1
|
Zorzetti N, Lauro A, D'Andrea V, Ruffato A, Ferruzzi L, Antonacci N, Tranchino RM. Benign Blockage: Gastric Outlet Obstruction due to a Prolapsing Gastric Pedunculated Polyp-Case Report and Literature Review. Dig Dis Sci 2021; 66:1791-1795. [PMID: 33634429 DOI: 10.1007/s10620-021-06890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 12/09/2022]
Affiliation(s)
- N Zorzetti
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy.
| | - A Lauro
- Department of Surgical Sciences, La Sapienza University, Rome, Italy
| | - V D'Andrea
- Department of Surgical Sciences, La Sapienza University, Rome, Italy
| | - A Ruffato
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - L Ferruzzi
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - N Antonacci
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - R M Tranchino
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| |
Collapse
|
2
|
Lemoine A, Asmandar S, Boutroux H, Tounian P, Ducou Le Pointe H, Coulomb A, Irtan S. Extrapancreatic primary solid pseudopapillary tumor in the gastric antrum: Case report. Pediatr Blood Cancer 2020; 67:e28415. [PMID: 32779872 DOI: 10.1002/pbc.28415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Anaïs Lemoine
- Department of Pediatric Nutrition and Gastroenterology, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Safaa Asmandar
- Department of Pathological Anatomy and Cytology, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Hélène Boutroux
- Department of Pediatric Hematology and Oncology, APHP, Trousseau Hospital, Paris, France
| | - Patrick Tounian
- Department of Pediatric Nutrition and Gastroenterology, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Hubert Ducou Le Pointe
- Department of Pediatric Imaging, APHP, Sorbonne University, Trousseau Hospital, Paris, France
| | - Aurore Coulomb
- Department of Pathological Anatomy and Cytology, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Sabine Irtan
- Department of Visceral and Neonatal Pediatric Surgery, APHP, Sorbonne University, Trousseau Hospital, Paris, France
| |
Collapse
|
3
|
Chang CF, Huang TY, Huang HH, Shih YL, Chang WK, Hsieh TY, Wu LS, Chen KW, Lin HH. Impact of endoscopic sedation on gastric polyp detection: A one-center retrospective observational study. Medicine (Baltimore) 2020; 99:e22556. [PMID: 33031301 PMCID: PMC10545299 DOI: 10.1097/md.0000000000022556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 05/03/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022] Open
Abstract
Sedation esophagogastroduodenoscopy (EGD) has become more prevalent in many countries. However, owing to the limitation of health insurance payment for sedation EGD in Taiwan, non-sedation EGD still accounts for the majority of cases. This study was aimed to explore the differences between the sedation and non-sedation groups in terms of endoscopic findings, such as detection rate of gastric polyp of any size, number of detected gastric polyps, and location of the gastric polyps detected.We enrolled 10,940 patients who underwent EGD between January 1, 2016 and December 31, 2016 at the Tri-Service General Hospital; among the patients, 1900 received intravenous sedation (IVS) and 9040 did not. The data reviewed included demographics, parameters of the polyp (number, size, and location), and pathology.Compared with the non-sedation group, the sedation group had a higher overall polyp detection rate (P < .001); a greater number of detected polyps (Odds ratio 1.50, P = .007); and a higher detection rate of smaller polyps, such as fundic gland polyp, and hyperplastic polyp (P < .001). Among the pathological findings, gastric neuroendocrine tumor (NET) was detected using EGD in 2 cases and manifested as small polyps (<0.05 cm), and it showed significantly better detection rates in the sedation EGD group than in the non-sedation EGD group (P = .002).Sedation EGD could enhance a patients willingness and cooperation during EGD. Furthermore, sedation EGD increased the detection rates of small gastric polyps and was more likely to enable identification of unusual findings, such as gastric NET.
