Eosinophilic esophagitis (EoE) is a clinicopathological disorder characterized by dense eosinophil infiltration of the esophageal mucosa-at least 15 eosinophils per high-power field-and symptoms such as heartburn, chest pain, and dysphagia. 1Because these symptoms overlap with those of functional esophageal disorders, the Rome IV criteria advocate ruling out EoE before labeling the patient as functional esophageal disorder. 2EoE was long underrecognized as most of the patients with gastroesophageal reflux disease (GERD)like symptoms are usually treated empirically with protonpump inhibitors (PPIs) without further evaluation. 2Once researchers appreciated that some patients with GERD-like symptoms and eosinophilic esophagitis did not respond to PPIs, it became evident that EoE is a distinct condition requiring targeted diagnosis and management.The worldwide epidemiology of EoE has shifted dramatically in the past two decades.Population-based studies suggested a pooled prevalence of roughly 22.7 per 100,000 and an annual incidence around 3.7 per 100,000. 3High-income countries have reported prevalence rising above 34 per 100,000 and incidence approaching 7.7 per 100,000 adults. 4Asia, once considered largely free of EoE, is now experiencing growing detection.A Japanese registry reported an incidence of 2.82 per 100,000 and prevalence of 10.68 per 100,000, whereas a meta-analysis documented an increase from 19.8 to 73 per 100,000 in the region between 2005 to 2009 and 2015 to 2019. 5 These figures illustrate that EoE is not solely a Western disease and that improved awareness and surveillance can reveal cases that previously went undiagnosed.In India, however, published data remain scarce, prompting investigators to assess how frequently EoE occurs among patients with reflux-like symptoms. 6,7

Abstract Endoscopic gastroplasty (EG) offers a minimally invasive alternative to bariatric surgery for obesity management. While multiple randomized controlled trials (RCTs) have compared EG with lifestyle modification (LM), the extent of benefit and influence of procedural technique remain uncertain. We conducted a meta-analysis restricted to RCTs comparing EG with LM in adults with obesity. The primary outcome was total body weight loss (TBWL) at 12 months. Secondary outcomes included TBWL and excess weight loss (EWL) at 6 months, and EWL at 12 months. Pooled mean differences (MDs) were estimated using a random-effects model. Subgroup analyses were performed based on techniques, such as OverStitch ESG, Endomina, and Primary Obesity Surgery Endoluminal (POSE). Trial sequential analysis (TSA) and assessment of adverse events and publication bias were also conducted. Five RCTs involving 696 participants were included. EG resulted in significantly greater TBWL at 12 months compared to LM (MD: 7.67%; 95% confidence interval [CI]: 4.38–10.96; I 2 = 92.5%). TSA confirmed the conclusiveness of this finding. EG also led to superior TBWL at 6 months (MD: 6.98%; 95% CI: 3.76–10.20) and greater EWL at 6 months (MD: 24.85%; 95% CI: 13.44–36.27) and 12 months (MD: 26.24%; 95% CI: 11.19–41.29). Subgroup analysis showed highest efficacy with OverStitch ESG (MD: 10.82%), followed by Endomina (6.50%) and POSE (5.61%). The pooled incidence of any adverse event was 10.8%, while serious adverse events were rare (2.9%). EG is more effective than LM for weight loss at 6 and 12 months, with an acceptable safety profile. Among techniques, OverStitch ESG demonstrated the highest efficacy. These findings support the incorporation of EG into the obesity treatment algorithm, especially for patients unsuitable for surgery.

CaseMagnetic compression anastomosis (MCA) is an emerging technique for managing enteroenteral, bilioenteric, and biliobiliary tract anastomosis. [1][2]2][3] MCA is a minimally invasive technique, often performed through laparoscopic, endoscopic, or combined laparoendoscopic approaches. 3,4 The procedure involves placing two cylindrical or circular rare earth magnets (parent and daughter) on either side of a stenotic digestive segment, facilitating gradual compression anastomosis.Despite efficacy, the use of MCA is limited by unavailability of dedicated magnets and accessories to deploy the magnets.Here, we report an easy method of creating an MCA for the management of malignant rectosigmoid stricture.A 45-year-old male, presented with progressive difficulty in passing stools over 3 months.Initially experiencing constipation, his symptoms worsened, prompting further evaluation.Blood tests revealed anemia and elevated carcinoembryonic antigen levels.Colonoscopy showed a rectal mass 9 cm above the anal verge causing severe luminal narrowing.Biopsy from mass confirmed poorly differentiated adenocarcinoma.Contrast-enhanced computed tomography showed circumferential wall thickening at the rectosigmoid junction measuring approximately 6 cm, with metastatic spread to the liver and lungs.He was diagnosed with stage IV colorectal cancer and started on chemotherapy.Two months into treatment, he developed subacute intestinal obstruction with a transition zone at the rectosigmoid junction.He declined a diversion colostomy and was referred for palliative luminal stenting.However, severe luminal narrowing and angulation prevented the guidewire passage across the stricture.Following multidisciplinary discussion, MCA was considered as a novel alternative.

