Reassessing the Risk of Esophageal Cancer in Achalasia Post-Therapy: Findings From a Large United States Multi-Centre Retrospective Propensity-Matched Cohort Study.

Background: Achalasia is associated with an increased risk of esophageal cancer; though reported incidence rates vary widely (0.4% to 9.2%) due to differences in demographics, follow-up duration, and diagnostic methods.

Functional Lumen Imaging Probe as Part of Multimodality Assessment of Esophagogastric Junction Opening Is Important in Longitudinal Follow-Up of Patients With Treated Achalasia.

Background: Functional lumen imaging probe (FLIP) utility is established in treatment-naïve achalasia but less clear following lower esophageal sphincter (LES) directed therapy.

Methods: Achalasia patients with LES directed therapy across three tertiary care centers between 2017 and 2024 with post-treatment FLIP and timed barium esophagram (TBE) were retrospectively identified. Reduced esophagogastric junction (EGJ) opening was defined by distensibility index (DI) < 2 mm/mmHg and diameter < 12 mm.

Secondary Peristalsis Is More Affected Than Primary Peristalsis by Increased Intragastric Pressure After Metabolic Bariatric Surgery: Findings From Functional Lumen Imaging Probe and High-Resolution Esophageal Manometry.

Introduction: Esophageal dysmotility following metabolic bariatric surgery (MBS) may relate to decreased gastric compliance. We investigated high-resolution esophageal manometry (HRM) and secondary peristalsis assessed by functional lumen imaging probe (FLIP) and their association with intragastric pressure after MBS.

Methods: Patients undergoing HRM, FLIP, and barium esophagram (BE) after MBS were included.

The use of Bevacizumab in the treatment of brain arteriovenous malformations: a systematic review.

Brain arteriovenous malformations (bAVMs) are high-flow vascular anomalies associated with a significant risk of intracranial haemorrhage, particularly in young individuals. Standard treatments-including microsurgery, stereotactic radiosurgery (SRS), and endovascular embolization-are not feasible for all patients, especially those with high-grade or surgically inaccessible lesions. Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor (VEGF), has emerged as a potential medical therapy aimed at modulating angiogenesis and managing post-treatment complications.

Prediction of seizure risk after repetitive mild traumatic brain injury in childhood.

Objective: Despite the known negative physiological impact of repeated mild head trauma events, their multiplicative impact on long-term seizure risk remains unclear. The objective of this study was to evaluate how multiple mild traumatic brain injuries (mTBIs) impact long-term seizure risk by testing 3 distinct machine learning approaches. Baseline and injury-specific characteristics were incorporated to enhance prognostication of individual seizure risk.

Three-to-six month post-POEM timed barium esophagram can predict esophageal contents and may stratify aspiration risk on follow-up EGD.

Background: Peroral endoscopic myotomy (POEM) is an increasingly utilized endoscopic therapy for achalasia. When undergoing esophagogastroduodenoscopy (EGD), patients with a diagnosis of achalasia may receive endotracheal intubation (EI) to reduce the risk of aspiration. The risk of aspiration on post-POEM EGD should be reduced due to improved esophageal emptying.

Peroral plication of the esophagus as a treatment option for end-stage achalasia with sump formation.

Introduction: Peroral plication of the esophagus (POPE) can reduce sump size and improve symptoms in end-stage achalasia. However, its long-term efficacy and safety are unknown.

Methods: Patients with end-stage achalasia who underwent POPE at our institution (2016-2024) were identified.

A Standardized Approach to Performing and Interpreting Functional Lumen Imaging Probe Panometry for Esophageal Motility Disorders: The Dallas Consensus.

Background & Aims: Functional lumen imaging probe (FLIP) panometry provides assessment of the esophagogastric junction opening and esophageal body contractile activity during an endoscopic procedure and is increasingly being incorporated into comprehensive esophageal motility assessments. The aim of this study was to provide a standardized approach and vocabulary to the procedure and interpretation and update the motility classification scheme.

Methods: A working group of 19 FLIP panometry experts convened in a modified Delphi consensus process to produce and assess statements on the FLIP panometry procedure and interpretation.

Computer-assisted classification of the squamocolumnar junction.

Background And Aims: An irregular Z-line is characterized by a squamocolumnar junction (SCJ) that extends proximally above the gastroesophageal junction by <1 cm, whereas Barrett's esophagus is defined as a columnar-lined esophagus (CLE) that extends proximally by ≥1 cm with the presence of specialized intestinal metaplasia on biopsy sampling. Measurement of the CLE is most accurate for lengths ≥1 cm, and, as such, guidelines do not recommend biopsy sampling of an irregular Z-line when seen on endoscopy. However, a CLE is often estimated by visual inspection rather than direct measurement, making this characterization imprecise.

Optimizing Assessment of Contraction Reserve in Ineffective Esophageal Motility: A Study of Upright Multiple Rapid Swallows.

