Objective: Narrow-Band Imaging (NBI) is as sensitive as Lugol chromoendoscopy to detect oesophageal squamous cell carcinoma (SCC) but its specificity, which appears higher than than that of Lugol chromoendoscopy in expert centres, remains to be established in current practice. This study aimed to prove the superiority of NBI specificity over Lugol chromoendoscopy in the detection of oesophageal SCC and high-grade dysplasia (HGD) in current practice (including tertiary care centres, local hospitals, and private clinics). Trial Design: Prospective randomised multicentre trial including consecutive patients with previous or current SCC of the upper aerodigestive tract addressed for gastroscopy. Patients included were randomly allocated to either the Lugol or NBI group. In the Lugol group, examination with white light and Lugol chromoendoscopy were successively performed. In the NBI group, NBI exam was performed after white light endoscopy. We compared the diagnostic characteristics of NBI and Lugol chromoendoscopy in a per-patient analysis. Results: 334 patients with previous history of SCC were included and analysed in intention-to-tret from 15 French institutions between March 2011 and December 2015. In a per-patient analysis, sensitivity, specificity, positive and negative likelihood values were respectively 100%, 66.0%, 21.2%, and 100% for Lugol chromoendoscopy vs. 100%, 79.9%, 37.5%, and 100% for NBI. NBI specificity was greater than Lugol chromoendoscopy (p=0.0023). Conclusions: As previously demonstrated in expert centres, NBI is more specific than Lugol in current gastroenterology practice for the detection of early SCC but combined approaches with both NBI and lugol could improve the detection of squamous neoplasia.

Most serious button-battery ingestions are not witnessed and they can cause life threatening complications. We present here the case of a 3-year-old girl who swallowed a button battery in January 2016 with a delayed diagnosis being made after 10 days. A 5-mm tracheoesophageal fistula was endoscopically diagnosed (▶ Fig. 1). The first attempts at closure involved the deployment of two successive esophageal covered stents between January and May (▶ Fig. 2). The fistula decreased in size but persisted, so we then attempted controlled wound healing with a nasogastric tube, but the fistula still remained. Next, we tried a side fistula abrasion with argon plasma coagulation. Unfortunately, these techniques did not allow full recovery, even though the fistula reduced notably. After 1 year, we tried endoscopic submucosal dissection (ESD) of the mucosa surrounding the fistula, resecting a 1-cm mucosal patch centered on the fistula. After injecting the submucosa and making the mucosal incision, we used a Dual-Knife (Olympus) to dissect the fibrotic area. After the dissection, the fistula was closed with three clips anchored into the submucosa of the resected area (▶ Fig. 3; ▶ Video 1). We arranged a radiologic check with contrast, which Video 1 Views of the fistula and previous attempts to close it. The endoscopic submucosal dissection procedure is performed to resect the surrounding mucosa, which is subsequently clipped to close the fistula. ▶ Fig. 1 Appearance of the tracheoesophageal fistula in a 3-year-old girl after ingestion of a button battery. ▶ Fig. 2 Radiographic images showing: a the fistula on a barium swallow; b the first attempted closure procedure with a stent positioned in the esophagus.

The presented study demonstrated after one year follow-up a better functional result, a higher degree of contentment and fewer complications after total knee replacement with patella resurfacing in patients without or mild preoperative anterior knee pain.

No abstract