Bismuth Subsalicylate Increases Intracellular Ca2+, MAP-Kinase Activity, and Cell Proliferation in Normal Human Gastric Mucous Epithelial Cells

Clinical and laboratory studies have shown that bismuth subsalicylate (BSS) is helpful in the healing of gastric ulcers because of the bactericidal effects of bismuth (Bi3+) on H. pylori. Bismuth or BSS has also been reported to possess other nonbactericidal or "gastroprotective" effects in the stomach. It is known in other cell types that the effects of extracellular divalent or trivalent cations (e.g., Ca2+) can activate a plasma membrane-bound calcium-sensing receptor (CaSR). In a previous study, we found the existence of a CaSR which was activated by extracellular Ca2+ and found to increase intracellular Ca2+ [Ca2+]i, MAP-kinase activity, and gastric epithelial cell proliferation. In the present study, we were interested in determining whether the effects of the trivalent cation Bi3+ (in the form of BSS) on [Ca2+]i, MAP-kinase activity, and proliferation of gastric cells. We found that BSS dose dependently increased [Ca2+]i, p44/p42 and p38 MAP-kinase activites, and gastric mucous epithelial cell growth. The addition of BAPTA to chelate intracellular Ca2+ blocked BSS-induced p44/p42 MAP-kinase activities but not p38 MAP-kinase activity. The p44/p42 MAP-kinase inhibitor PD98059 and the p38 MAP-kinase inhibitor SB203580 dose dependently decreased gastric mucous cell growth over a 24 hr. All of the BSS-induced changes in [Ca2+]i, MAP-kinase activity, and gastric cell proliferation could be reproduced with the CaSR-agonist gadolinium (Gd3+). Our data suggest that BSS may possess additional novel effects by increasing gastric mucous epithelial cell growth through a Ca2+/MAP-kinase-dependent pathway.     

Prospective study of cardiac troponin I release in patients with upper gastrointestinal bleeding

Background and Aim:  The rate of cardiac injury in upper gastrointestinal hemorrhage is unclear. The aims of this study were to determine prospectively the risk of cardiac troponin I release and associated adverse cardiac events in patients with acute upper gastrointestinal hemorrhage.
Methods:  From January to September 2003, we prospectively studied patients with documented hematemesis and melena referred to the gastroenterology unit in a tertiary teaching hospital in Melbourne, Australia. Serial assays for cardiac troponin I were performed at 0, 12 and 24 h. Serial creatine kinase levels and electrocardiographs were also performed. Clinical and biochemical data were collected. The primary endpoint was a troponin level >0.5 μg/L within 24 h of recruitment. Various clinical variables were then compared between the groups of patients with or without troponin rise.
Results:  A total of 156 patients were included in the study. The mean age was 67 years (range 19–96). There were 104 (67%) male patients. A troponin level of greater than 0.5 μg/L was found in 30/156 (19%); 126 (81%) patients had normal troponin levels. Age greater than 65 years, signs of hemodynamic instability at presentation, a recent history of cardiac disease, cardiovascular compromise following endoscopy, and re-bleeding were associated with troponin release.
Conclusion:  Upper gastrointestinal bleeding is associated with a risk of cardiac injury of up to 19%. Troponin assay could be used to screen for cardiac damage, especially in elderly patients who present with hemodynamic instability.     

泮托拉唑治疗急性上消化道出血疗效观察

目的　观察泮托拉唑治疗上消化道出血的效果。方法　 98例急性上消化道出血患者经内镜诊断急性糜烂出血性胃炎 3 4例 ,十二指肠球部溃疡伴出血 5 2例 ,胃溃疡伴出血 12例。分三组治疗 ,A组静滴泮托拉唑 40mg 2次 /d ,B组静滴法莫替丁2 0mg 2次 /d ,C组静滴止血芳酸 0 3 2次 /d。结果　A组有效率 97 2 2 % ,B组有效率 78 79% ,C组有效率 5 5 17%。A组与B、C两组比较P <0 0 1。结论　泮托拉唑治疗急性上消化道出血疗效显著     

