Body Of Stomach Research Articles

Gastric Neoplasm – A Diagnostic Puzzle

Introduction: Paragangliomas are non-epithelial neuroendocrine tumors originating from neural crest derived paraganglion cells situated in the region of the autonomic nervous system ganglia and accompanying nerves. Very few cases of primary gastric paraganglioma have been reported in the literature till date. We report a rare case of primary gastric paraganglioma. Case Report: A 38 year old woman presented with history of melena and dyspepsia. Physical examination revealed mild tenderness in the right hypochondrium, and she was diagnosed to have gall stone disease. However, upper gastrointestinal endoscopy and contrast enhanced computed tomography whole abdomen revealed presence of a small elevated intraluminal lesion at the body of stomach along greater curvature and clinically diagnosed as gastrointestinal stromal tumor(GIST). Endoscopic biopsy report revealed a diagnosis of submucosal Brunner’s gland hamartoma. Laparoscopic cholecystectomy and laparoscopy assisted wedge resection of the stomach mass was done and the specimens were sent for histopathological examination. The stomach mass was diagnosed as paraganglioma which was confirmed by immunohistochemistry. Conclusion: Primary gastric paraganglioma is a very rare tumor. They are more difficult to diagnose if they are non-functional. Complete surgical excision is the first line treatment that can be performed with open surgical resection or laparoscopic technique.

The Effect of “Seiza” Sitting Position During Dzikr After Moslem Prayer on Stomach Circumference Changes: A Case Report

Introduction.The Japanese floor-sitting Seiza is reflected of femoral artery pinched, which improved of tissues oxygenation and circulation. It might play role on body metabolism, also the nerves system.Methods: Study was conducted on a 20-year-old obese man performed routinely dzikr with Seiza sitting, so the time duration counted. Stomach circumference and body weight was monitoring twice weekly until 1 month.Results: The stomach circumference measurements of 114 cm observed improvement, as at week 1 (1.75%), week 2 (0.88%), week 3 (63%), and week 4 (3.51%) underwent 316 to 334 seconds weekly of Seiza sittings. A 100,4 kg of body weight showed gradually improvement: 0.55%, 0.35%, 0.25%, and 1.89% in each weeks.Discussion: The Seiza sitting might be relate to St36 Meridian points. It stimulated of parasympathetic system, digest and absorption, aliementary glands activated, also fat metabolism.Conclusions: The Seiza sitting during dzikr after prayer might improve of body metabolism.International Journal of Human and Health Sciences Vol. 07 No. 02 April’23 Page: 202-206

Deep learning site classification model for automated photodocumentation in upper GI endoscopy (with video)

Background and AimsPhotodocumentation during EGD can be automated and standardized using deep learning (DL) models for anatomic site classification. EGD video data contain a significant number of suboptimal quality image frames for computational analysis (eg, off-center or blurry). We aimed to develop a DL model that extracts high-quality frames from EGD video data for anatomic classification.MethodsThe photodocumentation algorithm consisted of 2 image filters that extract high-quality image frames (appropriately centered, minimal to no blurriness) classified into 1 of 8 anatomic sites: esophagus, gastroesophageal junction, stomach body, fundus, angularis, antrum, duodenal bulb, and duodenum. Model training, testing, and internal validation were performed using 8231 EGD still images and 26,103 video-derived images with an even split among anatomic sites. Images were independently rated per category by 2 gastroenterologists. External validation was performed using an independent dataset of 2142 EGD still images. Model performance (accuracy, F1 score) for 5 EGD videos (6308 frames) was analyzed using a majority vote strategy across 5, 10, 20, and 30 consecutive frame windows.ResultsInternal testing and external validation for site classification showed overall accuracies of 98.1% and 95.0%, respectively; F1 scores ranged from 90.0% to 99.0% and 92.0% to 97.0% across anatomic sites, respectively. When applied to EGD video data, overall accuracies ranged from 89.7% to 94.8% across sampling window sizes.ConclusionsWe present a DL model capable of extracting high-quality frames from EGD video data and performing subsequent anatomic site classification with acceptable accuracy, allowing automated photodocumentation for consistent study quality and video indexing for annotated study review. Photodocumentation during EGD can be automated and standardized using deep learning (DL) models for anatomic site classification. EGD video data contain a significant number of suboptimal quality image frames for computational analysis (eg, off-center or blurry). We aimed to develop a DL model that extracts high-quality frames from EGD video data for anatomic classification. The photodocumentation algorithm consisted of 2 image filters that extract high-quality image frames (appropriately centered, minimal to no blurriness) classified into 1 of 8 anatomic sites: esophagus, gastroesophageal junction, stomach body, fundus, angularis, antrum, duodenal bulb, and duodenum. Model training, testing, and internal validation were performed using 8231 EGD still images and 26,103 video-derived images with an even split among anatomic sites. Images were independently rated per category by 2 gastroenterologists. External validation was performed using an independent dataset of 2142 EGD still images. Model performance (accuracy, F1 score) for 5 EGD videos (6308 frames) was analyzed using a majority vote strategy across 5, 10, 20, and 30 consecutive frame windows. Internal testing and external validation for site classification showed overall accuracies of 98.1% and 95.0%, respectively; F1 scores ranged from 90.0% to 99.0% and 92.0% to 97.0% across anatomic sites, respectively. When applied to EGD video data, overall accuracies ranged from 89.7% to 94.8% across sampling window sizes. We present a DL model capable of extracting high-quality frames from EGD video data and performing subsequent anatomic site classification with acceptable accuracy, allowing automated photodocumentation for consistent study quality and video indexing for annotated study review.

