A new simplified classification of magnifying endoscopy for diagnosis of Barrett's dysplasia has been developed by Barrett's international narrow band imaging group. Further validation is needed to investigate its feasibility. The aim of our study was to evaluate the inter-observer agreement, accuracy, sensitivity, and specificity for the new classification system with a novel blue laser imaging modality. Total of 12 endoscopists (6 more experienced and 6 less experienced) from five medical centers in Taiwan joined this endoscopic training program, which was composed of three sessions: pretest, educational, and post-test. A set of 80 endoscopic images with non-dysplastic or dysplastic Barrett lesions was used for these tests. All raters were asked to predict presence or absence of dysplasia based on the newly developed classification after an educational module. The overall inter-observer agreement (κ value) before and after the educational module were 0.4419 and 0.5573. The inter-observer agreement before and after training were 0.5471 and 0.5837 in more experienced group, 0.3625 and 0.5499 in less experienced group, respectively. The overall accuracy, sensitivity, and specificity values before and after training did not change significantly, except for increased specificity in more experienced group from 0.7083 to 0.7526. Our validation study for diagnosis of Barrett's dysplasia by using simplified classification with blue laser imaging showed moderate inter-observer agreement and good accuracy. After an educational module, inter-observer agreement in both groups and specificity in more experienced group got improved in a different scale.

Pneumoperitoneum has been reported as an intraprocedural or acute postprocedural adverse event resulting from advanced endoscopic intervention. Here, we report a case of a massive pneumoperitoneum-mimicking delayed perforation after colonic endoscopic submucosal dissection. A 60-year-old man received endoscopic submucosal dissection for a large colon polyp. Room air was inadvertently used in the first half of the procedure. After 12 hours, the patient developed fever, abdominal pain, and bilateral shoulder pain, and massive pneumoperitoneum was detected through plain film and computed tomography. After urgent diagnostic paracentesis, the patient's symptoms dramatically improved, and laparotomy was avoided. Massive pneumoperitoneum rarely occurs in patients receiving complex and long-standing endoscopic procedures, and it may manifest similarly to delayed perforation. Prompt diagnostic paracentesis is valuable when the diagnosis is uncertain.

Patients with head and neck squamous cell carcinoma (HNSCC) are prone to develop second primary malignancy (SPM) at the esophagus synchronously, especially those with increased forkhead box P3 (FOXP3) positive regulatory T (Treg) cell infiltration in tumor tissue. We tested whether FOXP3 genetic polymorphisms can be associated with Treg cell infiltration and synchronous SPM in HNSCC patients. HNSCC patients received screening esophagogastroduodenoscopy during 2008 to 2016 were enrolled consecutively. After excluding and matching cigarette smoking and alcohol drinking status, the final cohort went on investigation. Three tag single nucleotide polymorphisms (tag SNPs) of the FOXP3 gene (rs2232365, rs3761548, and rs3761549) were selected from the HapMap database and genotyped by RT-PCR. FOXP3 immunohistochemistry was done to evaluate Treg cell amount in tumor tissues. A total of 270 male HNSCC patients were included, including 135 in the synchronous SPM (SynSPM group) and 135 in the HNSCC alone group. Compared with HNSCC alone group, synchronous SPM group had a HNSCC that was more commonly located at oro/hypopharynx (55.0% vs 39.6%, P = .012) and at earlier TNM stage with borderline significance (38.8% vs 29.0%, P = .124). In addition, carriage of G allele in rs3761549 of the FOXP3 gene significantly increased synchronous SPM risk (crude OR = 2.21, P = .009). After adjustment of HNSCC location and staging, rs3761549 G allele remained significantly associated with synchronous SPM risk (adjusted OR = 2.10, P = .024). Patients with G allele in rs3761549 also had higher FOXP3+ Treg cell infiltration in the tumor tissue than those with A allele (mean FOXP3+ cell number/mm 2 : 55.93 vs 36.39, P = .008). Male HNSCC patients with G allele in rs3761549 of the FOXP3 gene has a higher risk of synchronous SPM development and merit earlier screening endoscopy.