Repeat full-thickness resection device use for recurrent duodenal adenoma: A case report.

BACKGROUND: Endoscopic full-thickness resection of adenomas or subepithelial tumors is a novel and promising endoscopic technique. There have been several recent studies of full-thickness resection device (FTRD) use in the colon, but data regarding its use and efficacy in the duodenum are still limited. CASE SUMMARY: A 64-year-old female underwent resection of a recurrent adenoma of 7 mm in size in the duodenum after FTRD use for an adenoma eight months prior. The biopsies revealed a low-grade adenoma. The adenoma was removed using the gastroduodenal FTRD, and the pathology results revealed clear margins. Except for minor bleeding that was treated by argon plasma coagulation, no further complications occurred. CONCLUSION: Repeat use of the FTRD appears to be a safe and efficacious approach for the treatment of recurrent duodenal lesions. Further prospective studies are needed to investigate the long-term safety and utility of repeat FTRD use after Endoscopic full-thickness resection.

[A Lot of Hot Steam: the Cannabinoid Hyperemesis Syndrome]. / Viel heißer Dampf: das Cannabis-Hyperemesis-Syndrom.

HISTORY: The 43-year-old patient was admitted because of vomiting and abdominal pain. He had a history of depression and multiple discus prolapses. He reported the consumption of three beers per day. FINDINGS: The patient presented diffuse abdominal pain. The serume-kreatine was elevated (205 µmol/l), there was a leucocytosis (18,4^3/µl) and a mild elvation of y-GT (2,3µkat/l). Stool culture was negative. An abdominal ultrasound and a gastroscopy did not show groundbreaking findings. THERAPY AND COURSE: The acute kidney injury was treated by administration of intravenous fluid. The vomiting persisted despite of administration of Metoclopramid and Dimenhydrinat. Just Lorazepam and hot showers brought relief of symptoms. A decided drug history revealed a marijuana abusus. After ceasing marijuana consumption and administration of Haloperidol the vomiting stopped. CONCLUSIONS: The cannabinoid hyperemesis syndrome is characterized by vomiting, diffuse abdominal pain and taking hot showers. With typical combination of symptoms a drug history should be taken. The knowledge of this syndrome can help to avoid overdiagnostic.