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Korekawa K, Kunimitsu A. Endoscopic sealing hemostasis with polyglycolic acid sheet and fibrin glue as a novel endoscopic hemostatic technique: a report of three cases. Clin J Gastroenterol 2024:10.1007/s12328-024-01975-2. [PMID: 38678154 DOI: 10.1007/s12328-024-01975-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
Polyglycolic acid sheets and fibrin glue are routinely used in surgical procedures. Their usefulness in gastrointestinal endoscopy is mainly to prevent complications (bleeding, delayed perforation, stenosis, etc.) associated with procedures such as endoscopic submucosal dissection and endoscopic mucosal resection, with most reports on iatrogenic and secondary conditions. However, there are few reports on primary gastrointestinal diseases. Herein, we report three cases of gastrointestinal bleeding that were successfully treated with endoscopic hemostasis by sealing the lesions with polyglycolic acid sheets and fibrin glue. Case 1 was of an 83-year-old woman with a rare duodenal perforation that was treated with omental plugging who experienced subsequent bleeding from the greater omentum. Case 2 was of a 73-year-old woman with an acute hemorrhagic rectal ulcer that was difficult to treat even after performing standard endoscopic hemostasis techniques; however, surgery was avoided by sealing. Case 3 was that of an 89-year-old woman with a stercoral ulcer, treated curatively using a combination of sealing and argon plasma coagulation right from presentation based on the lessons learned from Cases 1 and 2. Endoscopic hemostasis using a polyglycolic acid sheet and fibrin glue may be a new treatment option for gastrointestinal bleeding particularly in refractory or rare causes.
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Affiliation(s)
- Kai Korekawa
- Department of Gastroenterology, Hachinohe City Hospital, Hachinohe, Aomori, 031-0011, Japan.
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Atsushi Kunimitsu
- Department of Gastroenterology, Hachinohe City Hospital, Hachinohe, Aomori, 031-0011, Japan
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
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Korekawa K, Naito T, Fujishima F, Nagai H, Shimoyama Y, Moroi R, Shiga H, Kakuta Y, Masamune A. Small bowel cancer in a patient with Crohn's disease diagnosed preoperatively by double-balloon enteroscopy. Clin J Gastroenterol 2023; 16:836-841. [PMID: 37597132 DOI: 10.1007/s12328-023-01846-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
A 53-year-old female patient, who had been treated for Crohn's disease for approximately 20 years, was admitted to our hospital with a chief complaint of persistent bloody stools. Colonoscopy, computed tomography, and magnetic resonance enterography revealed two stenoses of the ileum and multiple enlarged lymph nodes around the oral-side ileal stenosis. We accordingly performed transoral double-balloon enteroscopy and found ileal stenosis with an irregular mucosal surface. Based on pathological examination of the stenosis, adenocarcinoma of the small bowel was diagnosed for the oral-side stenosis. The stenosis on the anal side was benign. The two stenoses were resected simultaneously, and lymph node dissection was performed on the cancerous lesion. The diagnosis of the cancerous lesion was pStage IIIB, and immunohistochemical staining was positive for tumor protein 53. Patients with Crohn's disease are at a high risk of small bowel cancer, but no surveillance protocol has been established to date. We encountered a case of Crohn's disease in which radical surgery was possible, owing to preoperative pathological diagnosis, by using balloon-assisted enteroscopy. In this paper, we report a case that suggests the importance of performing balloon-assisted enteroscopy when small bowel stenosis is detected in patients with Crohn's disease.
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Affiliation(s)
- Kai Korekawa
- Division of Gastroenterology, Tohoku University Graduates School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Takeo Naito
- Division of Gastroenterology, Tohoku University Graduates School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan.
| | - Fumiyoshi Fujishima
- Department of Pathology, Tohoku University Graduates School of Medicine, Miyagi, Japan
| | - Hiroshi Nagai
- Division of Gastroenterology, Tohoku University Graduates School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Yusuke Shimoyama
- Division of Gastroenterology, Tohoku University Graduates School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Rintaro Moroi
- Division of Gastroenterology, Tohoku University Graduates School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Hisashi Shiga
- Division of Gastroenterology, Tohoku University Graduates School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Yoichi Kakuta
- Division of Gastroenterology, Tohoku University Graduates School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduates School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
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Korekawa K, Orikasa M, Kunimitsu A. Intestinal Obstruction Due to Reassembly after Endoscopic Crushing of a Bezoar. Intern Med 2023; 62:2965-2969. [PMID: 36889702 PMCID: PMC10641210 DOI: 10.2169/internalmedicine.1582-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/01/2023] [Indexed: 03/09/2023] Open
Abstract
An 87-year-old woman visited her primary-care doctor because of nausea and epigastric pain. Esophagogastroduodenoscopy (EGD) revealed a giant bezoar in her stomach. She was referred to our hospital after carbonated beverage dissolution proved ineffective and underwent endoscopic mechanical crushing. After crushing, the symptoms disappeared, and she began eating. Later, however, the crushed fragments reassembled in the duodenal bulb and caused intestinal obstruction. The patient underwent emergency EGD for crushing once more, and all of the fragments were extracted from the body. This case highlights the need for bezoars to be removed from the body after crushing in order to avoid reassembly.
