AIMTo characterize esophageal endoluminal landmarks to permit radial and longitudinal esophageal orientation and accurate lesion location.METHODSDistance from the incisors and radial orientation were estimated for the main left bronchus and the left atrium landmarks in 207 consecutive patients using white light examination. A sub-study was also performed using white light followed by endoscopic ultrasound (EUS) in 25 consecutive patients to confirm the findings. The scope orientation throughout the exam was maintained at the natural axis, where the left esophageal quadrant corresponds to the area between 6 and 9 o’clock. When an anatomical landmark was identified, it was recorded with a photograph and its quadrant orientation and distance from the incisors were determined. The reference points to obtain the distances and radial orientation were as follows: the midpoint of the left main bronchus and the most intense pulsatile zone of the left atrium. With the video processor system set to moderate insufflation, measurements were obtained at the end of the patients’ air expiration.RESULTSThe left main bronchus and left atrium esophageal landmarks were identified using white light in 99% and 100% of subjects at a mean distance of 25.8 cm (SD 2.3), and 31.4 cm (SD 2.4) from the incisors, respectively. The left main bronchus landmark was found to be a tubular, concave, non-pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. The left atrium landmark was identified as a round, convex, pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. Both landmarks were identified using white light on the anterior esophageal quadrant. In the sub-study, the left main bronchus was identified in 24 (92%) patients at 25.4 cm (SD 2.1) and 26.7 cm (SD 1.9) from the incisors, by white light and EUS, respectively. The left atrium was recognized in all patients at 30.5 cm (SD 1.9), and 31.6 cm (SD 2.3) from the incisors, by both white light and EUS, respectively. EUS confirmed that the landmarks corresponded to these two structures, respectively, and that they were located on the anterior esophageal wall. The Bland-Altman plot demonstrated high agreement between the white light and EUS measurements.CONCLUSIONThis study provides an endoscopic characterization of esophageal landmarks corresponding to the left main bronchus and left atrium, to permit radial and longitudinal orientation and accurate lesion location.
In December 2019, the World Health Organization office in China was informed of cases of pneumonia of unknown etiology detected in Wuhan. 1 A new coronavirus called SARS-CoV-2 was identified in lower respiratory tract samples from several patients. The virus has spread worldwide and on March 11, 2020, was declared a pandemic by the World Health Organization. From the time of its detection to April 26, 2020, more than 2,900,000 cases have been confirmed worldwide with more than 203,000 deaths. In Colombia, 5379 cases have been confirmed, with 244 deaths reported. [2][3][4] Healthcare professionals are exposed to contagion as part of their professional practice. World newspapers report high numbers of infections among doctors and an alarming number of deaths. According to data from the British Medical Journal, as of April 5, 2000, 198 physician deaths from COVID-19 had been reported worldwide. Among the countries with the highest mortality are Italy with 73 and Iran with 43 deceased doctors. Among these, the vast majority were men (90%). 5 Recently, the Journal of the American Medical Association reported more than 3000 infected health professionals in China, with more than 22 deceased. 6 On April 13, the Argentinian newspaper Mundo reported more
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