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Zorzetti N, Lauro A, D'Andrea V, Ruffato A, Ferruzzi L, Antonacci N, Tranchino RM. Benign Blockage: Gastric Outlet Obstruction due to a Prolapsing Gastric Pedunculated Polyp-Case Report and Literature Review. Dig Dis Sci 2021; 66:1791-1795. [PMID: 33634429 DOI: 10.1007/s10620-021-06890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 12/09/2022]
Affiliation(s)
- N Zorzetti
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy.
| | - A Lauro
- Department of Surgical Sciences, La Sapienza University, Rome, Italy
| | - V D'Andrea
- Department of Surgical Sciences, La Sapienza University, Rome, Italy
| | - A Ruffato
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - L Ferruzzi
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - N Antonacci
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - R M Tranchino
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
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Miyake M, Nishimura N, Shimodate Y, Doi A, Mouri H, Matsueda K, Mizuno M. Early gastric cancer with ball valve syndrome treated by endoscopic submucosal dissection. Clin J Gastroenterol 2019; 12:307-309. [PMID: 30838513 DOI: 10.1007/s12328-019-00955-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
An 84-year-old woman with pneumonia, congestive heart failure and chronic renal failure presented for iron-deficiency anemia and appetite loss. Esophagogastroduodenoscopy revealed a 60-mm sub-pedunculated tumor arising from the antrum of the stomach. The tumor was friable, with bleeding, and prolapsed into the duodenal bulb, the ball valve syndrome. The tumor was considered the cause of the anemia and appetite loss. Attempted endoscopic reduction of the prolapsing tumor was unsuccessful, but the base of its stalk could be identified through the transparent hood; thus, we removed the tumor with endoscopic submucosal dissection. The tumor was retrieved successfully, and pathohistological examination revealed the tumor to be a well-differentiated adenocarcinoma. This case suggests that endoscopic submucosal dissection is useful as an alternative to surgery for removal of gastric tumors that have prolapsed into the duodenal bulb when polypectomy was difficult, but provided the tumor's attachment site can be identified endoscopically.
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Affiliation(s)
- Muneaki Miyake
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Naoyuki Nishimura
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Yuichi Shimodate
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Akira Doi
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hirokazu Mouri
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Motowo Mizuno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
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Marley LK, Repenning P, Frank CB, Hackett ES, Nout-Lomas YS. Transendoscopic Electrosurgery for Partial Removal of a Gastric Adenomatous Polyp in a Horse. J Vet Intern Med 2016; 30:1351-5. [PMID: 27238860 PMCID: PMC5089670 DOI: 10.1111/jvim.13979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 04/19/2016] [Accepted: 05/04/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- L K Marley
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - P Repenning
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - C B Frank
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - E S Hackett
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Y S Nout-Lomas
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
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4
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Pinto-Pais T, Fernandes S, Proença L, Fernandes C, Ribeiro I, Sanches A, Carvalho J, Fraga J. A Large Gastric Inflammatory Fibroid Polyp. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:61-64. [PMID: 28868375 PMCID: PMC5580130 DOI: 10.1016/j.jpge.2014.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/16/2014] [Indexed: 12/16/2022]
Abstract
Inflammatory fibroid polyp (IFP) is an unusual benign gastrointestinal subepithelial tumor (SET). The endosonographic (EUS) features of IFPs were sporadically reported on imaging tips or small case series study. However, the differential diagnosis and optimal treatment of gastric IFP is still challenging. We report an unusual case of a large erosioned and prolapsing gastric submucosal lesion, presenting primarily with obstructive symptoms ("ball valve syndrome") and anemia. On EUS examination, a 50 mm SET in the distal antrum was seen, with hypoechoic but heterogeneous echo-pattern, located in the second and third sonographic layers of the gastric wall (deep mucosal and submucosal). The fourth (muscle) layer was intact; no peri-lesional adenopathies were identified. A decision was made to proceed to endoscopic treatment because of the mentioned symptoms. Histopathologic evaluation of the resected specimen with immunohistochemical staining was consistent with the diagnosis of IFP. IFP rarely reach these large dimensions or cause symptoms. Despite its benign etiology, endoscopic resection was important in both establishing a histologic diagnosis and treatment. EUS was crucial in the differential diagnosis. The literature concerning IFP is also reviewed.
