Volume 88 - 2025 - Fasc.2 - Original articles
Assessment of Esophageal Emptying in Patients with Dysphagia: Differences Between High-Resolution Impedance Manometry and Timed Barium Esophagram
Background/Aims: Assessment of esophageal emptying is
important in the evaluation of patients with dysphagia. As
several modalities can evaluate this, we aimed to compare two
tests frequently used for assessing esophageal emptying—highresolution
impedance manometry (HRiM) and timed barium
esophagram (TBE).
Methods: A retrospective study compared the results of
HRiM and TBE in patients with dysphagia between 2018 and
2022. Abnormal esophageal clearance was defined as ≥30%
swallows with incomplete bolus clearance on HRiM and as
residual barium ≥2 cm at 5 minutes on TBE.
Results: 77 patients were included in the study (mean age
51.6; 69% female). The most common HRiM diagnoses were
normal motility (37.7%), ineffective esophageal motility
(28.6%), and achalasia (19.5%). Effective esophageal clearance
was noted on HRiM in only 44 subjects (57.1%), while it was seen
on TBE in 57 subjects (74.0%)(P=0.027). There was agreement
between the studies in 58 subjects (75.3%). Agreement was
significantly affected by the HRiM diagnosis with the highest
rate (86.7%) among achalasia patients (P=0.032). The only
other factor correlated to agreement between the studies was a
lack of alcohol use (P=0.048).
Conclusions: According to the parameters used in this study,
TBE is more likely to reveal esophageal emptying than HRiM in
patients with dysphagia. While there is fair agreement between
the results of the two studies, results are especially concordant
in achalasia patients suggesting that either study may be useful
in evaluating esophageal emptying in that population.
Clinical analysis of ultrasound-guided warm saline enema in the treatment of pediatric intussusception
Objective: Few studies have explored using ultrasound-guided
warm saline enema to treat acute intussusception in children.
This article aimed to assess the effect of warm saline enema on
acute intussusception in children.
Methods: In this study, we retrospectively analyzed 169
children who underwent ultrasound-guided warm saline enema
treatment for pediatric intussusception in 3201 Hospital, Shanxi,
China between January 1, 2020, and December 31, 2022.
Results: Out of the 169 children included in the study, 156 were
successfully treated, while 13 did not respond to the treatment.
The success rate was 92.31%, and the failure rate was 7.69%.
The reduction time and hospital stay in 169 children ranged
from 9 to 54 minutes and 1 to 25 days, respectively. On average,
the reduction process took about 20.84±4.86 minutes, and the
hospital stay was around 3.79±2.49 days. Among the 169 children,
3 experienced nausea and vomiting, while none had postoperative
diarrhea or intestinal perforation. The overall incidence of
complications like nausea and vomiting was 1.78%.
Conclusions: A total of 169 children with intussusception
underwent treatment using ultrasound-guided warm saline
enema. The reduction time was consistent with the existing
literature. Complications were small in these cases, only
manifested as nausea and vomiting. These findings also provide
valuable evidence for clinical management of these diseases.
Balloon Dilation-assisted Extraction of Embedded Self-Expandable Metal Stents
Background and study aims: Embedded transpapillary
self-expandable metal stents (SEMS) may require extraction
over time and standard approaches often fail. In the current
study we describe a newly developed approach to refractory
embedded SEMS, using balloon dilation-assisted extraction.
Our aim was to evaluate the feasibility and outcomes of this
novel technique.
Patients and methods: This is an exploratory single-center
retrospective analysis of all consecutive patients undergoing
endoscopic balloon-assisted stent extraction. Baseline,
procedural and follow-up data were collected and analyzed.
Results: Twelve patients with embedded transpapillary
SEMS were identified (60.0% female, mean age 70.1 [SD±18.1]
years, uncovered SEMS 33.3%) with median dwell time of
457.5 (IQR 175.8-1042) days. Previous extraction attempts
were undertaken in the majority of cases (83.3%), including
SEMS-in-SEMS placement (41.7%). Using the balloon-assisted
stent extraction technique, successful SEMS extraction was
achieved in 10 out of 12 cases (83.3%). Adverse events occurred
in 3 patients (Grade II [n=2, 16.7%] - Grade III [n=1, 8.3%]).
