Esophageal Button Battery Retrieval: Time-In May Not Be Everything.

The management of ingested foreign bodies is a challenging task because each case is unique with multiple varying factors including a patient's age, anatomical considerations, clinical presentation, and the type and location of the foreign body ingested. Additionally, concern over complications associated with button battery ingestion typically drives management decisions. The common practice is the urgent retrieval of the foreign body within two to six hours of presentation. An unusual case is presented here that demonstrated significantly delayed endoscopic removal of an ingested button battery without complication, avoiding the many risks associated with any emergent endoscopic procedure. However, this practice is a case-by-case decision because there is a lack of literature to guide the current management.

Use of Upadacitinib in Refractory Esophageal Lichen Planus: Endoscopic Improvement in "Planus" Sight.

Although rarely reported, esophageal lichen planus is a chronic inflammatory disease that can lead to debilitating symptoms. It is reported to affect adult women in the fourth and fifth decades of life. Treatment ranges from medical therapy to endoscopic dilation. Owing to underdiagnoses and limited data on therapies, little guidance is provided in the literature regarding treatment of refractory cases. We report a case of a 68-year-old woman with esophageal lichen planus who had symptoms and lack of histological improvement despite being on budesonide and mycophenolate. She was then transitioned to upadacitinib 30 mg daily and had significant symptomatic and endoscopic improvement.

Lessons learned: Preventable misses and near-misses of endoscopic procedures.

Endoscopy is a complex procedure that requires advanced training and a highly skilled practitioner. The advances in the field of endoscopy have made it an invaluable diagnostic tool, but the procedure remains provider dependent. The quality of endoscopy may vary from provider to provider and, as a result, is not perfect. Consequently, 11.3% of upper gastrointestinal neoplasms are missed on the initial upper endoscopy and 2.1%-5.9% of colorectal polyps or cancers are missed on colonoscopy. Pathology is overlooked if endoscopic exam is not done carefully, bypassing proper visualization of the scope's entry and exit points or, if exam is not taken to completion, not visualizing the most distal bowel segments. We hope to shed light on this issue, establish areas of weakness, and propose possible solutions and preventative measures.

Could microbiome analysis be a new diagnostic tool in gastric carcinogenesis for high risk, Helicobacter pylori negative patients?

Helicobacter pylori (H. pylori) has long been believed to be the major colonizer of the stomach, but recent advances in genetic sequencing have allowed for further differentiation of the gastric microbiome and revealed the true complexity of the gastric microbiome. One of the few studies specifically evaluated the microbiome in the H. pylori negative patient population. They concluded that various stages of gastric carcinogenesis are associated with distinct bacterial taxa that could service both a predictive and diagnostic purpose. While the study has some limitations, the conclusions they make are intriguing and should prompt a larger prospective study to be done that spans multiple geographic regions.

Eosinophilic Esophagitis With Subsequent Eosinophilic Colitis: Keeping a High Index of Suspicion.

The prevalence of eosinophilic esophagitis (EoE) has significantly increased, while, in comparison, eosinophilic gastroenteritis and colitis remain rare entities. The diagnosis and management of eosinophilic gastrointestinal (GI) disorders can be challenging given the non-specific manifestations and variable treatment response. Symptoms refractory to initial therapies (e.g., proton pump inhibitors, dietary modifications, topical steroids) should raise suspicion for distal involvement of the GI tract. In this case report, we describe a patient with EoE with a subsequent diagnosis of eosinophilic colitis and symptom response to systemic corticosteroids. In addition, we review recent updates regarding the management of eosinophilic gastrointestinal disorders.

Esophageal Cancer: An Updated Review.

The incidence of esophageal cancer (EC) is on the rise. With the distinct subtypes of adenocarcinoma and squamous cell carcinoma comes specific risk factors, and as a result, people of certain regions of the world can be more prone to a subtype. For example, squamous cell carcinoma of the esophagus has the highest incidence in eastern Africa and eastern Asia, with smoking being a major risk factor, whereas adenocarcinoma is more prevalent in North America and western Europe, with gastroesophageal reflux disease being a leading risk factor. With that being said, adenocarcinoma and squamous cell carcinoma have similar and unfortunately poor survival rates, partly because EC is prone to early metastasis given that the esophagus does not have a serosa, as well as the superficial nature of its lymphatics compared with the rest of the gastrointestinal tract. This makes early detection of the utmost importance, and certain patients have been shown to have the benefit of screening/surveillance endoscopies, including those with Barrett's esophagus, lye-induced/caustic strictures, tylosis, and Peutz-Jeghers syndrome. Until treatments significantly improve, identifying EC at the earliest stage will have the best success for patient outcomes, and further elucidation of its pathogenesis and risk factors may lead to identifying other high-risk groups that should be screened.

Rare Gastric Cardia Polyp Causing Complete Esophageal Obstruction.

A 67-year-old man presented with food impaction and was found to have a gastric polyp obstructing the esophageal outlet. Due to the polyp's location and size, no immediate endoscopic intervention was performed, and the patient returned for intraoperative endoscopy and polypectomy. Cases of gastric polyps causing esophageal obstruction have not been identified in the literature. This case is unique for the location and size of the polyp, necessitating concomitant surgical management.

Acute eosinophilic myocarditis: diagnosis and treatment.

Hypereosinophilic syndrome (HES) is a rare disorder of unregulated eosinophilia, which if untreated, may lead to systemic tissue infiltration and inflammation. Cardiac involvement is a common and serious associated complication. We describe a case of HES associated myocarditis mimicking a non-ST elevation MI (NSTEMI). Unlike myocarditis in general, our patient responded well to high dose methylprednisone, the standard of care in HES. We review the clinical presentation, pathophysiology, pathology and treatment of eosinophilic myocarditis related to HES.