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Background and Aims: Magnet ingestion has recently increased among children. Multiple magnets can lead to serious adverse events owing to pressure necrosis of trapped bowel wall; therefore, urgent removal of the magnet is recommended. However, awareness of magnet ingestion and adverse events associated with it are lacking among the general population and some healthcare professionals. Herein, we demonstrate the adverse events associated with prolonged retention of ingested magnets and endoscopic management of ingested magnets in children. Methods: We present a case series of 3 patients with magnet ingestion. Foreign body ingestion was confirmed on fluoroscopy. After fluoroscopy, all children underwent EGD under propofol sedation in a left lateral position. A Roth net was used to remove magnets. Results: Three patients (median age 5 years), each with ingestion of 2 magnets of different shapes and sizes and with variable periods of ingestion, underwent EGD. In 2 patients, both magnets were Successfully removed. In 1 patient, 1 magnet could not be removed because it became dislodged deep in the jejunum. All 3 patients had developed magnet-related fistula (gastroduodenal: 1 patient; duodenojejunal: 2 patients). Patients with duodenojejunal fistula were managed conservatively. There was mild self-limited bleeding during magnet removal in 1 patient. There were no major adverse events related to endoscopic removal. Conclusions: Endoscopic removal of magnets is feasible and safe in children. Few patients with fistulas can be managed conservatively. There is an unmet need to increase societal awareness of magnet ingestions and adverse events associated with it.
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Motorized spiral enteroscopy (SE) is a novel technique for evaluation and management of small bowel lesions. Total enteroscopy rates are higher with SE. Power spiral tube with spiral soft fin helps in advancement of the scope. SE has low adverse event profile; however, perforation and pancreatitis have been reported. We report the unusual adverse event of power spiral tube with spontaneous dislodgement of spiral fin in 2 cases.
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BACKGROUND: Achalasia cardia is a rare esophageal motor disorder that is frequently diagnosed late. AIM: The aim of this study was to study the symptoms, treatment given, and response to treatment in patients with achalasia cardia in an Indian setting. MATERIALS AND METHODS: This retrospective study included all patients diagnosed with achalasia cardia on high-resolution esophageal manometry, using Chicago Classification v 3.0. On follow up, patients were contacted by telephone, and details of the treatment given and response were recorded in a predesigned pro forma. We excluded overseas patients, postoperative cases of achalasia, and those in whom the manometry catheter could not be passed across the gastroesophageal junction. RESULTS: A total of 452 patients (260 males, median age 44.5 years) were included in the study cohort. The major symptoms included dysphagia for solids and liquids (428, 94.7%), regurgitation (360, 79.6%), naso-oral regurgitation (182, 40.3%), weight loss (322, 71.3%), and chest pain (158, 35%). Type 2 achalasia (229, 50.6%) was the most common subtype, followed by type 3 (154, 34.1%). Chest pain was more common in type 3, and weight loss and naso-oral regurgitation were more common in type 2 achalasia. A majority of patients underwent Heller's myotomy and pneumatic dilatation. Of 280 patients for whom treatment details were available, 98% reported good response to endoscopic/surgical management. CONCLUSION: The predominant symptoms of achalasia cardia vary per the manometric subtype. Heller's myotomy and pneumatic dilatation are the most commonly used treatment options. Response to treatment is good. The choice of treatment modality was likely influenced by financial reasons and availability of local expertise.