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Miyake M, Nishimura N, Shimodate Y, Doi A, Mouri H, Matsueda K, Mizuno M. Early gastric cancer with ball valve syndrome treated by endoscopic submucosal dissection. Clin J Gastroenterol 2019; 12:307-309. [PMID: 30838513 DOI: 10.1007/s12328-019-00955-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
An 84-year-old woman with pneumonia, congestive heart failure and chronic renal failure presented for iron-deficiency anemia and appetite loss. Esophagogastroduodenoscopy revealed a 60-mm sub-pedunculated tumor arising from the antrum of the stomach. The tumor was friable, with bleeding, and prolapsed into the duodenal bulb, the ball valve syndrome. The tumor was considered the cause of the anemia and appetite loss. Attempted endoscopic reduction of the prolapsing tumor was unsuccessful, but the base of its stalk could be identified through the transparent hood; thus, we removed the tumor with endoscopic submucosal dissection. The tumor was retrieved successfully, and pathohistological examination revealed the tumor to be a well-differentiated adenocarcinoma. This case suggests that endoscopic submucosal dissection is useful as an alternative to surgery for removal of gastric tumors that have prolapsed into the duodenal bulb when polypectomy was difficult, but provided the tumor's attachment site can be identified endoscopically.
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Affiliation(s)
- Muneaki Miyake
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Naoyuki Nishimura
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Yuichi Shimodate
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Akira Doi
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hirokazu Mouri
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Motowo Mizuno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
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Ball Valve Syndrome Caused by the Migration of Gastrostomy Catheter Tip. Clin Gastroenterol Hepatol 2017; 15:e133-e134. [PMID: 28110093 DOI: 10.1016/j.cgh.2017.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 01/08/2017] [Accepted: 01/09/2017] [Indexed: 02/07/2023]
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Pinto-Pais T, Fernandes S, Proença L, Fernandes C, Ribeiro I, Sanches A, Carvalho J, Fraga J. A Large Gastric Inflammatory Fibroid Polyp. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:61-64. [PMID: 28868375 PMCID: PMC5580130 DOI: 10.1016/j.jpge.2014.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/16/2014] [Indexed: 12/16/2022]
Abstract
Inflammatory fibroid polyp (IFP) is an unusual benign gastrointestinal subepithelial tumor (SET). The endosonographic (EUS) features of IFPs were sporadically reported on imaging tips or small case series study. However, the differential diagnosis and optimal treatment of gastric IFP is still challenging. We report an unusual case of a large erosioned and prolapsing gastric submucosal lesion, presenting primarily with obstructive symptoms ("ball valve syndrome") and anemia. On EUS examination, a 50 mm SET in the distal antrum was seen, with hypoechoic but heterogeneous echo-pattern, located in the second and third sonographic layers of the gastric wall (deep mucosal and submucosal). The fourth (muscle) layer was intact; no peri-lesional adenopathies were identified. A decision was made to proceed to endoscopic treatment because of the mentioned symptoms. Histopathologic evaluation of the resected specimen with immunohistochemical staining was consistent with the diagnosis of IFP. IFP rarely reach these large dimensions or cause symptoms. Despite its benign etiology, endoscopic resection was important in both establishing a histologic diagnosis and treatment. EUS was crucial in the differential diagnosis. The literature concerning IFP is also reviewed.
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Affiliation(s)
- Teresa Pinto-Pais
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sónia Fernandes
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Luísa Proença
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Carlos Fernandes
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Iolanda Ribeiro
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Agostinho Sanches
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - João Carvalho
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - José Fraga
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Giant polypoid tumor expressing on the pyloric ring. Case Rep Med 2015; 2015:986971. [PMID: 25688271 PMCID: PMC4320937 DOI: 10.1155/2015/986971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/05/2015] [Indexed: 11/18/2022] Open
Abstract
A 66-year-old Japanese man was referred to our hospital because of suspected duodenal cancer. Upper gastric endoscopy revealed a giant polypoid-type tumor that extended from the duodenum bulb to the pyloric ring. A computed tomography scan revealed a slightly enhanced lobular tumor protruding into the duodenum bulb. Positron emission tomography showed an accumulation of (18)F-fluorodeoxyglucose in the area extending from the antrum of the stomach to the duodenum bulb. Since an endoscopic ultrasound test suggested that the tumor might invade the muscular tunic, indications of endoscopic mucosal resection were not favored, and the tumor was curatively removed via distal gastrectomy. The histopathologic diagnosis was papillary adenocarcinoma, and the invasion depth was the mucosal layer without vascular invasion, which was different from the preoperative diagnosis. Our case suggests the difficulties in precise diagnosis of the invasion depth of the giant polypoid cancer.
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