Eosinophilic gastroenteritis observed by double balloon enteroscopy and endoscopic ultrasonography in the whole gastrointestinal tract

Eosinophilic gastroenteritis is a chronic inflammatory disorder of the gastrointestinal tract characterized by the infiltration of eosinophils. It is a rare disease. There are no reports in the history of eosinophilic gastroenteritis being consecutively observed in the whole gastrointestinal tract by esophagogastroduodenoscopy (EGD), double-balloon enteroscopy (DBE), and endoscopic ultrasonography (EUS). A 66-year-old woman was admitted to our hospital because of abdominal pain and diarrhea. Laboratory findings included peripheral eosinophilia and a high serum immunoglobulin E level. We observed the whole gastrointestinal tract by EGD, DBE (antegrade and retrograde approaches), and EUS. DBE showed slightly edematous and reddish mucosa in the jejunum, ileum, and ascending colon, respectively. EUS in all portion of the gastrointestinal tract demonstrated almost normal five-layered structure without ascites. Histologic examination of the biopsy specimens from the stomach, duodenum, jejunum, ileum, colon and rectum revealed eosinophilic infiltration. No evidence of parasites, granulomas, malignancy, vasculitis or embolism was founded in any of the biopsy specimens. The patient was diagnosed with eosinophilic gastroenteritis with predominant mucosal layer form. She was treated with oral corticosteroid, and her symptoms subsided. To the best of our knowledge, this is the first case of eosinophilic gastroenteritis in which the whole gastrointestinal tract was consecutively observed by EGD, DBE, and EUS.

Successful endoscopic hemostasis for bleeding from an acquired ileal diverticulum

We herein report successful endoscopic hemostasis in a patient with a bleeding from acquired ileal diverticulum. A 65-year-old woman was introduced to our hospital after the sudden onset of painless hematochezia. When emergency colonoscopy was performed, the site of bleeding could not be identified because of extensive blood pooling in the colon and ileocecal region. After admission, repeat colonoscopy with a transparent hood device after bowel preparation disclosed oozing of blood from an ileal diverticulum approximately 15 cm proximal to the ileocecal junction. We performed endoscopic therapy with injection of a hypertonic saline-epinephrine solution and placement of additional hemoclips in the diverticulum. Since the latter treatment, the patient had no recurrent hematochezia, and occult blood tests in stool had been negative. In cases of lower gastrointestinal bleeding, bleeding from an acquired ileal diverticulum should be considered and the terminal ileum carefully observed.

Pedunculated duodenal lipoma treated with endoscopic polypectomy with a detachable snare

We report endoscopic polypectomy with a detachable snare in a patient with a hemorrhagic pedunculated duodenal lipoma. A 67-year-old man with a history of spinal canal stenosis was admitted to our hospital because of recurrent tarry stools and anemia. Esophagogastroduodenoscopy revealed a pedunculated submucosal tumor measuring approximately 4 cm, in the second part of the duodenum. The tumor had a slightly yellowish coloration, and longitudinal erosion was noted on the surface of the tumor. There were no significant findings in the esophagus, stomach and bulbs. Barium study revealed a pedunculated submucosal tumor measuring 40 x 12 mm in the second portion of the duodenum. We judged that the submucosal tumor may have been the hemorrhagic source, and removed it by endoscopic snare polypectomy with a detachable snare. No complications occurred during endoscopic procedures. Histopathological examination revealed that the tumor was composed of mature adipose tissue in the submucosa, which was consistent with a diagnosis of lipoma In our experience, endoscopic polypectomy with a detachable snare is useful for the treatment of hemorrhagic pedunculated duodenal lipoma.

Prospective cohort study evaluating the relationship between salted food intake and gastrointestinal tract cancer mortality in Japan

PURPOSE

To investigate whether a high salted food intake increases the risk of gastrointestinal tract cancer mortality.

METHODS

We conducted a prospective study of 6830 Japanese inhabitants to evaluate the association between salted food consumption and the risk of gastrointestinal tract cancer mortality. Data were obtained from a prospective cohort study in Japan. Salted food consumption, determined from a baseline questionnaire, was classified into the two categories of 'low intake' and 'high intake'. The Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CI).

FINDINGS

Total of 174 gastrointestinal tract cancer deaths (47 esophagus cancer, 87 stomach cancer, 23 colon cancer and 17 rectal cancer) were observed during 94996 person-years of follow-up, with a mean follow-up period of 8.9 years. After adjustment for age, body mass index, physical activity, smoking, alcohol, history of diabetes mellitus and dietary items, including vegetables, fruit, tea, red meat and processed meat, the HR for stomach cancer in males with high salt intake was 2.05 (95% CI:1.25 - 3.38) whereas that of rectal cancer was 3.58 (95% CI: 1.08 - 11.89). In contrast, no association was seen in females. Further, no association was seen between higher salted food consumption and esophagus and colon cancer in either sex.

CONCLUSIONS

A significant association was seen between higher salted food consumption and stomach and rectal cancer mortality in men, but not in women. No association was seen between higher consumption and esophagus and colon cancer mortality in either men or women.

[Preoperative antimicrobial therapy for patients with cholecystectomy for acute cholecystitis based on the administrative database associated with the Diagnosis Procedure Combination system]

We collected data from 2070 patients who had undergone cholecystectomy for acute cholecystitis, investigating the circumstance of preoperative antimicrobial therapy. The duration of preoperative antimicrobial therapy was significantly longer in delayed cholecystectomy than early cholecystectomy (p<0.001). The number of types of antimicrobial drugs was also significantly greater in delayed cholecystectomy patients. The length of preoperative hospital stay in accordance with the number of antimicrobial drugs used in delayed cholecystectomy (p<0.001). This study suggests the importance of early cholecystectomy and the appropriate use of preoperative antimicrobial drugs for acute cholecystitis.