String-capsule endoscopy was feasible, safe, accurate, highly acceptable, and preferred by cirrhotic patients undergoing screening/surveillance of esophageal varices. The technique may prove to be more cost effective than conventional EGD.
AIM:To investigate the proportion of patients with moderate-severe erosive esophagitis (EE) who will have Barrett's esophagus (BE) after healing of inflammation. METHODS: Patients with EE of Los Angeles (LA) class B, C and D who underwent follow-up endoscopy documenting complete mucosal healing. RESULTS: A total of 86/169 patients were suspected of having BE (38 before healing and 48 after healing of EE) and, 46/86 eventually had the histological confirmation. At index esophago-gastro-duodenoscopy (EGD), BE was suspected in 38/169 (22%), and ultimately, histologically confirmed in 20 of these. In 11 patients where biopsies were performed in the presence of inflammation, BE was detected in 2 and missed in 5 (including 2 dysplasias). In 131/169 patients (77.5%), BE was not suspected at index EGD. After healing of EE though, 48 patients had suspicion of BE who underwent biopsies, and in 26 of these histology was positive for BE. The length of inflammation had a linear correlation with the length of BE (P = 0.01). Out of multiple variables to predict BE, only the suspicion at index endoscopy was statistically significant (P = 0.01). CONCLUSION: B E wa s s e e n i n 4 6 / 1 6 9 ( 2 7 % ) patients with EE of LA class B, C and D. The length of EE can predict the length of underlying BE segment.Even when suspected, BE and associated dysplasia can be missed in the presence of inflammation; therefore, repeat evaluation should be considered after complete healing of esophagitis.
String capsule endoscopy had an acceptable sensitivity and specificity for the diagnosis of clinically significant esophageal varices but the lack of air insufflation still hampers its correlation with the grading used with EGD.
SUMMARY A case of chronic invasive paranasal aspergillosis is described which, despite an initial poor prognosis, responded well to treatment with itraconazole.
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