Endoscopic management of buried bumper syndrome using the Balloon Dilation Pull (BDP) technique: a multicenter analysis.

Background and study aims: Buried bumper syndrome (BBS) may complicate percutaneous endoscopic gastrostomy placement. In these patients, endoscopic treatment ought to be considered. Various approaches have been published, ranging from dissectionbased techniques to novel dedicated devices, although the evidence supporting the use of the Balloon Dilation Pull (BDP) technique has been limited to single case reports. The aim of this paper is to assess the feasibility, efficacy and safety of the systematic use of the BDPtechnique for the endoscopic treatment of BBS. Patients and methods: We performed a retrospective multicenter analysis of prospectively collected data from all patients treated with the BDP-technique between January 2011 and November 2021. Results: In total, 26 patients were identified (median age 72 (SD ± 13) years, 74% male, 84.6% underlying neurological disease). Technical success was achieved in 92.3%, with a median procedure time of 17.5 minutes (range 5-27). Adverse events were identified in 3.8% of patients (N=1, aspiration, ASGE lexicon severity grade: moderate). Conclusions: Our experience suggests that the BDP-technique is highly efficacious and safe, using accessories readily available in every endoscopic unit. Given the limited procedure time and tools required, this procedure has the potential to further optimize patient care in the context of BBS.

Single-centre experience on use of videocapsule endoscopy for obscure gastrointestinal bleeding in 120 consecutive patients.

BACKGROUND AND STUDY AIMS: Capsule endoscopy (CE) has become first choice for evaluation of the small bowel in case of obscure gastrointestinal bleeding (OGIB). The influence of clinical factors on CE diagnostic yield remains controversial and little is known about the exact impact of CE on management and outcome. We aimed to identify the ideal candidates for CE examination in daily practice by reviewing our own data and the available literature. PATIENTS AND METHODS: We retrospectively analyzed data of 120 consecutive patients with OGIB (33 overt - 87 occult) that underwent CE in a single centre. RESULTS: Complete evaluation of the small bowel was achieved in 82.5%, with only one case of capsule retention. The overall diagnostic yield was 47.5% and no difference was noted in the overt versus the occult group. Only the presence of cardiovascular comorbidity was associated with a statistically significant increase in diagnostic yield (p = 0,041). Arterio-venous malformation (AVM) was diagnosed most frequently in 68.4% of positive studies. Specific management alterations were made in 22 patients (18.3%) following CE, mostly guided by a positive result (91%) (p = 0,0001). CONCLUSION: In daily practice it remains very difficult to predict pathology detection rate on CE as well as to estimate the impact on further management and outcome in the individual patient. Diagnostic yield is significantly higher in patients with cardiovascular comorbidity than in those without.

An uncommon cause of visceral arterial embolism in patients presenting with acute abdominal pain: a report of 2 cases.

We report on 2 cases of visceral arterial embolism presenting with acute abdominal pain. In neither patient a cause could be established on initial clinical, laboratory, echographic or radiological investigation. Both patients were subsequently found to have a mural thrombus in the thoracic aorta, with visceral arterial embolism. Each underwent a successful operative thrombectomy. Both patients had a normal underlying aortic intima at inspection. The first patient was a young male with no known diseases. He regularly used cannabis and tested positive on admission, an association not yet reported with aortic mural thrombus. He was found to have a slightly reduced protein C. The second patient was a middle aged man with non-insulin dependent diabetes, hyperlipidaemia, arterial hypertension and hyperthyroidism. He was found to have an underlying adenocarcinoma of the lung and received chemotherapy. He died due to his cancer, 4 months after first presentation.

Treatment of Zenker's diverticulum through a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar forceps.