Collapse
Affiliation(s)
- Chao-Feng Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Lian-Shan Wu
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien County, Taiwan
| | - Kai-Wen Chen
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien County, Taiwan
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Jetha Z, Lisi M. Prolapsed fundic gastric polyp causing gastroduodenal intussusception and acute pancreatitis. J Surg Case Rep 2018; 2018:rjy139. [PMID: 29992001 PMCID: PMC6030949 DOI: 10.1093/jscr/rjy139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 05/28/2018] [Indexed: 12/22/2022] Open
Abstract
An 86-year-old female presented with a 6-month history of recurrent intermittent epigastric abdominal pain, postprandial fullness with nausea, vomiting, anemia and a 15-pound weight loss. A large fundic gastric polyp was intussuscepting into the duodenum causing intermittent compression and obstruction of the ampulla of Vater leading to acute pancreatitis. An overview of the clinical presentation, diagnosis and management of this entity, in addition to a review of the literature is provided.
Collapse
Affiliation(s)
- Zishan Jetha
- Division of General Surgery, University of Toronto, Toronto, Canada
| | - Michael Lisi
- Division of General Surgery, University of Toronto, Toronto, Canada.,McMaster University, Hamilton, Canada
| |
Collapse
|
6
|
Saito H, Miyazaki T, Sohda M, Sakai M, Honjyo H, Kumakura Y, Yoshida T, Yokobori T, Kurosawa K, Kuwano H. Postprandial cardiogenic syncope caused by gastric polyp-induced pyloric obstruction in an elderly woman with a giant hiatal hernia: a case report. Surg Case Rep 2017; 3:124. [PMID: 29238893 PMCID: PMC5729177 DOI: 10.1186/s40792-017-0403-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/03/2017] [Indexed: 11/21/2022] Open
Abstract
Background Hiatal hernias are common. In some reports, hiatal hernias have been implicated in causing dyspnea, syncope, and heart failure. Case presentation An 82-year-old woman with a hiatal hernia was admitted to our hospital because she had experienced postprandial syncope during the last few years. Esophagogastroduodenoscopy revealed a large hiatal hernia and a pedunculated polyp of the stomach antrum that fit into the pylorus. An upper gastrointestinal contrast study showed that the entire stomach had relocated to the thoracic cavity and that the body of the stomach was located above the fundus, resulting in a so-called upside-down stomach. Contrast-enhanced computed tomography revealed that a large portion of the stomach, transverse colon, and part of the pancreas were present in the mediastinum. We then performed transthoracic echocardiography followed by a water pouring test using a nasogastric tube. After instillation of 2000 ml of saline, the left atrium was markedly compressed and the area of the mitral annulus was reduced. We determined that stomach dilation by the hiatal hernia and gastric polyp had caused the syncope. The patient underwent laparoscopic hiatal hernia repair and endoscopic gastric polypectomy, and she experienced no syncopal episodes for 5 months postoperatively. Conclusions Clinicians should recognize that a large hiatal hernia may be a risk factor for syncope.
Collapse
Affiliation(s)
- Hideyuki Saito
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tatsuya Miyazaki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Makoto Sohda
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroaki Honjyo
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Yuuji Kumakura
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tomonori Yoshida
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takehiko Yokobori
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Department of Molecular Pharmacology and Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Koji Kurosawa
- Department of Clinical Laboratory Center, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| |
Collapse
|
7
|
Chahla E, Kim MA, Beal BT, Alkaade S, Garrett RW, Omran L, Ogawa MT, Taylor JR. Gastroduodenal Intussusception, Intermittent Biliary Obstruction and Biochemical Pancreatitis due to a Gastric Hyperplastic Polyp. Case Rep Gastroenterol 2014; 8:371-6. [PMID: 25685129 PMCID: PMC4322696 DOI: 10.1159/000369548] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We present the case of a 76-year-old man with gastroduodenal intussusception secondary to a gastric hyperplastic polyp. Intussusception in the adult population occurs infrequently. Our patient presented with gastroduodenal intussusception, which is very uncommon and accounts for <10% of all types of intussusception. This case is unique in that partial endoscopic resection of the gastric hyperplastic polyp resolved the patient's gastroduodenal intussusception, biliary obstruction and biochemical pancreatitis without the need for surgical intervention.
