ABSTRACT
Gastrointestinal (GI) bleeding is one of the most common conditions among patients visiting emergency departments in Korea. GI bleeding is divided into upper and lower GI bleeding, according to the bleeding site. GI bleeding is also divided into overt and occult GI bleeding based on bleeding characteristics. In addition, obscure GI bleeding refers to recurrent or persistent GI bleeding from a source that cannot be identified after esophagogastroduodenoscopy or colonoscopy. The small intestine is the largest part of the alimentary tract. It extends from the pylorus to the cecum. The small intestine is difficult to access owing to its long length. Moreover, it is not fixed to the abdominal cavity. When hemorrhage occurs in the small intestine, the source cannot be found in many cases because of the characteristics of the small intestine. In practice, small-intestinal bleeding accounts for most of the obscure GI bleeding. Therefore, in this review, we introduce and describe systemic approaches and examination methods, including video capsule endoscopy and balloon enteroscopy, that can be performed in patients with suspected small bowel bleeding in clinical practice.
ABSTRACT
Purpose@#Esophagojejunostomy leakage after total gastrectomy for gastric cancer is one of the most serious and sometimes life-threatening adverse events. The purpose of this study was to evaluate complications after total gastrectomy in patients with gastric cancer during the period when Histoacryl (B. Braun) injection was performed. Therapeutic outcome of endoscopic Histoacryl injection for esophagojejunostomy leakage was also determined. @*Methods@#This was a single-center retrospective study. Between January 2016 and December 2021, clinicopathologic characteristics and surgical outcomes of 205 patients who underwent total gastrectomy were investigated. Baseline characteristics and clinical outcomes of 10 patients with esophagojejunostomy leakage were also investigated. @*Results@#Postoperative complication and mortality rates of total gastrectomy in 205 patients were 25.4% and 0.9%, respectively. Serious complications more than Clavien-Dindo IIIb accounted for 6.3%. Ten (4.9%) esophagojejunostomy leakages occurred in 205 patients. Among 10 esophagojejunostomy leakage patients, endoscopic Histoacryl injection was performed on eight patients and leakage was successfully managed with endoscopic Histoacryl injection in seven patients (87.5%). Mean postinjection hospital stay of seven successfully managed patients was 13.8 days. They were able to drink water at 1–6 days after injection.Among eight patients with endoscopic Histoacryl injection, six patients were injected once and two patients were injected three times. @*Conclusion@#Endoscopic Histoacryl injection for esophagojejunostomy leakage after total gastrectomy can be considered as a useful treatment for some selected cases.
ABSTRACT
Background/Aims@#Endoscopic submucosal dissection is a widely used treatment for gastric epithelial neoplasms. Accurate delineation of the horizontal margins is necessary for the complete resection of gastric epithelial neoplasms. Recently, image-enhanced endoscopy has been used to evaluate horizontal margins of gastric epithelial neoplasms. The aim of this study was to investigate whether I-SCAN-optical enhancement (I-SCAN-OE) is superior to chromoendoscopy in evaluating the horizontal margin of gastric epithelial neoplasms. @*Methods@#This was a multicenter, prospective, and randomized trial. The participants were divided into two groups: I-SCAN-OE and chromoendoscopy. For both groups, we first evaluated the horizontal margins of early gastric cancer or high-grade dysplasia using white-light imaging, and then evaluated, the horizontal margins using I-SCAN-OE or chromoendoscopy. We devised a unique scoring method based on the pathological results obtained after endoscopic submucosal dissection to accurately evaluate the horizontal margins of gastric epithelial neoplasms. The delineation scores of both groups were compared, as were the ratios of positiveegative horizontal margins. @*Results@#In total, 124 patients were evaluated for gastric epithelial neoplasms, of whom 112 were enrolled in the study. A total of 112 patients participated in the study, and 56 were assigned to each group (1:1). There was no statistically significant difference in the delineation scores between the groups (chromoendoscopy, 7.80±1.94; I-SCAN-OE, 8.23±2.24; p=0.342). @*Conclusions@#I-SCAN-OE did not show superiority over chromoendoscopy in delineating horizontal margins of gastric epithelial neoplasms.
ABSTRACT
The stomach temporarily stores food and secretes gastric juices to break down and digest food. The normal process is the movement of food digested from the stomach to the duodenum, with the pylorus as a passageway. This paper reports the case of a patient with an ectopic gastric pylorus who presented with gastrointestinal bleeding. A 62-year-old man complained of melena with mild dizziness and nausea. An endoscopic examination revealed a gastric ulcer, approximately 1 cm in diameter, and exposed blood vessels on the posterior wall of the upper body. No normal pyloric structure was observed in the distal antrum, and an opening leading to the duodenum was noted in the posterior wall of the upper body adjacent to the ulcer. This case presents a congenital pyloric ectopic opening in the upper body of the stomach, not in the distal antrum, suggesting a rare gastric morphological variation.
ABSTRACT
An endoscopic mucosal resection (EMR) is used widely as an alternative treatment to a surgical resection for early gastric neoplasticlesions. Among the unusual complications of gastric EMR, perforation is usually manifested as a pneumoperitoneum. Thispaper reports a patient with a left-side pneumothorax without pneumoperitoneum as a complication of gastric EMR. The patientdeveloped a left side pneumothorax after gastric EMR in the gastric fundus and recovered without further complications afterconservative treatment, including endoscopic clipping.