Body Of Stomach Research Articles

Menetrier Disease in a Five Year Old Girl - A Case Report and Review of Literature

Introduction: Menetrier`s disease is one of the rarest protein losing gastropathies in childhood characterized by hypertrophy of gastric folds. Children with Menetrier disease tend to follow a self-limited course with symptoms typically completely resolving within 2 to 10 weeks. Case report: A five year old girl presented fever for two days, abdominal pain and vomiting. After two other days she presented periorbital swelling and skin rash. Laboratory findings on admission showed hypoalbuminemia and eosinophilia. Screening for Helicobacter pylori and cytomegalovirus resulted negative. Abdominal ultrasonography showed moderate ascitis and in chest X ray revealed effusion in both lungs. Gastroscopy showed severe erosions in fundus and in upper part of stomach body. The lower part of stomach and antrum was normal. Histopathology showed data compatible with Menetrier disease. She was treated with several albumin infusions and diuretics and her symptoms improved after 4 weeks of treatment. Conclusion: This is the first case of pediatric MD in our experience. Endoscopic images and histological data are very important to support

Adenocarcinoma gástrico com ossificação heterotópica em cão – relato de caso

This report describes and discusses the clinical, pathological and immunohistochemical findings in a case of gastric adenocarcinoma with heterotopic ossification in a 12-year-old male dog with a history of non responsive and frequent vomiting. At necropsy, the stomach fundus and body near the lesser curvature had a markedly thick, raised, irregular and firm wall. Light microscopy showed multifocal areas of malignant neoplastic proliferation of epithelial cells, forming tubules containing acini with variable amount of mucin and multiple foci of heterotopic ossification. The neoplastic cells were positive for cytokeratin and negative for vimentin and osteocalcin. Metastases of gastric cancer were observed in lymph nodes and lungs.

A Rare Case of Abdominal Pain: Gastric Sarcoidosis With Quiescent Pulmonary Disease

A 77-year-old African American female presented with 3-weeks of epigastric abdominal pain, bilious emesis, and dysphagia to solids. Pain was sharp, mid-epigastric, 10/10 in severity, and was exacerbated by oral intake. The patient's past medical history included hypertension, coronary artery disease, and pulmonary sarcoidosis, which was diagnosed by bronchoscopy 21 years prior and treated with corticosteroids for one year. She was followed closely and was in remission for 20 years. On presentation, physical exam was significant for hyperactive bowel sounds. Lab work was within normal limits. The patient underwent endoscopy, which showed a single non-bleeding 6mm ulcer in the stomach body and mucosal erythema and nodularity in the antrum and stomach body. Biopsies revealed non-necrotizing granuloma in the gastric mucosa with mild chronic and focal acute inflammation. Gastric ulcer histology was benign. Stains were negative for H. pylori, acid-fast bacilli, and fungal organisms. The patient was started on oral prednisone 40mg daily for a diagnosis of gastric sarcoidosis. She was symptomatically improved after two days of treatment. Sarcoidosis is a chronic disease; however, about ⅔ of patients have remission within a decade after diagnosis, while only ⅓ have progressive disease that leads to organ damage. Less than 5% of patients have disease recurrence after they are in remission for more than 1 year. Recurrence of active disease in an extrapulmonary location after a prolonged period of latency from pulmonary sarcoid is extremely rare. Most cases of gastric sarcoidosis are asymptomatic and found on incidental biopsy. Symptomatic patients most often present with epigastric pain, vomiting, and weight loss. Endoscopic findings range from mucosal erythema and ulcers to nodular lesions to linitis plastica. Biopsy showing noncaseating granulomas is critical for diagnosis, but not pathognomonic. Granulomas can also be seen in Crohn's disease, tuberculosis, gastric malignancy, lymphoma, and idiopathic granulomatous gastritis. To establish a diagnosis of GI sarcoidosis, in addition to histology, other etiologies must be excluded. There also must be clinical, radiographic or histopathologic evidence of sarcoidosis in another organ system. If the GI tract is the only organ involved, sarcoidosis cannot be confirmed. Oral corticosteroids are the mainstay for treatment of symptomatic GI sarcoidosis. Improvement can be seen quickly, as shown in our patient. Surgery is reserved for refractory or life-threatening cases. This case highlights the importance of having GI sarcoidosis in the differential diagnosis for epigastric pain, despite quiescent pulmonary disease.Figure 1Figure 2Figure 3

