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Eosinophilic colitis (EC) is a rare disease which characterized by infiltration of eosinophil in colon and peripheral eosinophilia. Other causes of peripheral eosinophilia need to be excluded before assumed EC such as food allergy, inflammatory bowel disease, or parasites. It has bimodal distribution, peaked at neonates and young adult. A 24-year-old man was admitted with abdominal pain and chronic diarrhea. He has no any disease, food, pollen, or drug allergy in his medical history. Leukocyte: 29,000/mm3 (neutrophil: 43.4%, eosinophil: 44.4%, lymphocyte: 8.2%), platelet: 453,000/mm3, total eosinophil: 17,582.1/μL (normal range: 50-300), immunoglobulin E: 1000 IU/mL (normal range 100 IU/mL) was counted in his blood examination. The colon biopsy was reported as eosinophilic colitis. We applied methylprednisolone 24 mg/day. With this treatment, the patient’s symptoms regressed. EC may involve any part of the gastrointestinal tract. An intense inflammatory infiltrate, consisting predominantly of eosinophils penetrates into one or more layers of the gastrointestinal tract. In 1937, Kaijser described this disorder. EC is classified into mucosal, submucosal or muscular, and serosal types. The endoscopic findings may vary from normal mucosa to frank ulceration. Our patient had chronic diarrhea and peripheral eosinophilia which are typical features of the mucosal types. It should be put in differential diagnosis in patients with chronic diarrhea.

Sinonasal schwannoma (SNS) is a rare entity with 4% occurring at this location and only 36 cases described in the literature. A 22-year-old woman presented recurrent unilateral epistaxis, hyposmia, unilateral nasal obstruction, and hemicranial headache for a year. The endoscopic examination showed a tissue mass filling the left nasal cavity and nasopharynx. Imaging showed a mass that occupied the left posterior ethmoid cells in the hyposignal T1, hyposignal T2, and gadolinium enhancing. A preoperative biopsy was made and the diagnosis was a schwannoma. The tumor mass was completely removed under general anesthesia. The final histopathological study reconfirmed the diagnosis of schwannoma. Six months after surgery, control endoscopic and imaging showed the absence of tumor recurrence. SNS is a rare entity and its diagnosis is generally based on a histological examination. Therefore, the possibility of schwannoma must be considered in front of a mass of the nasal fossa.

Abstract Background Bronchoalveolar lavage (BAL) cytology results from 1 lung might not be representative of both lungs. Objectives To determine whether the lung site sampled would influence the horse's BAL cytology profile, and if a pooled BAL sample would be superior with regard to BAL cytology diagnosis in a cohort of healthy and subclinical asthmatic warmblood horses. Animals Fifty-nine horses in 2021 and 70 horses in 2022, the follow-up included 53 of the same in each year. Methods A cross-sectional study with follow-up included BAL cytology samples from individual lungs and from pooled BAL samples. The BAL samples were enumerated and differential cell count were applied to categorize the horses as control or with airway inflammation (AI). Results Bronchoalveolar lavage mast cell count was higher in left lung compared to right lung (2021; median 1.6 [range, 0.6-3.3] vs 1.2 [0.7-1.5] P = .009, 2022; median 3.1 [2.1-4.2] vs 2.4 [1.7-3.4], P < .001) and compared to pooled samples (2022; median 2.6 [1.7-3.7], P < .001). Between year 2021 and 2022, 17 of the horses had changes in BAL cytology from control to AI or vice versa. Conclusions and Clinical Importance Pooled BAL sample was the least reliable for detecting AI, and was not representative of the overall lung condition.

Purpose This study aims to investigate the bleeding sites and their relationship with clinical characteristics in hospitalized epistaxis patients. Methods We retrospectively reviewed the data of 646 hospitalized epistaxis patients. Results The bleeding sites were identified in 395 (61.1%) patients and unidentified in 251 (38.9%). We found that age > 50 years (P = 0.030) and the history of cardiovascular diseases (P = 0.027) were more frequent in patients with unidentified bleeding sites. Among patients with identified sites, inferior meatus (n = 130, 32.9%) was the most common site, followed by the septal surface of the olfactory region (n = 102, 25.8%), nasal septum (n = 80, 20.3%), middle meatus (n = 60, 15.2%), and others (n = 23, 5.8%). After dividing patients into five groups by the area of the bleeding sites, we found significant differences in age (P = 0.026), history of hypertension (P = 0.001), cardiovascular diseases (P = 0.032), and nasal packing (P = 0.011). The logistic regression also revealed that these four factors were predictors for different bleeding sites. Conclusion The bleeding sites can be identified in most epistaxis patients. Age > 50 years and the history of cardiovascular diseases are more frequent in patients with unidentified bleeding sites. In our patients, the most common bleeding site is inferior meatus, followed by the septal surface of the olfactory region, nasal septum, and middle meatus. Age, histories of hypertension, cardiovascular diseases, and nasal packing are factors associated with the bleeding risks of different bleeding sites. According to the different clinical characteristics of patients, the order of the nasal endoscopic examination should be adjusted to develop their treatment plans.

