BACKGROUND AND OBJECTIVE

Evidence regarding the impact of performing endoscopy within 12 hours of variceal bleeding (VB) on outcomes is inconclusive, and there is a lack of local data on this topic. This study aimed to determine if the timing of endoscopy is associated with clinical outcomes.

This was a single-center retrospective cohort study which included adult cirrhotic patients admitted for VB from January 2016 to September 2022. The primary outcomes were in-hospital and 6-week mortality. Secondary outcomes included 5-day rebleeding, length of hospital stay (LOS), and blood transfusion requirements (BTR). The relationships between timing of endoscopy and outcomes were evaluated using regression analysis.

In 140 patients, 5.7% underwent urgent endoscopy (?12 hours). The overall median door-to-endoscopy time (DET) was 39.4 hours (IQR 20.0-73.4). The overall in-hospital mortality, 6-week mortality, and 5-day rebleeding rates were 12.9%, 11.4%, and 8.6%, respectively, without significant variability at different DET (p >0.05). Prolonged LOS was evident when endoscopy was delayed to >12 hours from admission (3.5 [IQR 2.25-5.75] vs 6 days [IQR 4-9.75], p = 0.021), while BTR was greater starting at endoscopies performed at >24 hours from admission (1 [0-2] vs 2 units [1-3], p = 0.000). Delayed endoscopy was significantly correlated with LOS (Beta 0.316, SE 0.011, p = 0.000) and BTR (Beta 0.214, SE 0.469, p = 0.003), but not with mortality and early rebleeding.

Timing of endoscopy may be independent of mortality and early rebleeding. Timely endoscopy may shorten hospitalization and decrease need for blood transfusion. Other factors affecting clinical outcomes may be at play.

BACKGROUND AND OBJECTIVE

Foreign body (FB) ingestion is a common pediatric concern in the Philippines, but local studies on flexible endoscopic management are lacking. This study aimed to describe the clinical profile and outcomes of children referred for flexible endoscopic management and identify factors associated with poor outcomes.

This retrospective cohort study included 145 patients agedRESULTS

Most FB ingestions (96.55%) were accidental, with coins as the most common FB (56.55%). Patients were admitted an average of 40.42 hours post-ingestion and referred for endoscopy within 9.28 hours. Flexible endoscopy was performed in 44.83% of cases, with a 98.46% success rate and an average procedure time of 32.25 minutes. Spontaneous passage occurred in 50.34% of cases. Poor outcomes were linked to age 48 hours; OR: 15.43, p = 0.0181), and prolonged procedures (>30 minutes; OR: 12, p = 0.0318). Good outcomes were associated with unremarkable physical exams (OR: 0.078; p = 0.0018), early admission (CONCLUSION

Flexible endoscopy is effective and safe for FB extraction in children. Early admission and timely intervention significantly improve outcomes, while delays and prolonged procedures increase the risk of complications.

Drug-induced sleep endoscopy (DISE) is used for directly visualizing sites of obstruction among patients with obstructive sleep apnea (OSA). Owing to the scarcity of data, there is still no consensus on the anesthetic regimen for conducting pediatric DISE.

This paper presents a 5-year-old patient who underwent DISE using an opioid-sparing regimen with dexmedetomidine and propofol infusion.

Simultaneous dexmedetomidine and propofol infusion is a promising opioid-sparing regimen for pediatric DISE.

BACKGROUND

Upper gastrointestinal bleeding (UGIB) is a common cause of hospitalizations in adult Filipinos. Upper endoscopy is the cornerstone of diagnosis and therapy with guidelines recommending endoscopy within 24 hours of hospital admission. However, data on the clinical outcomes in relation to the optimal timing of endoscopy remains limited in Davao City.

A retrospective cohort study of adult patients (age ≥19) with a primary or secondary diagnosis of UGIB who underwent an upper endoscopy was conducted in a tertiary hospital in Davao City, Philippines from January 2019 to December 2022. Patient demographics and clinical data were analyzed by chart review. Patients were categorized based on the timing of endoscopy from admission or from the presentation of UGIB symptoms in patients previously admitted for other complaints: urgent (t ≤6 hours), early (t >6-24 hours), late (t >24-48 hours), and very late (t >48 hours). The 30-day all-cause in-hospital mortality, and the rates for further bleeding, endoscopic treatment, average units of blood transfused, intensive care unit admission, and duration of hospitalization within 30 days were compared. Statistical analyses were performed using the JASP software, and a P value < 0.05 was considered as statistically significant.

A total of 142 patients were included in the study. Mean age was 62 years, with more males (66.2%) than females (33.8%). Non-variceal causes, particularly erosive diseases (53.7%), were the most common endoscopy findings in our center. Endoscopic treatments were only performed in 26 patients (18.3%). The 30-day all-cause in-hospital mortality rate did not differ between the urgent, early, late and very late elective endoscopy groups (25% vs 2.6% vs 9.3% vs 13%; p=0.26). Although it did not reach statistical significance, urgent timing (n=4) was associated with a higher further bleeding rate (25%), and the need for endoscopic intervention (50%). A significant association between early and late endoscopy groups in the duration of hospitalization of only one week was demonstrated (p=0.032). There was no difference regarding the rate of ICU admissions and mean number of blood transfused among the four groups.

There were no significant differences in mortality and other clinical outcomes between all four endoscopy groups except for the duration of hospitalization. Among admitted UGIB patients, optimal medical management is still emphasized and elective endoscopy within 24 hours or until the patient is stabilized can be safely performed in most acute UGIB patients.