Good History and High Suspicion of Gastric Volvulus in Patient With Known Hiatal Hernia Are Key to Better Outcomes

Introduction: Gastric volvulus is relatively uncommon, potentially life-threatening entity that occurs when the stomach twists upon itself. We present a case with history of hiatal hernia that presented with Mesenteroaxial gastric volvulus. Mesenteroaxial gastric volvulus accounts for about one-third of the cases where stomach folds along its short axis from the lesser to greater curvature. Presentation of Case: A 79-year-old female with history of hiatal hernia, COPD, coronary artery disease and infrarenal abdominal aortic aneurysm (AAA) presented with epigastric pain, nausea and non-bilious/non-bloody vomiting. Reports having regular bowel movements. On exam: Temperature 98.3F, Blood Pressure 94/61, Heart Rate 82, Respiratory rate 22 and Oxygen saturation 93% on room air. Abdominal exam was significant for mild distention but otherwise soft and non-tender. Laboratory findings were notable for WBC 7.6 and Lactate 1.3. On bedside ultrasound was found to have severely dilated stomach and CT angiography of abdomen/pelvis was done to rule out dissection of AAA and further investigate ultrasound findings. It showed large hiatal hernia with gastroesophageal junction, pylorus and antrum above diaphragm and distended body of the stomach below suggestive of gastric volvulus (see image 1). She was managed with decompression with nasogastric tube and patient was kept NPO on IV fluids and IV protonix (PPI). Upper endoscopy (EGD) was performed and showed abnormal anatomical configuration of fundus and body of stomach (see image 2) were body was noted to loop up towards the diaphragm adjacent to the gastroesophageal junction and with great difficulty of intubating the pylorus. No evidence of torsion was seen. EGD finding were consistent with paraesophageal hernia type IV and mesenteroaxial gastric volvulus without signs of strangulation. Patient underwent laparoscopic paraesopphageal hernia and gastric volvulus repair and was doing well on postop clinic follow up. Conclusion: Gastric volvulus can range from a transient event, with mild symptoms of abdominal pain and vomiting to complete obstruction with ischemia and necrosis of the stomach. A good history and physical examination can provide the clues needed to make the presumptive diagnosis, which can then be confirmed with radiographic studies and EGD, ultimately leading to early surgical treatment which is essential to reduce the morbidity and mortality of gastric volvulus.Figure 1Figure 2Figure 3

