices. It was found that the use of paraclinics, abdominal ultrasound, ultrasound with portal Doppler and esophagogastroduodenoscopy were the most used in the clinical context of patients diagnosed with PHT.

Early and severe onset of esophageal dysfunction after laparoscopic sleeve gastrectomy: a case report and review of literature / Inicio temprano y severo de disfunción esofágica después de manga gástrica laparoscópica: reporte de caso y revisión de la literatura

ABSTRACT After bariatric surgery one of the most common complications is dysphagia. The etiology of this disease has not been fully elucidated but it is known that it may be due to structural changes due to surgery. This case describes a 65-year-old female with early and severe onset of dysphagia following laparoscopic sleeve gastrectomy. The patient's final diagnosis was postobesity surgery esophageal dysfunction and laparoscopic proximal gastrectomy with esophagojejunal Roux-en-Y anastomosis was performed. Physicians should be aware of this condition in order to offer early diagnosis and treatment.

RESUMEN Después de una cirugía bariátrica una de las complicaciones más comunes es la disfagia. La etiología de esta enfermedad no ha sido completamente dilucidada, pero se sabe que puede deberse a cambios estructurales debidos a la cirugía. En este reporte se describe el caso de una mujer de 65 años con disfagia severa de aparición temprana después de una en manga gástrica laparoscópica. El diagnóstico final del paciente fue de una disfunción esofágica posterior a una cirugía de obesidad y se planteó como manejo una gastrectomía proximal laparoscópica con anastomosis esofagoyeyunal en Y de Roux. Hay que tener en cuenta las complicaciones a corto y largo plazo que se pueden presentar luego de cirugías de obesidad para poder realizar un diagnóstico temprano y poder ofrecer un tratamiento adecuado.

Role of NF-κB Signaling Pathway in "Reflux Esophagitis-esophageal Cancer" and Traditional Chinese Medicine Intervention：A Review / 中国实验方剂学杂志

Reflux esophagitis is an inflammatory disease of esophageal mucosa damage caused by the reflux of gastric contents into the esophagus. Its incidence is on the rise， and it has become an important precancerous disease of esophageal cancer. Studies have shown that the continuous inflammatory response stimulates the esophageal mucosa， causing abnormal proliferation of esophageal epithelial cells and damage to esophageal mucosal tissue， which eventually leads to the occurrence of heterogeneous hyperplasia and even carcinogenesis. The nuclear transcription factor-kappa B （NF-κB） signaling pathway is one of the most classical inflammatory and cancer signaling pathways. It has been found that abnormal activation of the NF-κB signaling pathway is crucial to the development and prognosis of reflux esophagitis and esophageal cancer. It is widely involved in the proliferation， autophagy， apoptosis， and inflammatory response of esophageal epithelial cells and tumor cells， accelerating the transformation of reflux esophagitis to esophageal cancer and making it a potential target for the treatment of reflux esophagitis and esophageal cancer. Currently， there is no specific treatment for reflux esophagitis and esophageal cancer， and large side effects often appear. Therefore， finding a promising and safe drug remains a top priority. In recent years， traditional Chinese medicine scholars have conducted a lot of research on NF-κB signaling pathway， and the results indicate that NF-κB signaling pathway is an important potential target for traditional Chinese medicine to prevent and treat reflux esophagitis and esophageal cancer， but there is a lack of comprehensive and systematic elaboration. Therefore， this paper summarized the relevant studies in recent years， analyzed the relationship among NF-κB signaling pathway， reflux esophagitis， esophageal cancer， and transformation from inflammation to cancer， and reviewed the research literature on the regulation of the NF-κB signaling pathway in traditional Chinese medicine to prevent and treat reflux esophagitis and esophageal cancer， so as to provide new ideas for the prevention and treatment of reflux esophagitis and esophageal cancer.

Chinese Medicine Regulates Signaling Pathways Related to Esophageal Cancer： A Review / 中国实验方剂学杂志

Esophageal cancer is a common malignant tumor of the digestive tract. At present， the pathogenesis of esophageal cancer has not been fully clarified. Although surgery， radiotherapy， chemotherapy， targeted therapy， and immunotherapy have achieved good clinical results in the treatment of esophageal cancer， there are still many complications and severe adverse reactions. As an important part of traditional Chinese medicine （TCM）， in recent years， many basic experiments and clinical studies have proved that Chinese medicine has a good effect in treating esophageal cancer. At the same time， the multi-component and multi-target characteristics of Chinese medicine and unclear pathogenesis of esophageal cancer determine that there are some problems such as unclear mechanisms of Chinese medicine in preventing and treating esophageal cancer. It is necessary to start with modern medicine and reveal the mechanism of Chinese medicine in preventing and treating diseases from the aspects of molecular biology and network pharmacology. It is believed in TCM that the occurrence of esophageal cancer is mostly attributed to stagnation of liver Qi， phlegm stasis and Qi stagnation， fluid consumption and heat accumulation， the decline of healthy Qi， and the cementation of cancer toxicity. According to the literature review， Chinese medicinal compounds mainly include tonic formulae （such as Liu Junzitang）， drying and moistening formulas （such as Qigesan）， and heat-clearing formulas （such as Fufang Kushen injection）. Chinese medicinal monomers mainly include drugs potent in attacking poison and killing insects， clearing heat， activating blood and resolving stasis， and regulating Qi， which is consistent with the etiology and pathogenesis of esophageal cancer in TCM. It is also found that Chinese medicine can promote cell apoptosis and autophagy， block cell cycle， and reverse cell resistance by regulating phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt）， neurogenic locus notch homolog protein （Notch）， Wnt/β-catenin， mitogen-activated protein kinase （MAPK）， nuclear factor-κB （NF-κB）， Janus kinase 2/signal transducer and activator of transcription 3 （JAK2/STAT3）， and other related signaling pathways， but there is no systematic summary. This study systematically summarized the relevant signaling pathways of Chinese medicine in regulating esophageal cancer， which is helpful to clarify the relevant mechanisms of Chinese medicine in the process of esophageal cancer occurrence， development， invasion， and metastasis， so as to provide new targets and new perspectives for the treatment of esophageal cancer and promote the modernization of TCM.