Mechanisms of action of rebamipide in the treatment of chronic erosive gastritis patients with type 1 diabetes mellitus

Introduction. Type 1 diabetes mellitus (DM-1) and its complications pose a serious medical and social problem. Erosive changes in the gastric mucosa are among the most common lesions of the digestive system in diabetes mellitus, and can lead to life-threatening gastrointestinal bleeding and early disability of patients.Aim. Substantiation of the effectiveness of rebamipid course treatment based on an assessment of the functional state and antioxidant activity of the supraepithelial gastric mucosa in chronic erosive gastritis in patients with DM-1.Materials and methods. A comprehensive examination of 12 DM-1 patients with erosive gastritis and 11 healthy individuals was carried out, including FGDS with biopsy of the antrum mucosa and stomach body, exclusion of Helicobacter pylori infection, determination of the biochemical composition of structural glycoproteins of mucus and the concentration of degraded glycoproteins, evaluation of the antiradical activity of the supraepithelial mucous layer of the stomach.Results and discussion. In chronic erosive gastritis in patients with DM-1, a significant predominance of degraded monosaccharides in the supraepithelial mucous layer of the stomach was revealed (6 times higher than in healthy individuals), a decrease in the concentration of polymerized glycoproteins in gastric mucus (21% vs. 80%) and a significant increase in the antiradical activity of mucus. Course treatment of chronic erosive gastritis in patients with type 1 diabetes with rebamipid at a dose of 100 mg 3 times a day for 3 weeks contributes to the normalization of the indicators of glycoproteins of native mucus, antiradical activity of the mucosa and complete epithelization of the erosions of the antrum of the stomach.Conclusions. The use of rebamipid in the treatment of chronic erosive gastritis in patients with type 1 diabetes contributes to reducing the degradation of polymerized glycoproteins of native mucus, normalizing the antiradical activity of the mucosa and complete epithelization of erosions of the antrum of the stomach.

Comparative morphological characteristics of helicobacter pylori and autoimmune gastritis

Objective: to conduct a comparative morphological analysis of helicobacter pylori (H. pylori) and autoimmune gastritis and to determine the significant morphological criteria for differential diagnosis.Materials and methods. 30 cases of chronic atrophic helicobacter gastritis and 30 cases of chronic atrophic autoimmune gastritis were retrospectively selected for the study. In all cases of helicobacter gastritis, the presence of H. pylori was confirmed by morphological diagnostic methods using Giemsa staining or additionally using immunohistochemistry. All cases of autoimmune gastritis were additionally confirmed by clinical and laboratory diagnostic methods, some patients had a long history of follow-up and biopsy material was taken from them repeatedly. A prerequisite was taking at least 5 biopsies according to the Sydney Protocol.Results. The main differential diagnostic feature in our study was the detection of H. pylori, as well as the localization of the lesion in the stomach body characteristic of autoimmune gastritis and in the antrum in helicobacter gastritis. The study groups differed by gender (the predominance of females in the group of autoimmune gastritis), the prevalence and activity of inflammation (all cases of helicobacter gastritis had signs of inflammation activity). When studying the content of neuroendocrine cells in cases of helicobacter gastritis in the stomach body, simple hyperplasia of neuroendocrine cells was noted, in cases of autoimmune gastritis, the appearance of chains and nodules was noted, which corresponded to linear and nodular hyperplasia of neuroendocrine cells.Conclusion. The morphological criteria obtained in the study make it possible to make a differential diagnosis between helicobacter and autoimmune gastritis. This is extremely important because of the differences in treatment approaches and dynamic monitoring tactics in these variants of chronic gastritis.

