• Title/Summary/Keyword: Gastroenterology

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Portal cavernography during endoscopic retrograde cholangiopancreatography: from bilhemia to hemobilia

  • Rawad A. Yared;Paraskevas Gkolfakis;Arnaud Lemmers;Vincent Huberty;Thierry Degrez;Jacques Deviere;Daniel Blero
    • Clinical Endoscopy
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    • v.56 no.4
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    • pp.521-526
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    • 2023
  • Portobiliary fistulas are rare but may lead to life-threatening complications. Biliary plastic stent-induced portobiliary fistulas during endoscopic retrograde cholangiopancreatography have been described. Herein, we present a case of portal cavernography and recurrent hemobilia after endoscopic retrograde cholangiopancreatography in which a portobiliary fistula was detected in a patient with portal biliopathy. This likely indicates a change in clinical presentation (from bilhemia to hemobilia) after biliary drainage that was successfully treated by placement of a fully covered, self-expandable metallic stent.

Efficacy of the pocket-creation method with a traction device in endoscopic submucosal dissection for residual or recurrent colorectal lesions

  • Daisuke Ide;Tomohiko Richard Ohya;Mitsuaki Ishioka;Yuri Enomoto;Eisuke Nakao;Yuki Mitsuyoshi;Junki Tokura;Keigo Suzuki;Seiichi Yakabi;Chihiro Yasue;Akiko Chino;Masahiro Igarashi;Akio Nakashima;Masayuki Saruta;Shoichi Saito;Junko Fujisaki
    • Clinical Endoscopy
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    • v.55 no.5
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    • pp.655-664
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    • 2022
  • Background/Aims: Endoscopic submucosal dissection (ESD) for residual or recurrent colorectal lesions after incomplete resection is challenging because of severe fibrosis. This study aimed to compare the efficacy of the pocket-creation method (PCM) with a traction device (TD) with that of conventional ESD for residual or recurrent colorectal lesions. Methods: We retrospectively studied 72 patients with residual or recurrent colorectal lesions resected using ESD. Overall, 31 and 41 lesions were resected using PCM with TD and conventional ESD methods, respectively. We compared patient background and treatment outcomes between the PCM with TD and conventional ESD groups, respectively. The primary endpoints were en bloc resection and R0 resection rates. The secondary endpoints were the dissection speed and incidence of adverse events. Results: En bloc resection was feasible in all cases with PCM with TD, but failed in 22% of cases of conventional ESD. The R0 resection rates for PCM with TD and conventional ESD were 97% and 66%, respectively. Dissection was significantly faster in the PCM with TD group (13.0 vs. 7.9 mm2/min). Perforation and postoperative bleeding were observed in one patient in each group. Conclusions: PCM with TD is an effective method for treating residual or recurrent colorectal lesions after incomplete resection.

Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy

  • Kei Matsumoto;Shinwa Tanaka;Takashi Toyonaga;Nobuaki Ikezawa;Mari Nishio;Masanao Uraoka;Tomoatsu Yoshihara;Hiroya Sakaguchi;Hirofumi Abe;Tetsuya Yoshizaki;Madoka Takao;Toshitatsu Takao;Yoshinori Morita;Hiroshi Yokozaki;Yuzo Kodama
    • Clinical Endoscopy
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    • v.55 no.1
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    • pp.86-94
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    • 2022
  • Background/Aims: The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Different reconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomotic site. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastric cancers at the anastomotic site. Methods: We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at the anastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and nonBillroth II groups. Results: The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm; p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation time was longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth II group. Conclusions: Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with a background of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involved longer operative times and more frequent bleeding episodes than that in patients without Billroth II.

Complete Remission of Unresectable Esophageal Cancer Achieved with Concurrent Chemoradiotherapy: A Case Report

  • Jung Min Lee;Bora Keum;Sang Yup Lee;In Kyung Yoo;Seung Han Kim;Hyuk Soon Choi;Eun Sun Kim;Hoon Jai Chun
    • Journal of Digestive Cancer Research
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    • v.5 no.1
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    • pp.70-72
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    • 2017
  • A 41-year old woman with dysphagia visited, which was aggravated after eating. On physical examination, there was a palpable mass on the left supraclavicular area. Endoscopic examination revealed a mass on the distal esophagus with irregular mucosa, erythema and a whitish plaque with luminal narrowing. The patient was diagnosed with unresectable esophageal cancer (squamous cell carcinoma, T3N2M1, Stage IV). The patient received CCRT (total 63 Gy) with cisplatin and 5-fluorouracil (5-FU). After CCRT, the patient took an additionally 2 cycles of chemotherapy for consolidation (cisplatin and 5-FU every 4 weeks). After additional chemotherapy, endoscopic examination showed no residual tumor, a chest CT scan revealed that the mass in the distal esophagus had decreased and there was no enlargement of the lymph nodes around the left supraclavicular area. The patient has been in complete remission for 5 years.

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