Parasitic Egg Consistent With Schistosoma on Rectosigmoid Biopsy

A 39 years-old Ethiopian male presented with complaints of changes in bowel habits, diarrhea, and rectal pain of less than one month. He denied any previous episodes and does not have any past medical history. He states that he does not take any medications, and has not changed his diet in the past month. His history is significant for recent immigration to the United States. The patient was referred to a gastroenterologist for an elective outpatient colonscopy and esophagogastroduodenoscopy. The patient's initial complete blood count demonstrated mildly elevated eosinophil percentage (7.2%) and a slightly elevated mean corpuscular hemoglobin (33.1 pg). His basic metabolic panel was within normal limits. The coagulation profile demonstrated a decreased international normalized ratio (0.93). Findings on colonscopy demonstrated a normal appearing terminal ileum; however, mild colitis in the rectosigmoid junction [Figure 1] and rectum. The mucosa was erythematous and edematous. Three cold forcep biopsies were taken [Figures 2, 3]. There were also three polyps measuring less than 5mm in size found in the rectosigmoid junction. Furthermore, there were two polyps measuring 5 and 3 mm found in the rectum. Both were completely removed by cold snare polypectomy. Internal hemorrhoids were also noted. Then the patient had an esophagogastroduodenoscopy. There were moderately erythematous mucosa found in the antrum, body, and fundus of stomach. Four biopsies were taken. There were also evidence of duodenitis in the duodenal bulb and the second portion of the duodendum.Figure 1Figure 2The patient was instructed to follow-up in two weeks for biopsy results, start a high fiber diet, and avoid non-steroidal anti-inflammatory drugs. Biopsy results from the rectosigmoid showed a parasitic egg consistent with Schistosoma species [figure 3], patchy acute and chronic inflammation with mucosal eosinophilia. The polyps biopsied in both the rectosigmoid junction and rectum were consistent with hyperplasia. While biopsy results from the gastric biopsies were consistent with chronic active gastritis, with immunostain for H. pylori being positive. Slides from specimens were reviewed for quality assurance and consensus regarding diagnosis of parasitic egg consistent with Schistosoma species.Figure 3The patient was treated with praziquantel. He will follow up in 6 months for antigen testing of stool and urine for excreting eggs and direct assays for eggs in stool and urine via microscopy. He instructed to return sooner if symptoms recur.

EUS-guided Endoscopic Transduodenal Necrosectomy in a Patient With Sleeve Gastrectomy

Walled-off pancreatic fluid collections (PFC) occur after an acute attack of pancreatitis in approximately 10 percent of cases. Decompression of the collection is advocated when specific indications are met, such as pain, gastric outlet or biliary obstruction, fluid leakage, fistulization, weight loss and infection. Endoscopic drainage has been widely adopted as the primary approach for symptomatic walled-off PFC. Difficulty can arise in cases of altered gastric anatomy, as the procedure requires an adequate amount of space to maneuver. We present the first case of a patient with sleeve gastrectomy who underwent successful endoscopic transduodenal necrosectomy (TDN). 40 year old woman with history of morbid obesity status post sleeve gastrectomy in 2009 with intermittent post-prandial RUQ abdominal pain was found to have symptomatic gallstone disease. Patient's course was complicated by severe necrotizing gallstone pancreatitis and further complicated by symptomatic walled off pancreatic necrosis (WOPN). Imaging at 8 weeks revealed 10.8 x 7.6 cm fluid collection with portions of solid components seen in the body and tail of the pancreas. The decision was made to attempt endoscopic necrosectomy. EGD revealed a 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. The patient underwent successful TDN with placement of three 10Fr pigtail stents. Patient had symptomatic improvement and was discharged to outpatient follow-up. Although the transgastric approach is preferred for walled-off PFC, usually due to more favorable location, as well as the comfort level of endoscopists, there is no definite evidence that transgastric drainage is superior to transduodenal drainage. The duodenal approach was used in our patient as sleeve gastrectomy involves removal of the stomach body and a large portion of the antrum producing a high pressure system inside the stomach which may lead to inadequate drainage. Additionally, intervention adjacent to the staple line may predispose to anastomotic leak and break down of the staple line. One prior case has been reported of a patient with sleeve gastrectomy undergoing laparoscopic cyst-gastrostomy after aborted endoscopic cyst-gastrostomy due to limited working space and the inability to visualize the posterior aspect of the stomach. Although laparoscopic cyst-gastrostomy is an acceptable approach for these patients, randomized trials have demonstrated equal efficacy between endoscopic and surgical luminal pancreatic pseudocyst drainage, with endoscopic treatment associated with shorter hospital stays and lower cost. This case illustrates the feasibility of endoscopic necrosectomy in patients with altered gastric anatomy.Figure 1Figure 2Figure 3

Diets and body condition of polar cod (Boreogadus saida) in the northern Bering Sea and Chukchi Sea

