Factors Affecting Route Selection of Balloon-Assisted Enteroscopy in Patients with Obscure Gastrointestinal Bleeding: A KASID Multicenter Study

Balloon-assisted enteroscopy (BAE) is an important diagnostic modality for ongoing obscure gastrointestinal bleeding (OGIB). However, it is difficult to determine the optimal insertion route. We retrospectively analyzed the records of patients with OGIB contained in a multicenter enteroscopy database of 1108 balloon-assisted enteroscopy (BAE) procedures (875 patients) to find out factors affecting BAE route selection in patients with OGIB. A total of 603 BAE procedures in 512 patients were investigated: there were 392 (65.0%) bidirectional and 211 (35.0%) unidirectional procedures. Overt OGIB was more frequent in the latter group (p = 0.024). Computed tomography (CT) was more frequently performed in the unidirectional group (p < 0.001). Capsule endoscopy and a small bowel barium study were performed more frequently in the bidirectional group (p < 0.001 and p = 0.039, respectively). Multivariate analysis showed that occult OGIB, capsule endoscopy and a small bowel barium study were independently associated with use of the bidirectional approach (p = 0.011, p = 0.013 and p = 0.046, respectively). Conversely, CT was associated with use of the unidirectional approach (p < 0.001). Conclusion: CT can aid the selection of an optimal insertion route in OGIB patients. However, capsule endoscopy and small bowel barium study are unhelpful.

Leiomyoma an uncommon benign esophageal tumor

Leiomyoma are rare esophageal masses. Majority remain asymptomatic but may present with dysphagia when more than five centimeters in size. Barium swallow is the initial diagnostic investigation. Small lesion can be observed. Symptomatic and large lesion should undergo prompt surgical enucleation. Here we presented a case of a 35 year old female presenting with progressive dysphagia and gradual weight loss for 5 years along with regurgitation for one year. Clinical examination was unremarkable. Barium study was suggestive of smooth intramural defect with normal mucosa. Computed tomography showed well defined homogenous opacity located intramuraly at the level of junction of middle and distal third of esophagus with normal surrounding structures. Surgical enucleation was done through a right posterolateral thoracotomy. Muscle defect was repaired and checked for possible leaks. Liquid diet was commenced on 5th postoperative day. Patient was discharged on semisolid diet for two weeks with progression to solid meal.

A Rare Cause of Dyspepsia: A Case Report of Gastric Diverticulum

A gastric diverticulum is an outpouching from the gastric mucosa. It is extremely rare. It is normally asymptomatic, but some may present with non-specific abdominal pain. A combination of upper gastrointestinal endoscopy and radiological contrast study such as oral barium study and computed tomography are needed to make a definite diagnosis and to rule out other associated pathology. Although treatment with medical therapy has been reported to be effective, the use of open and laparoscopic resection also yields a good outcome in the management of complicated gastric diverticulum. We present a case of symptomatic gastric diverticulum which has been successfully treated with medical therapy.

Diagnosis of dysphagia in Primary Care

In this work, we present the case of an elderly patient, who consulted for dysphagia mainly to solids, of early appearance. The anamnesis, in the context of an esophageal dysphagia, motivated the speed of the approach, in order to rule out a malignant disease. A barium study was requested that reports a probable diagnosis of achalasia. We highlight the value of the anamnesis in the course of the pathologies diagnosed in Primary Care, despite of limitation of complementary tests.

Gastro-oesophageal fistula in an achalasia patient following myotomy as an unusual cause of heartburn

We report a case of delayed presentation of a gastro-oesophageal fistula following a Heller myotomy and anterior fundoplication for achalasia in a 28-year-old man. After a period of symptom resolution following initial operation, dysphagia and severe heartburn commenced temporarily, related to non-steroidal anti-inflammatory drug (NSAID) use. Endoscopy demonstrated a secondary opening in the lower oesophagus and a barium swallow showed an oesophageal fistula to the stomach. Currently, reasonable symptom control has been obtained on double dose pantoprazole. Barium study best demonstrated the abnormality. NSAIDs should possibly be avoided in cases of severe dysmotility of the oesophagus.

PS01.019: BARIUM FLUOROSCOPY AS A GOOD DIAGNOSTIC MODALITY FOR THE PATIENTS WITH LATE DIAGNOSIS OF ESOPHAGEAL ACHALASIA

Background Achalasia is a relatively rare disorder and the diagnosis would be delayed or mistaken as eating disorders like as anorexia nervosa. This study aimed to assess the diagnostic modalities to find the potential achalasia with delayed diagnosis. Methods Thirty-eight patients of achalasia presented to Tohoku University Hospital during 2006 to 2015 were retrospectively analyzed based on the medical records. Twenty-three patients that took less than 6 months to diagnosis (group A); 15 patients that took more than 6 months (group B) were evaluated in the duration for diagnosis, modalities and their clinical findings. Results No patients of group B and 16 of 21 patients of group A underwent barium study in the first 6 months after visiting to their physician (P = 0.0001). During the subsequent clinical coarse after 6 months from first visit to physician, 13 cases and 8 cases of group B were diagnosed by barium study and by endoscopic examination, respectively. Conclusion No obstructive finding of gastrointestinal endoscopy is insufficient to deny the possibility of achalasia. It is useful for patients with eating disorders due to unknown origin should be considered to perform the barium study to make potential achalasia apparent. Disclosure All authors have declared no conflicts of interest.

Radiographic findings in sheep with abomasal phytobezoariasis

The purpose of this study was to characterise the radiographic appearance of abomasal phytobezoars in sheep as well as to evaluate the utility of abdominal radiography to identify them. Twenty-seven fat-tailed Herrick sheep with a clinical suspicion of abomasal impaction were examined radiographically. Abdominal survey radiographs in right lateral recumbency were taken. Abomasal phytobezoars (AP) were seen in abdominal survey radiographs in 25/27 sheep (92%). Their radiographic survey appearance was round-to-oval masses with radiopaque margins and radiopacity similar to the ingesta centrally. An additional gastrographic barium study was performed in six of the sheep, followed by exploratory laparotomy where phytobezoars were removed through abomasotomy. The optimal time to visualise the APs was 48 h post-contrast. A significant correlation was noted between phytobezoars size in radiology and surgery (r = 0.651, P &lt; 0.001). Use of the barium study can improve the phytobezoar-ingesta contrast and visibility of the phytobezoars. Plain radiography with sheep positioned in right lateral recumbency is a useful supplementary technique which can be used to evaluate abomasal phytobezoariasis. This study shows that radiography is a suitable diagnostic method for detecting the presence of, but not the number of, abomasal phytobezoars in sheep.