儿童幽门螺杆菌感染情况及其与上消化道症状的关系

[目的]探讨儿童幽门螺杆菌（Hp）感染与上消化道症状及胃黏膜病变的关系.[方法]纳入300例有上消化道症状患儿,Hp感染情况采用13C或尿素呼气试验或血清Hp抗体检查,204例患儿接受胃镜检查.[结果]①Hp阳性率为34.67％（103/300）,男女患者Hp阳性率差异无统计学意义（P＞0.05）,3～6岁、7～10岁及11～14岁年龄组Hp阳性率依次升高,组间差异有统计学意义（P＜0.05）;②胃镜检查显示39.21％患儿（80/204）有胃黏膜病变,Hp阳性者胃黏膜病变比例高于Hp阴性者（P＜0.05）;③Hp阴性者胃黏膜病变以轻-中度为主,而Hp阳性者胃黏膜病变以中-重度为主,两者病变严重程度的差异有统计学意义（P＜0.05）.[结论]有上消化道症状儿童Hp阳性率较高,且随年龄增长而增高,Hp感染与胃黏膜病变发生及严重程度相关.     

Perforation of the colon by ingested chicken bone,leading to diagnosis of carcinoma of the sigmoid

The patient described is the first reported case of a chicken bone perforating a tumorous narrowing of the lumen of the colon. Although unique, it illustrates one mechanism of foreign-body perforation of the bowel and underscores the advantage for prompt examination of all operative speciments     

Localized AL amyloidosis of the colon: an unrecognized entity

Virtually all patients who present with rectal bleeding and amyloid of the colon have evidence of systemic amyloidosis and require therapy. The small subset of patients with amyloidosis localized to the colon must be recognized and treatment avoided. We queried our file for patients who had amyloidosis of the colon but no evidence of systemic amyloidosis during long-term follow-up. We identified 3 patients who presented with rectal bleeding and who, on investigation, had primary amyloidosis of the colon but no evidence of systemic amyloidosis during a follow-up of 4.5 to 20 years. These patients had no evidence of a plasma cell dyscrasia and received no chemotherapy to prevent deposition of amyloid. It is important to recognize this rare subset and avoid treatment with alkylating agents or high-dose therapy followed by autologous stem cell transplantation. Alkylating agent therapy may be associated with myelodysplasia or acute leukemia. In addition, the cost, inconvenience, and morbidity of therapy are avoided by observation. Patients who present with rectal bleeding and a subsequent diagnosis of amyloidosis of the colon likely will be subjected to chemotherapy or transplantation. Such patients must be recognized and treatment avoided if there is no evidence of systemic amyloidosis because they remain stable for many years.     

'Short' double-balloon enteroscope endoscopic retrograde cholangiopancreatography in patients with a surgically altered upper gastrointestinal tract

BACKGROUND:

Endoscopic retrograde cholangiopancreatography (ERCP) remains a challenge for endoscopists in patients with surgically altered anatomy of the upper gastrointestinal tract. Double-balloon enteroscopes (DBEs) have revolutionized the ability to access the small bowel. The indication for its therapeutic use is expanding to include ERCP for patients who have undergone small bowel reconstruction. Most of the published experiences in DBE-assisted ERCP have used conventional double-balloon enteroscopes that are 200 cm in length, which do not permit use of the standard ERCP accessories. The authors report their experience with DBE-assisted ERCP using a ‘short’ DBE in patients with surgically altered anatomy.

METHODS:

A retrospective review of patients with previous small bowel reconstruction who underwent ERCP with a ‘short’ DBE at the Centre for Therapeutic Endoscopy and Endoscopic Oncology (Toronto, Ontario) between February 2007 and November 2008 was performed.

