Ösophagus

Ösophagus

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Favorable Long-Term Outcomes With ESD for Esophageal Squamous Cell Cancer

Endoscopic resection is a minimally invasive and curative treatment option for those with superficial esophageal squamous cell carcinoma (ESCC). Endoscopic submucosal dissection (ESD), although more

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Potassium Competitive Acid Blocker Better Than Proton Pump Inhibitor in Healing Higher Grades of Erosive Esophagitis

Erosive esophagitis, a complication of chronic gastroesophageal reflux disease (GERD), is documented in 30% to 50% of GERD patients undergoing endoscopy. Current guidelines recommend proton

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Wireless pH Monitoring Is Better at 96 Hours Than 48 Hours in Patients With GERD Unresponsive to PPI Therapy

A significant portion of patients with reflux-like symptoms do not have GERD and could potentially discontinue proton pump inhibitor (PPI) therapy. Although wireless pH monitoring

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Top Recommendations for the Diagnosis and Management of Esophagogastric Variceal Bleeding

The European Society of Gastrointestinal Endoscopy has released updated recommendations on the diagnosis and management of esophagogastric variceal hemorrhage. Of the 16 recommendations, all are

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Increased Risk of Eosinophilic Gastritis and Enteritis in Families of Patients With Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is influenced by both genetic and environmental factors. The genetic risk of distal eosinophilic gastrointestinal diseases in patients with EoE is not

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Artificial Intelligence Can Help Extract Dysplasia Diagnoses From Electronic Health Records

Natural language processing (NLP) is a branch of artificial intelligence (AI) systems that involves teaching computers the ability to understand written text like how humans

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Dietary Therapy for Eosinophilic Esophagitis Unpopular Among Gastroenterologists

Recent studies have demonstrated that dietary elimination therapy is an effective nonprescription treatment for eosinophilic esophagitis (EoE), yet many providers are still hesitant about recommending

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Trigger-Food Elimination Diets Are Effective for Patients With Eosinophilic Esophagitis

One treatment method for patients with eosinophilic esophagitis (EoE) is the six-food elimination diet (SFED), which removes milk, wheat, soy, egg, tree nuts/peanuts, and fish/shellfish

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Healing of Mucosal Ablation Areas After Radiofrequency Ablation in Patients With Barrett’s Esophagus

Endoscopic therapy for patients with neoplastic Barrett’s esophagus (BE) involves resection followed by mucosal ablation. Radiofrequency ablation (RFA) of the flat BE mucosa leads to

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Decrease in Dietary Sugar Reduces GERD Symptoms and Esophageal Acid Exposure

Although dietary changes are recommended for patients with gastroesophageal reflux disease (GERD), randomized controlled trials (RCTs) supporting these management strategies are lacking. This RCT evaluated

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Endoscopic Submucosal Dissection Plus Radiofrequency Ablation Exhibits High Eradication Rates in Patients With Barrett’s Esophagus

Current strategies for the endoscopic treatment of Barrett’s esophagus (BE) focus on resection of nodular lesions within BE and then the ablation of the flat

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Upper Endoscopy Is an Aerosol-Generating Procedure

It is unclear whether SARS-CoV-2 can be transmitted through the aerosol route during GI endoscopic procedures. As more hospitals and endoscopy units are resuming prepandemic

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Chronic Opioid Exposure Can Lead to a Higher Likelihood of Hypercontractile Esophagus and Distal Esophageal Spasm

Given a major increase (50%) in opioid prescriptions across the United States from 2000 to 2010, there is renewed interest in evaluating the effects of

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Improving Quality in Upper Endoscopy

With more than 6.1 million EGDs performed in the United States annually, establishing quality measures is imperative. Having well-defined quality measures can ensure consistency for

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Peroral Endoscopic Myotomy for Achalasia Is Effective up to 4 Years

Recent guidelines have recommended peroral endoscopic myotomy (POEM) as first-line therapy for all subtypes of achalasia, given that POEM and laparoscopic Heller myotomy have comparable

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Artificial Intelligence Detects Dysplasia in Histopathology Slides From Patients With Barrett’s Esophagus

The degree of dysplasia in patients with Barrett’s esophagus (BE) is key to determining the application of BE endoscopic therapy and assigning surveillance intervals. Multiple

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Benign Tight Esophageal Strictures Can Be Managed With Weekly Dilations

For patients with complex benign esophageal strictures, including tight, long, or tortuous strictures, endoscopic dilation is usually performed at 2- to 4-week intervals. The success

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Expert Review Advises Personalized Approach to GERD Diagnosis and Treatment

