BACKGROUND AND AIMS: Patients after endoscopic treatment of Barrett's esophagus (BE) related neoplasia (BORN) should enter endoscopic surveillance with biopsies to detect persistent or recurrent neoplasia or intestinal metaplasia (IM). Probe-based confocal laser endomicroscopy (pCLE) serves as a virtual biopsy and could replace standard biopsies. However, the role of pCLE in patients after endoscopic treatment of BORN has not been systematically assessed. The aim of this study was to compare pCLE with biopsies in detecting persistent/recurrent IM/neoplasia. METHODS: A single center, prospective and pathologist-blinded study was performed. Patients after endoscopic treatment of BORN (endoscopic resection or dissection, radiofrequency ablation) underwent surveillance endoscopy with pCLE followed by biopsies. RESULTS: A total of 56 patients were enrolled: initial diagnoses were low-grade dysplasia (LGD) in 24 patients (43%), high-grade dysplasia (HGD) in 12 patients (21%) and early adenocarcinoma (EAC) in 20 patients (36%). Only one patient (2%) experienced recurrent neoplasia (LGD), which was diagnosed by pCLE only. Twenty patients (35.7%) experienced persistent/recurrent IM, diagnosed by both pCLE and biopsies in 17 patients (17/30, 85%) and by pCLE only in 3 pts (3/30, 15%). Sensitivity, specificity, positive and negative predictive values to diagnose recurrent/persistent IM did not differ significantly between pCLE and biopsies; diagnostic accuracy was 100% (95%CI 93.6-100) for pCLE and 94.6 (95%CI 85.1-98.9%) for biopsies, p=0.25. In patients with IM detected by both tested methods, pCLE detected significantly more goblet cells (median 43 per patient) than biopsies (median 12 per patient), p=0.01. CONCLUSION: pCLE is at least as effective as standard biopsies in the detection of persistent/recurrent IM after endoscopic treatment of BORN.

• MeSH
• Barrettův syndrom patologie   chirurgie   MeSH
• biopsie MeSH
• časové faktory MeSH
• dospělí MeSH
• ezofagektomie * škodlivé účinky   MeSH
• ezofágoskopie * škodlivé účinky   MeSH
• konfokální mikroskopie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru * MeSH
• nádory jícnu patologie   chirurgie   MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• radiofrekvenční ablace * MeSH
• reprodukovatelnost výsledků MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stupeň nádoru MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

INTRODUCTION: Complete circular endoscopic dissection (CED) is frequently accompanied with post-operative strictures formation in the esophagus. Various types of therapeutic approaches have recently been tested to prevent these strictures, e.g. cell therapy or stenting. METHODS: Miniature pigs of Gottingen/Minnesota origin (n=10) were used in the study. First, we made the complete CED in the mid esophagus; next, the defect was left untreated or covered with mesenchymal stem cells (MSCs) or a mixture of MSCs and primary oral keratinocytes (pOKs) suspension without/with fully covered self-expandable metallic stent (SEMS). Consequently, we performed a control endoscopy with a stent removal, and necropsy was performed 17-36 days after cells application. RESULTS: All CED procedures were completed successfully without serious complications. Although we were able to detect MSCs or pOKs in the post-CED defects up to the 36th day after transplantation, the combination of MSCs or MSCs/pOKs with or without SEMS application did not prevent post-CED strictures development. The mixture of MSCs and pOKs resulted in the formation of cellular aggregates, which were mainly observed in submucosa, and the post-CED defect was covered with collagen fibers containing a thin scarred epithelium, accompanied by various degrees of reconstruction and integrity. CONCLUSION: Suspension application of autologous MSCs alone or in combination with pOKs with or without SEMS was ineffective in the prevention of strictures formation after complete CED. Nevertheless, the presence of MSCs or pOKs in the post-CED defect was confirmed even 5 weeks after transplantation.

• Klíčová slova
• benign esophageal stricture, circular endoscopic dissection, endoscopic submucosal dissection, mesenchymal stem cells, primary oral keratinocytes,
• MeSH
• ezofágoskopie * škodlivé účinky   MeSH
• ezofágus * chirurgie   MeSH
• miniaturní prasata MeSH
• prasata MeSH
• stenóza MeSH
• stenty MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

The case report dissertates upon successful treatment of iatrogenic perforation of distal oesophagus with subcutaneous emphysema, pneumoperitoneum and pneumomediastinum. The endoclips and classic conservative treatment were used in therapy. The patient was treated 3 hours after the injury, no early or late complications related to perforation were noted.

• MeSH
• chirurgické nástroje * MeSH
• dospělí MeSH
• ezofágoskopie škodlivé účinky   MeSH
• lidé MeSH
• perforace jícnu etiologie   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

Endoscopic extraction of foreign bodies from the upper part of the digestive tract has become recently the method of choice. As this method can be associated with very serious complications which cannot be resolved endoscopically and which may have permanent sequelae, it is important to consider the indication of endoscopic extraction of foreign bodies from the oesophagus or stomach very carefully. Fore illustration the authors present the case of a young female patient who swallowed by mistake a fork During its extraction a serious injury of the oesophagus occurred which had to be treated surgically. In the discussion pros and cons of endoscopic extraction are considered, the main principle being primum non nocere.

• MeSH
• cizí tělesa terapie   MeSH
• dospělí MeSH
• ezofágoskopie škodlivé účinky   MeSH
• ezofágus zranění   MeSH
• lidé MeSH
• penetrující rány etiologie   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

The author describes four patients treated in 1988 on account of iatrogenic oesophageal injury during diagnostic endoscopy. Twice the cervical portion of the oesophagus was perforated, once the lower thoracic portion and once subperitoneal perforation in hiatus hernia was involved. The latter was manifested only by a major pneumomediastinum and emphysema of the neck and face, while contrast examination of the oesophagus and stomach did not suggest perforation and recovery was achieved by conservative treatment. In the remaining three patients surgical revision and suture were performed and complete recovery was achieved, twice without complications after a hospitalization of 14 and 18 days and once the course was complicated by an abscess in the mediastinum. Its treatment called for repeated drainage and a total hospitalization period of 57 days. Finally the author emphasizes that early diagnosis of this serious complication and subsequent early treatment (with the exception of one female patient the others were treated within six hours after the injury) may get the patient over this complication without serious damage.

• MeSH
• dospělí MeSH
• ezofágoskopie škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• perforace jícnu diagnostické zobrazování   etiologie   chirurgie   MeSH
• radiografie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• ezofágoskopie škodlivé účinky   MeSH
• iatrogenní nemoci MeSH
• lidé středního věku MeSH
• lidé MeSH
• mediastinoskopie škodlivé účinky   MeSH
• perforace jícnu etiologie   terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• brániční hernie komplikace   MeSH
• břicho MeSH
• dospělí MeSH
• ezofágoskopie škodlivé účinky   MeSH
• ezofágus zranění   MeSH
• lidé MeSH
• nemoci jícnu komplikace   MeSH
• nemoci žaludku komplikace   MeSH
• technologie optických vláken MeSH
• tlak škodlivé účinky   MeSH
• žaludeční sliznice etiologie   zranění   MeSH
• zvracení komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

• MeSH
• časové faktory MeSH
• cizí tělesa chirurgie   MeSH
• dítě MeSH
• ezofágoskopie škodlivé účinky   MeSH
• gastroskopie škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metody MeSH
• perforace jícnu diagnóza   etiologie   MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• endoskopie * MeSH
• ezofágoskopie škodlivé účinky   MeSH
• gastroskopie škodlivé účinky   MeSH
• lidé MeSH
• perforace jícnu * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH