We report a rare case of cervical cancer with duodenal obstruction accompanied by obstructive symptoms, which was treated using duodenal stenting. A 48-year-old woman was diagnosed with stage IV cervical cancer (according to the International Federation of Gynecology and Obstetrics staging system), which had invaded the vagina, the uterine body, and the external iliac and common iliac lymph nodes. Endoscopy showed an encircling mass with erythematous mucosa and luminal narrowing in the second and third portions of the duodenum, which prevented the endoscope from advancing. We placed an uncovered stent in the duodenum, which ameliorated abdominal discomfort, nausea, and vomiting, and simultaneously performed a biopsy. Endoscopic stent insertion appears to be the most effective treatment for duodenal obstruction in patients with advanced cancer.
Biopsy ; Duodenal Obstruction ; Duodenum ; Endoscopes ; Endoscopy ; Female ; Gynecology ; Humans ; Lymph Nodes ; Middle Aged ; Mucous Membrane ; Nausea ; Obstetrics ; Phenobarbital ; Stents ; Uterine Cervical Neoplasms ; Vagina ; Vomiting

Efferent loop bezoars rarely occur. However when patients have a history of gastrectomy and gastrojejunal anastomosis, they are sometimes found. Small bowel obstruction by efferent loop bezoar has a mortality rate as high as 30%. Although various endoscopic procedures were reported to remove gastric bezoars, the traditional treatment option of small bowel bezoars is operative management. But as in the cases we describe here, endoscopic procedure may offer an effective alternative for efferent loop bezoars. Bezoars obstructing efferent loop were found in patients with history of gastrectomy and they were removed by endoscopy successfully.
Bezoars ; Endoscopy ; Gastrectomy ; Humans

We introduce a rare case of gastric emphysema. A 68-year-old man presented with vomiting and dyspnea. Simple abdominal X-ray and CT showed marked dilatation of the stomach and abnormal intramural gas consistent with gastric emphysema. We performed gastric decompression via nasogastric tube drainage and parenteral nutritional support. Nine days after admission, the abnormal intramural gas had disappeared on follow-up CT. The acute gastric dilatation in this patient may have resulted from gastric hypomotility as a result of diabetic gastroparesis in addition to superior mesenteric artery syndrome resulting from malnutrition.
Aged ; Decompression ; Dilatation ; Drainage ; Dyspnea ; Emphysema ; Follow-Up Studies ; Gastric Dilatation ; Gastric Outlet Obstruction ; Gastroparesis ; Humans ; Malnutrition ; Mesenteric Artery, Superior ; Nutritional Support ; Stomach ; Superior Mesenteric Artery Syndrome ; Vomiting

Recent research reveal that the diagnosis of gastric extraluminal compressions mimicking subepithelial tumor is increasing in numbers as esophagogastroduodenoscopy becomes widespread. Endoscopic ultrasonography is a very useful tool for differentiating extraluminal compressions from subepithelial tumors. Gastric extraluminal compressions are due to compression by either normal adjacent organs or pathologic conditions. Pathologic conditions are mainly benign, but some requires operation according to its size. We report a case of a 24-year-old female, who underwent esophagogastroduodenoscopy and was misdiagnosed with gastric subepithelial tumor. Endoscopic ultrasonographic findings showed anechoic cyst outside the gastric wall, which revealed to be a splenic cyst.
Endoscopy, Digestive System ; Endosonography ; Female ; Humans ; Young Adult

Intramural hematoma of the gastrointestinal tract is uncommon, with the majority being localized to the esophagus or duodenum. Hematoma of the gastric wall is extremely rare and caused by coagulopathy, peptic ulcer disease or blunt trauma. Recently due to the increase in patients with antiplatelet use, liver cirrhosis, and/or end stage reanal disease, occurrence of gastric submucosal hematomas after endoscopic hemostasis can increase. This is a case of gastric submucosal hematoma which occurred in a patient taking dual antiplatelet therapy after endoscopic hemostasis for gastric peptic ulcer bleeding. We report a case of gastric submucosal hematoma which improved with medical therapy and healed naturally with an ulcer scar.
Cicatrix ; Duodenum ; Esophagus ; Gastrointestinal Tract ; Hematoma ; Hemorrhage ; Hemostasis, Endoscopic ; Humans ; Liver Cirrhosis ; Peptic Ulcer ; Peptic Ulcer Hemorrhage ; Platelet Aggregation Inhibitors ; Ulcer