GERD, manifested by typical symptoms of heartburn as well as regurgitation and additional extraesophageal symptoms, such as chronic cough, sore throat, and globus sensation, affects

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Screening Endoscopy Should Be Considered in Patients With Head and Neck Cancer to Identify a Second Primary Esophageal Tumor

Individuals diagnosed with head and neck squamous cell carcinoma (HNSCC) are known to have an increased risk of developing a second primary tumor in the

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Poor Squamous Regeneration After Barrett’s Endoscopic Therapy Increases Risk for Treatment Failure and Disease Progression

A small subset of patients who undergo Barrett’s endoscopic therapy (BET) using radiofrequency ablation (RFA) will have evidence of poor mucosal healing (mucosal edema, ulcers,

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Robotic Endoscopy Improves Efficacy and Safety of Endoscopic Submucosal Dissection

Endoscopic submucosal dissection (ESD) is technically difficult and relies on appropriate countertraction and visibility to safely remove lesions of interest. Robot-assisted endoscopy has been under

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The Functional Lumen Imaging Probe Can Be Used to Assess Response to Peroral Endoscopic Myotomy

Clinical response after peroral endoscopic myotomy (POEM) is subjectively assessed using the Eckardt score (ES) or objectively tested using high-resolution manometry (HRM) or barium esophagram.

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Progression in Barrett’s Esophagus Score Can Be Used for Estimating Neoplastic Progression

Barrett’s esophagus (BE) is a known precancerous lesion for esophageal dysplasia and adenocarcinoma (EAC); however, it is unclear who will progress to high-grade dysplasia (HGD)

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Empiric Esophageal Dilation Is Not Useful for Nonobstructive Dysphagia

Empiric esophageal dilation often is performed for patients presenting with dysphagia who have no evidence of an anatomic obstruction or lesion. However, there is little

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Endoscopic Submucosal Dissection Use Changes Histologic Diagnosis in More Than Half of All Patients With Visible Barrett’s Esophagus Neoplasia

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have emerged as important treatment techniques for patients with visible lesions in Barrett’s esophagus (BE). Whereas

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Barrett’s Endoscopic Therapy Using Hybrid-Argon Plasma Coagulation Is Safe and Effective

Endoscopic therapy for Barrett’s esophagus (BE) usually involves resection of visible lesions by endoscopic mucosal resection followed by mucosal ablation using radio frequency ablation. Hybrid

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Endoscopic Resection for Early Esophageal Squamous Cell Carcinoma Invading the Muscularis Mucosae Without Lymphovascular Invasion

Superficial esophageal squamous cell carcinoma (ESCC) involving the epithelium and lamina propria is treated with endoscopic resection (ER) due to negligible risk of lymph node

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Single Dose of Intravenous Antibiotics Before Peroral Endoscopic Myotomy Is Sufficient for Infection Prevention

Peroral endoscopic myotomy (POEM) is an endoscopic procedure that exposes the contents of the esophagus to the sterile mediastinum during the myotomy. This allows microbial

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Cryoballoon Ablation Has Similar Efficacy to but Higher Stricture Rates Than Radiofrequency Ablation in Barrett’s Endoscopic Therapy

Radiofrequency ablation (RFA) is widely utilized in the treatment of neoplastic Barrett’s esophagus (BE) after endoscopic resection of all visible lesions. Cryotherapy is another form

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A Negative Upper Endoscopy in Patients With GERD Reduces Incidence and Mortality From Upper GI Cancers

Gastroesophageal reflux disease (GERD) is the most common reason for referral for upper endoscopy. This study sought to determine whether there is a relationship between

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Barrett’s Esophagus-Specific Training Improves Adherence to Diagnosis and Treatment Guidelines

The accurate diagnosis and management of patients with Barrett’s esophagus (BE) are important for the early recognition and minimally invasive treatment of BE neoplasia. Despite

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Artificial Intelligence Similar to Expert Endoscopists at Differentiating Between Mucosal and Submucosal Barrett’s Cancer

Artificial intelligence (AI) systems using convolutional neural networks have been developed to differentiate between esophageal cancer (EAC), high-grade dysplasia, and nondysplastic Barrett’s esophagus. However, until

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Smoking, Obesity, Alcohol, and GERD Continue To Be Common, Modifiable Risk Factors for Upper GI Cancers

Among upper gastrointestinal (UGI) cancers, gastric and esophageal cancers rank third and sixth, respectively, as the most common cause of death due to cancer worldwide.