Primary esophageal lymphoma is a rare disease whose pathogenesis may be related to immune abnormalities. We report a case of primary esophageal marginal zone lymphoma (MZL) in the esophagus for 2 years, which initially presented with respiratory symptoms and was subsequently diagnosed by endoscopic ultrasound-guided fine-needle aspiration. A 68-year-old male presented with a 10-day history of cough, excessive sputum production, and wheezing after physical activity. Two years prior to this admission, the patient had sought medical attention at our hospital for fever and cough. After completing the relevant examinations, the preliminary diagnosis was considered to be a pulmonary infection, with the possibility of an esophageal neoplastic lesion. Upon readmission, a follow-up chest CT revealed thickening of the esophageal wall in multiple segments, which was more pronounced than it had been 2 years previously, and tracheal compression. Upper gastrointestinal endoscopy revealed a widespread, protruding lesion along the entire esophagus, with a smooth mucosal surface and no ulceration. Endoscopic ultrasound revealed the disappearance of the normal layered structure of the esophageal wall at the site of the lesion. PET-CT demonstrated uneven increased radioactive uptake throughout the esophagus. Bone marrow aspiration did not reveal any tumor involvement. Histopathological and immunohistochemical examinations revealed marginal zone lymphoma. Primary esophageal lymphoma has significant clinical heterogeneity, typically starting with progressive dysphagia and weight loss. This patient has a long history of atypical symptoms, representing the first case to present with respiratory symptoms without dysphagia. Due to the extremely low incidence of primary esophageal lymphoma and the lack of typical symptoms, imaging findings, and endoscopic manifestations, it is prone to misdiagnosis. Differential diagnosis is necessary to distinguish it from esophageal malignancies such as esophageal squamous cell carcinoma and esophageal adenocarcinoma, as well as benign esophageal conditions like esophagitis and esophageal tuberculosis. Performing endoscopic ultrasound-guided fine needle aspiration to complete pathological biopsy is crucial to reduce the risk of misdiagnosis and facilitate early diagnosis. Currently, after two courses of the G-CVP regimen (Obinutuzumab + Cyclophosphamide + Vincristine + Prednisone) demonstrated suboptimal efficacy, the treatment was switched to a triple combination of Obinutuzumab, Orelabrutinib, and Lenalidomide, which has now completed six courses.

This study examines two cases of primary MALT lymphoma in the base of the tongue, larynx, and trachea. Both cases were finally diagnosed through pathological and immunohistochemical examinations, with common laryngoscopic features: scattered circumferential follicular‐like mucosal elevations with smooth surfaces on the affected mucosal areas.

Pseudoexfoliation syndrome (PEX) is a systemic fibroproteinopathy with limited global epidemiological data and unclear pathogenesis. This case report describes a 70-year-old Asian woman presenting with left eye soreness and blurred vision. She was diagnosed with PEX based on typical ocular characteristics, including grayish-white debris on the pupillary margin, pigment residues in the anterior chamber angle, and annular opacity around the anterior lens capsule after pupil dilation. During surgery, endoscopic observation revealed extensive grayish-white flocculent deposits covering the entire circumference of the zonules, resembling a spider web—findings consistent with the “fibrin-like deposits” described in autopsy studies. Such exfoliated material may damage the intraocular environment through mechanical damage and chronic inflammatory responses. This is supported by intraoperative anterior chamber depth instability and a markedly elevated interleukin-8 (IL-8) concentration (557.3 pg/mL) in the anterior chamber fluid. This case provides in vivo visualization of zonular abnormalities in a living Asian PEX patient using endoscopic technology, offering insights that extend beyond the capabilities of traditional imaging. It contributes direct evidence to enhance understanding of the pathogenesis of PEX-related glaucoma and suggests that intraoperative endoscopic assessment may serve as a valuable tool for evaluating zonular integrity and intraocular inflammation in PEX patients. Future integration of artificial intelligence-based image analysis, combined with intraocular fluid inflammatory marker assessment, may enable quantification of deposit parameters and establishment of a zonular lesion grading system, potentially optimizing PEX management.

Objectives To examine the annual trends in the occurrence of eosinophilic gastrointestinal disease (EGID) in Japan. Methods This study examined data from patients with EGID who underwent endoscopy at 716 facilities between January 2015 and March 2023. Data extracted from the Japanese Endoscopy Database (JED) included endoscopic procedure counts, patient demographics, Helicobacter pylori infection status, comorbidities, and balloon dilatation. Analyses incorporated both confirmed and suspected EGID cases. Results In total, 9,940,870 endoscopic procedures were performed, identifying 9669 cases of EGID. From 2015 to 2023, the Cochran–Armitage trend test showed a significant increase in cases of eosinophilic esophagitis (EoE), eosinophilic gastritis (EoG), and eosinophilic duodenitis (EoD) (p < 0.001). However, no significant trend was observed for eosinophilic enteritis (EoN) or eosinophilic colitis (EoC) (p = 0.136). The number of EoE cases increased, with reporting rates changing from 36 (0.0464%) in 2015 to 3631 (0.176%) in 2022 (p < 0.001). EoG + EoD cases increased from one (0.0013%) to 410 (0.0199%) (p < 0.001), while EoN + EoC cases remained stable (p = 0.136). Conclusions The JED project data showed increasing detection of EoE, EoG, and EoD in Japan, while EoN and/or EoC cases remained stable. These findings are based on reporting rates from individuals undergoing endoscopy, rather than estimates from population‐based endoscopist reporting rates. We analyzed 9,940,870 endoscopic procedures from the Japanese Endoscopy Database (2015–2023), identifying 9,669 eosinophilic gastrointestinal disease (EGID) cases. The prevalence of eosinophilic esophagitis, gastritis, and duodenitis increased significantly (p < 0.001), while enteritis and colitis remained unchanged (p = 0.136). EoE rose from 36 cases (0.0464%) in 2015 to 3631 (0.176%) in 2022. These findings indicate rising detection of upper gastrointestinal EGIDs in Japan, based on endoscopy reporting rates rather than population prevalence.