To understand trophic responses of polar cod Boreogadus saida (a key species in Arctic food webs) to changes in zooplankton and benthic invertebrate communities (prey), we compared its stomach contents and body condition between three regions with different environments: the northern Bering Sea (NB), southern Chukchi Sea (SC), and central Chukchi Sea (CC). Polar cod were sampled using a bottom trawl, and their potential prey species in the environment were sampled using a plankton net and a surface sediment sampler. Polar cod fed mainly on appendicularians in the NB and SC where copepods were the most abundant in the environment, while they fed on copepods, euphausiids, and gammarids in the CC where barnacle larvae were the most abundant species in plankton samples on average. The stomach fullness index of polar cod was higher in the NB and SC than CC, while their body condition index did not differ between these regions. The lower lipid content of appendicularians compared to other prey species is the most plausible explanation for this inconsistency.

Endoscopic versus surgical resection of GI stromal tumors in the upper GI tract

Endoscopic resection has been performed for treatment of GI stromal tumors (GISTs) in the upper GI tract. However, the therapeutic roles of the endoscopic procedure remain debatable. We aimed in this retrospective study to evaluate the feasibility and long-term follow-up results of endoscopic resection of GISTs in the upper GI tract, compared with surgery. Between March 2005 and August 2014, 130 cases of GIST in the upper GI tract were resected. We compared baseline characteristics and clinical outcomes including R0 resection rate and recurrence rate between the endoscopy group (n = 90) and surgery group (n = 40). The most common location of GIST was the stomach body in the endoscopy group, whereas it was the duodenum in the surgery group (P = .001). Tumor size was significantly smaller (2.3 vs 5.1 cm; P < .001), and procedure time (51.8 ± 36.2 vs 124.6 ± 74.7 minutes; P < .001) and hospital stay (3.3 ± 2.4 vs 8.3 ± 5.4 days; P < .001) were significantly shorter in the endoscopy group than in the surgery group. The R0 resection rate was 25.6% in the endoscopy group, whereas it was 85.0% in the surgery group (P = .001), and 50.0% of resected tumors belonged to a very low-risk group in the endoscopy group, whereas 35.0% and 30.0% belonged to low-risk and high-risk in the surgery group (P = .001). However, during 45.5 months of follow-up, the recurrence rate was not significantly different between the 2 groups (2.2% vs 5.0%; P = .586). Endoscopic resection might be an alternative therapeutic modality for GISTs in the upper GI tract in selective cases.

