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An 80-year-old woman presented with a 30-mm protruding lesion-like submucosal tumor with a central depression located at the anterior wall of the upper gastric body. The depressed area had a well-demarcated margin, while the other area was covered by a non-neoplastic mucosa. A biopsy specimen revealed neuroendocrine carcinoma. Endoscopic ultrasonography revealed a heterogeneous mass with a clearly distinguished border in the submucosal layer. The mass had two distinct areas adjacent to each other. In addition, a hypoechoic zone was observed on the margin of the mass. Distal gastrectomy was performed. The final diagnosis was a mixed neuroendocrine-non-neuroendocrine neoplasm arising from the heterotopic gastric gland.

Video Video 1 Extensive gastric endoscopic submucosal dissection using the water pressure method, which made it easy to process the greater curvature of the gastric body.

Protein-losing gastroenteropathy is a rare syndrome of protein loss from the gastrointestinal system. It manifests with hypoproteinemic edema, which may be due to either lymphatic leakage due to increased interstitial pressure or leakage of protein-rich fluids due to intestinal disorders. Our case describes a 65-year-old female with life-threatening protein-losing enteropathy (PLE) requiring multiple transfers to intensive care unit for vasopressor support. In this rare instance, her extensive initial workup did not reveal any etiology for PLE, but she was later found to have underlying Crohn’s colitis. Protein-losing enteropathy is an underdiagnosed complication of inflammatory bowel disease and must be considered while treating patients with colitis.

BACKGROUND Predominance of blind feeding tube placement makes esophageal tube misplacement and aspiration risk commonplace. Accurate estimation of nose-to-stomach length could reduce this risk. Standards for estimating this length were audited against the length measured from guided tube placement. METHODS This prospective, single-center observational study used electromagnet-guided tube placement to measure the length from nose to gastric body flexure as part of routine care. This measurement was used to audit standard equations used to estimate this length from external measures: xiphisternum-ear-nose + 10 cm (XEN+10), nose-ear-xiphisternum (NEX), and Hanson_A and Hanson_B. RESULTS From April 23, 2015, to March 2, 2020, measurements were obtained from 200 primary tube placements. Median length to the gastric body flexure (61 cm) was significantly different from that to the pre-gastroesophageal junction flexure (48 cm) or lengths predicted by NEX (51 cm) or Hanson_A (50.5 cm) and Hanson_B (56.1 cm) (all P < .00001) but similar to XEN+10 (61 cm). Esophageal placement was a potential risk for all methods (NEX: 96.3%, Hanson_A: 99.5%, Hanson_B: 86.9%, XEN+10: 43.2%) and a definite risk for most (NEX and Hanson_A: 14.9%, Hanson_B: 1%, XEN+10: 0%). CONCLUSIONS NEX and Hanson methods of predicting the length from nose to gastric body flexure are too short and risk esophageal misplacement. XEN+10 reduces but does not eliminate this risk. External measurement predictions are clinically unsafe as a guide blind tube placement. Guided placement is recommended.

A foreign body can be intentionally or accidentally ingested. Timing of endoscopy relies on foreign body shape and size, location in gastrointestinal tract, patient's clinical conditions, occurrence of symptoms or onset of complications. In this short case, we present a middle age woman, who accidentally swallowed a portion of a nasopharyngeal swab half-broken during a diagnostic test for SARS-CoV-2. Upper gastrointestinal endoscopy was promptly performed to prevent the swab from crossing the pylorus leading to serious complications and, therefore, risk of surgical intervention. The broken nasopharyngeal swab was detected in the gastric body, and immediately removed with a foreign body forceps. Our hospital performs many nasopharyngeal swabs and to our knowledge, this is only the second reported swab ingestion during SARS-CoV-2 test. This article is protected by copyright. All rights reserved.

A 61-year-old male was hospitalized in our department due to Intermittent melena for 4 days. Laboratory tests showed a reduced hemoglobin level (10.7 g/L). Abdominal computed tomography (CT) showed gastric wall thickening in the gastric body.

