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Endoscopic Removal of a Proximally Migrated Metal Stent during Balloon Sweeping after Stent Trimming.

Nam Jun CHO ; Tae Hoon LEE ; Sang Heum PARK ; Han Min LEE ; Kyung Hee HYUN ; Suck Ho LEE ; Il Kwun CHUNG ; Sun Joo KIM

Clinical Endoscopy.2013;46(4):418-422. doi:10.5946/ce.2013.46.4.418

Placement of a self-expanding metal stent (SEMS) is an effective method for palliation of a malignant biliary obstruction. However, metal stents can cause various complications, including stent migration. Distally migrated metal stents, particularly covered SEMS, can be removed successfully in most cases. Stent trimming using argon plasma coagulation may be helpful in difficult cases despite conventional methods. However, no serious complications related to the trimming or remnant stent removal method have been reported due to the limited number of cases. In particular, proximal migration of a remnant fragmented metal stent after stent trimming followed by balloon sweeping has not been reported. We report an unusual case of proximal migration of a remnant metal stent during balloon sweeping following stent trimming by argon plasma coagulation. The remnant metal stent was successfully removed with rotation technique using a basket and revised endoscopically.
Argon Plasma Coagulation ; Cholangiopancreatography, Endoscopic Retrograde ; Pancreatic Neoplasms ; Stents

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Endoscopic Treatment of a Symptomatic Ileal Lipoma with Recurrent Ileocolic Intussusceptions by Using Cap-Assisted Colonoscopy.

Eun Sung LEE ; Kang Nyeong LEE ; Kyung Soo CHOI ; Hang Lak LEE ; Dae Won JUN ; Oh Young LEE ; Byung Chul YOON ; Ho Soon CHOI

Clinical Endoscopy.2013;46(4):414-417. doi:10.5946/ce.2013.46.4.414

A 73-year-old woman presented with intermittent abdominal pain and weight loss of 15 kg for 2 years. Colonoscopy revealed an erythematous polypoid tumor with a long and wide stalk in the cecum, but with air inflation, it abruptly went away through the ileocecal valve (ICV). An abdominal computed tomography showed a well-demarcated pedunculated subepithelial mass of 2.6x2.7 cm size with fat attenuation in the terminal ileum. It was an intussusceptum of the ileal lipoma through the ICV. This ileal lipoma was causing her symptoms because repeated ileocolic intussusceptions resulted in intermittent intestinal obstructions. In order to avoid surgical sequelae of ileal resection, snare polypectomy using cap-assisted colonoscopy technique was performed within the ileum without complications. The histopathology report confirmed it as a subepithelial lipoma. After endoscopic resection of the ileal lipoma, the patient has been free of symptoms and was restored to the original weight.
Abdominal Pain ; Cecum ; Colonoscopy ; Female ; Humans ; Ileocecal Valve ; Ileum ; Inflation, Economic ; Intestinal Obstruction ; Intussusception ; Lipoma ; SNARE Proteins ; Weight Loss

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Superior Mesenteric Artery Syndrome Diagnosed with Linear Endoscopic Ultrasound (with Video) in a Patient with Normal Body Mass Index.

Jee Wan WEE ; Tae Hee LEE ; Joon Seong LEE ; Wan Jung KIM

Clinical Endoscopy.2013;46(4):410-413. doi:10.5946/ce.2013.46.4.410

Superior mesenteric artery (SMA) syndrome is an uncommon disease that results from SMA compression of the third portion of the duodenum. Patients with SMA syndrome present with upper gastrointestinal symptoms, such as nausea, vomiting, and abdominal pain. The diagnosis is usually made from an upper barium study or computed tomography. Typically, SMA syndrome is caused by a decreased aortomesenteric angle of 6degrees to 25degrees. An underweight body mass index (BMI) is a risk factor for development of SMA syndrome. There are few reports of the role of linear endoscopic ultrasound (EUS) in the diagnosis of SMA syndrome. We report a case of SMA syndrome, with normal BMI, that was diagnosed with the aid of linear EUS. Although SMA syndrome is not typically within the scope of practice of endosonographers, it is useful to get familiar with the findings.
Abdominal Pain ; Barium ; Body Mass Index ; Duodenum ; Humans ; Mesenteric Artery, Superior ; Nausea ; Risk Factors ; Superior Mesenteric Artery Syndrome ; Thinness ; Vomiting

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A Case of Squamous Metaplasia of the Stomach.