Objective:To explore the characteristics and therapeutic strategies of Pott's puffy tumor（PPT）. Methods:The clinical data of two patients with PPT were retrospectively analyzed and combined with the literature, focusing on the comprehensive analysis of perioperative diagnosis and treatment strategies. Both patients underwent muti-disciplinary treatment, including timely administration of sufficient antibiotics capable of penetrating the blood-brain barrier. Early removal of PPT lesions was performed using a combined internal and external approach under nasal endoscopic guidance. Results:After standardized perioperative management, the symptoms of the two patients were completely relieved, with no recurrence after one=year follow=up. Postoperative complications such as frontal pain, numbness, local depression, or scar hyperplasiawere not present. Conclusion:PPT, being relatively rare and severe, requires careful attention. Key strategies for standardized perioperative management include multi-disciplinary consultation, timely and adequate antibiotic administration, and surgical intervention using a combined intranasal and extranasal endoscopic approach for lesion removal.
Humans ; Pott Puffy Tumor/complications* ; Retrospective Studies ; Tomography, X-Ray Computed ; Endoscopy/adverse effects* ; Postoperative Complications ; Anti-Bacterial Agents/therapeutic use* ; Frontal Sinusitis/complications*

Humans ; Diagnosis, Differential ; Constriction, Pathologic/diagnosis* ; Bile Duct Neoplasms/diagnosis* ; Endoscopy, Digestive System

Humans ; Early Detection of Cancer ; Endoscopy ; Esophageal Neoplasms/epidemiology* ; Risk Factors ; Mass Screening

Endoscopy ; Health Services Needs and Demand

Objective: To compare the severity of symptoms of patients diagnosed with Eosinophilic Chronic Rhinosinusitis with Nasal Polyposis (eCRSwNP) versus Non - Eosinophilic Chronic Rhinosinusitis with Nasal Polyposis (non-eCRSwNP) using the Filipino Sinonasal Outcome Test (Filipino SNOT 22) and determine the most common symptoms experienced by patients with eCRSwNP versus non-eCRSwNP. : Methods Design: Cross-Sectional Study Setting: Tertiary Government Training Hospital Participants: A total of 68 patients diagnosed with Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) from November 7, 2018 to August 31, 2022 were included in the study. Results: Of the 68 patients included in the study, 33 (48.5%) had non-eCRSwNP while 35 (51.5%) had eCRSwNP. The age of the patients with non-eCRSwNP group was 50.6 + 18.45 and those with eCRSwNP was 52.9 + 16.6 years old. Non-eCRSwNP patients had a lower mean Filipino SNOT 22 score of 39.7 ± 16.1 compared with eCRSwNP with a score of 62.7± 13.5. The non-eCRSwNP patients had symptom severity classified as mild in 2 (6.1%), moderate in 25 (75.8%) and severe in 6 (18.2%) based on Filipino SNOT-22. Among the eCRSwNP group, majority of the patients, 29 (82.9%) were classified as severe, 6 (17.1%) as moderate, and none with mild severity. Using the Filipino SNOT 22, the most common symptoms of patients with eCRSwNP were item 2 (baradong ilong; nasal blockage) at 28.6%, then item 7 (malapot na sipon; thick nasal discharge) at 25.7%, Item 8 (pagbabara ng tenga; ear fullness) and item 12 (pagkawala/ pagkabawas ng panlasa/ pang amoy; decreased sense of smell/taste) were tied at 14.3%, item 13 (hirap sa pagtulog; difficulty falling asleep) at 25.7%, and item 17 (pagkapagod; fatigue during the day) at 31.4% while patients with no-eCRSwNP were noted with item 2 (baradong ilong; nasal blockage) at 48.5%, followed by item 4 (hindi tumitigil na pagtulo ng sipon; runny nose) at 21.2%, item 11 (pananakit ng mukha; facial pain) at 33.3%, Item 7 (malapot na sipon; thick nasal discharge) at 18.2%, and item 20 (pagiging irritable/pagkainis; irritability) at 21.2%. Conclusion Our present study suggests that the higher the SNOT 22 score, the more likely it is to be eosinophilic chronic rhinosinusitis. Although nasal blockage was the most common symptom found in both patients with eCRSwNP and non-eCRSwNP, patients with thick nasal discharge, decreased sense of smell/taste and ear fullness were more likely to be suffering from eCRSwNP, while patients with runny nose, facial pain and thick nasal discharge were more likely to have non-eCRSwNP.
Sinusitis ; Endoscopic Surgical Procedure ; Endoscopy ; SNOT-22 ; Sino-Nasal Outcome Test ; Nasal Blockage ; Nasal Obstruction

Objective: To describe a technique of endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma, based on anatomic studies and surgeries. Methods: Three dry human skulls and five fresh human cadaver heads were used for anatomic study of a endoscopic transoral approach to expose petroclival and jugular foramen. The anatomical landmarks and the extent of exposure were recorded. Six clinical cases who were treated in Eye & ENT Hospital, Fudan University from June 2020 to April 2022 were used to illustrate the technique and feasibility of this approach and to assess its indications and advantages, including 3 males and 3 females, aged 42 to 69 years old. Descriptive analysis was used in this research. Results: On the basis of the preservation of the internal pterygoid muscle and the external pterygoid muscle, this approach could fully expose the parapharyngeal, petrosal and paraclival segment internal carotid arteries, and safely deal with the lesions of jugular foramen and petroclival region. The 6 patients in our study tolerated the procedure well. Postoperative enhanced MRI showed complete resection of the tumor and no postoperative masticatory dysfunction. Conclusion: Endoscopic transoral approach is a safe, minimally invasive and effective surgical treatment for petroclival and jugular foramen recurrent nasopharyngeal carcinoma.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Nasopharyngeal Carcinoma ; Jugular Foramina ; Neoplasm Recurrence, Local ; Endoscopy/methods* ; Nasopharyngeal Neoplasms/surgery*