Child ; Cysts ; diagnostic imaging ; Endosonography ; methods ; Female ; Gastric Mucosa ; diagnostic imaging ; Humans ; Stomach ; diagnostic imaging ; Ultrasonography ; methods

BACKGROUND/AIMS: We evaluated the effectiveness of an endoscopic ultrasonography (EUS)-based treatment plan compared to an endoscopy-based treatment plan in selecting candidates with early gastric cancer (EGC) for endoscopic submucosal dissection based on the prediction of invasion depth. METHODS: We reviewed 393 EGCs with differentiated histology from 380 patients who underwent EUS from July 2007 to April 2010. The effectiveness of the EUS-based and endoscopy-based plans was evaluated using a simplified hypothetical treatment algorithm. RESULTS: The numbers of endoscopically determined mucosal, indeterminate, and submucosal cancers were 253 (64.4%), 56 (14.2%), and 84 (21.4%), respectively. Overall, the appropriate treatment selection rates were 75.3% (296/393) in the endoscopy-based plan and 71.5% (281/393) in the EUS-based plan (p=0.184). For endoscopic mucosal cancers, the appropriate treatment selection rates in the endoscopy-based plan were 88.1% (223/253), while the use of an EUS-based plan significantly decreased this rate to 81.4% (206/253) (p=0.036). For endoscopic submucosal cancers, the appropriate selection rates did not differ between the endoscopy-based plan (46.4%, 39/84) and the EUS-based plan (53.6%, 45/84) (p=0.070). CONCLUSIONS: EUS did not increase the likelihood of selecting the appropriate treatment in differentiated-type EGC. Therefore, EUS may not be necessary before treating differentiated-type EGC, especially in endoscopically presumed mucosal cancers.
Adult ; Aged ; Aged, 80 and over ; Algorithms ; Clinical Decision-Making/*methods ; Early Detection of Cancer ; Endoscopy, Gastrointestinal/*statistics & numerical data ; Endosonography/*statistics & numerical data ; Female ; Gastric Mucosa/ultrasonography ; Humans ; Male ; Middle Aged ; *Patient Selection ; Prospective Studies ; Retrospective Studies ; Stomach Neoplasms/surgery/*ultrasonography

An inverted hyperplastic polyp (IHP) found in stomach is rare and characterized by downward growth of hyperplastic mucosal component into the submucosa. Because of such characteristic, IHP can be misdiagnosed as subepithelial tumor or malignant tumor. In fact, adenocarcinoma was reported to have coexisted with gastric IHP in several previous reports. Because only 18 cases on gastric IHP have been reported in English and Korean literature until now, pathogenesis and clinical features of gastric IHP and correlation with adenocarcinoma have not been clearly established. Herein, we report a case of gastric IHP which was initially misdiagnosed as gastrointestinal stromal tumor and resected using endoscopic submucosal dissection. Literature review of previously published case reports on gastric IHP is also presented.
Adult ; Gastric Mucosa/pathology/surgery ; Humans ; Hyperplasia/*diagnosis/diagnostic imaging ; Male ; Polyps/pathology/surgery ; Stomach/diagnostic imaging ; Stomach Neoplasms/diagnosis/diagnostic imaging/pathology ; Tomography, X-Ray Computed ; Ultrasonography

No abstract available.
Aged ; Carcinoma, Medullary/*diagnosis/surgery/ultrasonography ; Epstein-Barr Virus Infections/diagnosis ; Gastric Mucosa/pathology/surgery ; Gastroscopy ; Humans ; Immunohistochemistry ; Keratins/metabolism ; Male ; Stomach Neoplasms/*diagnosis/surgery/ultrasonography

Duplication cysts are uncommon congenital malformations that may occur anywhere throughout the alimentary tract. The stomach is an extremely rare site of occurrence. Here, we report a case of gastric duplication cyst initially presenting with a gastric submucosal tumor. A 28-year-old man complained of dyspepsia lasting 1 year and upper endoscopy revealed an ellipsoid submucosal tumor at the greater curvature of the antrum. We intended to use the injection-and-cut technique: however, after saline injection, the lesion was dented and impossible to grasp with a snare. Therefore, we decided to perform endoscopic submucosal dissection and removed the tumor without complication. Histopathology revealed a 0.6x0.6 cm-sized duplication cyst, and there has been no recurrence in 2 years.
Adult ; Cysts/congenital/*pathology/*surgery ; Dissection ; Gastric Mucosa/*pathology/*surgery ; *Gastroscopy ; Humans ; Male ; Pyloric Antrum/pathology ; Stomach Diseases/*pathology/*surgery/ultrasonography

A gastric carcinoma with the endoscopic features resembling a submucosal tumor (SMT) is rare, and reportedly accounting for 0.1% to 0.63% of all resected gastric carcinomas in Japan. A diagnosis of a SMT-like gastric carcinoma is often difficult as the tumors are almost entirely covered with normal mucosa. Furthermore mucinous gastric adenocarcinoma is uncommon histologic subtype of gastric cancer. These tumors are detected mostly in an advanced stage and rarely in an early stage. Early mucinous gastric adenocarcinoma is characterized as an elevated lesion resembling SMT due to abundant mucin pools in the submucosa. Here we report one case of SMT-like mucinous gastric adenocarcinoma, diagnosed by the usual endoscopic biopsy and treated with surgery.
Adenocarcinoma, Mucinous/*diagnosis/pathology/ultrasonography ; Aged ; Diagnosis, Differential ; Gastric Mucosa/pathology ; Gastroscopy ; Humans ; Male ; Stomach Neoplasms/*diagnosis/pathology/ultrasonography ; Tomography, X-Ray Computed

PURPOSE: Intestinal duplication is a rare congenital anomaly that may be found anywhere from the mouth to the anus. The clinical presentation varies depending on the anatomic location or the size of the duplication, and the presence of the ectopic gastric tissue. The aim of this study was to analyze the clinical characteristics, the diagnostic and therapeutic methods, the location, the anatomic type and the associated anomalies of intestinal duplication. METHODS: We reviewed the medical record of eighteen patients with duplication of the alimentary tract and these patients had been treated at Kyungpook National University Hospital from July 1995 through October 2007. RESULTS: There were 9 boys and 9 girls. Their ages ranged from 3 days to 15 years. The most common symptom was abdominal pain. The duplicated segment acted as a leading point of intussusception in 3 cases. Two patients had melena. The duplications were cystic in fifteen cases and three others were tubular. In twelve cases, the lesions were located in the ileum; two other cases were located in the anal canal, one other was located in the in the transverse colon, another was located in the transverse and descending colon, one was located in the in the duodenum and one was located in the jejunum. Ultrasonography, computed tomography and barium enema were helpful as diagnostic tools. Three cases were diagnosed by prenatal ultrasonography. Associated anomalies were documented in four cases. All the patients underwent surgery. A duplicated lesion was lined with ectopic gastric mucosa in only one case. One patient still suffers from short bowel syndrome as a result of volvulus. CONCLUSION: The early operative treatment of intestinal duplication is safe and effective to prevent complications. In patients with intussusception, duplication should be considered as one of the causes of the leading point of intussusception.
Abdominal Pain ; Anal Canal ; Barium ; Colon, Descending ; Colon, Transverse ; Duodenum ; Enema ; Gastric Mucosa ; Humans ; Intestinal Volvulus ; Intussusception ; Jejunum ; Medical Records ; Melena ; Mouth ; Short Bowel Syndrome ; Ultrasonography, Prenatal

