Endotherapy for and tailored approaches to treating GERD, and refractory GERD.

This paper presents commentaries on how endoluminal antireflux procedures compare to laparoscopic fundoplication; new endoscopic procedures being studied to treat refractory gastroesophageal reflux disease (GERD); the new Stretta; the relationship between obesity and proton pump inhibitor (PPI) resistance; data concerning acid hypersensitivity and sensory receptors (vallinoid, TRPV1) causing refractory GERD; whether microscopic esophagitis is relevant in determining symptoms of non-erosive reflux disease (NERD); how concomitant functional gastrointestinal disorders affect the PPI response in NERD; the evidence that a functional esophagus is associated with inflammatory bowel syndrome (IBS); the role of GABA agonists in the treatment of refractory GERD; the role of biofeedback and antidepressants in refractory GERD; and endoluminal fundoplication using the EsophyX device.

The dose of omeprazole required to achieve adequate intraesophageal acid suppression in patients with gastroesophageal junction specialized intestinal metaplasia and Barrett's esophagus.

Background: The mainstay of medical therapy for Barrett's esophagus is normalization of esophageal acid exposure with proton pump inhibitors (PPIs). However, the optimal dose and whether once daily or twice daily is required for acid suppression is unknown.

Aim: The purpose of this study was to assess whether adequate intra-esophageal acid suppression could be achieved with once daily versus twice daily omeprazole in patients with gastroesophageal specialized intestinal metaplasia (GEJSIM), short-segment (SSBE) and long-segment Barrett's esophagus (LSBE).

Persistence of nondysplastic Barrett's esophagus identifies patients at lower risk for esophageal adenocarcinoma: results from a large multicenter cohort.

Background & Aims: Recent population-based studies have shown a low risk of esophageal adenocarcinoma (EAC) in patients with nondysplastic Barrett's esophagus (NDBE). We evaluated whether persistence of NDBE over multiple consecutive surveillance endoscopic examinations could be used in risk stratification of patients with Barrett's esophagus (BE).

Methods: We performed a multicenter outcomes study of a large cohort of patients with BE.

Endoscopic ultrasound-guided transesophageal thoracic duct puncture in a Swine model: a survival study.

Background And Study Aims: The study of lymph as a biofluid is lacking because of absence of a safe site and technique for lymph acquisition. Injury to the thoracic duct during surgery is known to cause chylothorax. The aim of this interventional study was to puncture the thoracic duct under endoscopic ultrasound (EUS) guidance and observe for complications in a swine model.

Barrett's esophagus: surveillance and reversal.

The following on surveillance and reversal of Barrett's esophagus (BE) includes commentaries on criteria for surveillance even when squamous epithelium stains normally with a variety of biomarkers; the long-term follow-up of surgery versus endoscopic ablation of BE; the recommended surveillance intervals in patients without dysplasia; the sampling problems related to anatomic changes following fundoplication; the value of tissue spectroscopy and optical coherence tomography; the cost-effectiveness of biopsy protocols for surveillance; the quality of life of Barrett's patients; and risk stratification and surveillance strategies.

Barrett's esophagus: endoscopic treatments II.

The following on endoscopic treatments of Barrett's esophagus includes commentaries on animal experiments on cryotherapy; indications for cryotherapy, choice of dosimetry, number of sessions, and role in Barrett's esophagus and adenocarcinoma; recent technical developments of RFA technology and long-term effects; the comparative effects of diverse ablation procedures and the rate of recurrence following treatment; and the indications for treatment of dysplasia and the role of radiofrequency ablation.

Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy.

Context: The role of EUS to evaluate subtle radiographic abnormalities of the pancreas is not well defined.

Objective: To assess the yield of EUS+/-FNA for focal or diffuse pancreatic enlargement/fullness seen on abdominal CT scan in the absence of discrete mass lesions.

Design: Retrospective database review.

A randomized comparison of methylene blue-directed biopsy versus conventional four-quadrant biopsy for the detection of intestinal metaplasia and dysplasia in patients with long-segment Barrett's esophagus.

Objectives: Methylene blue (MB) selectively stains specialized intestinal metaplasia (SIM) and may assist in surveying a columnar-lined esophagus for Barrett's esophagus associated dysplasia.

Methods: This is a prospective, randomized crossover study comparing 4-quadrant random biopsies (4QB) versus MB-directed biopsies for the detection of SIM and dysplasia in 48 patients with long segment Barrett's esophagus (LSBE). Patients randomly underwent two endoscopies over a 4-wk time period with either 4QB or MB-directed biopsies as their first or second exam.

Endoscopic therapy of a splenic abscess: definitive treatment via EUS-guided transgastric drainage.

Background: Splenic complications of pancreatitis are exceedingly rare, occurring in only 2.2% of cases. Patients typically present in a dramatic fashion and often need an urgent procedure to prevent overwhelming infection or hemorrhage.

A randomized comparison of EUS-guided FNA versus CT or US-guided FNA for the evaluation of pancreatic mass lesions.

Background: Diagnosing pancreatic cancer by EUS-FNA is a potentially appealing alternative to percutaneous biopsy.

Aim: To compare EUS-FNA with CT or US-guided FNA for diagnosing pancreatic cancer.

Design: Single center, prospective, randomized, cross-over.

Proximal migration of a 3 French pancreatic stent in a patient with pancreas divisum: suggested technique for successful retrieval.

Context: Pancreatic stents may be placed during therapeutic ERCP for a variety of indications. One such indication is to prophylax against the development of pancreatitis following sphincterotomy of the minor papilla in patients with recurrent acute pancreatitis and pancreas divisum. Increasingly, endoscopists that perform pancreatic ERCP are placing small caliber (3 Fr), unflanged, single pigtail stents into the long axis of the pancreatic duct with the expectation that these stents will only stay in place for a few days and the majority will pass spontaneously on their own without the need for follow-up endoscopic retrieval.

Defining the diagnostic algorithm in pancreatic cancer.

Most patients with pancreatic cancer present with a mass on radiologic studies, however, not every pancreatic mass is cancer. Since radiological studies alone are insufficient to establish the diagnosis of a pancreatic mass and patient management depends on a definitive diagnosis; confirmatory cytology or histology is usually required. As a minimally invasive procedure, EUS and EUS FNA avoid the risk of cutaneous or peritoneal contamination that may occur with CT or US-guided investigations and is less invasive than surgical interventions.