Background: Functional dyspepsia (FD) is associated with poor health-related quality of life. Recent evidence suggests that the main pathogenesis suspect is the gut mucosa-associated microbiota (MAM). However, little is known about the MAM in FD subjects. The aim of this study was to clarify the relationship between upper gastrointestinal symptoms in FD and the characteristics of the gastrointestinal MAM. Summary: Five mucosa samples from the upper gut (intraoral, mid-esophagus, gastric body, gastric antrum, and descending portion of the duodenum) were collected with a brush under endoscopic examination from FD and healthy control subjects. MAM profiles of each sample were analyzed by 16S-rRNA ­V3-V4 gene sequences. Questionnaire was used to assess gastrointestinal symptoms in FD. Between FD and healthy control subjects, although the comparison of MAM α-diversity showed no significant differences, the structure of MAM (β-diversity) was clearly different. Only the phylum Firmicutes was increased in FD compared to healthy control subjects in all sites of the upper gut. At the genus level, Streptococcus was significantly increased in all sites in the upper gut in FD. The relative abundance of Streptococcus was positively correlated with upper gastrointestinal symptoms in each upper gut group. Furthermore, the relative abundance of OTU 90 was positively correlated with upper gastrointestinal symptoms in all sites in the upper gut in FD. Key Messages: Streptococcus is a bacterium strongly correlated with upper gastrointestinal symptoms in FD.

The upper gastric body is of particular interest in relation to gastrectomy because this area includes a border; that is, both distal and proximal gastrectomy for early gastric cancer can involve this area. Laparoscopic subtotal gastrectomy (LsTG) is reported to be suitable procedure compared with laparoscopic proximal and total gastrectomy (LPG, LTG), regarding postoperative nutritional status and surgical safety. However, whether LsTG is an oncologically acceptable procedure for early gastric cancer in the upper gastric body is unclear. We analyzed 215 patients with cT1N0M0 gastric cancer limitedly located in the upper gastric body. The frequency of conversion from each intended procedure to an alternative procedure, the width of the pathological margin, the incidence of lymph node metastasis at each station and the 3-year overall survival (OS) and relapse-free survival (RFS) were evaluated. LsTG was planned for 65 patients, and LPG for 72 and LTG for 78, respectively. Conversion to other procedures was required in about 10% of patients for whom LsTG or LPG was planned. The width of the pathological margin in patients who underwent LsTG was significantly shorter than patients who underwent the others. No patients who underwent LsTG, LPG or LTG had metastases in station no. 2 or 4sa lymph node. The 3-year OS and RFS rates of patients for whom each procedure was planned were not different. LsTG could be an oncologically acceptable procedure for cT1N0M0 gastric cancer in the upper gastric body. LsTG could be one option for such disease.

Gastric mucosa has been widely studied during the pre/post-Helicobacter pylori (Hp) era. Excluding peptic ulcer disease (PUD), the duodenal mucosa has not been thoroughly analyzed, even less so in functional dyspepsia (FD). We would like to make some comments after studying 161 dyspeptic patients with samples taken from the gastric body, antrum, proximal and distal duodenum.

A 74-year-old male patient was admitted to our hospital, who complained of abdominal distension for 1 year with no previous history of disease. Esophagogastroduodenoscopy (EGD) revealed a submucosal tumor (SMT) in the gastric body.

In the past decade, laparoscopic sleeve gastrectomy (LSG) has gained significant popularity as a treatment for obesity. However there has been significant morbidity and mortality associated with post-operative anastomotic leaks. The reported incidence of LSG leaks range between 0.1 and 7% and can be higher in re-operative surgery (Deitel et al., Surg Obes Relat Dis 7(6):749–759, 2011; Kim et al., Surg Obes Relat Dis 11(4):739–748, 2015; Moszkowicz et al., Obes Surg 23(5):676–686 2013). Within the literature, the causes of a staple line leak are broadly grouped into either ischemic or mechanical causes. Leaks commonly occur in the proximal third of the anastomosis: large majority (>80%) at the angle of His or at the gastroesophageal junction (GEJ) and to a lesser degree the mid-aspect of the gastric body or distal third (Moszkowicz et al., Obes Surg 23(5):676–686 2013; Baker et al., Obes Surg 14(10):1290–1298 2004; Garofalo et al., Surg Obes Relat Dis 13(6):925–932, 2017).

La fibromatosis tipo desmoide es un tumor benigno de suma rareza con caracteristicas localmente agresivas. Se desarrolla en especial en tejidos blandos por su origen en los musculos y las aponeurosis. El diagnostico se establece por inmunohistoquimica con positividad para vimentina, B-catenina y en ocasiones para actina de musculo liso. El espectro clinico de presentacion es amplio, y segun este y la resecabilidad se ofrece el tratamiento. Presentamos el caso de una paciente con sintomas de obstruccion al vaciamiento gastrico secundaria a una lesion subepitelial en cuerpo con inmunohistoquimica concluyente para fibromatosis gastrica. Desmoid-type fibromatosis is an extremely rare benign tumor with locally aggressive features. It is predominantly developing in soft tissues due to its origin in muscles and aponeurosis. The diagnosis is established by immunohistochemistry with positivity for vimentin, B-catenin and sometimes for smooth muscle actin. The clinical spectrum of presentation is wide, based on this and resectability the treatment is offered. We present the case of a patient with symptoms of gastric outlet obstruction secondary to a subepithelial lesion in the gastric body with conclusive immunohistochemistry for gastric fibromatosis.

BACKGROUND: Endoscopic submucosal dissection (ESD) is a complex endoscopic procedure, with high rates of adverse events and technical difficulties. To overcome that problem, many training centers published the importance of animal models for skill acquirement in ESD. However, no study has used the submucosal dissection depth (DSUB) as a parameter to evaluate the learning curve in ESD, which might be a relevant factor since an optimal resection plane is important to achieve a curative resection and avoid intraoperative complications. OBJECTIVE: This study aimed to assess ESD skill acquirement after short-term training sessions by evaluating the submucosal dissection depth (DSUB) and the association with adverse events. METHODS: This experimental study included 25 experienced endoscopists in therapeuthic procedures (>5years) and 75 specimens resected by ESD (three resections / endoscopist). Learning parameters (resection time, size, en bloc resection rate, bleeding, perforation and submucosal dissection depth) were prospectively evaluated. The percentages of DSUB of all specimens resected were calculated. RESULTS: All specimens were resected from the gastric body (n=75). The mean size of the resected specimens was 23.97±7.2 mm. The number of adverse events, including bleeding, perforation, and death, were 17 (22.67%), 3 (4%), and 0 cases, respectively. The average mean time by the third dissection decreased from 28.44±9.73 to 18.72±8.81 min (P61% of the submucosal layer, the risk for bleeding during the procedure decreased (PPV, 0.97; 95% CI, 0.85-0.99). CONCLUSION: Improvement in the learning curve in ESD and a better cognitive ability were seen by the third dissection in these short term training courses. And a significant association between DSUB and the risk of bleeding.

The results of treatment of 112 patients of elderly and senile age patients with non-metastatic gastric cancer, complicated by bleeding were analyzed. Most often bleedings occurred for stomach cancer stage III−IV. The tumor was commonly located in the gastric body. The vast majority of patients had only one complication — bleeding. In the second (control) group, there was no unified diagnostic and treatment algorithm, patients were usually operated urgently upon admission or in case of recurrent bleeding. The differential diagnostic and treatment algorithm was developed for patients of group I (main) taking into account the condition of a patient and the severity of bleeding or repeated bleeding. In the control group, the indications for emergency surgery were continued bleeding and inefficiency of endoscopic hemostasis. In the main group, the risk of recurrent bleeding was considered as well, and in case of high risk emergency surgery was performed after a full preoperative preparation. In addition, the cardial part or 2/3 of the stomach were not resected by reason of the deliberate non-radical tactics. It is worth noting that in the I group argon plasma coagulation, complemented by the hemostatic system EndoClot was used for endoscopic hemostasis. Through the use of the developed algorithm we managed to reliably reduce the frequency of complications from 50 to 28.5% (p

Electromagnetic (EM)-guided tube placement has been successfully used to pre-empt lung misplacement, but undetected misplacements continue to occur. The authors conducted an audit to investigate whether official Cortrak or local guidance enabled differentiation of gastrointestinal (GI) from lung traces. X-ray, pH or an EM trace beyond the gastric body were used to independently confirm gastric position. The authors undertook 596 nasointestinal (NI) tube placements, of which 361 were primary GI placements and 41 lung misplacements. Official guidance that in GI traces a midline deviation is absent cannot differentiate GI from lung traces because deviation is common in both. However, when comparing a trace in the same patient, midline deviation during lung misplacement always occurred >18 cm above the horizontal line compared with only 33% of the subsequent GI deviation (p

Resumen La lesión de Dieulafoy representa aproximadamente el 2% de todos los casos de hemorragia gastrointestinal superior. En la mayoría de casos esta anomalía se ubica en el estómago, principalmente en la curvatura menor. Se presenta el caso de un adulto joven con hematemesis y signos de hipovolemia. Durante la esofagogastroduodenoscopia se evidenció un coágulo adherido en el cuerpo gástrico a nivel de la curvatura mayor, sugestivo de lesión de Dieulafoy. Inicialmente se realizó manejo médico sin mejoría significativa, por lo que se realizó laparotomía exploratoria con resección de la malformación vascular, finalmente con el informe histopatológico se confirmó el diagnóstico. A pesar de ser una causa infrecuente de hemorragia gastrointestinal superior, la lesión de Dieulafoy debe considerarse entre los diagnósticos diferenciales, especialmente si la hemorragia persiste aún con manejo médico. MÉD.UIS.2019;32(i):27-31. Abstract Dieulafoy's lesion represents approximately 2% of all causes of upper gastrointestinal bleeding. In most cases, this malformation is located in the stomach, mainly in the lesser curvature. We present the case of a young adult with hematemesis and signs of hypovolaemia. During the esophagogastroduodenoscopy, a clot adhering to the gastric body was seen at the level of the greater curvature, suggestive of Dieulafoy's lesion. Initially, medical management was performed without significant improvement, so an exploratory laparotomy was performed with resection of the vascular malformation, the histopathological report confirmed the diagnosis. Despite being an uncommon cause of upper gastrointestinal bleeding, the Dieulafoy lesion must be considered among the differential diagnoses, especially if the hemorrhage persists even with medical management. MÉD.UIS.2019;32(1):27-31.

In this paper, we aim to develop a diagnostic assistant system for labelling the stomach anatomical locations in upper GastroIntestinal Endoscopy (UGIE) examination. To address this task, we construct an appropriate manner which utilizes both ability of a convolutional neural network (CNN) and supportive interactions between machine and doctors. We solve the problem by a two-phase scheme. The first is a coarse-phase to classify seven major anatomical locations including cardiac orifice, gastric body, fundic, antrum, pyloric ring, lesser curvature and greater curvature using advances of a CNN. The constructed CNN network is compact with high performance and appropriate integration into a Graphic User Interface (GUI). In order to classify with 13 further detailed positions, a GUI is developed so that the endoscopists can conveniently specify the anatomical locations from results of the coarse-phase. In this the fine-phase, the doctors will prune the automatic results as well as specify the more detailed positions of each major location. In the experimental results, the developed application is shown as an efficient way in an UGIE diagnosis. It reduces a significant time from averagely 13:03 minutes in a manual procedure to 4:35 minutes by using the developed system when comparing with trainee endoscopists. The results of specifying anatomical locations satisfied accuracy requirements and showed promising research trend for future application as a computer-aided GIE diagnostic system.

Absztrakt: Az extrém kövérség kezelésére kifejlesztett eljárások közül az állítható gyomorgyűrű korábban igen elterjedt volt. Alkalmazását azonban számos késői panasz, illetve szövődmény kísérte, ezért egyre gyakrabban fordul elő, hogy eltávolításra kerülnek. Egy ilyen beavatkozás után fél évvel kialakult teljes gyomorkimeneti elzáródás klinikai képét előidéző belső kizáródás esetét mutatjuk be. A belső kizáródást az okozta, hogy a pylorusrégió becsúszott a gyűrű eltávolításakor készített plicatio és a gyomorcorpus fala közé. A beteg a műtéti megoldás után gyógyult. Hasonló okból kialakult gyomorelzáródás esetével az irodalom tanulmányozása során nem találkoztunk.

Foreign body (FB) ingestion is a common occurrence in the United States with a reported incidence of 120 per 1 million people, accounting for up to 1500 fatalities annually. The majority of FB ingestions will pass through the gastrointestinal tract spontaneously, while in 10% to 20% of patients, intervention will be necessary. A variety of endoscopic devices can be utilized to facilitate FB removal from the gastrointestinal tract, including snares, retrieval nets, and grasping forceps. We report the case of a 58-year-old female who required utilization of endoscopic scissors for FB removal in the setting of multiple failed attempts with traditional methods. This case highlights a novel approach to gastric FB removal utilizing endoscopic scissor forceps, which should be considered in select cases to further improve the efficacy of endoscopic FB removal and reduce the need for surgical intervention.

Aim. To evaluate the efficacy and safety of endoscopic submucosal tunnel dissection (ESTD) for resection of large superficial gastric lesions (SGLs). Methods. The clinicopathological records of patients performed with ESTD or endoscopic submucosal dissection (ESD) for SGLs between January 2012 and January 2014 were retrospectively reviewed. 7 cases undergoing ESTD were enrolled to form the ESTD group. The cases were individually matched at a 1 : 1 ratio to other patients performed with ESD according to lesion location, ulcer or scar findings, resected specimen area, operation time and operators, and the matched cases constituting the ESD group. The treatment outcomes were compared between the two groups. Results. The mean specimen size was 46 mm. 10 lesions were located in the cardia and 4 lesions in the lesser curvature of the lower gastric body. En bloc resection was achieved for all lesions. The mean ESTD resection time was 69 minutes as against 87.7 minutes for the ESD (P=0.01). The mean resection speed was faster for ESTD than for ESD (18.86 mm2/min versus 13.76 mm2/min, P=0.03). There were no significant differences regarding the safety and curability during the endoscopic follow-up (mean 27 months). Conclusions. ESTD is effective and safe for the removal of SGLs and appears to be an optimal option for patients with large SGLs at suitable sites.

Background and study aims: Endoscopic submucosal dissection (ESD) using insulation-tipped knives (IT knives) to treat gastric lesions located on the greater curvature of the gastric body remains technically challenging because of the associated bleeding, control of which can be difficult and time consuming. To eliminate these difficulties, we developed a novel strategy which we have called the “near-side approach method” and assessed its utility. Patients and methods: We reviewed patients who underwent ESD for solitary early gastric cancer located on the greater curvature of the gastric body from January 2003 to September 2014. The technical results of ESD were compared between the group treated with the novel near-side approach method and the group treated with the conventional method. Results: This study included 238 patients with 238 lesions, 118 of which were removed using the near-side approach method and 120 of which were removed using the conventional method. The median procedure time was 92 minutes for the near-side approach method and 120 minutes for the conventional method. The procedure time was significantly shorter in the near-side approach method arm. Although, the procedure time required by an experienced endoscopist was not significantly different between the two groups (100 vs. 110 minutes), the near-side approach group showed significantly shorter procedure time for a less-experienced endoscopist (90 vs. 120 minutes). Conclusions: The near-side approach method appears to require less time to complete gastric ESD than the conventional method using IT knives for technically challenging lesions located on the greater curvature of the gastric body, especially if the procedure is performed by less-experienced endoscopists.

to evaluate the thickness of the gastric wall at the time of intra gastric balloon (IGB) placement, at the time of its withdrawal and one month after withdrawal.: fifteen morbidly obese patients underwent the introduction of IGB under general anesthesia. In all patients, there was infusion of 500ml of distilled water in the balloon for the test. Measurements of the thickness of the gastric wall were made in the antrum, body and proximal body, using a radial echoendoscope with a frequency of 12MHz and maximum zoom, and its own balloon inflated with 5ml of distilled water.: the presence of IGB led to increased wall thickness of the gastric body by expanding the muscle layer. These changes were apparently transient, since 30 days after the balloon withdrawal there was a tendency to return of the wall thickness values ​​observed before the balloon insertion.: the use of intragastric balloon for the treatment of obesity determines transient increase in the wall thickness of the gastric body caused by expanded muscle layer.avaliar a espessura da parede gástrica no momento do posicionamento do balão intragástrico (BIG), no momento de sua retirada e um mês após a retirada.quinze pacientes obesos mórbidos foram submetidos à introdução de BIG sob anestesia geral. Em todos os pacientes foi feita infusão de 500 ml de água destilada e o balão foi insuflado com 5ml de água destilada. As medidas da espessura da parede gástrica foram feitas no antro, corpo e corpo alto utilizando-se um ecoendoscópio radial com frequência de 12MHz e zoom máximo.a presença do BIG levou ao aumento da espessura da parede do corpo gástrico pelo aumento de espessura da sua camada muscular. Estas alterações são aparentemente transitórias já que após 30 dias da retirada do balão existiu uma tendência de retorno da espessura da parede aos valores observados antes do seu posicionamento.a utilização do balão intragástrico para tratamento da obesidade determina aumento transitório da espessura da parede do corpo gástrico causado pelo aumento da camada muscular.

to evaluate the thickness of the gastric wall at the time of intra gastric balloon (IGB) placement, at the time of its withdrawal and one month after withdrawal.fifteen morbidly obese patients underwent the introduction of IGB under general anesthesia. In all patients, there was infusion of 500ml of distilled water in the balloon for the test. Measurements of the thickness of the gastric wall were made in the antrum, body and proximal body, using a radial echoendoscope with a frequency of 12MHz and maximum zoom, and its own balloon inflated with 5ml of distilled water.the presence of IGB led to increased wall thickness of the gastric body by expanding the muscle layer. These changes were apparently transient, since 30 days after the balloon withdrawal there was a tendency to return of the wall thickness values ​​observed before the balloon insertion.the use of intragastric balloon for the treatment of obesity determines transient increase in the wall thickness of the gastric body caused by expanded muscle layer.A preocupação com a melhoria dos resultados estéticos e funcionais sem comprometimento dos resultados oncológicos na cirurgia de cabeça e pescoço tem aumentado significativamente. Os procedimentos minimamente invasivos e principalmente aqueles que utilizam a tecnologia robótica permitiram o desenvolvimento de novas abordagens, incluindo o acesso retroauricular, que agora é usado rotineiramente, especialmente na Coréia do Sul. A presente nota irá ilustrar a técnica e a experiência inicial na América Latina, demonstrando que esta abordagem é viável, segura e eficaz oncologicamente, podendo ser utilizada em casos selecionados com um benefício estético evidente.

Gastric confirmation by pH is only achievable in approximately 50% of placements and X-rays are expensive and may be misinterpreted. Bedside electromagnetic (EM) guidance offers real-time confirmation. The authors determined the accuracy of guidance in predicting gastric body position from the EM trace using official Cortrak guidance (the EM trace reaches the bottom left quadrant of the anterior screen) compared with local guidance (detailed anterior-depth description of the GI flexures). X-ray, pH or an EM trace beyond the gastric body were used to independently confirm gastric position. Of 496 EM traces, 49% of tubes were in the oesophagus on entry to the lower left quadrant whereas 12% had already reached the gastric body in the upper left quadrant. Overall, predicting position by quadrant was 70% accurate whereas differentiating the pre-gastro-oesophageal junction (pre-GOJ) from the gastric body flexure was 100% accurate. Confirming gastric position by the anterior trace quadrant appears to be unsafe whereas expert differentiation of the pre-GOJ and gastric body flexures was reliable. The authors invite Corpak Medsystems (now owned by Halyard Health) to update its guidance in view of these findings.

We describe the case of a man with fundic gland polyposis associated with proton-pump inhibitor (PPI) use. Some investigators have reported an association between long-term PPI use and an increase in the risk of developing fundic gland polyps (FGPs). These FGPs are considered to be reversible on stopping PPI treatment. The current patient had used a PPI for 10 years, resulting in multiple FGPs in his gastric body. However, 6 months after cessation of the PPI, the FGPs had obvously regressed, even though a histamine-2 receptor antagonist had subsequently been prescribed. This case demonstrates a link between PPI treatment and FGPs. LEARNING POINTS Long-term proton-pump inhibitor (PPI) use can increase the risk of developing fundic gland polyps (FGPs). This phenomenon is thought to be reversible, and a few case reports have demonstrated spontaneous resolution of FGPs after cessation of PPI use. When fundic gland polyposis is detected, a family history of polyposis and a history of PPI use should both be sought.

Cystic Brunner’s gland hamartoma has been described under the various names including cystic hamartoma of Brunner’s glands, cystic Brunner’s gland heterotopia, Brunner’s gland cysts, Brunner’s gland cystadenoma, Brunner’s cyst, mucocele of Brunner’s glands, and cyst of Brunner’s glands. 1-4 Here, we report a rare case where a patient presented with an incidentally found, and long-standing pedunculated submucosal mass in the stomach body, which was diagnosed as a cystic Brunner’s gland hamartoma. To the best of our knowledge, no previous occurrence of cystic Brunner’s gland hamartoma in the

A 7-year-old spayed female domestic shorthair cat was referred for chronic intermittent vomiting. The frequency of vomiting increased recently, and the cat showed anorexia at presentation. There were no remarkable abnormalities on the blood analyses and diagnostic imaging. However, the endoscopic examination revealed focal erosions of the gastric body mucosa, and subsequent multiple biopsies were obtained. Histopathologic examination indicated mild to moderate lymphocytic gastritis. The vomiting was completely disappeared 7 days after the administration with prednisolone (PDS). However, because of side effects caused by the long-term PDS administration, cyclosporine was added on the prescription with tapered dose of PDS. The dog’s condition improved with continued cyclosporine treatment, and no further vomiting and anorexia episodes have been noted. This case describes the successful management with administration of cyclosporine in feline lymphocytic gastritis.

Background and Aim Effectiveness of capsule endoscopy (CE) for screening the small bowel in patients with portal hypertension (PHT) has been reported. However, few reports discuss CE detection of specific esophagogastric lesions related to PHT. Thus, we assessed whether CE is useful for detecting such lesions. Methods One hundred nineteen consecutive patients with PHT comprised the study group. All had undergone esophagogastroduodenoscopy (EGD) prior to CE. The diagnostic yield of CE for esophageal varices (EVs), gastric varices (GVs), and portal hypertensive gastropathy (PHG) was evaluated. In addition, diagnostic yield in relation to form, location of the varices, grade, and extent of PHG was evaluated. Results EVs were found by EGD in 71 patients. The overall diagnostic yield of CE for EVs was 72% (51/71). The diagnostic yield was significantly greater for F2/F3 EVs than for F1 EVs (87% vs 61%, P = 0.03). The diagnostic yield was significantly greater for Lm/Ls EVs than for Li EVs (85% vs 55%, P = 0.01). The diagnostic yield was significantly greater for locus superior/locus medialis EVs than for locus inferior EVs (85% vs 55%, P = 0.01). GVs were found by EGD in 29 patients. Only one case was detected by CE. PHG was found by EGD in 35 patients. The diagnostic yield of CE for PHG was 69% (24/35). There was no difference in diagnostic yield between cases of severe and mild PHG (82% vs 63%, P = 0.44). Diagnostic yield of CE for PHG in the gastric body was significantly greater than that in the fundus (100% vs 48%, P = 0.0009). Conclusion CE is reliable for diagnosis of F2/F3 and/or Lm/Ls EVs and of PHG in the gastric body.

Esophagogastroduodenoscopic examination shows diffuse redness of the mucosa of the gastric body, which can be identified as a deep reddish color. The present case underscores the importance of diffuse redness as a key endoscopic feature that enables prompt diagnosis of current Helicobacter pylori infection.

Closure of gastrotomy remains a major barrier to clinical application of NOTES. Full-thickness closure of gastrotomy using endoscopic suturing device is presumed to be safer than that by endoclips. We evaluated the safety and feasibility of closing gastrotomy by Eagle Claw VIII, endoclips, and surgical suturing. Fifty-one ex vivo porcine stomach models were included with 17 closures per arm. A 2-cm linear incision was created at the gastric body using scalpel externally. The time for gastrotomy closure, pneumatic bursting pressure, site of air leakage and number of suturing, or clips used were recorded. In addition, the technical difficulties of closure using Eagle Claw VIII and endoclips were assessed by a quantitative scale. All gastrotomies were successfully closed without leakage upon full gaseous distension. Closure time of Eagle Claw VIII was significantly longer than that of endoclips and surgical suturing. The median pneumatic bursting pressures were 56 (range 35–110) mmHg for Eagle Claw VIII, 19 (range 9–65) mmHg for endoclips, and 78 (range 63–110) mmHg for surgical suturing. The bursting pressures for surgical suturing and Eagle Claw VIII were significantly higher than that of endoclips (P

A 37-year-old female presented to our hospital with the complaint of abdominal distension for one month. A gastroscopy examination showed extensive chyme retention and varying erosion and ulceration of the gastric body. The pathology showed moderate chronic inflammation and erosion of the gastric body mucosa, with accompanying Helicobacter pylori infection. She accepted treatment for one month. The patient then accepted to undergo endoscopic ultrasonography, which showed that normal structure of the gastric body intumescence was discernible. The pathology showed chronic mild-moderate inflammation of the gastric body mucosa associated with interstitial amyloidosis, with accompanying Helicobacter pylori infection. She accepted treatment for the eradication of Helicobacter pylori, and the original ulcer healed.

Trichobezoars are hairballs or hair-like fibers formed by chewing and swallowing hair or any other indigestible materials. Trichobezoars usually form in the gastric body and are thus prepyloric. However, trichobezoars may rarely pass through the pylorus into the duodenum, jejunum, ileum, and even the colon, in a condition referred to as Rapunzel syndrome. Here, we present a case of a 13-year-old girl with this rare syndrome and discuss the diagnosis and treatment of the disease.

Gastric gastrointestinal stromal tumors (GIST) have a distinct surgical therapy compared to gastric adenocarcinoma. Large oncologic margins and lymphadenectomy are not necessary rendering local resections suitable to treat the disease and spare the stomach. That may be accomplished through a minimally invasive approach. We present a case of a 67-year-old woman with an endophytic 3.5 cm gastric GIST located in the posterior wall of the gastric body that underwent an endogastric resection. Operation was uneventful. The patient was discharged in the following day. Pathologic examination showed free margins and a low grade GIST. Endogastric resection is a feasible option in endophytic GISTs located in the posterior wall of the stomach.

Background After an acute attack of pancreatitis, walled-off pancreatic fluid collections (PFC) occur in approximately 10 % of cases. Drainage of the cavity is recommended when specific indications are met. Endoscopic drainage has been adopted as the main intervention for symptomatic walled-off PFC. Altered gastric anatomy in these patients poses an interesting challenge. We present the first case of a patient with sleeve gastrectomy who underwent successful endoscopic transduodenal necrosectomy (TDN). Case presentation Forty year old woman with history of morbid obesity status post sleeve gastrectomy in 2009 was found to have symptomatic gallstone disease complicated by severe necrotizing gallstone pancreatitis and further complicated by symptomatic walled off pancreatic necrosis (WOPN). Imaging significant for 10.8 × 7.6 cm fluid collection with necrotic debris in the body and tail of the pancreas and endoscopic necrosectomy was attempted. EGD showed tubular gastric body and antrum, with extrinsic compression in the antrum and duodenal bulb from the pancreatic cyst. Duodenal bulb was selected as the preferred fistula site due to sleeve gastrectomy. Patient underwent successful TDN in two sessions. Patient had symptomatic improvement at follow-up with resolution of WOPN. Conclusion To our knowledge, this is the first reported case of EUS-guided endoscopic necrosectomy in a patient with sleeve gastrectomy. The duodenal approach was used in our patient due to history of sleeve gastrectomy.