Exploration of standardized procedures of laparoscopic sleeve gastrectomy

Objective To explore the standardized procedures of laparoscopic sleeve gastrectomy (LSG). Methods The clinical data of 153 patients with obesity who underwent LSG at the First Affiliated Hospital of Nanjing Medical University from December 2010 to December 2014 were retrospectively analyzed. All the 153 patients were divided into 3 groups: 22 patients in the first stage group were admitted to the hospital from December 2010 to September 2011, 57 patients in the second stage group were admitted to the hospital from October 2011 to December 2013 and 74 patients in the third stage group were admitted to the hospital from January 2014 to December 2014. In the first stage group, 1.1 cm gastroscope in diameter was introduced into the pylorus as a support, great curve of stomach with 5 cm distances from the pylorus was cut using a green cartridge, and then blue cartridges were used at the body and fundus of stomach. The 3-0 vicryl continuous and whole-layer suture was performed. The routine abdominal drainage was ended at postoperative hour 24 without the gastric tube placement. In the second stage group, 36 Fr bougie tube was placed at the gastric antrum, cutting at the proximal 5 cm from pylorus was performed using a green cartridge, and then blue cartridges were used. The 3-0 Vicryl interrupted and whole-layer suture was performed at the reinforcement of staple lines, and no drainage tube was placed. In the third stage group, 36 Fr bougie tube was placed at the gastric antrum, cutting at the proximal 3 cm from pylorus was performed using two green cartridges, and then blue cartridges were used. The 3-0 vicryl continuous and whole-layer suture was performed at the reinforcement of staple lines, and no drainage tube was placed. Other common perioperative management included as follows: free greater omentum was done by the supersonic knife. Patients had out-of-bed activity after waking up and intake of water and fluid diet at postoperative hour 6-8, including oral liquid diet of 300-500 mL at postoperative hour 24 and 500-1 000 mL at postoperative hour 48. Patients were followed up till May 2015, and return visit at postoperative month 1, 3, 6, 9 and 12 within 1 year and once every 6 months after postoperative year 2. The operation time, volume of intraoperative blood loss, duration of hospital stay and excess weight loss (EWL) percentage were analyzed. Comparison of count data was analyzed by the chi-square test. Measurement data with normal distribution were presented as ±s. Comparisons among groups were evaluated with the one-way ANOVA and chi-square test. Results All the patients received successfully LSG without conversion to open surgery, perioperative reoperation and death. Four patients were complicated with intraoperative injury, including 3 patients with liver injury and 1 patient with hepatic round ligament injury. No intraoperative and postoperative hemorrhea, postoperative gastric leakage and obstruction were detected. The operation time, volume of intraoperative blood loss, duration of hospital stay and 1-year EWL were (91±31) minutes, (51±33)mL, (4.1±3.4)days, 67%±12% in the first stage group, (56±27)minutes, (24±20)mL, (3.1±2.7)days, 65%±14% in the second stage group and (54±18)minutes, (21±20)mL, (3.0±2.1)days, 68%±24% in the third stage group, respectively. There were significant differences in the operation time and intraoperative volume of blood loss among the 3 groups (F=7.471, 6.037, P 0.05). All the patients were followed up. Nineteen patients with sleep apnea had complete remission of symptoms at postoperative month 3. Twenty-one patients with polycystic ovary syndrome had remission of symptoms after operations. Of 27 patients with type 2 diabetes mellitus, 25 patients had remission of symptoms at postoperative year 1 and 2 patients had improvement of symptoms. Fifty-seven of 79 patients with lipid metabolism disorders returned to normal at postoperative year 1. One hundred and twelve patients with fatty liver were improved after operation. Conclusions LSG is safe and feasible with a standardized operative procedure. Whole-layer suture may be prevent the leakage and no placement of gastric tube and drainage tube after operation can reduce the incidence of complications. Key words: Obesity; Sleeve gastrectomy; Bariatric surgery; Standardization; Laparoscopy

Effect of the number of lymph nodes harvested on the long-term survival of gastric cancer patients according to tumor stage and location: a 12-year study of 1,637 cases

BackgroundThe effect of the number of lymph nodes harvested on the long-term survival of gastric cancer according to Tumor, Node, and Metastasis (TNM) stage and tumor location remains unclear. MethodsPatients who underwent gastrectomy for gastric cancer (1998 to 2009) were evaluated retrospectively (1,637 patients). The patients’ clinicopathological variables, overall survival (OS), and progression-free survival (PFS) were recorded. The effect of the number of lymph nodes harvested on survival was analyzed according to TNM stage and tumor location. ResultsHarvest of greater than 30 lymph nodes was associated with significantly better OS and PFS than less than or equal to 14 lymph nodes, but no significant difference was observed between less than or equal to 14 and 15 to 29 lymph nodes harvested. The number of lymph nodes harvested was significantly associated with the OS or/and PFS of late stage cancer (N+, T3 to T4, and stage III to IV), harvest of greater than 30 lymph nodes brought significantly better survival compared with the other 2 groups. A higher number of harvested lymph nodes was associated with significantly better PFS for gastric cancer of the body of stomach, but not for proximal, distal, and whole stomach cancer. When the tumor was located in the body of the stomach, the PFS was better with 15 to 29 lymph nodes than less than 14 lymph nodes; however, the OS and PFS were not significantly different between greater than 30 lymph nodes and 15 to 29 lymph nodes. TNM stage and number of lymph nodes harvested were the independent risk factors affecting the survival. ConclusionTailored lymphadenectomy according to TNM stage and tumor location might be considered for gastric cancer patients.

