Leiomyoma-like clip artifact after endoscopic full-thickness resection.

An endoscopic full-thickness resection with FTRD system (Ovesco Endoscopy, Tübingen, Germany) was performed in a 69-year-old man with a granular laterally spreading tumor (G-LST) with non-lifting sign in the ascending colon. Histology showed a low-grade dysplasia tubulovillous adenoma, R0 resection. At surveillance colonoscopy after 12 months, the clip was found with a polypoid tissue with regular mucosal surface pattern trapped inside. Since the length of time the clip was left in place ensured proper healing and in order to avoid any recurrence of adenoma in the area, the polypoid lesion and the clip were resected en bloc. The histological study revealed a polypoid formation with muscular tissue surrounded by healthy mucosa, suggesting a leiomyoma. Immunohistochemical actine staining confirmed the presence of muscularis mucosae and the muscularis propria inside the polypoid lesion, due to a full-thickness clip entrapment of the colon wall, with the development a leiomyoma-like clip artifact. The presence of foreign bodies such as clips at the resection site may produce artifacts leading to confusion in the diagnosis as in this case in which it has been able to produce an abnormal growth of the muscularis propria. The detection of a clip artifact leiomyoma has not yet been reported and highlights the importance of transmitting correct information about the case and the technique to the pathologist in order to achieve a correct diagnosis.

Short and long-term outcomes of underwater EMR compared to the traditional procedure in the real clinical practice.

BACKGROUND AND AIMS: underwater endoscopic mucosal resection (U-EMR) has been recently described as an alternative to endoscopic mucosal resection (EMR) for flat colorectal polyps. However, the real applications remain unclear due to the lack of comparative studies. METHODS: a multi-centric prospective study was performed from November 2016 to December 2017. All lesions larger than 15 mm that were resected with both techniques were included in the study. The samples were matched using the size, morphology, site and access (SMSA) score as a reference. The efficacy, efficiency and adverse events rates were compared. RESULTS: a total of 162 resections were collected (112 EMR and 50 U-EMR) with an average size of 25 mm. U-EMR achieved better results for the en bloc resection rate (49 vs 62%; p = 0.08) and there were no cases of an incomplete resection (10.7 vs 0%; p = 0.01). U-EMR was faster than EMR and there were no differences in the adverse events rate. Furthermore, U-EMR tended to achieve better results in terms of recurrence. Performing the resection in emersion appeared to prevent the cautery artefact, especially in sessile serrated adenomas. CONCLUSION: in the real clinical practice, U-EMR and EMR are equivalent in terms of efficacy and safety. Furthermore, U-EMR may be a feasible approach to prevent cautery artefact, allowing an accurate pathologic assessment.

Bile duct hepatocellular carcinoma thrombi.

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and the third cause of death related to cancer. Through the application of surveillance programs the percentage of early diagnosis has increased but the diagnosis is still made at advanced stages in some patients. The presentation of HCC as progressive jaundice secondary to bile duct tumor thrombi is uncommon. In such cases it is extremely difficult to distinguish such biliary lesions from cholangiocarcinoma or even common bile stones. We report a case of a 34-year-old male patient with common bile duct invasion secondary to HCC that mimicked choledocholithiasis. The diagnosis of HCC was confirmed after thrombi extraction during ERCP.