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(B) Fluoroscopic image of stent deployment. (C and D) Endoscopic images of the stent successfully deployed and placed in duodenal stenosis. (E) Endoscopic image immediately after stent removal. (F) Endoscopic image of the previous site of duodenal stenosis 5 months after stent removal, without inflammation or stenosis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carme Loras, Marta Piqueras, Pablo Ruiz, Diana Zaffalon" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Carme" "apellidos" => "Loras" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Piqueras" ] 2 => array:2 [ "nombre" => "Pablo" "apellidos" => "Ruiz" ] 3 => array:2 [ "nombre" => "Diana" "apellidos" => "Zaffalon" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382424001275?idApp=UINPBA00004N" "url" => "/24443824/0000004700000007/v2_202409230509/S2444382424001275/v2_202409230509/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "Endocytoscopy of muscularis propria in rapidly evolving achalasia and recurrence of post-Heller achalasia" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "761" "paginaFinal" => "762" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Hugo Uchima, Raquel Muñoz-González, Íngrid Marín, Noemí Caballero, Claudia Cepero, Ignacio Iborra, Juan Colán-Hernández, Edgar Castillo, Vicente Moreno" "autores" => array:9 [ 0 => array:4 [ "nombre" => "Hugo" "apellidos" => "Uchima" "email" => array:1 [ 0 => "huchima.germanstrias@gencat.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Raquel" "apellidos" => "Muñoz-González" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" 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"etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Edgar" "apellidos" => "Castillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "Vicente" "apellidos" => "Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Endoscopias, Servicio de Gastroenterología, Hospital Universitari Germans Trias I Pujol, Badalona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Endoscopias, Centro Médico Teknon, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Endoscopias, Servicio de Gastroenterología, Hospital Universitari Joan XXIII, Tarragona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Endocitoscopia de la muscular propia en acalasia de rápida evolución y recidiva de acalasia post-Heller" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1170 "Ancho" => 1344 "Tamanyo" => 181239 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Intratunnel view of peroral endoscopic myotomy with white light.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Endocytoscopy enables microscopic endoscopic visualisation (x520) in real-time by applying topical dyes and taking the lens closer to the tissue. There are several studies on its application in gastrointestinal cancerous lesions<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> and a report on the study of the muscularis propria in patients with achalasia without previous surgery,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> in which no morphological alterations were found in the muscle cells.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present two cases, a 29-year-old male patient with rapidly evolving achalasia (<3 months) who presented with aphagia and a 64-year-old patient with recurrence of achalasia and previous Heller myotomy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In both cases, after performing the peroral endoscopic myotomy (POEM), before closing the incision, topical 0.1% methylene blue staining was applied to the previously identified spastic muscle area (Figs. <a class="elsevierStyleCrossRef" href="#fig0005">1</a> and <a class="elsevierStyleCrossRef" href="#fig0010">2</a>). Evaluation was performed by an endoscopist with previous experience in optical diagnosis and review of histologies, with the endocytoscope (GF-H290EC, Olympus, Japan), identifying in both cases elongated spindle-shaped muscle cells, without morphological changes related to atrophy or obvious hypertrophy (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), confirmed in the biopsies performed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Real-time microscopic evaluation of the muscularis propria is feasible. No morphological alterations were observed in the muscle fibres in patients with achalasia, although the inflammatory infiltrate associated with achalasia was not assessed. Endocytoscopy would make it possible to differentiate idiopathic muscular hypertrophy of the oesophagus,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> a rare (or underdiagnosed) disorder.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical considerations</span><p id="par0025" class="elsevierStylePara elsevierViewall">The preparation of this article was carried out in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki), and informed consent was obtained from the patients to perform the procedure.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">No funding was received for this paper.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">Hugo Uchima is a Lumendi consultant, collaborates with ERBE Spain, Olympus Iberia and Izasa, and has received inscription fees for conferences from Casen-Recordati.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The other authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1170 "Ancho" => 1344 "Tamanyo" => 181239 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Intratunnel view of peroral endoscopic myotomy with white light.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1152 "Ancho" => 1298 "Tamanyo" => 143594 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Intratunnel view of peroral endoscopic myotomy after staining with methylene blue.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1128 "Ancho" => 1298 "Tamanyo" => 155504 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Endocytoscopy view of muscle fibres without morphological alterations.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endocytoscopic microvasculature evaluation is a reliable new diagnostic method for colorectal lesions (with video)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. 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Journal Information
Vol. 47. Issue 7.
Pages 761-762 (August - September 2024)
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Vol. 47. Issue 7.
Pages 761-762 (August - September 2024)
Image of the month
Endocytoscopy of muscularis propria in rapidly evolving achalasia and recurrence of post-Heller achalasia
Endocitoscopia de la muscular propia en acalasia de rápida evolución y recidiva de acalasia post-Heller
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