Gastrointestinal duplication is a rare congenital anomaly which can occur anywhere along the digestive tract. The most common site is the mesenteric border of the terminal ileum. Intestinal duplication usually becomes symptomatic early in life with the severity of symptoms depending on the location and type of mucosal lining. Ectopic gastric mucosa is an associated possibility. Gastrointestinal hemorrhage is the most serious complication, which can cause severe anemia and shock. Another complication, although rare, is carcinoma in a duplicate cyst. We experienced an unusual case of a 12-years-old girl who presented with intermittent abdominal pain and hematochezia. There was no abnormality on Meckel's scan. Abdominal CT revealed a cystic mass in the pelvic cavity and subsequent transabdominal ultrasound showed the double-layered wall of the duplication. We performed laparoscopy-assisted, segmental resection of the ileum. The patient was discharged without any complication on the 7th postoperative day.
Abdominal Pain ; Anemia ; Child* ; Female* ; Gastric Mucosa ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Humans ; Ileum ; Shock ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: The proper diagnosis of Meckel's diverticulum (MD) is difficult and delayed because of the variety of clinical manifestations. We reviewed clinical characteristics of symptomatic MD to facilitate early detection. METHODS: We analyzed retrospectively the clinical manifestations, diagnostic tools, histopathological findings, and operative findings in 58 patients with symptomatic MD. RESULTS: The male to female ratio was 2.8 : 1. The most common symptom of MD was bleeding. Others symptoms included: vomiting, abdominal pain, irritability, abdominal distension and fever in the order of frequency. The clinical manifestations of symptomatic MD were lower gastrointestinal bleeding, intestinal obstruction, perforation, diverticulitis and hemoperitoneum, in the order of frequency. The causes of intestinal obstruction were intussusception, internal hernia, band, volvulus, invagination, in the order of frequency. Seventy five percent of patient with MD were diagnosed prior to 5 years of age. The most frequently used diagnostic tool was the Meckel's scan. The diverticulum was located 2 cm to 120 cm proximal to the ileocecal valve. The length of the diverticulum ranged from 1 cm to 10 cm and 94% were less than 5 cm. The most common ectopic tissue found in the MD was gastric mucosa. Ileal resection was more frequently performed than diverticulectomy. CONCLUSION: In cases of unexplained gastrointestinal bleeding, obstruction and repeated intussusception, the meckel's scan, ultrasound and computed tomography shoud be considered to rule out MD, and if clinically necessary, an exploratory laparotomy when needed.
Abdominal Pain ; Choristoma ; Diagnosis ; Diverticulitis ; Diverticulum ; Female ; Fever ; Gastric Mucosa ; Hemoperitoneum ; Hemorrhage ; Hernia ; Humans ; Ileocecal Valve ; Intestinal Obstruction ; Intestinal Volvulus ; Intussusception ; Laparotomy ; Male ; Meckel Diverticulum* ; Retrospective Studies ; Ultrasonography ; Vomiting

PURPOSE: The diagnosis of Meckel's diverticulum is difficult and delayed because it presents with various clinical symptoms. We evaluated clinical, imaging and pathologic findings of Meckel's diverticulum to facilitate detection of Meckel's diverticulum in children. METHODS: Review of clinical, imaging, surgical and pathological findings in 10 children aged 7 days to 14 years with Meckel's diverticulum during an 8-year period, 1993-2001, at Ewha Womans University Hospital was undertaken. RESULTS: The male to female ratio was 2.3 : 1. The chief complaint was painless lower gastrointestinal(GI) bleeding; others were abdominal pain, abdominal distention and vomiting, in order of frequency. The diagonsis before surgery were Meckel's diverticulum in 5 patients, non-reducible intussusception in 3 patients and intestinal obstruction in 2 patients. The diverticulum was located between 35 cm to 70 cm proximal to the ileocecal valve. The length of the diverticulum ranged from 4 cm to 12 cm and 80% of it was within 5 cm. A Meckel scan(99mTc-pertechnetate scintigraphy) after cimetidine administration was done in 6 cases. All 5 cases that presented with lower GI bleeding had ectopic gastric mucosa confirmed on pathology. Out of 5 cases of ectopic gastric mucosa, only 4 cases were positive on the Meckel's scan. CONCLUSION: In cases of unexplained GI bleeding, obstruction, or inflammation diagnostic workup should be carried out to rule out Meckel's diverticulum. Laparoscopy, high resolution ultrasonography and computed tomography of the abdomen may be indicated in the assessment of pediatric patient with lower GI bleeding, especially in patients with suspected bleeding from Meckel's diverticulum showing negative Meckel's scan.
Abdomen ; Abdominal Pain ; Child ; Cimetidine ; Diagnosis ; Diverticulum ; Female ; Gastric Mucosa ; Hemorrhage ; Humans ; Ileocecal Valve ; Inflammation ; Intestinal Obstruction ; Intussusception ; Laparoscopy ; Male ; Meckel Diverticulum* ; Pathology ; Ultrasonography ; Vomiting