Transnasal endoscopy is the traditional modality of choice to evaluate the upper gastrointestinal tract, and patient anxiety and the unpleasantness of medical procedures remain a major problem in clinical practice. In this study, we examined whether mindful breathing can improve patients' wellbeing before nasal endoscopy. This prospective, non-randomized controlled trial was conducted between January and March 2024 in the international outpatient endoscopy unit of Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital). A total of 249 adult patients scheduled for transnasal esophagogastroduodenoscopy (EGD) were enrolled. Participants were allocated to either the intervention group or the control group based on their order of arrival and personal preference. The intervention group comprised 124 patients who received a structured mindful breathing protocol, while the control group consisted of 125 patients undergoing standard care without additional breathing guidance. The intervention included pre-procedural instruction, directed breathing before and during the procedure with ongoing coaching. Primary outcome was pain intensity, measured using the Numeric Rating Scale (NRS, 0-10) at three time points: pre-procedure, intra-procedure, and post-procedure. Secondary outcomes included the severity of nausea and vomiting, categorized into four grades, and subjective wellbeing, assessed using a four-point Likert scale. All assessments were recorded by independent observers blinded to group allocation. The statistical results showed significant difference in both groups. In the intervention group, after practicing mindful breathing, participants' mean pain level was significantly lower than before they practiced it (2.00 ± 1.05 versus 2.67 ± 1.46, with statistical significance at < 0.001), with a greater percentage experiencing only minor discomfort (95.97% versus 84.80%, = 0.005). The intervention group also showed decreased nausea and vomiting symptoms (1.13 ± 0.53 versus 1.34 ± 0.72, = 0.01), with a higher number of cases rated as mild (93.55% versus 76.80%, < 0.001). Regarding patient comfort, the mindfulness group scored consistently better both prior to (3.01 ± 0.49 vs. 2.77 ± 0.65, < 0.001), (3.03 ± 0.48 vs. 2.69 ± 0.59, < 0.001), but not following examination ( = 0.076). The correlations persisted with adjustment of potential confounders in multiple regression analysis. Mindfulness breathing correlates to a significant decrease of procedure-related pain, particularly in the reduction of pain and GI discomfort with transnasal endoscopy. Such a finding is evidenced-cost-effective technique is a promising method to improve patients' acceptance, and it may need to be adopted into routine practice by the endoscopic nurses.

Reduced laryngeal sensation and accumulated pharyngeal secretions are known predictors of aspiration. Yet, their association with residue has not been fully explored. One Hundred and ten fiberoptic endoscopic examination of swallowing (FEES) examinations were retrospectively analyzed. Murray’s secretion scale (MSS) for secretion stasis and laryngeal sensation were tested for association with residue severity (Yale pharyngeal residue severity rating scale, YPR-SRS) and the number of swallows required to clear the bolus. The bolus challenges of each consistency (liquid, purée and solid) with the highest PAS and YPR-SRS scores were analyzed. Impaired laryngeal sensation (ILS) and MSS were both independently significantly associated with higher YPR-SRS for all consistencies examined. Mean YPR-SRS for patients with both ILS and secretion stasis was respectively 2.4 ± 1.1, 2.5 ± 1.2, 2.4 ± 1.2 for liquid, purée and solids in the vallecula, and 2.9 ± 1.3, 2.3 ± 1.1, 2 ± 1 for pyriform sinuses residue compared to 1.8 ± 0.7, 1.6 ± 1, 1.6 ± 1 for vallecular residue and 1.8 ± 0.8, 1.4 ± 0.8, 1.3 ± 0.7 for pyriform sinus residue of patients with normal laryngeal sensation and no stasis (p < 0.05 for all except liquids in vallecula). The combined findings of both ILS and MSS ≥ 1 had a sensitivity of 25.9%, specificity of 94.2%, positive predictive value (PPV) of 83.3% and negative predictive value (NPV) of 53.3% for prediction of pharyngeal residue and a sensitivity of 58.3%, specificity of 88.8%, PPV of 39.9% and a NPV of 94.6% for prediction of aspiration. Both ILS and MSS were significantly associated with increased number of swallows required to clear a bolus. Abnormal laryngeal sensation and secretion stasis are associated with pharyngeal residue severity and reduced residue clearing on FEES.