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Affiliation(s)
- Kai Korekawa
- Department of Gastroenterology, Hachinohe City Hospital, Japan
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | | | - Atsushi Kunimitsu
- Department of Gastroenterology, Hachinohe City Hospital, Japan
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
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Korekawa K, Kunimitsu A, Morishima R. Microsatellite Instability-high-positive Cancer of Unknown Primary Origin with a Long-term Survival after Surgery Alone. Intern Med 2022; 61:3301-3308. [PMID: 35650125 PMCID: PMC9683802 DOI: 10.2169/internalmedicine.9218-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 80-year-old woman was referred to our hospital for a thorough examination of enlarged lymph nodes on the lesser curvature of the stomach. Upon suspicion of malignant lymphoma, the patient underwent open lymphadenectomy and was diagnosed with lymph node metastasis of poorly differentiated adenocarcinoma. The patient was subsequently diagnosed with microsatellite instability-high cancer of unknown primary origin. Surgical removal of the affected lymph nodes achieved full remission. Chemotherapy was considered in case of recurrence or identification of the primary site. Recurrence has not occurred in three years since the surgery. However, a long-term survival without chemotherapy is rare.
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Affiliation(s)
- Kai Korekawa
- Department of Gastroenterology, Hachinohe City Hospital, Japan
- Division of Gastroenterology, Tohoku University Graduates School of Medicine, Japan
| | - Atsushi Kunimitsu
- Department of Surgery, Hachinohe City Hospital, Japan
- Division of Surgery, Tohoku University Graduates School of Medicine, Japan
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Hirayama Y, Takai C, Korekawa K, Saito M, Akasaka A, Nagasawa H, Iwai W, Hachimori H, Satoh M, Yajima N, Oki M. Gastric Arteriovenous Malformation with Characteristic Endoscopic Findings. Intern Med 2018; 57. [PMID: 29526928 PMCID: PMC6148157 DOI: 10.2169/internalmedicine.0003-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Gastric arteriovenous malformation (AVM) is an uncommon cause of upper gastrointestinal bleeding, and the endoscopic findings are unclear. We herein describe a case of gastric AVM in a 28-year-old man. Esophagogastroduodenoscopy showed a Dieulafoy lesion surrounded by a red mucosa with a sharp margin, which implied blood vessel malformation. Computed tomography angiography and conventional angiography revealed aggregated vessels on the greater curvature. Partial gastrectomy was performed, with no recurrent bleeding postoperatively. The histopathological diagnosis was AVM. We conclude that gastric AVM should be considered in the differential diagnosis of patients who present with a Dieulafoy lesion surrounded by a red mucosa.
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Affiliation(s)
- Yoji Hirayama
- Department of Gastroenterology, Endoscope and Chemotherapy, Hachinohe City Hospital, Japan
| | - Chihiro Takai
- Department of General Internal Medicine, Mito Kyodo General Hospital, Japan
| | - Kai Korekawa
- Department of Gastroenterology, Endoscope and Chemotherapy, Hachinohe City Hospital, Japan
| | - Masahiro Saito
- Department of Gastroenterology, Endoscope and Chemotherapy, Hachinohe City Hospital, Japan
| | - Asuka Akasaka
- Department of Gastroenterology, Endoscope and Chemotherapy, Hachinohe City Hospital, Japan
| | - Hitoshi Nagasawa
- Department of Gastroenterology, Endoscope and Chemotherapy, Hachinohe City Hospital, Japan
| | - Wataru Iwai
- Department of Gastroenterology, Miyagi Cancer Center, Japan
| | - Hisashi Hachimori
- Department of Gastroenterology, Endoscope and Chemotherapy, Hachinohe City Hospital, Japan
| | - Masahiro Satoh
- Department of Gastroenterology, Endoscope and Chemotherapy, Hachinohe City Hospital, Japan
| | | | - Motoji Oki
- Department of Gastroenterology, Endoscope and Chemotherapy, Hachinohe City Hospital, Japan
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