Gastric schwannomas are rare benign tumors among the mesenchymal tumor of the gastrointestinal tract, arising from the nerve tissue which has a schwann cell sheath. These neoplasms are grossly similar to gastrointestinal stromal tumor (GIST), however, the clinical course of GIST is more aggressive compared to that of schwannomas. Synchronous occurrence of gastric epithelial and subepithelial tumors is rare. Besides, most subepithelial lesions are GIST. We present the case of a 57-year-old male with synchronous gastric schwannoma and gastric adenoma in the stomach. We found a gastric subepithelial lesion incidentally, the size of which was increasing and tubular adenoma was discovered in the covering mucosa during endoscopy follow-up. The synchronous lesion was removed by wedge resection, which was diagnosed as schwannoma with adenoma.
Adenoma ; Endoscopy ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Male ; Middle Aged ; Mucous Membrane ; Nerve Tissue ; Neurilemmoma ; Stomach

Eosinophilic gastroenteritis is defined as primary eosinophilic infiltration of the gastrointestinal tract. Endoscopic findings of this disease entity are non-specific, and huge gastric ulceration as initial presentation is extremely rare. We experienced a case of eosinophilic gastroenteritis presenting with abdominal pain in a 38 year-old-woman. Deep and huge ulceration in gastric antrum and body looked like advanced gastric cancer. Surgical resection was performed and histopathological examination showed dense infiltration of eosinophil without malignant cells. 5 years after surgery, diffuse abdominal pain and generalized edema developed and computed tomography showed entire wall thickening of the gastrointestinal tract. Random mucosal biopsy of the remnant stomach and terminal ileum showed mucosal eosinophilic infiltrations. She was treated with steroids and azathioprine but experienced frequent relapses and was dependent on steroids to maintain remissions. After 3 years, she died from infective endocarditis due to the prolonged use of immunosuppressive agents.
Abdominal Pain ; Azathioprine ; Biopsy ; Edema ; Endocarditis ; Enteritis ; Eosinophilia ; Eosinophils ; Gastric Stump ; Gastritis ; Gastroenteritis ; Gastrointestinal Tract ; Ileum ; Immunosuppressive Agents ; Pyloric Antrum ; Recurrence ; Steroids ; Stomach Neoplasms ; Stomach Ulcer ; Ulcer

BACKGROUND/AIMS: Gastric atrophy can be diagnosed by serum pesinogen I/II ratio. The aim of this study was to investigate whether the changes of serum pepsinogen I/II ratio can be predicted by gastroscopy. MATERIALS AND METHODS: Sixty healthy subjects who underwent screening for serum pepsinogen I/II levels, serum Helicobacter pylori (H. pylori) antibody, and gastroscopy for two sequential years were included. Endoscopic findings were classified into four different categories according to the degree of chronic atrophic gastritis; none, mild, moderate, and severe. Changes of the serum pepsinogen I/II ratio, body mass index, H. pylori antibody, and endoscopic findings were analyzed after a year. RESULTS: The serum pepsinogen I/II ratio showed a tendency to decrease after a year in subjects with H. pylori infection (P=0.013) and those with moderate to severe atrophic gastritis (P=0.004), whereas it increased in subjects without H. pylori infection and those with none to mild atrophic gastritis. On multivariate analysis, the degree of atrophic gastritis was the only factor that was related to the changing trends of the serum pepsinogen I/II ratio (odds ratio=5.385, P=0.023). CONCLUSIONS: The degree of atrophic gastritis on endoscopic findings can predict the changes of the serum pepsinogen I/II ratio after a year. Regardless of the current status of H. pylori infection, the serum pepsinogen I/II ratio decreases after a year in subjects with moderate to severe atrophic gastritis.
Atrophy ; Body Mass Index ; Gastritis, Atrophic ; Gastroscopy ; Helicobacter pylori ; Mass Screening ; Multivariate Analysis ; Pepsinogen A

