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Avoidance of PEG 3350 in patients with CHF, cirrhosis, and chronic kidney disease

Polypectomy devices

GI endoscopic reprocessing: maintaining public confidence in the face of decreasing reimbursements

ASGE guideline on screening for pancreatic cancer in individuals with genetic susceptibility: summary and recommendations

Multisociety guideline on reprocessing flexible GI endoscopes: 2016 update

The Road Ahead

70-Year-Old Man With Chronic Nausea and Vomiting

Guidelines on genetic evaluation and management of Lynch syndrome: A consensus statement by the U.S. Multi-Society Task Force on Colorectal Cancer

Artificial Intelligence–Aided Colonoscopy for Characterizing and Detecting Colorectal Polyps: Required, Nice to Have, or Overhyped?

Is more always better in Barrett’s esophagus?

To compare improvement in symptoms following Heller's myotomy with Dor fundoplication and endoscopic pneumatic dilatation for the treatment of achalasia cardia. The prospective comparative study was conducted at the Department of Upper Gastroenterology and Minimally Invasive Surgery, Civil Hospital, Karachi, from February 2016 to January 2019, and comprised patients diagnosed with achalasia cardia on oesophageal manometry. The subjects were randomised into endoscopic pneumatic dilatation group A and laparoscopic Heller's myotomy with Dor fundoplication group B. Eckardt scores were compared between the groups at one-year follow-up. Data was analysed using SPSS 22. Of the 42 patients, 21(50%) were in each of the two groups. The mean age of patients in group A was 37±12.87 years compared to 34±8.59 years in group B. Treatment success in group A was 11(52%) compared to 21(76%) in group B. Eckardt scores between the groups were significant (p<0.001). Patient satisfaction was significantly more in group B (p<0.05). The efficacy of Heller's myotomy with Dor fundoplication was found to be greater than endoscopic pneumatic dilatation for improvement in dysphagia and overall patient satisfaction at one-year follow-up.

How To Maximize Trainee Education During the Coronavirus Disease-2019 Pandemic: Perspectives From Around the World

Achalasia is a rare primary esophageal motility disorder characterized by failure of the lower esophageal sphincter (LES) to relax and absence of normal peristalsis in the esophagus. Patients typically present with progressive dysphagia to both solids and liquids, regurgitation, chest pain, and weight loss. Diagnosis is confirmed by high-resolution manometry demonstrating incomplete LES relaxation and aperistalsis, with supportive findings on barium esophagram (e.g. “bird’s beak” narrowing) and endoscopy to exclude pseudo achalasia. Achalasia is subdivided into three manometric subtypes (I–III) based on esophageal pressure patterns, which have prognostic significance. Treatment is directed at relieving the distal esophageal obstruction, with options including pneumatic balloon dilation, laparoscopic Heller myotomy (LHM) with partial fundoplication, and peroral endoscopic myotomy (POEM). Botulinum toxin injection is reserved for high-risk patients. Current evidence from guidelines and recent studies indicates that LHM and pneumatic dilation have comparable efficacy in appropriate candidates, and POEM offers similar symptomatic relief to LHM. Manometric subtype guides therapy—type II achalasia responds best to any therapy, whereas type III often benefits from a tailored myotomy approach. The addition of fundoplication to Heller myotomy significantly reduces post-treatment reflux without compromising achalasia symptom control. In pediatric achalasia, Heller myotomy yields superior long-term outcomes compared to dilations. Robotic-assisted Heller myotomy is an emerging technique showing comparable efficacy to LHM with a potential reduction in perforation risk. An individualized, patient-centered approach - considering achalasia subtype, patient age/comorbidity, and available expertise is essential to optimize outcomes. This review synthesizes the current evidence on achalasia management, highlighting the role of Heller myotomy relative to other therapies in light of recent clinical guidelines and studies.

Therapies for bleeding gastric varices: is the fog starting to clear?

Importance of preoperative and postoperative pH monitoring in patients with esophageal achalasia