Simultaneous Imaging of Ga-DOTA-TATE and Lu-DOTA-TATE in Murine Models of Neuroblastoma.

68Ga-DOTA-TATE and 177Lu-DOTA-TATE are radiolabeled somatostatin analogs used to detect or treat neuroendocrine tumors. They are administered separately for either diagnostic or therapeutic purposes but little experimental data for their biokinetics are measured simultaneously in the same biological model. By co-administering 68Ga-DOTA-TATE and 177Lu-DOTA-TATE in three laboratory mice bearing two IMR32 tumor xenografts expressing different levels of somatostatin receptors (SSTRs) on their shoulders and imaging both 68Ga and 177Lu simultaneously, we investigated the relationship between the uptake of 68Ga-DOTA-TATE and 177Lu-DOTA-TATE in organs and tumors. In addition, using the percent of injected activity (%IA) values of 68Ga-DOTA-TATE at 0 hr and 4 hr, we investigated the correlation between 68Ga-DOTA-TATE %IA and the time-integrated activity coefficients (TIACs) of 177Lu-DOTA-TATE to estimate the organ-based and tumor-based doses of 177Lu-DOTA-TATE. The results showed that the extrapolated clearance time of 68Ga-DOTA-TATE linearly correlated with the TIACs of 177Lu-DOTA-TATE in the IMR32-SSTR2 tumor, kidneys, brain, heart, liver, stomach and remainder body. The extrapolated %IA value at 0 hr of 68Ga-DOTA-TATE linearly correlated with the TIACs of 177Lu-DOTA-TATE in the IMR32 tumor and lungs. In our murine study, both kidneys and lungs were organs that showed high absorbed doses of 177Lu-DOTA-TATE.

GASTRIC ULCER PERFORATING POSTERIORLY – A RARE CASE REPORT WITH REVIEW OF LITERATURE

The population studies have shown that peptic perforation remains a major health problem worldwide. The lifetime frequency of peptic ulcer diseases in United States has been shown to be approximately 10%. The epidemiology of peptic ulcer is showing declining trend in India over last two decades. The frequencies of both duodenal ulcer and gastric ulcer showed a decline from 1988 to 2008 that is from 12% to 2.9% and 4.5% to 2.7% respectively. Although there is decreasing trend in peptic ulcer diseases, complications are encountered in 10-20% of cases and 2-14% of ulcers perforate. Peptic ulcer can occur in body of stomach, lesser curvature, and pylorus to duodenum. These perforate most commonly on anterior aspect of duodenum. However anterior or incisural gastric ulcers may perforate posteriorly in to lesser sac, which can be particularly difficult to diagnose as these may not have symptoms of peritonitis even. If peritonitis is present and perforation not found on normal course then, they should be looked over in lesser sac also.

Large variations between NICU nurses in predicting nasogastric tube insertion length in a mannequin study.

To evaluate the inter- and intraindividual variation of predicted nasogastric tube insertion lengths by nurses working in two neonatal intensive care units in the Netherlands, using a mannequin model. A total of 110 nurses (55 nurses from Center A and 55 from Center B) were asked to predict the nasogastric tube insertion length on a neonatal mannequin. We evaluated the length and prediction method used by the nurses. We also estimated the number of tubes that would have correctly been placed in the stomach of a neonate according to the seize of the mannequin. The mean predicted insertion length of the nasogastric tube was 30.0cm with an interindividual variation of 12cm (range 24-36cm). The mean intraindividual variation was 0.75cm. The two centers used two different prediction methods in their local guidelines, but overall at least 6 different methods were used by the nurses. We estimated that 77% (85/110) of the tubes would have ended in the body of the mannequins stomach, while 10% (11/110) would have ended in the esophagus and 13% (14/110) would have ended against the stomach lining or in the duodenum. Nurses in two neonatal intensive care units used many different methods which lead to a large interindividual variation in predicted insertion lengths of the nasogastric tubes. Regular evaluations using this mannequin model could lead to more uniformity and reduce the risk of tube misplacement in neonates.