RESULTS:

A total of 20 patients (10 men) with a mean age of 57.9 years (range 26 to 85 years) underwent 29 sessions of ERCP with a DBE. Six patients underwent Billroth II gastroenterostomy, seven patients Roux-en-Y hepaticojejunostomy, five patients Roux-en-Y gastrojejunostomy, one patient Roux-en-Y esophagojejunostomy and one patient a Whipple’s operation with choledochojejunostomy. Some patients (n=12 [60%]) underwent previous attempts at ERCP in which the papilla of Vater or bilioenteric anastomosis could not be reached with either a duodenoscope or pediatric colonoscope. All procedures were performed with a commercially available DBE (working length 152 cm, distal end diameter 9.4 mm, channel diameter 2.8 mm). The procedures were performed under conscious sedation with intravenous midazolam, fentanyl and diazepam, except in one patient in whom general anesthesia was administered. Either the papilla of Vater or bilioenteric anastomosis was reached in 25 of 29 cases (86.2%) in a mean duration of 20.8 min (range 5 min to 82 min). Bile duct cannulation was successful in 24 of 25 cases in which the papilla or bilioenteric anastomosis was reached. Therapeutic interventions were successful in 15 patients (24 procedures) including sphincterotomy (n=7), stone extraction (n=9), biliary dilation (n=8), stent placement (n=9) and stent removal (n=8). The mean total duration of the procedures was 70.7 min (range 30 min to 117 min). There were no procedure-related complications.

CONCLUSION:

DBEs enable successful diagnostic and therapeutic ERCP in patients with a surgically altered anatomy of the upper gastrointestinal tract. It is a safe, feasible and less invasive therapeutic option in this group of patients. Standard ‘long’ DBEs have limitations of long working length and the need for modified ERCP accessories. ‘Short’ DBEs are equally as effective in reaching the target limb as standard ‘long’ DBEs, and overcomes some limitations of long DBEs to result in high success rates for endoscopic therapy.     

Evaluation of Effects of Ethyl Alcohol and Bismuth Subsalicylate on Gastric Mucosal Barrier in Man

The mucus-bicarbonate barrier provides the firstline of defense against potentially harmful gastricluminal contents. Its integrity can be assessed in manby demonstrating the presence of a pH gradient across the mucus gel layer, from the acidifiedlumen to near-neutral pH at the mucosa. Our aim was,firstly, to assess the effects of ethyl alcohol andbismuth subsalicylate on the integrity of thislumen-to-mucosal pH gradient and, secondly, to evaluate whetherpretreatment with bismuth subsalicylate would protectagainst any deleterious effects of ethyl alcohol. Tenhealthy adults underwent two upper endoscopic procedures with microelectrode measurement of juxtamucosalpH gradients. At the first endoscopy, the effects of 30ml of bismuth subsalicylate on the gradient wasevaluated. At the second endoscopy, gradients were measured before and after luminal installationof 60 ml of ethyl alcohol (40% v/v) and followingpretreatment with either 30 ml of bismuth subsalicylateor placebo. pH measurements were technically easy to perform and provided consistentlyreproducible results. A distinct juxtamucosal pHgradient (pH 4.0 ± 0.2 units) was identified inall subjects in the basal state. Neither bismuthsubsalicylate nor ethyl alcohol had a significant effect on thesegradients. We conclude that a distinct pH gradientbetween gastric luminal fluid and the mucus gel layercan be readily demonstrated in man. Neither bismuth subsalicylate nor ethyl alcohol have asignificant effect on this gradient.     