Diferenciación de cáncer gástrico temprano vs linitis plástica; ¿los síntomas hacen la diferencia?

El cáncer gástrico tiene un patrón de presentación que va desde el estadio temprano a la linitis plástica, con pronósticos radicalmente diferentes, el primero con sobrevida a cinco años superior a 90%, el segundo inferior a 5%.&#x0D; &#x0D; Objetivo: identificar si las características clínicas permiten diferenciar un estadío temprano de linitis plástica.&#x0D; &#x0D; Metodología: se revisaron las bases de datos de la unidad de gastroenterología y endoscopia digestiva de un hospital de tercer nivel entre julio de 2005 y julio de 2010, seleccionando los casos donde se encontró linitis plástica y cáncer gástrico temprano, todos confirmados por patología. &#x0D; &#x0D; Resultados: se incluyeron 56 pacientes, 15 linitis y 41 cáncer temprano. Edad promedio de 61.3 años, (IC95%54.5-68.2) para linitis y 63 años para cáncer temprano (39-85), 66.6% fueron mujeres y 33.4% hombres en linitis plástica y 51.2% mujeres y 48.8% hombres en cáncer temprano. Compromiso del cuerpo en linitis 76.9%, en cáncer temprano el cuerpo 29.3%, antro 43.9%. Pérdida de peso presentó un 73.3% en linitis y 26.8% en cáncer temprano. No hubo diferencias significativas en síntomas como: vómito, hematemesis, melenas o epigastralgia. El 26.8% de los pacientes tenían antecedente de cáncer gástrico&#x0D; &#x0D; Conclusion: los síntomas no son útiles como herramienta para diferenciar cáncer gástrico temprano de la linitis plástica, por lo cual se requieren otras estrategias para la detección del cáncer en estado temprano como podría ser la realización de EVDA en los pacientes con antecedentes familiares de&#x0D; este tumor.

Does treatment of Helicobacter pylori infection reduce gastric precancerous lesions?

Treatment of Helicobacter pylori (H. pylori) decreases the prevalence of gastric cancer, and may inhibit gastric precancerous lesions progression into gastric cancer. The aim of this study was to determine the effect of treatment on subsequent gastric precancerous lesion development. We prospectively studied 27 patients who had low grade dysplasia at the time of enrollment, in addition to dysplasia atrophic gastritis and intestinal metaplasia observed in all patients. All were prescribed quadruple therapy to treat H. Pylori infection for 10 days. Patients underwent endoscopy with biopsy at enrollment and then at follow up two years later. Biopsy samples included five biopsies from the antrum of lesser curvature, antrum of greater curvature, angularis, body of stomach and fundus. RESULTS of these biopsies were compared before and after treatment. Overall, the successful eradication rate after two years was 15/27 (55.6%). After antibiotic therapy, the number of patients with low grade dysplasia decreased significantly (p=0.03), also with reduction of the atrophic lesions (p=0.01), but not metaplasia. Treatment of H. pylori likely is an effective therapy in preventing the development of subsequent gastric premalignant lesions.

Proton pump inhibitors and helicobacter pylori-associated pathogenesis.

The fact that long-term use of proton pump inhibitors (PPIs) aggravates corpus atrophic gastritis in patients with Helicobacter pylori infection has been proven clinically and experimentally. Corpus atrophic gastritis is a known risk factor for gastric cancer. Therefore, gastric neoplasia might be associated with the long-term use of PPIs. One of the causes of worsening corpus atrophic gastritis, leading to the development of adenocarcinoma, might be bacterial overgrowth under conditions of hypochlorhydria. The production of potentially carcinogenic N-nitrosocompounds by nitrosating organisms under conditions of hypochlorhydria might be associated with carcinogenesis. Interactions between bile acids, pH, and H. pylori might also contribute to carcinogenicity, especially in patients with gastro-esophageal reflux disease (GERD). The concentration of soluble bile acids, which have bactericidal or chemorepellent properties toward H. pylori, in gastric contents is considerably higher in patients undergoing continuous PPI therapy than in healthy individuals with normal acid production. Under these circumstances, H. pylori might colonize the stomach body rather than the pyloric antrum. Hypergastrinemia induced by PPI administration might promote the development of gastric cancer. Because the main cause of corpus atrophic gastritis is H. pylori infection, and not PPI administration, H. pylori infection should be eradicated before starting long-term PPI therapy.