BACKGROUND AND STUDY AIMS: Zenker's diverticulum was commonly treated by means of external transcervical diverticulectomy, myotomy or diverticulopexy, or by means of an endoscopic myotomy through a rigid endoscope. Gastroenterologists first described flexible endoscopic therapy for Zenker's diverticulum in 1995. In our single-center study we report the safety and feasibility of endoscopic myotomy through a flexible endoscope, performed at a secondary referral centre. PATIENTS AND METHODS: A series of 21 patients with Zenker's diverticulum were treated using a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar coagulation forceps. Relief of the dysphagia was the main outcome measure with evaluation of safety and complications. Dysphagia was graded on a scale of 0 to 4 before and after treatment. General anesthesia was not used. RESULTS: Access to the esophagus was attained without problems in all patients. Oral feeding was resumed the following day. Complete relief of dysphagia was reported by all patients after 1 month. Dysphagia recurred in two patients (9.5%) after the first session. These patients were successfully treated again in the same way. Adverse events were limited to transient cervical emphysema in a single patient. CONCLUSIONS: This endoscopic technique is an efficient, safe and minimally invasive method for the treatment of Zenker's diverticulum. General anesthesia is not necessary and oral feeding can be resumed the next day. In view of the excellent results and minimal complications, it can be considered a safe alternative for the treatment of Zenker's diverticulum.

Atypical symptoms of GORD in Belgium: epidemiological features, current management and open label treatment with 40 mg esomeprazole for one month.

UNLABELLED: Frequency of atypical symptoms in patients suffering from gastro-oesophageal reflux disease (GORD) is not well known, and the optimal management of such symptoms has not been well established. Our aims were to set up an observatory of these atypical symptoms of GORD in Belgium and to study the efficacy of one month treatment with esomeprazole 40 mg. PATIENTS AND METHODS: Gastroenterologists participating in this observational survey were asked to register every new outpatient with symptoms of GORD during a period of 20 consecutive working days. All patients who reported predominant presence of atypical manifestations of GORD were documented and characterized more in detail. In patients with dominant chest pain or ENT symptoms, a treatment with esomeprazole 40 mg daily during 4 weeks was proposed. RESULTS: 90 gastroenterologists included 2864 patients consulting for symptoms suggestive of GORD, including 776 (27.1%) with dominant atypical symptoms. Endoscopy (performed in 2800 patients) showed significantly less oesophagitis in atypical than in typical GORD patients (68% vs. 81.1%; P < 0.0001). Management of atypical GORD patients appeared to be very heterogeneous. Overall 516/776 patients were included in the open phase of treatment with esomeprazole 40 mg, but data for analysis are only available in 228 patients. After one month, symptoms had disappeared in 57.1% and significantly improved in 26.6%. CONCLUSION: Atypical GORD represents a large number of consultations in gastroenterology in Belgium. It is associated with less endoscopic lesions than typical GORD. Its management is heterogeneous reflecting the lack of guidelines on this topic. Response rate after esomeprazole 40 mg for one month in this open uncontrolled trial was high. This result warrants confirmation in a placebo-controlled trial.

Recommendations for antibiotic prophylaxis before ERCP: can we come to workable conclusions after review of the literature?

Infectious complications after endoscopic retrograde cholangiopancreatography (ERCP) are rare and can mainly be divided into endocarditis and sepsis/cholangitis. There still remains uncertainty about the indications, antibiotic regimens, and timing for antibiotic prophylaxis. Several guidelines for antibiotic prophylaxis have been published. It is the purpose of the present paper to make an extensive review of the literature and to yield general recommendations on antibiotic prophylaxis before ERCP. Antibiotic prophylaxis is recommended for patients at high risk for endocarditis, as well as for patients with a vascular graft less than 1 year old. For sepsis/cholangitis, prophylaxis is mostly recommended for patients with a bile duct obstruction or with a pancreatic pseudocyst. For other conditions, a case-by-case evaluation by the physician/endoscopist is still inevitable.

EDC-mediated DNA attachment to nanocrystalline CVD diamond films.

Chemical vapour deposited (CVD) diamond is a very promising material for biosensor fabrication owing both to its chemical inertness and the ability to make it electrical semiconducting that allows for connection with integrated circuits. For biosensor construction, a biochemical method to immobilize nucleic acids to a diamond surface has been developed. Nanocrystalline diamond is grown using microwave plasma-enhanced chemical vapour deposition (MPECVD). After hydrogenation of the surface, 10-undecenoic acid, an omega-unsaturated fatty acid, is tethered by 254 nm photochemical attachment. This is followed by 1-ethyl-3-[3-dimethylaminopropyl]carbodiimide (EDC)-mediated attachment of amino (NH(2))-modified dsDNA. The functionality of the covalently bound dsDNA molecules is confirmed by fluorescence measurements, PCR and gel electrophoresis during 35 denaturation and rehybridisation steps. The linking method after the fatty acid attachment can easily be applied to other biomolecules like antibodies and enzymes.