Background/aims: Multiple rapid swallows (MRS) is a provocative test during high-resolution esophageal manometry (HRM) to evaluate contraction reserve (CR). This study aims to determine the prevalence of CR in patients with ineffective esophageal motility (IEM) and MRS performed in the upright position, and to assess the ideal number of MRS sequences.

Methods: We enrolled adult patients diagnosed with IEM according to the Chicago classification version 4.

Retrospective Comparison of Targeted Anticancer Drugs Predicted by the CNS-TAP Tool Versus Those Selected by a Molecularly Driven Tumor Board in Children With DIPG.

The recent trial Pediatric Neuro-Oncology Consortium 003 (PNOC003) utilized a molecular tumor board to recommend personalized treatment regimens based on tumor sequencing results in children with DIPG. We separately developed the Central Nervous System Targeted Agent Prediction (CNS-TAP) tool, which numerically scores targeted anticancer agents using preclinical, clinical, and patient-specific data. We hypothesized that highly scored agents from CNS-TAP would overlap with the PNOC003 tumor board's recommendations.

EoE Recurrence on PPI Maintenance Therapy: You Do Not Know if You Do Not Look!

Background And Aims: Data regarding histologic recurrence of EoE on PPI maintenance therapy are lacking.

Methods: Retrospective review of 101 patients with histologic PPI-responsive EoE.

Results: 52/101 (51%) patients underwent follow-up EGD with biopsies.

Course of Esophageal Strictures in Eosinophilic Esophagitis Using Structured Esophagram Protocol.

Background And Aims: A key unknown in eosinophilic esophagitis (EoE) is the long-term course of esophageal stenosis. Our aim was to evaluate the course of esophageal strictures using structured serial esophagrams and determine predictors of diameter improvement in patients with EoE.

Methods: This was a retrospective study of 78 EoE patients who completed 2 structured esophagrams at an academic tertiary referral center between 2003 and 2021.

Hepatolithiasis and Choledocholithiasis Secondary to Warm Autoimmune Hemolytic Anemia in the Setting of COVID-19 and Lupus.

Two major etiologies of hyperbilirubinemia include hemolysis and cholestasis. Although rare, the former can give rise to the latter through the formation of pigment gallstones and subsequent biliary tree obstruction. We report a case of a 57-year-old woman with systemic lupus erythematosus who presented with dyspnea and right upper quadrant abdominal pain.

Unraveling molecular advancements in chordoma tumorigenesis and treatment response: a review of scientific discoveries and clinical implications.

Chordomas are tumors thought to originate from notochordal remnants that occur in midline structures from the cloves of the skull base to the sacrum. In adults, the most common location is the sacrum, followed by the clivus and then mobile spine, while in children a clival origin is most common. Most chordomas are slow growing.

Post-bariatric Surgery Changes in Secondary Esophageal Motility and Distensibility Parameters.

Introduction: Despite the increasing number of bariatric procedures over the recent years, the physiological changes in secondary esophageal motility and distensibility parameters after surgery remain unknown.

Methods: This is a retrospective, single-center cohort study comparing esophageal planimetry and gastroesophageal junction (GEJ) distensibility in post-bariatric surgery patients (Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and conversion/revisional patients (DH)) and native-anatomy patients with obesity (NAC). Distensibility refers to the area achieved with a certain amount of pressure, and secondary peristalsis represents the esophageal response to an intended obstruction.

Development of a model to identify patients who do not need oesophageal biopsies when eosinophilic oesophagitis is suspected.

Background: Predictive models for eosinophilic oesophagitis (EoE) may not fully rule in the diagnosis.

Aim: To develop a reverse model that predicts against EoE to eliminate the need for oesophageal biopsies.

Methods: In this two-centre study, a predictive model was developed (Mayo Clinic) and validated (University of North Carolina [UNC]).

Clinical Efficacy of ONC201 in H3K27M-Mutant Diffuse Midline Gliomas Is Driven by Disruption of Integrated Metabolic and Epigenetic Pathways.

Unlabelled: Patients with H3K27M-mutant diffuse midline glioma (DMG) have no proven effective therapies. ONC201 has recently demonstrated efficacy in these patients, but the mechanism behind this finding remains unknown. We assessed clinical outcomes, tumor sequencing, and tissue/cerebrospinal fluid (CSF) correlate samples from patients treated in two completed multisite clinical studies.

Performance of an Artificial Intelligence Model for Recognition and Quantitation of Histologic Features of Eosinophilic Esophagitis on Biopsy Samples.

We have developed an artificial intelligence (AI)-based digital pathology model for the evaluation of histologic features related to eosinophilic esophagitis (EoE). In this study, we evaluated the performance of our AI model in a cohort of pediatric and adult patients for histologic features included in the Eosinophilic Esophagitis Histologic Scoring System (EoEHSS). We collected a total of 203 esophageal biopsy samples from patients with mucosal eosinophilia of any degree (91 adult and 112 pediatric patients) and 10 normal controls from a prospectively maintained database.