Features of gastric cancer by anatomic subsite in northern China: A multi-center Health Science Report database study.

The features of gastric cancer based on the anatomic site remain unknown in northern China patients. To analyze gastric cancer features and associated trends based on the anatomical site in northern China patients. This cross-sectional study used incident gastric cancer case data from 10 Peking University-affiliated hospitals (2014 to 2018). The clinical and prevailing local features were analyzed. A total of 10709 patients were enrolled, including antral (42.97%), cardia (34.30%), and stomach body (18.41%) gastric cancer cases. Cancer in the cardia had the highest male:female ratio, proportion of elderly patients, and patients with complications, including hypertension, diabetes, cerebrovascular, and coronary diseases (P < 0.001). gastric cancer involving the antrum showed the lowest proportion of patients from rural areas and accounted for the highest hospitalization rate and cost (each P < 0.001). The proportion of patients with cancer involving the cardia increased with an increase in the number of gastroesophageal reflux disease cases during the same period (P < 0.001). Multivariate analysis revealed that tumor location in the cardia increased the risk of in-hospital mortality (P = 0.046). Anatomical subsite was not linked to postoperative complications. The features of gastric cancer based on the anatomical site differ between northern China and other regions, both globally and within the country. Social factors may account for these differences and should affect policy-making and clinical practice.

SoRSS: A Soft Robot for Bio-Mimicking Stomach Anatomy and Motility.

A human stomach is an organ in the digestive system that breaks down foods by physiological digestion, including mechanical and chemical functions. The mechanical function is controlled by peristaltic waves generated over the stomach body, known as antral contraction waves (ACW). The stomach's physiological digestion is essential to sustain nutrition and health in humans. Replicating the digestion process in a robot provides a test environment as an alternative solution to in vivo testing, which is difficult in practice. Stomach robots made of rigid rods and metal cylinders are unrealistic replicas to contract and expand like biological examples. With soft robotics technology, it is possible to translate biological behavior into an engineering context. Soft robotics introduce potential methods to replicate peristaltic waves and achieve a soft-bodied stomach simulator. This work presents a soft robotic stomach simulator's (SoRSS) concept, design, and experimental validation. A pneumatic bellows actuation for linear elongation and a ring of bellows actuation for circular contraction are proposed first. Multi-ring actuators are then arranged to form an SoRSS that generates ACW and antral contracting pressure (ACP). The SoRSS satisfies the specification of human stomach anatomy and motility and finally undergoes experimental validation using videofluoroscopy with the outcomes presenting the ACW, ACP, and the digestion phases during the actuation process. Those are compared with other medical studies to validate SoRSS functionality.

Equine Stomach Development in the Foetal Period of Prenatal Life-A Histological and Histometric Study.

Histological and morphometrical analysis of the stomach wall was performed during the foetal period divided into three age groups (4th-11th month of gestation). The material was taken from non-glandular (the blind ventricular sac) and glandular parts (the plicated edge margin/cardiac part, the body of stomach and the pyloric part) of the stomach. It was preserved and prepared according to the standard protocol. The histological slides were stained (H-E, Masson-Goldner and PAS). The analyses were performed using the light microscope. All measurements were statistically elaborated. The crown-rump length growth rate was estimated as isometric. The blind ventricular sac growth rate was lower than CRL (negative allometric) and the partition of stomach mucosa into non-glandular and glandular part occurred in the 1st age group. The plicated edge margin/cardiac part and the pyloric part shoved similar tendencies. Only the body of stomach demonstrated a higher growth rate than CRL (positive allometric), which can be explained due to the strongest development of fundic glands. Moreover, comparing the adult reference group to the three parts of the foetal period, all metric values were lower than those achieved prenatally. The blind ventricular sac was covered with the multiple plane epithelium. The glandular parts of stomach that formed the superficial concave areas were covered with the simple columnar epithelium in the 1st age group, which developed to the cardiac, fundic, and pyloric glands in the 2rd and 3rd age groups. The propria mucosae was built with the mesenchyme, which differentiated later to the loose connective tissue. The muscular layer of mucosa was not clearly distinguishable in the 1st age group. The muscular layer of the stomach wall was formed with myoblasts in the 1st age group and later in the 2nd and the 3rd age groups built with fusiform myocytes divided into internal and external layers. The non-differentiated cells of glandular epithelium transformed into the parietal and chief cells. The first were visible in the gastric glands of the 2nd age group. Both of them were present in the 3rd age group gastric mucosa. The PAS staining proved a moderate PAS-positive reaction in the 2rd age group, while it was estimated as intense Pas-positive in the gastric glands in the 3rd age group and was comparable to postnatal observation (the adult reference group).

