Severe lower gastrointestinal bleeding caused by rectal Dieulafoy's lesion: Case reports and literature review.

RATIONALE: Dieulafoy's lesion are relatively rare and can cause severe gastrointestinal bleeding. A Dieulafoy's lesion is defined as an artery that erodes the overlying epithelium without the presence of an ulcer. Bleeding in Dieulafoy's lesion predominantly involves the proximal stomach and upper gastrointestinal tract and is rarely observed in the lower gastrointestinal tract. PATIENT CONCERNS: Case 1 was a 58-year-old woman complaining of sudden headache and vomiting who was diagnosed with subarachnoid hemorrhage. She underwent transcatheter embolization for intracranial aneurysm treatment but had an acute profuse hematochezia on the 11th day of admission. Case 2 was a 63-year-old man admitted to the respiratory intensive care unit because of fever with altered consciousness level for a week. He was diagnosed with advanced lung cancer that had metastasized to multiple organs one month prior. On the third day of admission, he had an attack of profuse hematochezia, and quickly developed shock and apathy. DIAGNOSIS: Both patients were diagnosed with actively bleeding rectal Dieulafoy's lesion by bedside emergency colonoscopy. INTERVENTIONS: Endoscopic hemostatic clipping was performed in 2 patients. OUTCOMES: Hemostasis was successfully achieved in these 2 patients, and there was no recurrence of symptoms during follow-up. CONCLUSIONS: We propose that hemostatic clipping is one of the options in the treatment of rectal Dieulafoy's lesions.

Management of gastrointestinal endoscopy unit during post covid-19 endemic outbreak: A report from Wuhan epicenter.

The COVID-19 pandemic is caused by severe acute respiratory syndrome coronavirus 2 and causing a global public health emergency. During the outbreak, Wuhan was the first reported and hardest-hit city. With the dramatic drop in number of confirmed cases and subsequent ending of Wuhan lock down, asymptomatic carriers and patients in their recovery period still pose an increased risk. Strict and effective infection control protocols should be established and followed.

Performing EUS during COVID-19 postendemic period: A report from endoscopy center in Wuhan.

In early April 2020, the 3-month-long city-wide lockdown was lifted in Wuhan, the epicenter of China during Coronavirus Disease 2019 (COVID-19) global pandemic. However, continuing precautions are still practiced considering the risk of transmission from asymptomatic carriers. Given that COVID-19 is spread via airborne droplets, including aspiration of oral and fecal material through endoscopes, our endoscopy center has strategically assigned health-care providers to ensure triage workflow and to minimize concomitant exposure from potential asymptomatic carriers. Here, we share the experience of performing EUS-FNA during the COVID-19 pandemic and postendemic periods. We illustrate our workflow using a patient with a left adrenal mass as an example and followed a biosafety level-2 standard. We believe all endoscopy centers need to focus on these three directions: (1) pre-EUS patients risk assessment and triage, (2) Personal protective equipment (PPE), and (3) dressing code modalities. We fully adopted them in our hospital to reduce COVID-19 resurgence risk.

Foreign body embedded in the lower esophageal wall located by endoscopic ultrasonography: A case report.

RATIONALE: Ingested esophageal foreign bodies are commonly seen in adult population. In very few instances, esophageal foreign body may pass through the mucosal surface, re-epithelialize or migrate into surrounding soft tissues. PATIENT CONCERNS: A 55-year-old Chinese male was admitted to our hospital with a 10-day history chest and upper abdominal pain without dysphasia, cough or other symptoms. DIAGNOSES: We initially suspected chronic gastritis, and thoracic computed tomography and endoscopy ultrasonography (EUS) were used to identify a fish bone completely embedded within the lower esophageal wall. INTERVENTIONS: Under the EUS-guidance, we marked the foreign body using methylene blue with saline solution, which was followed by successful thoracoscopy and surgical removed of the foreign body. OUTCOMES: The patient recovered well and was discharged 1 week postoperatively. One month postoperatively, the patient was symptom free and the chest wound was complete healed. LESSONS: Our case showed that computed tomography is necessary to diagnose the esophageal foreign body, and EUS may help confirm the position of foreign body, especially those embedded in the esophageal submucosa. We advocate necessary surgery at the first accurate diagnosis in patient with esophageal foreign body when endoscopy is not possible.

Multidetector CT Enterography versus Double-Balloon Enteroscopy: Comparison of the Diagnostic Value for Patients with Suspected Small Bowel Diseases.

Aim. To compare the diagnostic value of multidetector CT enterography (MDCTE) and double-balloon enteroscopy (DBE) for patients with suspected small bowel diseases. Methods. From January 2009 to January 2014, 190 patients with suspected small bowel diseases were examined with MDCTE and DBE. The characteristics of the patients, detection rates, diagnostic yields, sensitivity, specificity, positive predictive value, and negative predictive value were described and analyzed. Results. The overall detection rates of DBE and MDCTE were 92.6% and 55.8%, respectively (P<0.05), while the overall diagnostic yields were 83.2% and 33.7%, respectively (P<0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of DBE were all higher than those of MDCTE. DBE had a higher diagnostic yield for OGIB (87.3% versus 20.9%, P<0.05). The diagnostic yields of DBE were higher than those of MDCTE for inflammatory diseases, angioma/angiodysplasia, and diverticulums, while being not for gastrointestinal tumors/polyps. Conclusions. The diagnostic value of DBE for small bowel diseases is better than that of MDCTE as a whole, but if gastrointestinal tumors are suspected, MDCTE is also needed to gain a comprehensive and accurate diagnosis.