Quantitative eosinophil alterations and IL-5+ cells may indicate enhanced cellular activation with degranulation, which is implicated in the pathogenesis of IBD. Increase in IL-5+ cells may reflect a predominant local Th2 response in UC as compared with CD.

In our pediatric series, combined medical (corticosteroids, elemental diet, and food elimination diet) and endoscopic approach (repeated balloon dilation) were effective and safe in patients with severe EoE and esophageal stricture.

Ambulatory placement of gastrostomy tubes is viable and safe in head and neck cancer patients in good clinical condition. The early complication rates are similar to those described for hospitalized patients. Unnecessary admissions are avoided and costs of hospitalization are reduced.

Background and study aims Both Heller myotomy (HM) and per-oral endoscopic myotomy (POEM) are efficacious therapies for achalasia. The efficacy and safety of POEM vs HM in Latin America and specifically in patients with Chagas disease is unknown. Patients and methods Consecutive patients undergoing either HM or POEM for achalasia were included from nine Latin American centers in a prospective registry over 5 years. Technical success was defined as undergoing a successful myotomy. Clinical success was defined as achieving an Eckardt score < 3. Data on demographics, procedure info, Eckardt score, and adverse events (AEs) were collected. Student’s t test, Chi squared, and logistic regression analyses were conducted. Results One hundred thirty-three patients were included (59 male; 44 %; mean age 47). POEM was performed in 69 patients, HM in 64 patients. A total of 35 patients had Chagas disease, 17 of 69 in the POEM group, 18 of 64 in the HM group. Both groups had significant reduction in Eckardt scores (P < 0.00001), but successful initial therapy was significantly higher in the POEM group compared to the HM group (P = 0.01304). AEs were similar in both group (17 % vs 14 %) and consisted of pneumothorax (n = 3 vs 2), bleeding requiring transfusion (n = 3 vs 2), and mediastinitis (n = 3 vs 1). Hospital stay was longer in the HM group than in the POEM group (P < 0.00001). In the Chagas subgroup, post-procedure Eckardt score in the POEM group was significantly reduced by 5.71 points (P < 0.00001) versus 1.56 points in the HM group (P = 0.042793). Conclusion Both HM and POEM are efficacious for achalasia, but POEM was associated with higher initial therapy success and shorter hospital stay in Latin America. In Chagas patients with achalasia, POEM was significantly more effective than HM.

Water jet fluid continuous injection speeds up ESD, whereas pulsed WJ dissection does not.

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Per oral endoscopic myotomy (POEM) has been a minimally invasive treatment option for patients with achalasia for the past 10 years. Although comparable to laparoscopic Heller's myotomy (LHM) in terms of efficacy, POEM has the advantages of minimal invasiveness, allowance for a longer myotomy, and the ability to perform a posterior or anterior myotomy. [1][2][3][4][5][6] After 10 years of consistent safety and efficacy, POEM is now being performed worldwide and has been increasingly used in Latin America where Chagas disease is prevalent. Reports on POEM for Chagas disease are scarce. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] POEM in Chagas disease is technically more challenging than in patients with achalasia, due to a higher rate of submucosal scarring, 21 most likely related to chronic esophagitis caused by esophageal stasis (clinical observation, unpublished data). Two recently published studies have shown that Chagas disease-related achalasia responds better to POEM. 15,22 Nonetheless,