Hyperplasia of enterochromaffin-like (ECL) cells as a precursor of neuroendocrine gastric tumors in autoimmune gastritis

The purpose of this publication is to update knowledge about chronic autoimmune gastritis and about cases of hyperplasia of enterochromaffin-like (ECL) cells as precursors of the development of neuroendocrine gastric tumor type 1 due to clinical example’s demonstration. Discussion: the types and main characteristics of neuroendocrine tumors of the stomach were discussed, in particular tumors type 1 associated with autoimmune gastritis. The mechanisms of formation of neuroendocrine tumors in the stomach against the background of an autoimmune process were presented, two clinical examples presenting the algorithm of diagnosis of autoimmune gastritis and associated neuroendocrine tumors were presented. Both clinical examples demonstrated the presence of subepithelial formations of the stomach body according to FGDS, which have not been morphologically identified. Timely repeated FGDS with sampling of biopsies according to the OLGA standard made it possible to verify the formations, and the serological markers helped in clarifying the diagnosis and morphological nature of tumors. Conclusion: analysis of clinical data, anamnesis and esophagoduodenoscopy with morphological evaluation of the gastric mucosa biopsy may help to find out the cause and nature of chronic inflammation in the gastric mucosa. Atrophy of the glands in the stomach body, pseudopiloric metaplasia, hyperplasia of enterochromaffin (ECL) cells are sufficient morphological criteria for autoimmune gastritis. The study of the level of chromogranin A in blood serum can be considered as a marker of the development of type 1 neuroendocrine gastric tumor in patients with autoimmune gastritis and the presence of polyps in the stomach body.

Laparoscopic distal gastrectomy for gastric cancer in a patient with situs inversus: a case report

BackgroundSitus inversus (SI) is a rare congenital condition characterized by organ transposition from their normal positions. Careful preoperative planning is important for the safe operation of patients with SI because only a few surgeons have operated on such patients. Here, we report the case of a patient with SI who underwent laparoscopic distal gastrectomy (LDG) with D2 lymph node dissection (LND) for advanced gastric cancer (GC).Case presentationThe patient was a 72-year-old man diagnosed with GC. Upper endoscopy revealed a type 3 tumor in the anterior wall of the stomach body. Multidetector computed tomography showed no obvious GC metastasis or inverted organs. The preoperative diagnosis was cStage IIB (i.e., cT3, cN0, and cM0) GC with SI. Although liver retracting and intracorporeal suturing required special attention, LDG with D2 LND and Billroth-I reconstruction were safely performed by reversing the usual procedure. The patient was discharged 10 days after the surgery.ConclusionsTo safely perform laparoscopic surgery for GC in patients with SI, sufficient preoperative preparation is necessary. In particular, a reversible method of liver retraction should be prepared.

S2657 Successfully Treated Severe Cameron Type Ulcer in a Recurrent Morgagni Hernia: A Case Report