Moo Song JEON ; Gwang Ha KIM ; Do Youn PARK ; Jae Hoon JEONG ; Dong Hwahn KAHNG ; Hye Yoon JANG ; Jong Hyun CHOI ; Eun Kyoung PARK

Clinical Endoscopy.2013;46(4):407-409. doi:10.5946/ce.2013.46.4.407

Intestinal metaplasia of the stomach is a common metaplastic lesion associated with chronic gastritis and mucosal atrophy. However, squamous metaplasia is a comparatively rare condition. On endoscopy, squamous metaplasia is usually observed as a whitish mucosal lesion in the lesser curvature of the cardiac region of the stomach. When Lugol's iodine solution is applied, the lesion stains brown in the same way as normal esophageal mucosa. We report a case of 79-year-old man with a whitish flat lesion in the lesser curvature of the cardiac region on surveillance endoscopy after endoscopic treatment of gastric adenoma. The endoscopic biopsy showed stratified squamous epithelial mucosa.
Adenoma ; Atrophy ; Biopsy ; Coloring Agents ; Endoscopy ; Gastritis ; Iodides ; Iodine ; Metaplasia ; Mucous Membrane ; Stomach

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Successful Treatment of Duodenal Variceal Bleeding by Endoscopic Clipping.

Su Bin PARK ; Sang Ho LEE ; Jin Hee KIM ; Hyun Jung LEE ; Sung Pil JANG ; Jae Nam LEE ; Jong Ho HWANG

Clinical Endoscopy.2013;46(4):403-406. doi:10.5946/ce.2013.46.4.403

Duodenal varix bleeding is an uncommon cause of gastrointestinal bleeding in patients with portal hypertension but can cause severe and potentially fatal bleeding. However, the incidence is low and a good treatment method has not been well established yet. Duodenal variceal bleeding can be treated surgically or nonsurgically. We have successfully treated a patient with duodenal variceal bleeding secondary to liver cirrhosis using hemoclips to control the bleeding.
Hemorrhage ; Humans ; Hypertension, Portal ; Incidence ; Liver Cirrhosis ; Varicose Veins

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A Large-Sized Phytobezoar Located on the Rare Site of the Gastrointestinal Tract.

Jee Eun YANG ; Ji Yong AHN ; Gi Ae KIM ; Ga Hee KIM ; Da Lim YOON ; Sung Jin JEON ; Hwoon Yong JUNG ; Jin Ho KIM

Clinical Endoscopy.2013;46(4):399-402. doi:10.5946/ce.2013.46.4.399

Bezoars are concretions of undigested material and are most often observed in the stomach. They can occur at any site in the gastrointestinal tract; however, duodenal localization is very rare. We report the case of a 71-year-old male who had undergone subtotal gastrectomy with gastroduodenostomy and experienced severe epigastric discomfort, abdominal pain, and vomiting for a few days. An approximately 7x8 cm-sized mass was found on an abdominal computed tomography scan. On following endoscopy, a large bezoar was revealed in the duodenum and was removed using an endoscopic removal technique, assisted by a large amount of Coca-Cola infusion.
Abdominal Pain ; Bezoars ; Duodenum ; Endoscopy ; Gastrectomy ; Gastrointestinal Tract ; Humans ; Male ; Stomach ; Vomiting

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Biliary-Pancreatic Endoscopic and Surgical Procedures in Patients under Dual Antiplatelet Therapy: A Single-Center Study.

Ahmed ABDEL SAMIE ; Michael STUMPF ; Rui SUN ; Lorenz THEILMANN

Clinical Endoscopy.2013;46(4):395-398. doi:10.5946/ce.2013.46.4.395

BACKGROUND/AIMS: Dual antiplatelet therapy has to be used for at least 1 month after placement of bare metal coronary stents and for a minimum of 1 year after placement of drug eluting stents. Because of the higher risk of bleeding, guidelines strongly recommend to delay elective surgery until dual antiplatelet therapy is ended. However, no data are available regarding the bleeding risk in patients on combined aspirin/clopidogrel therapy undergoing surgical or high-risk endoscopic procedures. METHODS: We retrospectively analyzed the medical reports of patients on dual antiplatelet therapy, the patients who had to undergo emergency biliary-pancreatic surgery or endoscopic retrograde cholangiography with endoscopic sphincterotomy while in our unit between January 2009 and July 2012. RESULTS: In our series, biliary-pancreatic surgical and endoscopic procedures were safely performed in 11 consecutive patients on dual antiplatelet therapy with no evidence of bleeding. CONCLUSIONS: In emergency, surgical and high risk endoscopic procedures may be performed in patients on dual antiplatelet therapy.
Cholangiography ; Drug-Eluting Stents ; Emergencies ; Hemorrhage ; Humans ; Retrospective Studies ; Sphincterotomy, Endoscopic ; Stents

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Photodynamic Therapy in Unresectable Cholangiocarcinoma: Not for the Uncommitted.

