Since its advent in the 1980s endoscopic ultrasound (EUS) has played an important role in the diagnosis, staging, and therapeutic management of various gastrointestinal malignancies. EUS has emerged as a vital tool in the evaluation of esophageal cancer as it provides a detailed view of the layers of the esophageal wall and surrounding tissues. This permits determination of tumor invasion depth and local lymph node metastases. It is the most sensitive and specific method available for locoregional staging of esophageal cancer. The information obtained via EUS is vital in determining the appropriate diagnosis, prognosis, and treatment options. Thus, this article aims to present a review of the accuracy and utilization of EUS in the staging of esophageal cancer.

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Aim  The objectives of this study are to examine clinical characteristics of patients undergoing anterograde and retrograde double balloon enteroscopy (DBE) and to assess factors predicting positive diagnostic yield, therapeutic yield, and readmission. Methods  We conducted a retrospective cohort study of patients (n = 420) who underwent DBE at a tertiary care center between 2012 and 2016 at a tertiary referral center. Measures of central tendency and frequency distributions were used for univariate analysis. Chi-square and t-test analyses were used to compare patient characteristics. Logistic regression was used to predict outcomes of interest. Results  Of patients included in the study, 59 % were male with a mean age of 61.49 (SD = 15.15) Altered anatomy was noted in 14 %, while 5 % and 13 % of patients had end stage renal disease (ESRD) and current use of anticoagulation, respectively. The most common indication for DBE was obscure gastrointestinal bleed (OGIB) (33 %). Forty-nine patients had obscure and overt gastrointestinal bleeding (GIB) and 22 % had occult GIB with iron deficiency. The cohort’s rate of positive diagnostic yield was 73 % and 35 % for therapeutic yield. The 30-day and 6-month readmission rates were both 11 %. A higher proportion of those readmitted were male (75 % vs 57 %, P  = 0.027) and had longer procedural time (38.68 vs 46.57, P  = 0.011). Likewise, occult GIB with iron deficiency anemia and iron deficiency alone (OR = 2.45, CI: 1.233 – 4.859, P  = 0.011), inpatient status (OR 2.42, CI 1.344 – 4.346, P  = 0.003), and longer procedural time (OR = 1.02, CI: 1.004 – 1.029, P  = 0.008) were associated positively with readmission. Conclusion  DBE procedures have relevant efficacy for both diagnostic and therapeutic yield while evaluating small bowel disease. Readmission rates are low and more in those with GI bleed and iron deficiency with longer index procedural times.

Background and study aims  Colonoscopy can be technically challenging and cause discomfort in patients. The integrated Scope Guide assist is built in to show that with its use outcomes are improved during colonoscopy. We aimed to test the usefulness of the Magnetic Scope Guide Assist (ScopeGuide ) with respect to cecal intubation time, and other procedural quality outcomes. Patients and methods  We conducted a prospective study of outpatients undergoing elective colonoscopy at the endoscopic units of the University of Alabama at Birmingham (UAB) from March 2016 to July 2016. Patients were randomly assigned in a 1:1 block design to groups that either had standard colonoscopy or Scope-guided colonoscopy. The primary outcome measure was cecal intubation time (CIT). Secondary outcome measures included use of manual pressure, position changes for cecal intubation and sedation requirements. Results  Three hundred patients were randomized to either group; standard (n = 150) vs. Scope-guided (n = 150). The mean CIT was not statistically different for the standard and the Scope-guided groups (4.6 vs. 4.3 minutes; P  = 0.46). There were also no statistical differences in frequency of manual pressure applied (16.7 % for Scope-guided vs. 19.1 % for standard; P  = 0.65) or position changes (11.4 % for scope guided vs. 8.8 % standard; P  = 0.56). Sedation requirements showed lesser use of midazolam (3.9 mg vs. 4.7 mg, P  = 0.003) in the Scope-guide group, while there was no significant difference in use of fentanyl (fentanyl – 62.1 mg vs. 68.9 mg, P  = 0.09 similar between groups, for Scope-guided vs. standard groups, respectively). Adverse events were similar in both groups. Conclusions  In patients undergoing routine elective colonoscopy, use of ScopeGuide by experienced colonoscopists did not improve CIT or affect the frequency of ancillary maneuvers. The benefit of this device during training of endoscopists could be considered for further studies.

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INTRODUCTION: Tubular adenoma is a common finding in the colon accounting for majority of the colonic adenomas. Consensus guidelines have outlined surveillance intervals for patients with tubular adenoma in the colon based on the number and size. We present a unique case of a tubular adenoma in the interpositioned colon. Colonic interposition is a common surgery in patients with esophageal atresia. We present a unique case of a TA with high-grade dysplasia in the interpositioned colon. CASE DESCRIPTION/METHODS: A 50-year-old female with a past history of esophageal atresia who underwent colonic interposition between the upper esophagus and stomach at the age of five presented with dysphagia. A barium swallow was performed which showed delayed emptying in the mid-esophagus. An esophagogastroduodenoscopy (EGD) was performed which showed food material stuck in the proximal interpositioned colon. There were no strictures at the site of the anastomosis. Incidentally a 10 mm polypoid lesion was seen in the interpositioned segment of the colon [Figure 1]. The polypoid lesion was biopsied and histological examination showed disorganized glands in the background of normal colonic mucosa along with hyperchromatic nuclei with increased mitosis in the cells, consistent with tubular adenoma. Repeat EGD showed three sessile polyps ranging from 10 mm to 20 mm in size. The polyps were successfully resected using hot snare polypectomy. Pathological examination showed two tubular adenomas, and the largest polyp had tubular adenoma with focal high grade dysplasia [Figure 2]. Resection margins were negative for dysplasia. A colonoscopy was also performed which found two sub-centimeter adenomatous polyps as well. DISCUSSION: Esophageal atresia is a congenital malformation of the upper gastrointestinal tract. The prevalence varies from 1 in 2500 to 1 in 4500 births. Currently, there is no ideal replacement for the esophagus. Primary anastomosis of the esophagus is performed in about 90% of cases, and a colonic interposition is performed when there is an extremely long gap. Common complications with colonic interposition include stenosis of the anastomosis, esophageal dysmotility, and gastroesophageal reflux. Development of adenomatous polyps in the interpositioned segment of the colon are exceedingly rare and usually an incidental finding. Our case and other similar reports highlight that surveillance strategies need to be developed in these patients to prevent carcinoma.

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