Introduction: Morgagni hernias are rare diaphragmatic hernias located in the anterior or retrosternal areas and comprise only 2-5% of congenital hernias. There are only a handful of cases in the literature in which these hernias present with upper gastrointestinal bleeding. Typical endoscopic treatments can be limited due to anatomic and technical reasons. We present a patient with successfully treated upper gastrointestinal bleed from a recurrent Morgagni hernia. Case Description/Methods: A 44-year-old Native American male presented with four days of weakness and orthostatic hypotension to the emergency department. Medical history included a Morgagni hernia repair with Nissen fundoplication many years ago with ongoing tobacco and aspirin use. He had three melanotic stools over the preceding two weeks along with a 50-pound unintentional weight loss over the last year. He was tachycardic and hypotensive with an initial hemoglobin of 5.3. Following resuscitation with transfusions and intravenous fluids, he underwent an EGD which showed three ulcers causing circumferential stenosis in the mid-gastric body near the hernia. Two ulcers were superficial without stigmata of bleeding and the third was cratered with a visible vessel without active hemorrhage. After injection with 1:10,000 epinephrine, the ulcer was treated with bipolar diathermy along with placement of three clips along the ulcer base. Gastric biopsies were negative for H. pylori. He was referred to surgery after hospital discharge for repair of the recurrent Morgagni hernia. He was lost to follow-up and suffered a myocardial infarction two years later. He developed a gastric outlet obstruction from the hernia which improved with conservative management. He eventually underwent surgical repair of the hernia without recurrence. (Figure) Discussion: Morgagni hernias are rare congenital diaphragmatic hernias. These hernias usually develop on the right side of the diaphragm and can be found incidentally during chest or upper abdominal imaging. They originate from failure of the pars tendinalis of the costochondral arches fusing with the pars sternalis. The underlying pathophysiology of bleeding is similar to that of Cameron type lesions from erosion due to the hernia rubbing the diaphragm defect. Typical endoscopic treatments can be limited due to anatomic and technical reasons, however, in this patient bipolar cautery and clipping achieved hemostasis. Definitive management of Morgagni hernias include surgery to prevent complications including incarceration.Figure 1.: A - Vessel oozing after initial contact in stomach view prior to clipping on EGD B - Upper GI Series showing recurrent Morgagni Hernia with first portion of duodenum above hernia defect on right side with stomach body and GE junction below the diaphragm C - CT showing Morgagni hernia prior to initial repair with stomach antrum in right chest and stomach body under left diaphragm.

S3685 Unusual Stomach Mass: Gastric Metastasis of Malignant Leiomyosarcoma

Introduction: Metastases in the stomach are rare findings, and likely represent a progressive malignant disease. With reported incidence of 0.2%-0.7%, the tumor can spread through hematogenous, lymphatic direct and peritoneal dissemination. Gastric metastases of leiomyosarcoma (LMS), a rare malignant mesenchymal smooth muscle tumor, have only been documented in a handful of case reports. We present a case of metastatic leiomyosarcoma in the stomach presenting with gastrointestinal bleeding. Case Description/Methods: A 64-year-old male with history of metastatic LMS of his left lower extremity came with melena for 3 days. Hemoglobin on presentation was 8.7 g/dl from his baseline of 13-14g/dl. He was diagnosed with grade 3 LMS 3 years ago, involving femoral vessel wall and muscle of his left thigh. He underwent radical excision without any adjuvant chemo and radiotherapy despite recommendations. He subsequently developed metastasis to the lung two years later at which time he started chemotherapy. An esophagogastroduodenoscopy revealed a 6 mm mucosal nodule and a 3 cm mass with a clean based ulcer in the body of stomach. Biopsy, however, was negative for malignancy. He then underwent endoscopic ultrasound guided biopsy for cytology which revealed malignant spindle cell neoplasm in the background of lymphoid tissue consistent with metastatic LMS (Figure 1). Discussion: LMS, a malignant tumor of smooth muscle origin, represents 20%-30% of soft tissue sarcomas. Predominantly uterine in origin, it can arise from the peritoneum, extremities, and blood vessels. Primary gastric LMS has also been reported in literature, but they are extremely rare and now are considered a type of gastrointestinal stromal tumor. LMS has a rapid tendency to metastasize, with lung, peritoneum, bone, and liver being common targets. Some rare cases of LMS metastasizing to pancreas, stomach and oral cavity have been reported. In general, metastases to the stomach are uncommon. The most common gastric metastases come from breast, lung, renal cell cancer and malignant melanoma. Metastasis of LMS to gastric mucosa has been limited to only a handful of case reports with primary tumors arising from kidney, uterus, and broad ligaments. The lesions are described as nodules, submucosal tumors, and ulcerative lesions, most of which are asymptomatic but can present as GI bleeding and abdominal pain. These metastases typically portray a poor prognosis. Local excision of the primary lesion with hormonal therapy and chemotherapy is considered standard treatment.Figure 1.: A. Endoscopic appearance of the metastatic LMS as a gastric body mass with clean based ulcer B. Endosonographic image of the mass in the gastric image.