Endoscopic Diagnosis of Intestinal Lipomas

A retrospective endoscopic study of 11 patients with intestinal lipomas was conducted. The patients included 2 with duodenal—, 2 with small intestinal—, and 7 with large intestinal lipomas. Endoscopically, in addition to features common to all submucosal tumors, lipomas often present characteristic findings including a yellowish surface color and softness of the tumor. The yellowish color was noticed in the 6 patients whose tumors were 10 mm and more in size. In the 2 patients with lipomas in the small intestine, the yellowish color was diminished by hemorrhages, inflammation and fibromusculosis in the lamina propria mucosa due to mechanical irritations such as peristalsis and intussusception. Thus, the appearance of the yellow color was related to the size of the tumors and the histological changes in the overlying mucosa. Endoscopic palpation with biopsy forceps aids in making a diagnosis of lipomas; and the cushion sign was noticed in 3 of 4 patients who underwent the palpation. The naked fat sign is pathognornonic but was observed in only 1 patient with a duodenal lipoma, in which the fat tissue was exposed by denuding the mucosa with the biopsy forceps. Scopic biopsies revealed lipomas in 3 patients. Careful observation of the color and palpation during the endoscopic examination are important for making a correct diagnosis and avoiding the unnecessary resection of lesions.     

Confocal endomicroscopy for in vivo detection of microvascular architecture in normal and malignant lesions of upper gastrointestinal tract

Background and Aim: Confocal laser endomicroscopy allows subsurface analysis of gastrointestinal mucosa during ongoing endoscopy. The present study assessed the feasibility of in vivo detecting superficial vascular architecture by confocal endomicroscopy in normal upper gastrointestinal mucosa and malignant lesions. Methods: Early gastric cancer in eight patients, superficial esophageal carcinoma in six patients, and asymptomatic normal control in 10 patients were studied by confocal endomicroscopy. The characteristic of endomicroscopic microvascular architecture from normal and malignant mucosa was described and images were evaluated. Results: Confocal endomicroscopy enabled clear visualization of the vascular networks of gastroesophageal mucosa. Honeycomb‐like and coil‐shaped regular microvascular architecture surrounding gastric pits were visible in the normal gastric body and antrum, respectively. Differentiated gastric cancerous mucosa showed hypervascularity and various caliber microvessels with irregular shapes. Undifferentiated gastric cancers disclosed a hypovascularity and irregular short branch vessels. Normal squamous epithelium had regular intraepithelial papillary capillary loops (IPCLs) directed toward the luminal surface. In superficial esophageal squamous carcinoma, dilated IPCLs were visible at the upper layer of the squamous mucosa. In esophageal adenocarcinoma, abnormal microvascular architecture showed tortuous and various calibers blood vessels. Of all the images, 41% were graded as good quality. The mean kappa value for interobserver agreement for the prediction of cancerous mucosa was 0.792. Conclusions: Confocal laser endomicroscopy system could yield very clear images of superficial microvascular network in the gastroesophageal mucosal layer both in malignant and normal mucosa. Endomicroscopic observation of vascular architecture may be of assistance in the identification of early gastroesophageal cancers.     

Mechanism of Gastroprotection by Bismuth Subsalicylate Against Chemically Induced Oxidative Stress in Cultured Human Gastric Mucosal Cells

Reactive oxygen species (ROS) are implicated inthe pathogenesis of chemically induced gastric mucosalinjury. We have investigated the effects of ethanol,hydrochloric acid (HCl), and sodium hydroxide (NaOH) on: (1) enhanced production of ROSincluding superoxide anion and hydroxyl radicals, (2)modulation of intracellular oxidized states by laserscanning confocal microscopy, and (3) DNA fragmentation, indices of oxidative tissue, and DNA damage ina primary culture of normal human gastric mucosal cells(GC), which were isolated and cultured from Helicobacterpylori-negative endoscopic biopsies from human subjects. The induction of ROS and DNAdamage in these cells following exposure to ethanol(15%), HCl (150 mM) and NaOH (150 mM) were assessed bycytochrome c reduction (superoxide anion production), HPLC detection for enhanced production ofhydroxyl radicals, changes in intracellular oxidizedstates by laser scanning confocal microscopy, and DNAdamage by quantitating DNA fragmentation. Furthermore, the protective ability of bismuth subsalicylate(BSS) was assessed at concentrations of 25, 50, and 100mg/liter. Incubation of GC with ethanol, HCl, and NaOHincreased superoxide anion production by approximately 8.0-, 6.1- and 7.1-fold and increased hydroxylradical production by 13.3-, 9.6-, and 8.9-fold,respectively, compared to the untreated gastric cells.Incubation of GC with ethanol, HCl, and NaOH increased DNA fragmentation by approximately 6.7-, 4.3-,and 4.8-fold, respectively. Approximately 20.3-, 17.5-,and 13.1-fold increases in fluorescence intensities wereobserved following incubation of gastric cells with ethanol, HCl, and NaOH, respectively,demonstrating dramatic changes in the intracellularoxidized states of GC following exposure to thesenecrotizing agents. Preincubation of GC with 25, 50, and 100 mg/liter of BSS decreased ethanol-inducedincreases in intracellular oxidized states in thesecells by 36%, 56%, and 66%, respectively, demonstratinga concentration-dependent protective ability by BSS. Similar results were observed withrespect to BSS in terms of superoxide anion and hydroxylradical production, and DNA damage. The present studydemonstrates that ethanol, HCl, and NaOH induce oxidative stress and DNA damage in GC and thatBSS can significantly attenuate gastric injury byscavenging these ROS.     

