Endoprostheses are prone to tribological wear and biological processes that lead to the release of particles, including aluminum nanoparticles (Al NPs). Those particles can diffuse into circulation. However, the toxic effects of NPs on platelets have not been comprehensively analyzed. The aim of our work was to investigate the impact of Al NPs on human platelet function using a novel quartz crystal microbalance with dissipation (QCM-D) methodology. Moreover, a suite of assays, including light transmission aggregometry, flow cytometry, optical microscopy and transmission electron microscopy, were utilized. All Al NPs caused a significant increase in dissipation (D) and frequency (F), indicating platelet aggregation even at the lowest tested concentration (0.5 µg/mL), except for the largest (80 nm) Al NPs. A size-dependent effect on platelet aggregation was observed for the 5–20 nm NPs and the 30–50 nm NPs, with the larger Al NPs causing smaller increases in D and F; however, this was not observed for the 20–30 nm NPs. In conclusion, our study showed that small (5–50 nm) Al NPs caused platelet aggregation, and larger (80 nm) caused a bridging–penetrating effect in entering platelets, resulting in the formation of heterologous platelet–Al NPs structures. Therefore, physicians should consider monitoring NP serum levels and platelet activation indices in patients with orthopedic implants.

Background and aims: Per oral endoscopic myotomy (POEM) has become an established treatment for achalasia, but no Scandinavian studies with long-term follow-up exist. This study from a tertiary referral center in Norway investigates the short-, mid-, and long-term feasibility, safety, efficacy, and complications of POEM. Methods: Prospective data from the first 84 patients who underwent POEM from 2014 to 2019 were analyzed. The median follow-up time was 44 months. Clinical success was defined as the Eckardt score (ES) ⩽3, and reflux as pathological if the acid exposure time (pH < 4) was more than 6%. ES was used for symptom evaluation before, and at 6, 12, and up to 64 months after POEM. Results: A total of 50 males and 34 females were included. A total of 43 (51%) were treatment naïve, 24 (28.6%) had been previously treated with botulinum toxin, pneumatic balloon dilatation, or both, and 17 (20.2%) were previously treated with Heller’s myotomy. The median post-POEM ES at 12 months was 1 (0–9), compared to pre-POEM 7 (4–12) (p < 0.01). At 12 months after POEM, clinical success persisted in 74 patients (88.1%). Clinical success was the highest for patients who were naïve to treatment, 41/43 (95%), and lower for those previously treated with Heller’s myotomy 12/17 (70.6%). Long-term follow-up at 5–6 years of 42 patients showed a clinical success rate of 94%. We experienced adverse events in five patients (6%). Post-POEM pathological reflux was found in 46% (28/61). After 3–4 years, the median ES was 1, and after 5–6 years, it was 2. Conclusion: POEM was safe and relieved the symptoms of achalasia significantly and persistently. The procedure had a better outcome in treatment naïve than previously treated patients. However, POEM is associated with significantly increased esophageal acid exposure. Twitter summary: Norwegian single-center study: POEM had a clinical success rate of 94% after 5–6 years since its introduction at the center in 2014, providing a safe and effective treatment for achalasia.

Aims Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition characterized by eosinophilic infiltration of the esophageal mucosa. Endoscopic findings in EoE may be non-specific. The diagnosis is confirmed on histology. Multiple biopsies from≥2 segments are generally recommended but are occasionally negative due to a patchy distribution of EoE. This study aimed to evaluate whether chromoendoscopy with Iodine-Potassium iodine (IPIS) in the esophagus can improve the detection of EoE. Methods Patients with dysphagia and suspected EoE underwent gastroscopy with IPIS 1% staining of the esophagus. An adequate number of biopsies were taken in≥2 segments of the esophagus. In patients with heterogeneous staining from IPIS, selective biopsies were taken from areas with and without IPIS staining. Results 50 patients were included, of whom 30 had histologically proven EoE. All patients with EoE had diminished uptake of IPIS. Among patients with EoE, five had segmental and nine had a patchy disease. Six patients with other esophageal mucosa diseases, but no EoE had diminished uptake of IPIS. In patients with segmental or patchy EoE, the median number of eosinophils was significantly higher in areas with diminished uptake of IPIS, compared to areas with normal uptake (86 versus 7 eosinophils/high power field, p=0.01). Conclusions Chromoendoscopy with IPIS may be an useful in vivo technique for identifying EoE during endoscopy, and may allow targeted biopsies in patients with segmented or patchy disease. Publication Date: 14 April 2022 (online) © 2022. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany