Gastrointestinal Panendoscopy Research Articles

A Case Study of Achalasia Presenting with Chest Pain

<p>胸痛為臨床常見主述，在排除心因性問題後，常因病人合併胃灼熱感，診斷為胃食道逆流。然而本案例為一位36歲女性，因反覆進食後胸痛、胃灼熱及逆流等症狀，依醫囑斷續服用氫離子幫浦抑制劑（Proton Pump Inhibitor, PPI）治療胃食道逆流約一年仍未改善，直至夜間逆流咳嗽加劇，轉至本院消化內科求治，問診後發現合併有吞嚥困難及體重減輕情形，安排上消化道內視鏡排除食道腫瘤後，經食道攝影檢查確診為食道弛緩不能症（achalasia）。個案接受經口內視鏡肌層切開術治療、營養重建及心理諮商後，胸痛、逆流及吞嚥困難等症狀大幅改善，體重也從44 kg回復至50 kg，焦慮程度亦漸緩解。針對反覆出現與胃食道逆流相似症狀，或經藥物治療無效者，應進一步評估有無吞嚥困難，與胃食道逆流作鑑別診斷，避免病人因進食困難，造成營養不良併發症，以及長期睡眠困擾導致負向情緒感受，嚴重影響生活品質。</p> <p> </p><p>Chest pain as a relatively common clinical symptom especially when excluding ischemic heart dis­ease, patients are often diagnosed with gastroesophageal reflux disease due to acid regurgitation and a sensation of heartburn. A 36-year-old woman had had been intermittently treated with an oral proton pump inhibitor (PPI) under the impression of gastroesophageal reflux disease for approximately one year due to recurrent chest pain, heartburn, and a sensation of regurgitation. However, the symptoms deteriorated with exacerbation at night, which was an indication of poor response to the oral medi­cation. Thus, she was transferred to the Department of Gastroenterology for further examination and treatment. After detailed inquiry, the patient also suffered from progressive dysphagia with body weight loss, chest pain and regurgitation sensation. Therefore, an upper gastrointestinal panendoscopy was performed to exclude the presence of esophageal tumors. A diagnosis of esophageal achalasia was confirmed after an upper gastrointestinal examination series was conducted. After informing the patient, per-oral-endoscopic myotomy was performed. Nutritional supplementation and psychological consultation were also provided. The patient’s symptoms (e.g., chest pain, regurgitation, and dyspha­gia) improved significantly. Body weight increased from 44 kg to 50 kg, and her anxiety level was gradually reduced. For those who diagnosed with recurrent gastroesophageal reflux disease along with a poor response to oral medications, a detailed inquiry and a specific examination should be conduct­ed for other differential diagnoses, (e.g., achalasia) that may have long-term negative impact on the patient’s nutritional status, sleep disturbance, negative emotions, and quality of life</p> <p> </p>

Recent upper gastrointestinal panendoscopy increases the risk of pyogenic liver abscess.

AIMTo investigate the association between a recent gastrointestinal (GI) endoscopy and the subsequent risk of pyogenic liver abscess (PLA).METHODSWe designed a nested case control study. Using the Taiwan National Health Insurance Research Database, 2135 patients with a first diagnosis of PLA were identified from 1998 to 2011. Another 10675 patients without PLA matched by age and sex were selected as reference controls. We identified and compared the possible risk factors for PLA and GI endoscopies performed before the index date (when PLA was diagnosed) between the two cohorts. Multivariate analysis was conducted to examine the risk of PLA within the 90 d after the GI endoscopies.RESULTSPatients with a history of diabetes [adjusted odds ratio (aOR) = 4.92, 95%CI: 1.78-13.61], end-stage renal disease (aOR = 3.98, 95%CI: 1.45-10.91), biliary tract infection (aOR = 2.68, 95%CI: 2.11-3.40), liver cirrhosis (aOR = 2.19, 95%CI: 1.39-3.46), GI malignancies (aOR = 5.68, 95%CI: 4.23-7.64), appendicitis (aOR = 3.16, 95%CI: 2.27-4.41), diverticulitis (aOR = 1.64, 95%CI: 1.01-2.64), and recent endoscopic retrograde cholangiopancreatography (aOR = 27.04, 95%CI: 11.65-62.72) were significantly associated with an increased risk of PLA. After adjusting for the above risk factors and the frequency of outpatient department visits and abdominal ultrasounds during 90 d before the index date, an upper GI panendoscopy (aOR = 2.75, 95%CI: 2.05-3.69) but not a lower GI endoscopy (aOR = 1.07, 95%CI: 0.62-1.86) was significantly associated with PLA.CONCLUSIONAn upper GI panendoscopy performed before 90 d may increase the risk of PLA.

Metachronous duodenal metastasis from renal cell carcinoma

Renal cell carcinoma (RCC) is a common aggressive genitourinary tract tumor and in which distant metastases eventually develop. It is known to have potential to metastasize to almost any site, but metastatic RCC to the duodenum is extremely rare. We discuss a 57-year-old male patient who had undergone a right radical nephrectomy 12 years previously and free of disease for RCC presented with a 3-days history of shortness of breath, fatigue, dyspepsia, black tarry stools, and generalized weakness. The diagnosis made from the biopsy specimens on upper gastrointestinal panendoscopy study was metastatic RCC in the duodenum. He underwent the surgical exploration for pancreaticoduodenectomy subsequently. He had an uneventful recovery with Sutent (Sunitinib malate) was used after surgery for adjuvant target therapy and there was no evidence of recurrence 6 months after the procedure.

Endocrine carcinoma of the pancreatic tail exhibiting gastric variceal bleeding

Nonfunctional endocrine carcinoma of the pancreas is uncommon. Without excess hormone secretion, it is clinically silent until the enlarging or metastatic tumor causes compressive symptoms. Epigastric pain, dyspepsia, jaundice, and abdominal mass are the usual symptoms, whereas upper gastrointestinal (GI) bleeding is rare. Here, we describe the case of a 24-year-old man with the chief complaint of hematemesis. Upper GI panendoscopy revealed isolated gastric varices at the fundus and upper body. Ultrasonography and computed tomography showed a tumor mass at the pancreatic tail causing a splenic vein obstruction, engorged vessels near the fundus of the stomach, and splenomegaly. After distal pancreatectomy and splenectomy, the bleeding did not recur. The final pathologic diagnosis was endocrine carcinoma of the pancreas. Gastric variceal bleeding is a possible manifestation of nonfunctional endocrine carcinoma of the pancreas if the splenic vein is affected by a tumor. In non-cirrhotic patients with isolated gastric variceal bleeding, the differential diagnosis should include pancreatic disorders.

An unusual cause of haematemesis: Left-sided portal hypertension due to a large pancreatic tumour

A 28 year-old woman presented to our hospital after several pisodes of bloody vomitus for 1 day. The physical examinaions showed pale conjuctiva and a palpable mass over left upper uadrant of abdomen without tenderness. The laboratory tests evealed white-cell count of 11,980/Cumm with 80% neutrophils nd haemoglobin of 6.6 g/dL. An upper gastrointestinal panenoscopy showed isolated gastric varices and external compression f stomach from posterior wall of body (Fig. 1). A contrast enhanced omputed tomographic scan of the abdomen revealed a huge cystic ass, 18 cm × 11 cm × 12 cm, over the pancreatic tail and budding he splenic hilum. The splenic vein was anteriorly displaced and ompressed (Fig. 2A, arrow). Distal pancreatectomy and splenecomy were performed (Fig. 2B). The pathological diagnosis was onfirmed with mucinous cystadenoma of pancreas. The patient ecovered well and discharged in good health 5 days after the opertion. She received an upper gastrointestinal panendoscopy 1 year ater for regular follow-up and no gastric varices were presented. Left-sided portal hypertension (LSPH) is a rare clinical syndrome hich may lead to bleeding from isolated gastric varices [1]. Panreatic disease is the most common aetiology. LSPH is also one of he rare curable syndromes causing portal hypertension. Since haeatemesis is a life-threatening condition, as early to diagnose and reat as possible may result in better prognosis.

LYMPHATIC TUMOR EMBOLI OF PERIRENAL FAT IN PATIENT WITH NEPHROTIC SYNDROME RECEIVING RENAL BIOPSY, ULTIMATELY REVEALED GASTRIC ADENOCARCINOMA WITH MEMBRANOUS GLOMERULONEPHRITIS

The association of malignancy with nephrotic syndrome and renal histopathologic abnormalities is well documented. Paraneoplastic proteinuria caused by membranous glomerulonephritis usually is made simultaneously with the diagnosis of a malignant tumor, or the two conditions are diagnosed within a year of each other. We reported a patient who presented with nephrotic syndrome initially. Incidentally, in kidney specimens, pathologic findings showed perirenal fatty tissue with malignancy tumor emboli in lymphatics. Thereafter, gastric adenocarcinoma was diagnosed by gastrointestinal panendoscopy with gastric biopsy under impression of malignancy associated with glomerulonephritis. Patient died of complications of malignancy-related disseminated intravascular coagulation without chemotherapy after confirming diagnosis was made three months later.

Clinicopathological features of elevated lesions of the duodenal bulb

We present here our findings on patients with an elevated lesion of the duodenal bulb. All these patients were treated in our clinics between the years 1984 and 1988. These lesions were present in 36 of 8,802 patients who underwent upper gastrointestinal pan-endoscopy. Two patients had a duodenal carcinoma, 2 an adenoma, and 1 a Brunner's gland adenoma. There were 15 with a hyperplastic polyp, 3 with a heterogenic gastric mucosa, 3 with Brunner's gland hyperplasia, 6 with duodenitis, and 4 with regenerative mucosa. Among these 36 lesions, only 69% (25 lesions) were evident on the upper gastrointestinal X-ray series. Adenoma and Brunner's gland adenoma were of a pedunculated form of the gross type and had an irregular surface mucosa. Both duodenal carcinomas were detected by endoscopic biopsy and were resected. Histologically, these lesions were limited to the submucosal layer and were of the non-pedunculated polypoid form, but there were no other characteristic endoscopic features, in comparison with other elevated lesions. Thus, upper gastrointestinal endoscopy with routine observations of the duodenal bulb plus endoscopic biopsy will lead to a definite diagnosis of these elevated lesions and to the early detection and treatment of this rare malignant lesion.

Screening examination of the larynx and pharynx during upper gastrointestinal panendoscopy

With the flexible fiberoptic esophagogastroduodenoscopes now in use, the larynx and posterior pharynx can be easily viewed during routine upper gastrointestinal endoscopy. Screening laryngeal-pharyngeal examinations were carried out during 1120 upper gastrointestinal endoscopies. Mean additional examination time was 30 sec. Thirty-nine laryngeal lesions were detected, mostly variants of chronic laryngitis. Two patients had leukoplakia, one of whom on subsequent biopsy revealed squamous cell cancer. The brief additional endoscopic time may result in the detection of early curable neoplasms. Thus a screening laryngeal-pharyngeal examination should be part of each upper gastrointestinal endoscopic examination.

Strangulated small intestinal obstruction following upper gastrointestinal panendoscopy

Upper gastrointestinal fiberoptic panendoscopy is a safe and reliable means of diagnosing disease of the esophagus, stomach, and duodenum. Complications do, however, occur in less than 0.4% of procedures. ' · 2 They include aspiration, intramural hematomas, intestinal pseudo-obstruction, perforation, and impaction. 36 An unusual complication, strangulated small bowel obstruction, following an emergency panendoscopy is reported. CASE REPORT A 62-year-old man was referred because of passing melena stools for 48 hours. Duodenal ulcer had been demonstrated radiologically in the past. Ten years previously, right hemicolectomy had been performed for appendiceal abscess. Twelve months following this operation an episode of adhesive small intestinal obstruction had been corrected surgically. ·Reprint r-equests: Dr. E.J. Pollard, C/Royal Brisbane Hospital, Herston Road, Herston, Brisbane, 4029, Qld., Australia.

Pepsin Secretion, Pepsinogen, and Gastrin in “Barrett's Esophagus”

Four cases of Barrett's esophagus are presented. Three cases presented with significant esophageal bleeding and one case presented with high esophageal stricture. Gastrointestinal panendoscopy was done in each case and multiple biopsies were taken. The biopsies were utilized for histomorphology, pepsinogen agar gel electrophoresis, and tissue gastrin assays. Tissue gastrin levels in esophageal mucosa were elevated in 2 cases when compared to controls with and without hiatus hernia. Pepsin and acid secretory studies were done by isolating the esophagus. Barrett's esophagus was shown to produce pepsin by both chemical studies (2 cases) and agar gel electrophoresis at pH 5.7 (3 cases), and was also shown to produce acid. The mucosa contained either cathepsin or cathepsin and pepsinogens in all cases. Nissen's fundoplication was performed in all of the patients. Of 3 patients who were bleeding, 2 who consented for this operation stopped bleeding after the operation. It is to be noted that the usual clinical treatment of antacids, bedrest, and raising the head end of the bed failed in all of the patients. The follow-up of 9 months to 3 years postoperatively has shown persistence of Barrett's mucosa with no evidence for any reversion to normal esophageal type.

Gastrointestinal Pan‐endoscopy: Esophagroscopy

Medical Journal of AustraliaVolume 2, Issue 8 p. 317-318 BOOK REVIEW Gastrointestinal Pan-endoscopy: Esophagroscopy Allan Kerr Grant, Allan Kerr GrantSearch for more papers by this author Allan Kerr Grant, Allan Kerr GrantSearch for more papers by this author First published: August 1975 https://doi.org/10.5694/j.1326-5377.1975.tb105839.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume2, Issue8August 1975Pages 317-318 RelatedInformation