上部消化管内視鏡検査で偶然発見されたHamartomatous inverted polypの1例

An 88-year-old woman was admitted to our hospital with general malaise. Upper gastrointestinal endoscopy revealed a submucosal tumor-like lesion in the body of stomach. Endoscopic ultrasonography (EUS) revealed the lesion to be in the submucosal layer with multiple cyst-like masses. As definitive diagnosis was difficult from these findings and adenocarcinoma could not be ruled out, we performed partial gastrectomy. Pathological examination revealed the mucosa invaginated into the submucosal layer. Based on these findings, we diagnosed the lesion as HIP. If one is able to suspect HIP, EUS becomes useful in its diagnosis. If it can be confirmed that the lesion is localized within the submucosal layer by EUS, minimally invasive treatments such as endoscopic submucosal dissection can be selected. HIP thus should be included in the differential diagnoses of protruding lesions in order to perform appropriate and accurate pre-operative diagnoses.

Imaging of common bile duct by linear endoscopic ultrasound.

Imaging of common bile duct (CBD) can be done by many techniques. Endoscopic retrograde cholangiopancreaticography is considered the gold standard for imaging of CBD. A standard technique of imaging of CBD by endoscopic ultrasound (EUS) has not been specifically described. The available descriptions mention different stations of imaging from the stomach and duodenum. The CBD lies closest to duodenum and choice of imaging may be restricted to duodenum for many operators. Generally most operators prefer multi station imaging during EUS and the choice of selecting the initial station varies from operator to operator. Detailed evaluation of CBD is frequently the main focus of imaging during EUS and in such situations multi station imaging with a high-resolution ultrasound scanner may provide useful information. Examination of the CBD is one of the primary indications for doing an EUS and it can be done from five stations: (1) the fundus of stomach; (2) body of stomach; (3) duodenal bulb; (4) descending duodenum; and (5) antrum. Following down the upper 1/3(rd) of CBD can do imaging of entire CBD from the liver window and following up the lower 1/3(rd) of CBD can do imaging of entire CBD from the pancreatic window. This article aims at simplifying the techniques of imaging of CBD by linear EUS.

Simultaneous Esophageal and Gastric Metastases from Lung Cancer.

We report of a patient with metastatic adenocarcinoma of the esophagus and stomach from lung cancer. The patient was a 68-year-old man receiving radiotherapy and chemotherapy for stage IV lung cancer, without metastases to the gastrointestinal (GI) tract at the time of the initial diagnosis. During the treatment period, dysphagia and melena newly developed. Upper GI endoscopy revealed geographic erosion at the distal esophagus and multiple volcano-shaped ulcers on the stomach body. Endoscopic biopsy was performed for each lesion. To determine whether the lesions were primary esophageal and gastric cancer masses or metastases from the lung cancer, histopathological testing including immunohistochemical staining was performed, and metastasis from lung cancer was confirmed. The disease progressed despite chemotherapy, and the patient died 5 months after the diagnosis of lung cancer. This is a case report of metastatic adenocarcinoma in the esophagus and stomach, which are very rare sites of spread for lung cancer.

Effects of different periods of gastric ischaemia in the viability of the tissue of body, fundus and antrum region of rabbit stomach.

