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Owen CK, Felinski MM, Bajwa KS, Walker PA, Mehta SS, Wilson EB, Boodoo S, Kudav V, Akhtar SJ, Shah SK, Kling ME. Frequency of Clinically Significant Findings in the Surgical Pathology Specimen Following Laparoscopic Sleeve Gastrectomy and Concordance with Preoperative Endoscopy: Insights from a Large Single-Center Experience. Obes Surg 2024; 34:1442-1448. [PMID: 38472705 DOI: 10.1007/s11695-024-07155-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Endoscopy prior to bariatric surgery is not always performed, and in sleeve gastrectomy (SG), the surgical specimen is not always sent for pathological examination. There is limited data on the frequency of clinically significant findings in SG specimens or correlation with preoperative endoscopy. METHODS We reviewed 426 consecutive SG patients to determine the concordance of preoperative endoscopy findings in patients with clinically significant postoperative pathology. RESULTS Preoperative endoscopy was performed on 397 patients (93.2%). Three hundred seventy-three patients had preoperative endoscopy and surgical pathology results available. Then, 20/373 (5.4%) patients had potentially significant postoperative pathology, including intestinal metaplasia, autoimmune metaplastic atrophic gastritis (AMAG), gastrointestinal stromal tumors, and/or gastric cancer. The overall incidence of AMAG in the entire cohort was 2.3%. Preoperative gastric biopsies (to include gastric body) identified AMAG in nearly 1/2 of patients. Patients with clinically significant postoperative pathology results had a median [interquartile range] of 3 [3-5] tissue blocks examined as compared to 3 [1-3] for the remainder of the cohort (p < 0.001). CONCLUSION This is one of the largest studies describing clinically significant postoperative pathology after SG. AMAG, in particular, is of particular importance as it is associated with a 3-fivefold increase in risk for gastric cancer. The incidence of significant postoperative pathology in this population is small but potentially clinically significant and requires validation in larger studies. We recommend wider sampling in preoperative endoscopy (body and antrum), especially in patients being planned for gastric bypass, consideration for routine pathological examination of SG surgical specimens, with careful gross examination and targeted sampling.
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Affiliation(s)
- Christopher K Owen
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Melissa M Felinski
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kulvinder S Bajwa
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Peter A Walker
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Erik B Wilson
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Vishal Kudav
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shaan J Akhtar
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shinil K Shah
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
- Michael E DeBakey Institute of Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA.
| | - M Elaine Kling
- Brown and Associates Medical Laboratories, Sugar Land, TX, USA
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Lin SH, Liu W, Yan XL. Gastritis cystica profunda. J Gastrointest Surg 2024; 28:592-593. [PMID: 38583915 DOI: 10.1016/j.gassur.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Si-Huang Lin
- The Affiliated Quanzhou First Hospital of Fujian Medical University, Quanzhou, China
| | - Wei Liu
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China; Institute of Digestive Disease, China Three Gorges University, Yichang, China; Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China.
| | - Xiao-Li Yan
- The Affiliated Quanzhou First Hospital of Fujian Medical University, Quanzhou, China.