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Upper GI Screening Endoscopy in Individuals With a Family History of Barrett’s Esophagus or Esophageal Cancer

The incidence of esophageal adenocarcinoma (EAC) continues to increase and is still associated with a poor prognosis with a 5-year survival rate of 20%. The

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Endoscopic Septotomy Is Safe and Effective for the Treatment of Zenker’s Diverticulum

Zenker’s diverticulum (ZD) can lead to dysphagia to both solids and liquids and can be treated endoscopically or surgically. This retrospective, single-center, observational study evaluated

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Artificial Intelligence During Barrett’s Endoscopy Is Accurate for Reporting Prague Criteria

During endoscopy, the extent of Barrett’s esophagus (BE) is quantified by endoscopists using the widely accepted Prague C&M (circumferential and maximal lengths) criteria. Prague C&M

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Peroral Endoscopic Myotomy Is Effective and Safe for Spastic Esophageal Motility Disorders

Spastic esophageal motility disorders (SEMDs) include a group of esophageal dysmotility conditions that are difficult to treat and often refractory to nonsurgical and/or endoscopic measures.

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Neoplasia Detection Rate Can Be Used as a Quality Indicator for Endoscopy in Barrett’s Esophagus

Standardized quality metrics evaluating the performance of a high-quality examination in patients with Barrett’s esophagus are lacking. The neoplasia detection rate (NDR), defined as the

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Narrow-Band Imaging Is a Good Screening Modality for Esophageal Squamous Cell Cancer for Expert and General Endoscopists

Those at high risk or with a prior history of esophageal squamous cell cancer (SCC) are recommended to undergo screening or surveillance using dye-based chromoendoscopy.

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Only 80% Eradication Rates of Barrett’s Esophagus With Long-Term Follow-Up of Endoscopic Therapy Studies

Patients with high-grade dysplasia and/or early cancer in Barrett’s esophagus (BE) are treated with endoscopic therapy (BET), with the goal of complete eradication of all

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Peroral Endoscopic Myotomy Is Safe and Effective: A 10-Year Follow-Up of Patients

Peroral endoscopic myotomy (POEM), an endoscopic modality for managing major esophageal motility disorders, has gained popularity in the last decade. Multiple controlled studies and systematic

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Esophageal Dilation Is Safe and Effective in Patients With Difficult-to-Treat Eosinophilic Esophagitis

The phenotypes of eosinophilic esophagitis (EoE) range from mild inflammation to severe fibrostenotic disease. Although current therapies (diet, proton pump inhibitors, and steroids) have shown

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Adverse Events Are Uncommon After Peroral Endoscopic Myotomy, Score Predicts Those at Risk

Peroral endoscopic myotomy (POEM) is a widely accepted, effective endoscopic procedure for the management of achalasia. Although POEM is considered a relatively safe procedure, studies

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Oral Budesonide Suspension Is Effective in Patients With Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE), a chronic inflammatory disorder, can be treated with steroids, proton pump inhibitors, and dietary modifications. There have been advances in the formulations

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Endoscopic GERD Treatment With Full-Thickness Plication Is Safe and Effective

Gastroesophageal reflux disease (GERD), a relatively common condition impacting up to 40% of the adult population, can be treated with proton pump inhibitors (PPIs), laparoscopic

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Nonendoscopic Detection of Barrett’s Esophagus Using Methylated DNA Markers

Currently, an upper GI endoscopy with biopsies of the columnar-lined distal esophagus is necessary to diagnose Barrett’s esophagus (BE). Easier, noninvasive, nonendoscopy-based testing techniques have

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POEM and Surgical Myotomy for Achalasia Show Comparable Functional Luminal Imaging Probe Measurement Results at 1 Year

The functional luminal imaging probe (FLIP) measures the distensibility index (DI) at the gastroesophageal junction (GEJ). This is a measure of GEJ compliance, which has

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Antireflux Surgery Is Associated With a Low 90-Day Mortality Rate in Patients With GERD

Laparoscopic antireflux surgery (ARS) is an effective treatment for patients with well-documented gastroesophageal reflux disease (GERD). In this retrospective cohort study, investigators used national databases

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Pneumatic Dilation Is Ineffective for Postfundoplication Dysphagia

Persistent dysphagia (ie, symptoms for more than 3 months) after fundoplication surgery is reported in up to 25% of patients. After anatomical causes of dysphagia

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Linked Color Imaging Improves Neoplasia Detection

Image-enhanced endoscopy is aimed at improving the detection of neoplastic lesions in the luminal GI tract during standard white-light endoscopy (WLE). Linked color imaging (LCI)

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Endoscopic Features for Recognizing Buried Barrett’s Esophagus

Buried Barrett’s esophagus (BE) mucosa, or subsquamous intestinal metaplasia, is defined as intestinal metaplasia that is present under a lining of endoscopically intact squamous epithelium.