Abstract Pharyngocutaneous fistula is a comparatively rare complication following neck surgery, presenting challenges in management and potential morbidity. These patients are difficult to treat by any conventional techniques and often a multidisciplinary approach is required for treating such patients. Here, we present a case of a 43/M patient who developed a pharyngocutaneous fistula following anterior discectomy for cervical compression. Since endoscopy provides a minimal invasive approach for managing such complex cases, we decided to use endoscopic fistula plug insertion in this patient. This case underscores the importance of early recognition and tailored intervention in the management of pharyngocutaneous fistulae.

Abstract The diagnostic journey in gastrointestinal lesions, particularly when presenting with atypical features, often poses formidable challenges in clinical practice. This challenge is vividly illustrated in the case of an 88-year-old man with severe acute-on-chronic gangrenous cholecystitis. Imaging studies prior to surgery unveiled an unexpected 30 × 26 mm nodular formation nestled between the pancreas and duodenum suspected for neoplasia. Endoscopic ultrasound allows obtaining an atypical benign diagnosis of a benign subepithelial lesion. This intriguing case highlights the intricate nature of differential diagnosis in such lesions, especially when they attain substantial dimensions. The nuanced imaging features and integration of advanced techniques like endoscopic ultrasound with DWI and elastography emerge as pivotal tools in achieving precise diagnosis and guiding tailored treatment strategies.

Abstract Background Endoscopic resection of large pedunculated colorectal polyps with a thick stalk is technically difficult. Endoloop-assisted endoscopic resection and endoscopic submucosal dissection have been confirmed to be effective and safe, respectively. Here, we compared the efficacy and safety of these two different methods. Methods In total, 124 patients with large pedunculated polyps treated by endoloop-assisted endoscopic resection (group B) or endoscopic mucosal resection (group A) were enrolled in the study. Results There were two cases of immediate postpolypectomy bleeding and one case of delayed postpolypectomy bleeding in group A, while there were four cases of immediate postpolypectomy bleeding and 0 case of delayed postpolypectomy bleeding in group B. There was no significant difference in postpolypectomy bleeding between the two groups (p = 0.68 and 1.0). The mean operation time in group A was 29.31 ± 5.64 minutes, which was significantly longer than that in group B (p < 0.001). The mean hospitalization time in group A was 7.14 ± 1.1 days, but in group B it was 5.98 ± 1.18 days (p < 0.001). In addition, the number of clips used in group A was 5.58 ± 1.3, which was also more than that in group B (p < 0.001). Conclusions Endoloop-assisted endoscopic resection is effective and safe for the removal of large pedunculated polyps, while endoscopic submucosal dissection may be an alternative option for difficult areas with poor visibility or polyps with large or lobulated head.

Abstract Objectives Oral intake of corrosive substances is a significant cause of morbidity and sometimes mortality in childhood. Early evaluation is essential in determining the course of possible damage. This study aimed to compare early endoscopic evaluation and clinical observation methods in patients with corrosive substance ingestion. Materials and Methods Seventy-five patients with corrosive substance ingestion were hospitalized in a tertiary pediatric surgery clinic between January 2019 and December 2020. They were enrolled in a prospective randomized controlled manner, 35 of whom were in the endoscopy group and 40 in the clinical observation group, and their data were collected after obtaining consent from their families. Results It was observed that the most common chemical agents in hospitalized patients with a history of corrosive substance intake were dish polishers and sink openers, and contact with strong alkaline substances was the most common case. Endoscopic evaluation increased the total cost compared with clinical observation but decreased the nil per os (nothing by mouth) duration, the number of drugs they took, and the inpatient duration (p < 0.05). Neither the presentation symptoms nor physical examination findings were to the pH level of the corrosive substance ingested (p > 0.05). Conclusions Endoscopic evaluation could be a choice for reducing the length of hospital stay, drug doses, and the nil per os period, but it increases the total cost. Since no cases with significant esophageal damage were detected in our clinic at the time of this study, the results should be supported by larger series.