After a median follow-up time of 171 (58-260) days, 1 biliary
recurrence occurred for which endoscopic re-evaluation was
performed.
Conclusions: Our data suggest that endoscopic balloonassisted
stent extraction should be considered for extraction
of embedded self-expandable metal stents, as it showed high
efficacy without any major procedure-related adverse events,
using readily available endoscopic tools.
Mortality and rebleeding rate of Dieulafoy lesions throughout the gastrointestinal tract
Background/Objectives: Dieulafoy lesion (DL) is a rare yet
potentially life-threatening cause of gastrointestinal bleeding.
This study retrospectively analyzed all patients diagnosed with
DL over the past two decades, focusing on clinical outcomes
such as rebleeding and mortality. We aimed to identify factors
associated with these outcomes to improve the understanding
and management of this condition.
Materials/Methods: This study included 39 hospitalized
patients who underwent endoscopy for gastrointestinal
bleeding and were diagnosed with Dieulafoy lesions. Data
were collected retrospectively, and regression analysis was
performed to assess factors associated with all-cause mortality
and rebleeding rates.
Results: The study included 39 patients, with a mean
age of 64 years; 13 (33%) were women. The most common
presenting complaint was hematemesis (41%). The most
common localization of DLs was the stomach, with 25 (64.1%)
DLs detected. Rebleeding rates within one week and mortality
within 90 days were 33% and 28%, respectively. In univariate
analysis, esophageal localization (HR: 3.398, p = 0.042), low
hemoglobin levels (HR: 0.758, p = 0.030), and high Glasgow-
Blatchford score (HR: 1.179, p = 0.035) were associated
with rebleeding. Duodenal localization was independently
associated with higher mortality (HR: 27.276, p < 0.001), after
adjusting for age, sex, and comorbidity index.
Conclusion: Dieulafoy lesions are most commonly found
in the stomach but can also occur in atypical sites like the
jejunum or hernia pouch. Enteroscopy is crucial for diagnosing
and treating DLs, especially those in atypical small intestine
locations. Lesion localization plays a key role in predicting
both rebleeding and mortality rates.
Efficacy and safety of capecitabine-temozolomide (CAPTEM) regimen in patients with neuroendocrine neoplasms – experience from NETwerk, a Belgian ENETS Center of Excellence
Neuroendocrine neoplasms (NEN) are rare tumors
originating from neuroendocrine cells, commonly found in the
gastrointestinal tract and the pulmonary tract. Metastatic welldifferentiated
neuroendocrine tumors (NET) grade 3 present
unique challenges, as they are positioned between the more
indolent NET grade 1-2 and the aggressive neuroendocrine
carcinomas (NEC). Due to the scarcity of data regarding
the optimal systemic treatment for metastatic NET grade
3 and aggressive NET grade 2 subtypes, guidelines remain
inconclusive.
This retrospective study analyzed data from the NETwerk
database, encompassing patients treated with the capecitabinetemozolomide
(CAPTEM) regimen between June 2016 and
January 2024. The cohort included patients with NET grades
1-3 and NEC. The study focused on assessing the efficacy
and safety of CAPTEM. In total, data from 36 patients was
analyzed.
The median progression-free survival (mPFS) was 13
months, and median overall survival (mOS) was 17 months.
Overall response rate (ORR) was 25.8%, and the disease
control rate (DCR) was 67.7%. NET grade 2 patients had the
highest mPFS, while NET grade 3 exhibited the most favorable
mOS. Subgroup analysis showed that panNEN had superior
mPFS and mOS compared to other primary tumor sites, with
significant differences in mOS based on NEN type. Safety
analysis in 20 patients indicated good tolerance and safety .
CAPTEM is an efficient and safe regimen for metastatic
NEN, with promising outcomes in NET grade 2-3 patients. The
promising findings pave the way for further exploration into
various aspects of CAPTEM, to better define its position in the
therapeutic landscape of NEN.