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Endoscopic Screening Reduces Mortality From Esophageal Cancer in High-Risk Population

Although esophageal adenocarcinoma (EAC) is the most common type of esophageal cancer in the Western world, esophageal squamous cell carcinoma (ESCC) is the dominant type

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Artificial Intelligence Accurately Identifies Esophageal Lesions

Artificial intelligence (AI) studies for detecting and differentiating gastrointestinal lesions are on the rise. Various groups have developed a multitude of machine-learning algorithms to accurately

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Recurrence of Intestinal Metaplasia in the Cardia After Barrett’s Endoscopic Therapy: What To Do?

In patients undergoing Barrett’s endoscopic therapy (BET), complete eradication of intestinal metaplasia (CE-IM) is the final goal. However, studies have reported recurrence of IM, specifically

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Reflux Monitoring Can Reduce the Inappropriate Use of Proton Pump Inhibitors in Patients With GERD

Proton pump inhibitors (PPIs) are the main treatment for gastroesophageal reflux disease (GERD). However, 30% to 50% of patients with GERD fail to achieve adequate

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Diaphragmatic Breathing Can Help Reduce GERD

Upright gastroesophageal reflux disease (GERD), also known as upright reflux, is thought to be a result of increased intragastric pressure. In turn, increases in intragastric

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Achalasia Patients at Increased Risk for Esophageal Cancer

Achalasia can cause food retention, leading to bacterial overgrowth, irritation, and chronic inflammation, a proposed pathophysiological process that may lead to squamous cell carcinoma (SCC).

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Cryoballoon Ablation Can Be Used for Barrett’s Esophagus Endoscopic Therapy

Cryotherapy involves the application of a cryogen by way of spraying liquid nitrogen to the esophageal mucosa or by surface contact with a nitrous oxide-filled

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Relapse in Eosinophilic Esophagitis Occurs Despite Treatment With Swallowed Topical Corticosteroids

Swallowed topical corticosteroids (STC) are effective as initial treatment in patients with eosinophilic esophagitis (EoE) and in achieving histological remission. However, their role in the

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Neoplasia Detection Rate in Barrett’s Esophagus: A Measure of High-Quality Upper Endoscopy

Studies have reported that up to 25% of esophageal adenocarcinomas (EACs) are detected within 1 year of index endoscopy (missed cancer), emphasizing the need for

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Budesonide Can Be Used for Maintaining Long-Term Remission in Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a chronic antigen-mediated immunological disorder that has a high relapse rate of >80% with cessation of therapy. Although corticosteroids (both topical

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Implementing a Standardized Protocol Helps to Increase Diagnosis of Eosinophilic Esophagitis

The incidence of eosinophilic esophagitis (EoE), a condition characterized by esophageal eosinophilia and dysfunction, has been reported in about 5 to 10 per 100,000 individuals.

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Motility Disorders Can Exist in Patients With Eosinophilic Esophagitis, Specifically in Those Not Responding to Therapy

Eosinophilic esophagitis (EoE) is characterized by the presence of esophageal dysfunction along with histological evidence of ≥15 eosinophils per high-power field from esophageal biopsies. Recent

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Dysphagia Is Common After Bariatric Surgery

Symptoms of dysphagia due to obstruction (mechanical or functional) can be caused by a noncompliant gastric pouch after bariatric surgery and, theoretically, could lead to

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Nonendoscopic Screening for Barrett’s Esophagus: Are We There?

Upper endoscopy (EGD) with biopsy remains the gold standard for the diagnosis of Barrett’s esophagus (BE). Several nonendoscopic techniques (sponge, capsule) have utilized biomarkers, such

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Peroral Endoscopic Myotomy Can Be Safe and Effective for Persistent Symptoms After Heller Myotomy

Persistent and recurrent symptoms have been reported in up to 20% of patients with achalasia after surgical treatment with Heller myotomy. The aim of this

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Is Barrett’s Esophagus Thickness a Marker for Response to Radiofrequency Ablation Therapy?

Radiofrequency ablation (RFA) is a widely used modality for treating flat Barrett’s esophagus (BE) dysplasia, with the goal of achieving complete eradication of intestinal metaplasia

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Is Obesity a Risk Factor for Barrett’s Esophagus?