Collapse
Affiliation(s)
- Elie Chahla
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Michael A Kim
- Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Brandon T Beal
- Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Samer Alkaade
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Robert W Garrett
- Department of Radiology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Louay Omran
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Michael T Ogawa
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Jason R Taylor
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| |
Collapse
|
8
|
Akbarzadeh-Jahromi M, Owji SM, Geramizadeh B, Shekarkhar G, Alizade Naini M. A 57 year old woman with polypoid gastric mass. Middle East J Dig Dis 2014; 6:241-3. [PMID: 25349688 PMCID: PMC4208933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 08/11/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mojgan Akbarzadeh-Jahromi
- 1 Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
,Corresponding Author: Mojgan Akbarzadeh Jahromi, MD Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran, Zand Avenue, Shiraz, Iran PO Box: 71345-1864 Telefax: + 98 71 32301784
| | - Seyed Mohammad Owji
- 1 Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- 1 Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Golsa Shekarkhar
- 1 Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahvash Alizade Naini
- 2 Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
9
|
Antral hyperplastic polyp: A rare cause of gastric outlet obstruction. Int J Surg Case Rep 2014; 5:287-9. [PMID: 24747755 PMCID: PMC4066575 DOI: 10.1016/j.ijscr.2014.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 02/14/2014] [Accepted: 03/17/2014] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Gastric polyps are usually found incidentally during upper gastrointestinal endoscopic examinations. These polyps are generally benign, with hyperplasia being the most common. While gastric polyps are often asymptomatic, they can cause gastric outlet obstruction. PRESENTATION OF CASE A 64 years-old female patient presented to our polyclinic with a history of approximately 2 months of weakness, occasional early nausea, vomiting after meals and epigastric pain. A polypoid lesion of approximately 25mm in diameter was detected in the antral area of the stomach, which prolapsed through the pylorus into the duodenal bulbus, and subsequently caused gastric outlet obstruction, as revealed by upper gastrointestinal endoscopy of the patient. The polyp was retrieved from the pyloric canal into the stomach with the aid of a tripod, and snare polypectomy was performed. DISCUSSION Currently, widespread use of endoscopy has led to an increase in the frequency of detecting hyperplastic polyps. While most gastric polyps are asymptomatic, they can cause iron deficiency anemia, acute pancreatitis and more commonly, gastric outlet obstruction because of their antral location. Although there are no precise principles in the treatment of asymptomatic polyps, polyps >5mm should be removed due to the possibility of malignant transformation. CONCLUSION According to the medical evidence, polypectomy is required for gastric hyperplastic polyps because of the risks of complication and malignancy. These cases can be successfully treated endoscopically.
Collapse
|
10
|
Jung EY, Choi SO, Cho KB, Kim ES, Park KS, Hwang JB. Successful endoscopic submucosal dissection of a giant polyp in a 21-month-old female. World J Gastroenterol 2014; 20:323-325. [PMID: 24415889 PMCID: PMC3886027 DOI: 10.3748/wjg.v20.i1.323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 09/17/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is now recognized as the preferred treatment modality for gastrointestinal epithelial lesions. A 21-month-old female was admitted with a giant hyperplastic polyp causing a gastric outlet obstruction. Successful ESD was performed with caution. The post-procedural course was uneventful without a bleeding episode. Although further study of the feasibility of ESD in early children is necessary, ESD could be applied to avoid laparotomy even in young children.