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Cai Z, Mu M, Ma Q, Liu C, Jiang Z, Liu B, Ji G, Zhang B. Uncut Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. Cochrane Database Syst Rev 2024; 2:CD015014. [PMID: 38421211 PMCID: PMC10903295 DOI: 10.1002/14651858.cd015014.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Choosing an optimal reconstruction method is pivotal for patients with gastric cancer undergoing distal gastrectomy. The uncut Roux-en-Y reconstruction, a variant of the conventional Roux-en-Y approach (or variant of the Billroth II reconstruction), employs uncut devices to occlude the afferent loop of the jejunum. This modification is designed to mitigate postgastrectomy syndrome and enhance long-term functional outcomes. However, the comparative benefits and potential harms of this approach compared to other reconstruction techniques remain a topic of debate. OBJECTIVES To assess the benefits and harms of uncut Roux-en-Y reconstruction after distal gastrectomy in patients with gastric cancer. SEARCH METHODS We searched CENTRAL, PubMed, Embase, WanFang Data, China National Knowledge Infrastructure, and clinical trial registries for published and unpublished trials up to November 2023. We also manually reviewed references from relevant systematic reviews identified by our search. We did not impose any language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs comparing uncut Roux-en-Y reconstruction versus other reconstructions after distal gastrectomy for gastric cancer. The comparison groups encompassed other reconstructions such as Billroth I, Billroth II (with or without Braun anastomosis), and Roux-en-Y reconstruction. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. The critical outcomes included health-related quality of life at least six months after surgery, major postoperative complications within 30 days after surgery according to the Clavien-Dindo Classification (grades III to V), anastomotic leakage within 30 days, changes in body weight (kg) at least six months after surgery, and incidence of bile reflux, remnant gastritis, and oesophagitis at least six months after surgery. We used the GRADE approach to evaluate the certainty of the evidence. MAIN RESULTS We identified eight trials, including 1167 participants, which contributed data to our meta-analyses. These trials were exclusively conducted in East Asian countries, predominantly in China. The studies varied in the types of uncut devices used, ranging from 2- to 6-row linear staplers to suture lines. The follow-up periods for long-term outcomes spanned from 3 months to 42 months, with most studies focusing on a 6- to 12-month range. We rated the certainty of evidence from low to very low. Uncut Roux-en-Y reconstruction versus Billroth II reconstruction In the realm of surgical complications, very low-certainty evidence suggests that uncut Roux-en-Y reconstruction compared with Billroth II reconstruction may make little to no difference to major postoperative complications (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.24 to 4.05; I² = 0%; risk difference (RD) 0.00, 95% CI -0.04 to 0.04; I² = 0%; 2 studies, 282 participants; very low-certainty evidence) and incidence of anastomotic leakage (RR 0.64, 95% CI 0.29 to 1.44; I² not applicable; RD -0.00, 95% CI -0.03 to 0.02; I² = 32%; 3 studies, 615 participants; very low-certainty evidence). We are very uncertain about these results. Focusing on long-term outcomes, low- to very low-certainty evidence suggests that uncut Roux-en-Y reconstruction compared with Billroth II reconstruction may make little to no difference to changes in body weight (mean difference (MD) 0.04 kg, 95% CI -0.84 to 0.92 kg; I² = 0%; 2 studies, 233 participants; low-certainty evidence), may reduce the incidence of bile reflux into the remnant stomach (RR 0.67, 95% CI 0.55 to 0.83; RD -0.29, 95% CI -0.43 to -0.16; number needed to treat for an additional beneficial outcome (NNTB) 4, 95% CI 3 to 7; 1 study, 141 participants; low-certainty evidence), and may have little or no effect on the incidence of remnant gastritis (RR 0.27, 95% CI 0.01 to 5.06; I2 = 78%; RD -0.15, 95% CI -0.23 to -0.07; I2 = 0%; NNTB 7, 95% CI 5 to 15; 2 studies, 265 participants; very low-certainty evidence). No studies reported on quality of life or the incidence of oesophagitis. Uncut Roux-en-Y reconstruction versus Roux-en-Y reconstruction In the realm of surgical complications, very low-certainty evidence suggests that uncut Roux-en-Y reconstruction compared with Roux-en-Y reconstruction may make little to no difference to major postoperative complications (RR 4.74, 95% CI 0.23 to 97.08; I² not applicable; RD 0.01, 95% CI -0.02 to 0.04; I² = 0%; 2 studies, 256 participants; very low-certainty evidence) and incidence of anastomotic leakage (RR 0.34, 95% CI 0.05 to 2.08; I² = 0%; RD -0.02, 95% CI -0.06 to 0.02; I² = 0%; 2 studies, 213 participants; very low-certainty evidence). We are very uncertain about these results. Focusing on long-term outcomes, very low-certainty evidence suggests that uncut Roux-en-Y reconstruction compared with Roux-en-Y reconstruction may increase the incidence of bile reflux into the remnant stomach (RR 10.74, 95% CI 3.52 to 32.76; RD 0.57, 95% CI 