While the role of obesity in gastroesophageal reflux disease (GERD) and the role of GERD in Barrett’s esophagus (BE) are independently well established, there is

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Use of a Magnetically Assisted Capsule Device for Examining the Esophagus

The magnetically assisted capsule endoscopy (MACE) system (MicroCam Navi; IntroMedic) is a novel noninvasive technique for visualizing the upper GI tract. This device utilizes a

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ESD Versus EMR for Resecting Esophageal Neoplasia

Endoscopic submucosal dissection (ESD) is an effective method of resecting larger superficial esophageal lesions en bloc; however, it is fraught with advanced training needs, longer

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Which Upper GI Findings During EGD Do Not Require Follow-Up?

The European Society of Gastrointestinal Endoscopy (ESGE) has issued recommendations on conditions that do not require routine surveillance. Those related to upper GI endoscopy include:

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Is Cryoballoon Ablation Ready for Barrett’s Endoscopic Therapy?

The 90˚-swipe cryoballoon ablation system (CbSAS90) is a new technology incorporating cryotherapy that has been proposed to treat Barrett’s esophagus (BE) segments. This technology is

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What Therapy to Use for Patients With EoE: PPIs, Steroids, or Elimination Diets?

Prateek Sharma, MD, FASGE, reviewing Laserna-Mendieta EJ, et al. Clin Gastroenterol Hepatol 2020 Jan 25. Proton pump inhibitors (PPIs), steroids, elimination diets, and esophageal dilation

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Bile Acid Sequestrants Demonstrate Significant Benefit As Adjunctive Therapy in Refractory GERD

Prateek Sharma, MD, FASGE, reviewing Vaezi MF, et al. Gastroenterology 2020 Feb 21. Proton pump inhibitor- (PPI) refractory GERD, accounting for about one-third of all

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Patients With Barrett’s Esophagus and Indefinite Dysplasia: What To Do?

Prateek Sharma, MD, FASGE, reviewing Krishnamoorthi R, et al. Gastrointest Endosc 2020 Jan. The risk of progression in Barrett’s esophagus (BE) with low-grade dysplasia has

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The Battle Zone of Barrett’s Endoscopic Therapy: The Gastric Cardia

Prateek Sharma, MD, FASGE, reviewing Eluri S, et al. Clin Gastroenterol Hepatol 2020 Jan. Long-term durability of complete eradication of intestinal metaplasia (CE-IM) is the

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Dupilumab: A New Treatment Option for Patients With Eosinophilic Esophagitis

Prateek Sharma, MD, FASGE, reviewing Hirano I, et al. Gastroenterology 2020 Jan. Medical treatment options for patients with eosinophilic esophagitis (EoE) include proton pump inhibitors,

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Physician and Patient Education Can Lead to Reduction in Inappropriate PPI Use

Prateek Sharma, MD, FASGE, reviewing Lin D, et al. Clin Gastroenterol Hepatol 2019 Dec 27. The use of proton pump inhibitors (PPIs) for the treatment

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POEM Versus Surgery for Achalasia Treatment: Which One To Select?

Prateek Sharma, MD, FASGE reviewing Werner YB, et al. N Engl J Med 2019 Dec 5. Both peroral endoscopic myotomy (POEM) and surgical laparoscopic Heller’s

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Does Prior Treatment Impact Outcomes of POEM in Patients With Achalasia?

Prateek Sharma, MD, FASGE reviewing Liu ZQ, et al. Endoscopy 2019 Apr. The major treatment options for achalasia include laparoscopic Heller myotomy, pneumatic balloon dilation,

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1% Lugol’s Iodine Solution Should Be Used for Esophageal Chromoendoscopy

Prateek Sharma, MD, FASGE reviewing Gotoda T, et al. Gastrointest Endosc 2019 Oct 25. Lugol’s iodine has been utilized for dye-spray chromoendoscopy to detect esophageal

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Medical Versus Surgical Treatment for Refractory Heartburn: What Should You Do?

Prateek Sharma, MD, FASGE reviewing Spechler SJ, et al. New Engl J Med 2019 Oct 17. Although proton pump inhibitors (PPIs) are widely utilized for

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How to Manage PPI-Refractory Regurgitation

Prateek Sharma, MD, FASGE reviewing Bell R, et al. Clin Gastroenterol Hepatol 2019 Sep 10. Magnetic sphincter augmentation (MSA) uses a series of titanium beads

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Patients With Eosinophilic Esophagitis Need Long-Term Treatment

Although it is known that eosinophilic esophagitis (EoE) is a chronic disease and recurs if treatment is discontinued, the rates of recurrence and the impact

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Are Potassium-Competitive Acid Blockers Superior to PPIs for GERD Treatment?

Proton pump inhibitors (PPIs) are widely used for the treatment of GERD, including healing erosive esophagitis. Since several PPIs have a slow, cumulative onset of

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