Collapse
|
11
|
Macedo G, Lopes S, Albuquerque A. Ball valve syndrome: gastric polypectomy as a safe endoscopic treatment of a potentially troublesome condition. Gastrointest Endosc 2012; 76:1080-1081. [PMID: 23078940 DOI: 10.1016/j.gie.2012.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/18/2012] [Indexed: 12/11/2022]
|
12
|
Otjen JP, Iyer RS, Phillips GS, Parisi MT. Usual and unusual causes of pediatric gastric outlet obstruction. Pediatr Radiol 2012; 42:728-37. [PMID: 22457062 DOI: 10.1007/s00247-012-2375-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/31/2012] [Accepted: 02/10/2012] [Indexed: 01/07/2023]
Abstract
Gastric outlet obstruction in children encompasses a spectrum of disorders that extends beyond hypertrophic pyloric stenosis. Each condition can result in the clinical syndrome of persistent nonbilious vomiting, which can progress to dehydration and electrolyte imbalances. This paper reviews the spectrum of both the common and uncommon entities that cause partial or complete gastric outlet obstruction and their imaging appearances. The correct diagnosis of those with gastric outlet obstruction can be achieved by combining clinical presentation with appropriate imaging, leading to optimal and timely patient management.
Collapse
Affiliation(s)
- Jeffrey P Otjen
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | | | | | | |
Collapse
|
13
|
Sun CK, Yang KC, Liao CS. Endoscopic Management of Gastric Polyp with Outlet Obstruction without Polypectomy. Case Rep Gastroenterol 2011; 5:267-71. [PMID: 21887127 PMCID: PMC3153338 DOI: 10.1159/000328443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Although gastric polyp is usually an incidental endoscopic finding, large-sized polyps can cause symptoms ranging from epigastralgia to bleeding from ulcerated polyps and gastric outlet obstruction. Although the gold standard of treatment is removal of the polyp either through endoscopic polypectomy or surgical excision, complications associated with these procedures cannot be ignored. The risk becomes a major concern for patients at high risk for surgery when complications arise. We describe a debilitated 74-year-old woman who presented with early satiety, intermittent postprandial nausea and vomiting for three months. Upper endoscopy revealed a 2.5 cm pedunculated polyp over the gastric antrum causing intermittent obstruction. Considering her high risk for polypectomy, detachable snaring was performed without polypectomy in an outpatient setting. The patient was complication-free with complete relief of obstructive symptoms one week after the procedure. Subsequent follow-ups showed satisfactory healing without signs of mucosal disruption or recurrence. The results suggest that detachable snaring without polypectomy may be a therapeutic option for high-risk patients with benign symptomatic gastric polyps.
Collapse
Affiliation(s)
- Cheuk-Kay Sun
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | | | | |
Collapse
|
14
|
Hartman DS, Claudio T. Coexpression of two distinct muscle acetylcholine receptor alpha-subunits during development. Nature 1990; 14:497-503. [PMID: 2300185 DOI: 10.1007/s11894-012-0292-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The nicotinic acetylcholine receptor is a ligand-gated channel that mediates signalling at the vertebrate neuromuscular junction. It is a pentameric complex of four different subunits, assembled with a stoichiometry of alpha 2 beta gamma delta. Muscle-like alpha-subunits have been cloned from Torpedo, mouse, calf, rat, chicken, human and Xenopus, and only a single alpha-subunit complementary DNA from each species has been detected. We report here the cloning and characterization of a second muscle alpha-subunit cDNA from Xenopus, and show that this and a previously reported Xenopus alpha-subunit cDNA are encoded by distinct genes. The novel alpha-subunit reported here is expressed uniquely in oocytes; but both types of alpha-subunit are coexpressed throughout muscle development. This latter observation indicates that the expression of these two alpha-subunits is different from a previously reported developmental 'subunit-switch' mechanism used to generate channel diversity.
Collapse
Affiliation(s)
- D S Hartman
- Department of Biology, Yale University, New Haven, Connecticut 06511
| | | |
Collapse
|