Endoscopic pedicle flap grafting in the treatment of esophageal fistulas: A case report

BACKGROUND

Fistulization is a rare complication of esophageal diverticula. Patients with this condition often require surgery, which unfortunately can be invasive and traumatic. Endoscopic therapy is an alternative method for treating esophageal fistula. Hereby we introduce a new endoscopic technique that uses an esophageal pedicle flap to close esophageal fistulas.

CASE SUMMARY

A 49-year-old male patient, complaining of backache and choking, was formerly diagnosed with chronic bronchopneumonia. Chest computed tomography and esophagram confirmed the presence of esophageal diverticulum and mediastinal esophageal fistula. The patient was then treated by covering the fistulas using a pedicled flap that was acquired through endoscopic submucosal dissection of a patch from the proximal esophageal mucosa. Then the pedicle flap was reversed 180° to cover the fistula. Titanium clips were used to fix the flap. The procedure ended with percutaneous endoscopic gastrostomy for enteral nutrition. The patient was followed up to evaluate the size reduction of the fistula. Cough, backache, and fever were alleviated within a week. Forty-five days after the surgery, endoscopic examination showed that the fistulas were reduced in size. The larger one reduced from 0.5 cm to 0.2 cm, while the smaller one was fully closed.

CONCLUSION

Transplantation of a pedicle flap obtained from the esophageal mucosa endoscopically is minimally invasive for the treatment of fistula.

Challenges in early detection and endoscopic resection of esophageal cancer: There is a long way to go

The publication by Qu et al provided a comprehensive discussion about the epidemiology, etiology, histopathology, early detection, and endoscopic treatment of esophageal carcinoma (EC) and summarized the progress in the advanced technologies for screening and endoscopic resection for EC. In this editorial, we will provide deeper insight into the challenges that hinder practical application of these advanced technologies along with the role of these technologies in upper endoscopy quality. More efforts need to be made to overcome the challenges and add the value of these technologies in upper endoscopy quality. Clinical outcomes of management strategies after noncurative endoscopic dissection for early EC patients need further investigation. The experiences with noncurative endoscopic resection of other organs may have certain implications for noncurative resection of early EC.

Synchronous multiple primary malignancies of the esophagus, stomach, and jejunum: A case report

BACKGROUND

Treatment of synchronous multiple primary malignancies is quite often very challenging. Herein, we report on a rare case of synchronous multiple primary malignancies in the esophagus, stomach, and jejunum.

CASE SUMMARY

A 50-year-old man who was a heavy drinker and smoker with a poor diet, and had a family history of cancer sought treatment due to dysphagia lasting for 4 mo. He was finally diagnosed with lower esophageal squamous cell carcinoma (pT3N2M0, G2, stage IIIB), gastric angular adenocarcinoma (pT3N2M0, G2-G3, stage IIIA) with greater omental lymph node metastasis, and jejunal stromal tumor (high risk). The high-risk jejunal stromal tumor was found during surgery. In spite of radical resection and adjuvant chemotherapy, lymph node metastasis occurred 21 mo later. The patient responded poorly to additional chemotherapy and refused further examination and therapy. He died of widespread metastases 33 mo after surgery.

CONCLUSION

This case indicates a poor prognosis of synchronous multiple advanced primary malignancies and the importance of comprehensive assessment in the population at high risk for cancer.

Double Band Ligation-Assisted Endoscopic Submucosal Resection for Rectal Neuroendocrine Tumors: Comparison With Conventional Endoscopic Mucosal Resection With Ligation (With Video)

INTRODUCTION

Based on endoscopic mucosal resection with ligation (EMR-L), we developed double band ligation-assisted endoscopic submucosal resection (ESR) for complete resection of small submucosal rectal neuroendocrine tumors (NETs). Both procedures use a multiband device to perform resection, with the only difference being that ESR adds an additional band to obtain deeper resection margin. The aim of this retrospective study was to validate its feasibility, safety, and effectiveness compared with EMR-L.