Sequential Group Trial to Determine Gastrointestinal Site of Absorption and Systemic Exposure of Azathioprine

Azathioprine (AZA) is used in the treatment of patients with refractory inflammatory bowel disease; however, its use is limited because of systemic toxicity associated with long-term use. Ileocecal delivery of AZA might be advantageous if local intestinal therapeutic effects could be provided with decreased systemic side effects. Decreased cecal systemic absorption would allow higher dosages of AZA to be administered. A two-phase study was performed to compare the systemic exposure of AZA and 6-mercaptopurine (6-MP) following administration of AZA into the stomach, jejunum, and cecum and to compare the systemic exposure to AZA and 6-MP following administration of three different dosages of AZA into the cecum. In phase I, six healthy male volunteers received three 50 mg sequential doses of AZA via an oral tube directly placed into the stomach, jejunum, and cecum, respectively. In phase II, six healthy male volunteers received three different dosages (50, 300, 600 mg of AZA) into the cecum. Plasma concentrations of AZA and 6-MP at various times were quantified and area under the plasma concentration-time curve (AUC) and mean residence time (MRT) were determined. No significant differences in the AUC of AZA were seen at the different sites. The AUC of 6-MP following administration of AZA into the jejunum (67.0 ± 30.1 ng×hr/ml) was higher compared to the stomach (39.9 ± 38.1 ng/hr/ml) and cecum (29.2 ± 10.9 ng×hr/ml). Jejunal absorption was 68% higher than absorption from the stomach and 129% higher than that of the cecum. Gastric absorption was 27% higher than that of the cecum. Increased dosages given into the cecum resulted in increased AUCs of AZA and 6-MP. The AUCs of AZA following 50, 300, and 600 mg dosages were 16.9 ± 7.4, 52.3 ± 67.2, and 132 ± 151 ng×hr/ml, respectively, and the AUCs of 6-MP were 22.2 ± 14.9, 63.4 ± 50.6, and 104 ± 115 ng×hr/ml, respectively. Systemic exposure to 6-MP is reduced following administration of AZA into the cecum, most likely secondary to reduced absorption of 6-MP from the colon. Higher dosages of AZA presented to the cecum do result in increased systemic absorption, but may still allow more drug to be administered with less toxicity than the same dose received orally.     

Clinical evaluation of hemorrhagic gastroduodenal ulcer in the elderly: Is Helicobacter pylori infection a risk factor for hemorrhage?