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) is causally associated with gastritis and peptic ulcer diseases. Recent data have demonstrated that triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor has an eradication rate of only 74~76% and new therapeutic protocols may be necessary. The aim of this study was to investigate the effects of Lactobacillus as supplementation to anti-H. pylori regimens on H. pylori eradication rates and therapy-associated side effects. MATERIALS AND METHODS: The PubMed, Medline and Korean Medical Database were searched in January 2012, with no language restrictions, for randomized controlled trials; additional references were obtained from reviewed articles. We included trials comparing Lactobacillus supplementation to placebo or no treatment during anti-H. pylori regimens. Meta-analysis was performed with Review Manager. RESULTS: Eleven trials involving a total of 1,107 participants met the inclusion criteria. Compared with placebo or no intervention, Lactobacillus given along with anti-H. pylori regimens significantly increased the eradication rate [84.7% vs. 78.8%, odds ratio (OR) 1.75, 95% confidence interval (CI) 1.26~2.42] and reduced the risk of overall H. pylori therapy related adverse effects (35.4% vs. 48.6%, OR 0.56, 95% CI 0.38~0.81), particularly of diarrhea (7.5% vs. 20.6%, OR 0.31, 95% CI 0.18~0.54), bloating (19.2% vs. 29.9%, OR 0.53, 95% CI 0.32~0.88) and taste disturbance (17.6% vs. 34.8%, OR 0.37, 95% CI 0.21~0.64). There were no significant differences between groups in the risk of other adverse effects. CONCLUSIONS: Our review suggests that supplementation with Lactobacilli could be effective in increasing eradication rates of anti-H. pylori therapy. Furthermore, Lactobacilli showed a positive impact on some H. pylori therapy-related side effects, particularly diarrhea, bloating and taste disturbance.
Amoxicillin ; Clarithromycin ; Diarrhea ; Gastritis ; Helicobacter ; Helicobacter pylori ; Lactobacillus ; Odds Ratio ; Peptic Ulcer ; Proton Pumps

BACKGROUND/AIMS: A triple therapy, comprised of a proton pump inhibitor, clarithromycin, and amoxicillin or metronidazole, is the most commonly used treatment for Helicobacter pylori (H. pylori) eradication. But, H. pylori have become resistant to antimicrobial agents, reducing eradication rates. Thus, we investigated the distribution of minimal inhibitory concentration (MIC) for these drugs and analyzed the factors that affect it. MATERIALS AND METHODS: From July 2008 through December 2009, we performed tissue culture with gastric mucosa from 51 patients who were infected with H. pylori and measured MIC by Epsilometer test (E-test). RESULTS: The mean age of the group was 56.8+/-13.8 years, and the male to female ratio was 2:1. Resistance rates of H. pylori to amoxillin, clarithromycin, metronidazole, ciprofloxacin, levofloxacin, tetracycline were 2%, 15.7%, 21.6%, 25.5%, 25.5%, and 0%, respectively. Statistically, there were no significant relationship between resistance rate and other factors including age, sex, alcohol or smoking. Follow up test revealed eradication failure in 4 of 22 patients but, MIC for amoxillin and clarithromycin of these four patients were considered to belong to the susceptible group. Three patients belonging to the clarithromycin-resistant group (MIC>256 microg/mL), were eradicated. In addition, one of the three patients showed resistant to not only clarithromycin (MIC 12 microg/mL), but also amoxiciliin (MIC 0.6 microg/mL). CONCLUSIONS: The microbial susceptability test of each antibiotics does not accurately reflecte successful eradication, but further investigation is needed to identify the factors that influence the eradication of H. pylori.
Amoxicillin ; Anti-Bacterial Agents ; Anti-Infective Agents ; Ciprofloxacin ; Clarithromycin ; Female ; Follow-Up Studies ; Gastric Mucosa ; Helicobacter ; Helicobacter pylori ; Humans ; Male ; Metronidazole ; Ofloxacin ; Proton Pumps ; Smoke ; Smoking ; Tetracycline