METHODS

This retrospective study included consecutive patients with small (≤10 mm) suspected submucosal rectal NETs who underwent ESR (n = 45) or EMR-L (n = 26) between June 2018 and October 2023 at West China Hospital. En bloc resection rate, complete resection rate, procedure time, margin distance, and adverse events were compared between 2 groups.

RESULTS

En bloc resections were achieved in all patients. The complete resection rate of ESR was higher than EMR-L (100% vs 88.5%, P = 0.045). The vertical margin distance and lateral margin distance were significantly longer in ESR group than EMR-L group (vertical margin distance 782.31 ± 359.45 μm vs 363.84 ± 222.78 μm, P < 0.001; and lateral margin distance 4,205.75 ± 2,167.43 μm vs 3,162.94 ± 1,419.22 μm, P = 0.008, respectively). There were no significant differences in procedure time, adverse events, postprocedural hospital stay, or medical cost between 2 groups. In addition, there was no evidence of recurrence or metastasis during the follow-up.

DISCUSSION

ESR seems to be safe and effective for complete resection of small submucosal rectal NETs. Larger, multicenter, prospective studies are needed to further assess this technique.

Endoscopic polidocanol foam sclerobanding for the treatment of Grade II-III internal hemorrhoids: The focus of clinical practice

We have read the article by Qu et al with great interest, as it presents an integration of endoscopic polidocanol foam sclerotherapy with rubber band ligation in patients with Grade II-III internal hemorrhoids. The authors conducted a prospective, multicenter, randomized study to evaluate the long-term symptomatic and endoscopic efficacy of this combined intervention. In this discussion, we focus on the procedural steps of this combined strategy and suggest potential avenues for future research.

Advancing early diagnosis of inflammatory bowel disease: A call for enhanced efforts

The diagnosis of inflammatory bowel disease (IBD) is complicated by its nonspecific clinical presentation and the limited accuracy of existing biomarker tests, frequently resulting in significant delays from the time of symptom onset to the achievement of a definitive diagnosis. Thus, improving the early identification of IBD remains a crucial focus for gastroenterologists. Blüthner et al innovatively utilized medical data from German IBD patients to investigate risk factors contributing to these diagnostic delays. However, certain methodological limitations in the study have impacted data extraction and interpretation, underscoring the need for more comprehensive analyses to validate these findings.

Refining the targeted population and achieving better for colorectal cancer screening

This editorial comments on the article entitled "Stage at diagnosis of colorectal cancer through diagnostic route: Who should be screened?" by Agatsuma et al, who conducted a retrospective study aiming at clarifying the stage at colorectal cancer (CRC) diagnosis based on different diagnostic routes. We share our opinion about CRC screening programs. The current situation suggests the need for a more specific and targeted population for CRC screening.

Scale offers the possibility of identifying adherence to lifestyle interventions in patients with non-alcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder, and dietary and lifestyle interventions remain the mainstays of NAFLD therapy. Zeng et al established a prediction system to evaluate adherence to lifestyle interventions in patients with NAFLD and choose optimal management. Here, we discuss the application scenarios of the scale and the areas warranting further attention, aiming to provide a possible reference for clinical recommendations.

Hereditary Colorectal Cancer Syndromes: Molecular Genetics and Precision Medicine

Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. Hereditary CRC syndromes account for approximately 5-10% of all CRC, with a lifetime risk of CRC that approaches 50-80% in the absence of endoscopic or surgical treatment. Hereditary CRC syndromes can be phenotypically divided into polyposis and non-polyposis syndrome, mainly according to the conditions of polyps. The typical representatives are familial adenomatous polyposis (FAP) and Lynch syndromes (LS), respectively. Over the past few decades, molecular genetics enhanced the discovery of cancer-predisposing genes and revolutionized the field of clinical oncology. Hereditary CRC syndromes have been a key part of this effort, with data showing that pathogenic variants are present in up to 10% of cases. Molecular phenotypes of tumors can not only help identify individuals with genetic susceptibility to CRC but also guide the precision prevention and treatment for the development of CRC. This review emphasizes the molecular basis and prevention strategies for hereditary CRC syndromes.