Jayant P TALREJA ; Marisa DEGAETANI ; Kristi ELLEN ; Timothy SCHMITT ; Monica GAIDHANE ; Michel KAHALEH

Clinical Endoscopy.2013;46(4):390-394. doi:10.5946/ce.2013.46.4.390

BACKGROUND/AIMS: Photodynamic therapy (PDT) in unresectable cholangiocarcinoma has been associated with improved survival. We report a single tertiary care center experience over the past 6 years. METHODS: Fifty-five patients with unresectable cholangiocarcinoma received PDT between 2004 and 2010. Plastic stents were placed after PDT to prevent cholangitis. RESULTS: Twenty-seven patients (49%) showed Bismuth type IV, 22 (41%) showed Bismuth type III, and six (10%) showed Bismuth type I and II. Twenty patients (37%) received chemotherapy and radiation therapy, five (9%) received chemotherapy only; and one (2%) received radiation therapy only. Mean number of PDT sessions was 1.9+/-1.5 sessions (range, 1 to 9). Mean survival duration was 293+/-266 days (median, 190; range, 25 to 1,332). PDT related complications included three (5%) facial burn, three (5%) photosensitivity, and two (3%) rash. Kaplan-Meier analysis comparing the survival means of patients who received PDT and chemotherapy/radiation therapy (median survival 257 days; 95% confidence interval [CI], 166 to 528) versus who received PDT only (median survival 183 days; 95% CI, 129 to 224) showed no significant difference (log-rank p=0.20). CONCLUSIONS: PDT has a measurable impact on survival in unresectable cholangiocarcinoma but requires aggressive stenting posttherapy.
Bismuth ; Burns ; Cholangiocarcinoma ; Exanthema ; Humans ; Kaplan-Meier Estimate ; Photochemotherapy ; Plastics ; Stents ; Tertiary Care Centers ; Triazenes

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Angular Positioning of Stent Increases Bowel Perforation after Self-Expandable Metal Stent Placement for Malignant Colorectal Obstruction.

Jeong Guil LEE ; Kwang Ho YOO ; Chang Il KWON ; Kwang Hyun KO ; Sung Pyo HONG

Clinical Endoscopy.2013;46(4):384-389. doi:10.5946/ce.2013.46.4.384

BACKGROUND/AIMS: Some factors like stent wires, balloon dilatation and use of guide wires seems to increase perforation after self-expandable metal stent (SEMS) placement, but few studies mentioned about the relationship between angulation of malignant stricture and perforation. The present study aimed to confirm that more angular positioning of stents increases perforation. METHODS: This study was conducted with retrospectively evaluation at Digestive Disease Center, CHA Bundang Medical Center, CHA University. Between January 2002 and August 2011, SEMS was inserted in 130 patients with malignant colorectal obstruction. We studied the difference in the angle of stenosis between perforation and non-perforation groups using fluorography images. RESULTS: SEMS insertion was performed in 130 cases of obstruction due to colon cancer. Perforation occurred in eight patients (6.2%) of them. Thirteen cases were excluded from the analysis due to poor fluoroscopic images. Among the eight patients with perforation, the mean stenosis angle was 109.9degrees compared to 153.1degrees in the nonperforation group, indicating that the angle was more acute in the perforation group (p=0.016). CONCLUSIONS: This study shows that more angular positioning of stent increases bowel perforation after SEMS placement for malignant colorectal obstruction.
Colonic Neoplasms ; Constriction, Pathologic ; Dilatation ; Humans ; Intestinal Perforation ; Retrospective Studies ; Stents

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Concordance of Endoscopic Ultrasonography-Guided Fine Needle Aspiration Diagnosis with the Final Diagnosis in Subepithelial Lesions.

Erkan CAGLAR ; Ibrahim HATEMI ; Deniz ATASOY ; Gurhan SISMAN ; Hakan SENTURK

Clinical Endoscopy.2013;46(4):379-383. doi:10.5946/ce.2013.46.4.379

BACKGROUND/AIMS: In this study we aimed to determine the rate of concordance of endoscopic ultrasonography (EUS)-guided fine needle aspiration (FNA) diagnosis with the final diagnosis obtained by surgery or endoscopic resection and follow-up in upper gastrointestinal subepithelial lesions. METHODS: We retrospectively studied patients with subepithelial lesions who underwent EUS at our center from 2007 to 2011. RESULTS: We had a final diagnosis in 67 patients (mean age+/-SD, 51.23+/-12.48 years; 23 [34.3%] female, 44 [65.6%] male). EUS-FNA was performed in all of the patients. On-site pathology was not performed. In nine of the patients, the obtained material which was obtained was insufficient. The cytologic examination was benign in 31 and malignant in 27 of the patients. Based on the final diagnosis, the EUS-FNA had a sensitivity of 96%, a specificity of 100%, and a diagnostic yield of 85%. CONCLUSIONS: The diagnostic yield of EUS-FNA, in the absence of the on-site cytopathologist, is feasible for the diagnosis of subepithelial lesions of the upper gastrointestinal system.
Biopsy, Fine-Needle ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Female ; Follow-Up Studies ; Humans ; Retrospective Studies ; Sensitivity and Specificity

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