S3675 Steroid Treatment for Patient With Intractable Nausea, Vomiting and Abdominal Pain With Underlying Autoimmune Gastritis

Introduction: Gastritis and cannabinoid hyperemesis syndrome (CHS) share many overlapping symptoms: nausea and vomiting (N&V), and abdominal pain.1 With the continued legalization and adoption of marijuana in the United States, it will become crucial to determine the etiology of the aforementioned cardinal symptoms to improve treatment plans. Case Description/Methods: Pleasant 29-year-old male with PMH of N&V in teen years presents with onset of nausea and episodes of vomiting over the last few months. Patient complained of heightened baseline nausea, exacerbations of post-prandial N&V, and occasional N&V without food. Claims bloating and denied dysphagia, GERD, headaches, or visual changes. Minimal relief with use of marijuana and ondansetron and adverse symptoms with promethazine. EGD was performed with subsequent gastric biopsy positive for H. pylori with concurrent autoimmune gastritis and underlying intestinal metaplasia; erythema and erosions found in the antrum and stomach body. Progressive worsening of symptoms, 20 lbs weight loss and LLQ abdominal pain prompted EGD and colonoscopy six weeks after initial upper endoscopy. Prior to EGD/Colonoscopy, patient reported previous history of yearly idiopathic pericarditis which is believed to be autoimmune in nature. Gastric mapping upon his second EGD showed ongoing autoimmune gastritis of the gastric body (lesser and greater curve). Prednisone 40 mg was started for patient with full resolution of GI symptoms in three weeks. Discussion: Patient’s initial symptoms were believed to be related to CHS. However, further EGD evaluation and patient’s updated PMH of pericarditis suggest a possible autoimmune origin. With steroid use, patient found resolution with N&V and abdominal pain. Hallmark symptoms of CHS are abdominal pain and recurring episodes of N&V with the cessation of adverse symptoms when cannabis use is stopped. If symptoms persist past cessation of cannabinoids, other sources of intractable N&V need to be evaluated. In the setting of autoimmune gastritis, with intractable nausea, vomiting, and abdominal pain, a trial of short-term steroids can be considered in a patient that has otherwise refractory GI symptoms, despite treatment of H Pylori and conservative pharmacologic management.

S2631 The Unusual Suspect: Gastrointestinal Bleeding From an Ampullary Dieulafoy Lesion

Introduction: Dieulafoy lesions (DLs) are an unusual but important cause of acute upper gastrointestinal bleeding (UGIBs), and can be difficult to diagnose. Three fourths are found in the stomach close to the gastroesophageal junction, but have also been reported in small bowel and colon. There are only a few reported cases of ampullary DLs. We present a rare case of a recurrent UGIB from an ampullary Dieulafoy lesion and its management. Case Description/Methods: A 65-year-old male presented for type B aortic dissection requiring endovascular repair, which was complicated by type 1 endoleak. His hospital course was complex owing to sepsis, respiratory failure, and cardiac arrest. Gastroenterology was consulted on day 16 for multiple tarry bowel movements. Esophagogastroduodenoscopy (EGD) showed healing ulcers in lower esophagus. and non-bleeding ulcers in the duodenal bulb. The culprit lesion was an oozing Dieulafoy at the major papilla. Hemostasis was achieved with epinephrine injection and thermal therapy. Rebleeding occurred 5 days after the initial EGD leading to shock and cardiac arrest. Once the patient was hemodynamically stabilized, he underwent another EGD that showed copious fresh blood in stomach body as well as the second and third portions of duodenum. Active arterial spurting was noted from the superior aspect of major papilla. Given the severe hemodynamic compromise from this bleeding, we elected to clip the lesion this time, accepting the risk of pancreatitis and/or biliary obstruction. One endoclip was placed across the dorsal aspect of major papilla and closed. Persistent oozing was noted from under the clip which was arrested by applying a hot snare to the already placed endoclip and delivering thermal energy to the area pinched by the endoclip. Complete hemostasis was then achieved [Figure 1]. Liver function tests and lipase were monitored for a week and the patient did not develop pancreatitis or biliary obstruction despite placement of endoclip across the major papilla. Discussion: Ampullary DLs are extremely rare and can present a unique diagnostic and therapeutic challenge due to their anatomical location. There is currently no consensus on how to best treat ampullary DLs. Verification of the diagnosis and definitive treatment might require repeated examinations. Early and aggressive endoscopic treatment should be adopted when an ampullary DL is suspected, and patients should be closely followed up given therapeutic interventions can potentially impair biliary drainage.Figure 1.: Endoscopic images of bleeding from ampullary Dieulafoy lesion before and after endoscopic intervention.