Aim: In this study, the aim was to determine the demographic characteristics of elderly patients with gastroduodenal ulcer who had undergone endoscopic hemostasis by comparing them with younger patients. Methods: A total of 353 patients with Forrest class I–IIa hemorrhagic gastroduodenal ulcer who underwent endoscopic hemostasis at our hospital between December 2004 and May 2010 were divided into two groups: one for those 75 years or older (old‐old group; n = 71; age ≥75 years) and one for those younger than 75 years (younger group; n = 282; age <75 years). Then, their demographic characteristics were compared. Results: There were significantly more female patients, patients with underlying chronic renal failure and patients using non‐steroidal anti‐inflammatory drugs in the old‐old group than in the younger group. In addition, the prevalence of open‐type atrophy in the background gastric mucosa was significantly higher in the old‐old group. Although more than half the patients in each group were infected with Helicobacter pylori, the prevalence was significantly higher in the younger group. Of the patients who underwent endoscopic hemostasis only once, those in the old‐old group constituted a significantly higher medical cost than those in the younger group. Comparison of deaths between the two groups revealed that the old‐old patients were more likely to develop severe complications associated with hematemesis, such as aspiration pneumonia. Conclusions: The observed lower prevalence of Helicobacter pylori infection among the elderly patients compared to the younger patients with hemorrhagic gastroduodenal ulcer suggests that other factors, such as non‐steroidal anti‐inflammatory drugs use and chronic renal failure, predispose the elderly to hemorrhagic ulcer.     

In-hospital mortality in non-variceal upper gastrointestinal bleeding Forrest 1 patients

Objective. Non-variceal upper gastrointestinal bleeding (NVUGIB) is recognized world-wide as a common cause of emergency hospitalization, and it often represents a life-threatening event. The purpose of this prospective study was to assess in-hospital mortality in NVUGIB Forrest 1 patients admitted to the emergency unit owing to active bleeding. Material and methods. We enrolled all patients consecutively admitted to the emergency unit for NVUGIB, acutely bleeding at endoscopy (spurting or oozing). Demographic characteristics, clinical and biochemical parameters, endoscopic findings and treatments were evaluated. Results. Of a total of 142 patients (98 M (69%), mean age±SD=66±14 years), spurting (16 (11.3%)) and oozing (126 (88.7%)) were identified. All patients received endoscopic treatment within 6 h of admission and were managed according to the guidelines. Seventeen (12%) patients suffered rebleeding, 4 patients (2.8%) required surgery to stop the bleeding, and 8 (5.6%) died during hospitalization (4 within 5 days and the remainder within 24 days of admission) – 3 as a consequence of bleeding (2.1%) and 5 of non-surgical complications (3.5%). Cox regression analysis showed that the lesions in more than one segment of the esophagogastroduodenal tract (p=0.008, hazard ratio (95% CI)=7.623 (1.680–34.600)) and the number of blood units transfused during the first 48 h of hospitalization (p=0.038, 2.075 (1.041–4.135)) were predictive of in-hospital death. Conclusions. In Forrest 1 patients given rapid endoscopic treatment, in-hospital mortality seems to be related to the contemporaneous presence of bleeding and non-bleeding lesions in more than one segment of the esophagogastroduodenal tract and the number of blood units transfused during the first 48 h of hospitalization.     

Three-dimensional endoscopic ultrasonography of lesions of the upper gastrointestinal tract using a radial-linear switchable thin ultrasound probe

BACKGROUND: The objective of three-dimensional (3-D) endoscopic ultrasonography (EUS) is to recognize lesions stereoscopically. METHODS AND RESULTS: We investigated a total of 43 lesions in the upper gastrointestinal (GI) tract by regenerating 3-D images in eight cases of oesophageal cancer, two cases of oesophageal submucosal tumour, two oesophageal varices, two cases of achalasia, 27 gastric cancers, one gastric carcinoid, and one duodenal submucosal tumour. Using a prototype system (Fujinon, Omiya, Japan), we reconstructed 3-D images from conventional EUS images taken by a thin ultrasound probe (Sonoprobe, SP-701, Fujinon) having a radial-linear scanning mode. The basic 3-D images could be obtained in a short period during EUS performed using the conventional thin-ultrasound probe. The acceptable quality level of the reconstructed 3-D images was 37% (57% in the oesophagus, 25% in the stomach and 100% in the duodenum). Deterioration of 3-D images was due to a wobbling of linear scanning mainly caused by peristalsis of the GI tract, cardiac impulses, and respiration. CONCLUSIONS: Our study has proved that the simple and speedy 3-D display system built using the existing linear-radial switchable probe is easily applicable to clinical cases.     