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Affiliation(s)
- Teresa Pinto-Pais
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sónia Fernandes
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Luísa Proença
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Carlos Fernandes
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Iolanda Ribeiro
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Agostinho Sanches
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - João Carvalho
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - José Fraga
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Park JS, Kwon CI, Jeong S, Kim K, Moon JH, Lee DH. Development of a swine bile duct dilation model using endoclips or a detachable snare under cap-assisted endoscopy. Gastrointest Endosc 2014; 80:325-9. [PMID: 24852106 DOI: 10.1016/j.gie.2014.03.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/20/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND A reproducible large animal model of bile duct dilation for the preclinical testing of new biliary devices and for training endoscopic biliary intervention is required. Surgical methods are mainly used to produce large animal models of biliary obstruction. OBJECTIVE To develop an animal model of bile duct dilation using endoscopic methods and to compare the merits of endoclips and detachable snares for the obstruction of major duodenal papillae. DESIGN Proof of concept experimental study. SETTINGS Animal laboratory. INTERVENTIONS Endoscopic clipping of the major duodenal papilla or closure of the major duodenal papilla with a detachable snare. MAIN OUTCOME MEASUREMENTS Feasibility, efficacy, and safety of endoscopic methods to develop swine models with bile duct dilation were estimated by degree of dilation at the common bile duct (CBD), intrahepatic duct (IHD), and gallbladder (GB). RESULTS All animals survived until the end of the experiment. Clipping of the major duodenal papilla and closure of the major duodenal papilla with a detachable snare were performed successfully in all swine. No technical difficulty or adverse event occurred during the procedures. Biliary dilatations in all animals were observed on cholangiograms (mean Δ% of postprocedural and preprocedural maximum diameters: CBD, 301%; IHD, 223.5%; GB, 34.8%). Degree of bile duct dilation in the snare group tended to be greater (CBD, 367.3%; IHD, 298.3%; GB, 47.8%) than in the endoclip group (CBD, 234.7%; IHD, 148.7%; GB, 21.8%), but this difference was not significant. An analysis of degrees of dilation according to location in the biliary tree showed that the GB was not dilated as well as the CBD or IHD. LIMITATIONS Animal model. CONCLUSION The 2 endoscopic procedures described are effective and safe for creating a swine model of bile duct dilation and could be helpful for training biliary intervention and for endoscopic biliary studies.
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Affiliation(s)
- Jin-Seok Park
- Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Chang-Il Kwon
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seok Jeong
- Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea; National Center of Efficacy Evaluation for the Development of Health Products Targeting Digestive Disorders (NCEED), Incheon, Korea
| | - Kwangil Kim
- Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Don Haeng Lee
- Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea; National Center of Efficacy Evaluation for the Development of Health Products Targeting Digestive Disorders (NCEED), Incheon, Korea; Utah-Inha DDS & Advanced Therapeutics Research Center, Incheon, Korea
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Antral hyperplastic polyp: A rare cause of gastric outlet obstruction. Int J Surg Case Rep 2014; 5:287-9. [PMID: 24747755 PMCID: PMC4066575 DOI: 10.1016/j.ijscr.2014.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 02/14/2014] [Accepted: 03/17/2014] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Gastric polyps are usually found incidentally during upper gastrointestinal endoscopic examinations. These polyps are generally benign, with hyperplasia being the most common. While gastric polyps are often asymptomatic, they can cause gastric outlet obstruction. PRESENTATION OF CASE A 64 years-old female patient presented to our polyclinic with a history of approximately 2 months of weakness, occasional early nausea, vomiting after meals and epigastric pain. A polypoid lesion of approximately 25mm in diameter was detected in the antral area of the stomach, which prolapsed through the pylorus into the duodenal bulbus, and subsequently caused gastric outlet obstruction, as revealed by upper gastrointestinal endoscopy of the patient. The polyp was retrieved from the pyloric canal into the stomach with the aid of a tripod, and snare polypectomy was performed. DISCUSSION Currently, widespread use of endoscopy has led to an increase in the frequency of detecting hyperplastic polyps. While most gastric polyps are asymptomatic, they can cause iron deficiency anemia, acute pancreatitis and more commonly, gastric outlet obstruction because of their antral location. Although there are no precise principles in the treatment of asymptomatic polyps, polyps >5mm should be removed due to the possibility of malignant transformation. CONCLUSION According to the medical evidence, polypectomy is required for gastric hyperplastic polyps because of the risks of complication and malignancy. These cases can be successfully treated endoscopically.
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Ball valve syndrome: gastric polypectomy as a safe endoscopic treatment of a potentially troublesome condition. Gastrointest Endosc 2012; 76:1080-1. [PMID: 23078940 DOI: 10.1016/j.gie.2012.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/18/2012] [Indexed: 12/11/2022]
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