S2247 Gastric Irritation Noted in Patients Using New Tablet-Based Colonoscopy Preparation

Introduction: In November 2020, the FDA approved a novel colonoscopy preparation, a tablet-based bowel prep containing poorly absorbed sulfate salts. This case series includes 3 patients undergoing upper and lower endoscopy who were found to have gastric irritation thought to be caused by this bowel preparation. Case Description/Methods: A 35-year-old male with gastroesophageal reflux presented with 5-day history of hematochezia and abdominal pain. He underwent colonoscopy which showed internal hemorrhoids and esophogastroduodenoscopy (EGD) showed ulceration of the stomach body (Figure, top left). Biopsies showed focal active gastritis and superficial erosion without H. pylori organisms. The patient started daily PPI and 3 months later repeat EGD showed normal mucosa both visually and pathologically. A 59-year-old female endorsed abdominal bloating and heartburn after completing treatment for H. pylori 1-month prior. She underwent EGD with colonoscopy (for screening). EGD showed multiple diminutive round erythematous spots in the stomach antrum with pinpoint foci of dark heme suggestive of hemorrhagic gastritis (Figure, top right). Biopsies showed moderate inactive chronic inflammation without H. pylori organisms. A 70-year-old female requested endoscopy as she had a personal history of remote H. pylori infection and her father had gastric cancer. On EGD, there were superficial erosions in the lesser curve of the stomach (Figure, bottom 3). Biopsies were obtained and showed gastric mucosa with reactive epithelial changes without evidence of H. pylori infection. Discussion: The preparation consists of 24 tablets total, each taken with 16 ounces of water. The ingredients include magnesium sulfate, potassium chloride, and sodium sulfate. The sulfate salts are responsible for the osmotic and therefore laxative effects of the medication. Potassium chloride is included to avoid diarrhea induced hypokalemia. Potassium chloride is a mucosal irritant that has been reported to cause upper gastrointestinal ulcers and erosions. In each case, gastric irritation was an unexpected finding in a patient without significant risk factors for developing gastric ulcers. The common factor among them all is the same tablet-based preparation used for colonoscopy. Noted was a similar pattern of ulceration in the gastric antrum and body noted in these patients, which was in a pattern of the tablets resting on the greater curve of the stomach. While gastric ulceration may be asymptomatic, it may lead to diagnostic confusion and further unnecessary workup.Figure 1.: Colonoscopy images.

Identificação dos ramos tributários da veia porta hepática na preguiça-comum, Bradypus variegatus Schinz, 1825 (Pilosa: Bradypodidae)

ABSTRACT Bradypus variegatus, the common sloth, belongs to the Bradypodidae family, being considered a biological model to be applied in multidisciplinary research. This study was developed with the aim of being applied to clinical medicine and to the adequate management of the common sloth. Ten sloths were utilized, obtained post-natural death. The animals were fixed and to obtain the results, they were submitted to the dissection technique. For 80% of the animals, the portal vein originated from five tributaries, which were: the resulting vein from the anastomosis of the cardia vein, fundic vein, and the pyloric branches; the mesenteric trunk; the vein formed by the confluence of the stomach body branches and the cranial portion of the cavity of the cardia; the pyloric vein and splenic vein. While in 20% of the animals, the portal vein was comprised of six tributaries, because the fundic vein and cardia vein form two direct anastomoses, arriving at the portal vein two tributary vessels. This pattern differs in number and arrangement of branches when compared to the main domestic species. Therefore, the hepatic portal system is responsible for the drainage of the stomach, spleen, pancreas and intestines.

Gastric metastasis of primary testicular mixed germ cell tumor: a case report

Testicular cancer is the most common solid tumor in men between ages 15 and 29. It can metastasize through the hematogenous or lymphatic routes to different organs such as the lung and liver (common) and the stomach (uncommon). We present thecase of a 30-year-old male patient with upper gastrointestinal bleeding due to two ulcers in the stomach body with histology of unspecified small-cell malignant neoplasm. CT scans showed a right testicular tumor with secondary implants in the brain, lung, liver and spleen. β-HCG (35,5354 mIU/mL), AFP (500 ng/mL) and LDH (1,669 IU/L) tests were conducted. A right radicalorchiectomy was performed. It is concluded that this was a clinical stage IIIC primary germ cell tumor of the right testis due to liver, spleen, lung, gastric and brain metastases.