What are the digestion and absorption models used to reproduce gastrointestinal protein processes?: A protocol for systematic review

Background:Animal, cell, and in vitro studies have been applied to simulate the human gastrointestinal tract (GIT) and evaluate the behavior of biomolecules. Understanding the peptides and/or proteins stability when exposed to these physiological conditions of the GIT can assist in the application of these molecules in the treatment of diseases such as obesity. This study describes a protocol of systematic reviews to analyze the methodologies that mimic the digestive and absorptive processes of peptides and/or proteins.Methods:The protocol follows the guidelines described by Preferred Reporting Items for Systematic Reviews and Meta-Analyzes Protocols (PRISMA-P). The search strategies will be applied in the electronic databases PubMed, ScienceDirect, Scopus, Web of Science, Evidence portal, Virtual Health Library, and EMBASE. The intervention group will be formed by in vivo, in cells, and in vitro (gastrointestinal simulating fluids) studies of digestion and absorption of peptides and/or proteins presenting a schedule, duration, frequency, dosages administered, concentration, and temperature, and the control group consisting in studies without peptides and/or proteins. The selection of studies, data extraction, and assessment of the risk of bias will be carried out independently by 2 reviewers. For animal studies, the risk of bias will be assessed by the instrument of the Systematic Review Center for Experimentation with Laboratory Animals (SYRCLE) and the Office of Health Assessment and Translation (OHAT) tool will be used to assess the risk of bias in cell studies.Results:This protocol contemplates the development of 2 systematic reviews and will assist the scientific community in identifying methods related to the digestive and absorptive processes of peptides and/or proteins.Conclusion:Both systematic reviews resulting from this protocol will provide subsidies for the construction of research related to the clinical application of bioactive peptides and/or proteins. In this context, they will make it possible to understand the gastrointestinal processes during administering these molecules, as the gastrointestinal environment can affect its functionality. Therefore, validating the effectiveness of these protocols is important, as it mimics in vitro biological conditions, reducing the use of animals, being consistent with the reduction, refine and replace program.     

Endoscopic management of foreign bodies in the upper gastrointestinal tract: a retrospective study of 1294 cases

Objective: To report our endoscopic outcomes and explore the effects of duration of impaction and anesthetic methods on the endoscopic removal of foreign bodies in the upper gastrointestinal tract.

Methods: All consecutive patients with suspected foreign body (FB) ingestion between January 2013 and June 2016 were enrolled. Demographic, clinical and endoscopic data were collected and analyzed.

Results: A total of 1294 patients aged seven months to 94 years were enrolled. Odynophagia (415 cases, 32.1%), FB sensation (340 cases, 26.3%) and sore throat (267 cases, 20.1%) were the most frequent complaints. The duration of FB impaction ranged from 4?h to over two years. Anatomically, foreign bodies were most commonly located in the esophagus (n?=?1025, 86.9%). Bony foreign bodies comprised the majority of identified foreign bodies. The most common underlying pathology was esophageal stricture (38 cases, 53.5%). Nearly half of the patients (49.9%) developed complications. As the duration of impaction increased, the success rate by endoscopy decreased (p?p?p?=?.793 and p?=?.085). Age?≥60, duration of impaction longer than one day, impaction in the esophagus, and sharp foreign bodies were identified as risk factors for complications.

Conclusions: Delayed flexible endoscopy in patients, especially elderly patients, with sharp FB impactions in the esophagus results in worse endoscopic outcomes. Endoscopic management under general anesthesia did not improve the therapeutic results compared with topical pharyngeal anesthesia.