BACKGROUND: Despite the rich vascular arcade of the stomach, gastric ischemia represents an important medical challenge and can be the consequence of obstructive or non-obstructive vascular processes of pathological or iatrogenic origin. AIM: To assess the effects of acute gastric ischaemia on the different regions of the stomach. METHOD: Fifteen New Zeland rabbits were divided into three groups: group 1, animals were observed during 3 h; group 2, during 6 h; group 3, during 12 h. Rabbit stomachs were subjected to devascularization of the greater and lesser curvatures. After predetermined time, the stomachs were removed for macro and microscopic studies. RESULTS: Haemorrhagic necrosis was more marked in the gastric fundus and body. In contrast, the antropylorus remained preserved in 80% of the animals. Necrosis of the gastric body and fundus mucosa were observed in all animals after 6 h and 12 h of ischaemia. CONCLUSION: Acute gastric ischaemia in rabbits produces haemorrhagic necrosis of the gastric fundus and body even in a short period of time. Beside this, the antropyloric region was significantly more resistant to ischaemia.

Mucous membrane pemphigoid as a cause of acute dysphagia - an endoscopic study.

Mucous membrane pemphigoid (MMP, formerly cicatricial pemphigoid) is a chronic autoimmune, subepithelial blistering disease usually of middle aged or elderly patients, more common in women. The prevalence is uncertain and the aetiology is still unknown. Target antigens are epithelial basement membrane proteins BPAG-1, BPAG-2, laminin-331, and laminin-332 [1]. Oral and conjunctival membranes are most frequently affected. Oesophageal involvement is rare but may be complicated with persistent dysphagia [2].

Gastrointestinal Involvement of Systemic Amyloidosis

Introduction: Amyloidosis presents with multiple organ system involvement at an annual incidence of approximately 3,000 cases in the U.S. It usually involves multiple organ systems, with the most common being renal and cardiac manifestations. Gastrointestinal (GI) system involvement is rare, occurring in approximately 3% of cases. Presentation may include hepatomegaly with or without splenomegaly and GI bleed; however, patients rarely present with GI bleed as the primary or sole symptom. We present a case of a patient who presented with symptoms of upper GI bleeding leading to esophagogastroduodenoscopy (EGD) and resultant biopsy diagnostic for amyloidosis. Case Report: A 72-year-old white male with PMH significant for peptic ulcer disease and coronary artery disease presented with 2 weeks of melena, fatigue, lower extremity edema, and increasing abdominal girth. In the emergency department, fecal occult blood testing was positive and the patient was admitted for suspected GI bleeding. EGD with biopsy was done, which revealed gastritis and polyps in fundus and body of stomach. Symptoms progressed to include acute renal failure with creatinine peaking at 1.6 mg/dL. Urinalysis showed nephrotic range proteinuria (>500 mg/dL). Pertinent labs included: AST 111 IU/L (5.0-34 IU/L), alkaline phosphatase 645 IU/L (40-150 U/L), serum albumin 1.5 g/dL (3.5-5.0 g/dL), and INR 1.3. Abdominal ultrasound showed ascites with a normal-appearing liver and normal-sized spleen. Ascitic fluid analysis resulted in a SAAG of 1.5 and protein of 0.8 g/dL, suggestive of portal hypertension. Gastric biopsy revealed amyloid deposits, positive for Congo red stain with apple green birefringence by polarized light. The patient underwent trans-jugular liver biopsy, which revealed near complete replacement of hepatic parenchyma with amyloid deposition confirming the diagnosis. The patient is currently being evaluated for further characterization, and pending studies include SPEP, UPEP, flow cytometry, skeletal survey, and bone marrow biopsy, which will dictate mode of treatment. Discussion: Amyloidosis is a systemic disease that may present with a constellation of symptoms. GI tract involvement with amyloid may result in occult bleeding in 45-75% of patients, which may be from ulceration, erosions, vascular fragility, and lack of vasomotor response. When present in the liver, amyloid may lead to portal hypertension and liver failure. In an infiltrative process such as amyloid, the elevation of alkaline phosphatase is most prominent. This is a rare case in which the presenting symptom of amyloidosis was GI bleeding and diagnosis was initially made by endoscopic biopsy.

Cystic Brunner's Gland Hamartoma in the Gastric Body: A Case Report.

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