An excerpt of AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis （2023） / 临床肝胆病杂志

This Practice Guidance intends to coalesce best practice recommendations for the identification of portal hypertension （PH）， for prevention of initial hepatic decompensation， for the management of acute variceal hemorrhage （AVH）， and for reduction of the risk of recurrent variceal hemorrhage in chronic liver disease. The most significant changes in the current Guidance relate to recognition of the concept of compensated advanced chronic liver disease， codification of methodology to use noninvasive assessments to identify clinically significant PH （CSPH）， and endorsement of a change in paradigm with the recommendation of early utilization of nonselective beta-blocker therapy when CSPH is identified. The updated guidance further explores potential future pharmacotherapy options for PH， clarifies the role of preemptive transjugular intrahepatic portosystemic shunt in AVH， discusses more recent data related to the management of cardiofundal varices， and addresses new topics such as portal hypertensive gastropathy and endoscopy prior to transesophageal echocardiography and antineoplastic therapy.

Interpretation of the updates of the NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version 3. 2023) / 中国胸心血管外科临床杂志

@#Esophageal cancer is the seventh most common cancer worldwide. On August 29, 2023, National Comprehensive Cancer Network (NCCN) released the NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version 3. 2023). This article aims to highlight the key updates in treatment and follow-up recommendations between the version 3 and the version 2 in 2023, providing the latest guidance for the management of esophageal cancer in our country.

Application progress of artificial intelligence in the diagnosis of esophageal cancer / 中国胸心血管外科临床杂志

@#Esophageal cancer is an aggressive malignancy with high morbidity and poor prognosis. Symptoms of early esophageal cancer are insidious and difficult to detect, while advanced esophageal obstruction, lesion infiltration and metastasis seriously affect patients’ quality of life. Early detection and treatment can help to increase the survival chance of patients. Recently, artificial intelligence (AI) has shown remarkable success in diagnosis of esophageal cancer, highlighting the great potential of new AI-assisted diagnostic modalities. This paper aims to review recent progress of AI in the diagnosis of esophageal cancer and to prospect its clinical application.

Disease Burden of Esophageal Cancer Attributable to High BMI and Death Prediction in China and the United States, 1990-2019 / 肿瘤防治研究

Objective To analyze trends in the disease burden of esophageal cancer attributable to high body mass index (BMI) in the Chinese and United States populations from 1990 to 2019 and predict deaths over the next 10 years. Methods This study used Global Burden of Disease 2019 data to obtain mortality and disability-adjusted life-year (DALY) data by year, gender, and age for the disease burden of esophageal cancer attributable to high BMI in China and the United States from 1990 to 2019. Joinpoint regression analysis was conducted to analyze long-term trends. Bayesian age–period–cohort analysis was used to predict age-standardized mortality attributable to esophageal cancer in 2020–2030. Results From 1990 to 2019, the age-standardized mortality rate for esophageal cancer attributable to high BMI in China increased from 1.44/105 to 1.80/105 and the age-standardized DALY rate increased from 34.17/105 to 40.79/105. From the perspective of gender, the number of deaths, DALYs, and the corresponding age-standardized rate of males in China and the United States increased from 1990 to 2019. The age-standardized mortality and DALY rates of Chinese women showed a downward trend, decreasing by 21.36/105 and 29.71/105, respectively. Joinpoint analysis results revealed that the average annual percentage changes (AAPCs) in mortality attributable to esophageal cancer in the total population and men in China from 1990 to 2019 increased by 0.78% (95%CI: 0.71-0.84) and 1.52% (95%CI: 1.44-1.60), respectively, and that in females decreased by 0.88% (95%CI: −0.96-−0.80). AAPC in women in the United States rose at a slow rate of 0.07% (95%CI: 0.02-0.09). The burden of esophageal cancer deaths attributable to high BMI is predicted to continue to rise in China and the United States in 2020–2030. Conclusion The disease burden of esophageal cancer attributable to high BMI significantly increased in China from 1990 to 2019. The disease burden of esophageal cancer caused by high BMI in China is expected to increase from 2020 to 2030.