0.43 to 0.71; NNT for an additional harmful outcome (NNTH) 2, 95% CI 2 to 3; 1 study, 108 participants; very low-certainty evidence) and may make little to no difference to the incidence of remnant gastritis (RR 1.18, 95% CI 0.69 to 2.01; I² = 60%; RD 0.03, 95% CI -0.03 to 0.08; I² = 0%; 3 studies, 361 participants; very low-certainty evidence) and incidence of oesophagitis (RR 0.82, 95% CI 0.53 to 1.26; I² = 0%; RD -0.02, 95% CI -0.07 to 0.03; I² = 0%; 3 studies, 361 participants; very low-certainty evidence). We are very uncertain about these results. Data were insufficient to assess the impact on quality of life and changes in body weight. AUTHORS' CONCLUSIONS Given the predominance of low- to very low-certainty evidence, this Cochrane review faces challenges in providing definitive clinical guidance. We found the majority of critical outcomes may be comparable between the uncut Roux-en-Y reconstruction and other methods, but we are very uncertain about most of these results. Nevertheless, it indicates that uncut Roux-en-Y reconstruction may reduce the incidence of bile reflux compared to Billroth-II reconstruction, albeit with low certainty. In contrast, compared to Roux-en-Y reconstruction, uncut Roux-en-Y may increase bile reflux incidence, based on very low-certainty evidence. To strengthen the evidence base, further rigorous and long-term trials are needed. Additionally, these studies should explore variations in surgical procedures, particularly regarding uncut devices and methods to prevent recanalisation. Future research may potentially alter the conclusions of this review.
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Affiliation(s)
- Zhaolun Cai
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Gastrointestinal Tumor Epigenetics and Genomics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Mingchun Mu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Ma
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chunyu Liu
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhiyuan Jiang
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Baike Liu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Ji
- Department of Digestive Surgery, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Bo Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Gastrointestinal Tumor Epigenetics and Genomics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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Wang Z, Zhou W, Li J, Wen W, Liang Z, Huo Z. A puzzling case report of well-differentiated neuroendocrine tumor mixed with gastric adenocarcinoma of the fundic gland type associated with autoimmune gastritis. Sci Prog 2024; 107:368504231220765. [PMID: 38373437 PMCID: PMC10878229 DOI: 10.1177/00368504231220765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Gastric adenocarcinoma of the fundic gland type (GA-FG) is a rare gastric neoplasm. We present a unique case of multiple GA-FG that coexisted with the well-differentiated neuroendocrine tumors in a patient with autoimmune gastritis. To our knowledge, this is the first documented instance of such a co-occurrence and the molecular mechanism of their origin has been reviewed systematically. A 47-year-old male presented to our hospital with abdominal distension for over 10 years. Gastroscopy revealed multiple gastric eminence lesions (0.2-1.5 cm). After endoscopic mucosal resection, the pathological morphology showed mixed tumor components infiltrating into the submucosa with puzzling similarity. One with uniform-sized tumor cells arranged in nests or tubes and the other a well-differentiated tubular adenocarcinoma with irregular branching and visible gland fusion. Immunohistochemistry findings revealed the first component expressed typical markers of neuroendocrine tumor, whereas the second component expressed pepsinogen and mucin-6, indicating the presence of oxyntic gland adenocarcinoma. Due to the tumors' proximity to the surgical margins, the patient underwent laparoscopic subtotal gastrectomy three months after the diagnosis without any tumor residue and showed no recurrence or metastasis occurred in the following regular checkups.
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Affiliation(s)
- Zheng Wang
- Department of Pathology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Weixun Zhou
- Department of Pathology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jingnan Li
- Department of Gastroenterology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Wenlong Wen
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Zhiyong Liang
- Department of Pathology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Zhen Huo
- Department of Pathology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
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Chivu R, Evanghelides A, Georgescu DE, Pa Traşcu T. Navigating Through Surgical Implications of Helicobacter pylori: An Up-to-Date Comprehensive Literature Review. Chirurgia (Bucur) 2023; 118:568-583. [PMID: 38228590 DOI: 10.21614/chirurgia.2023.v.118.i.6.p.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/18/2024]
Abstract
Helicobacter pylori, a gram-negative bacterium, has been identified as a major contributor to gastrointestinal diseases, ranging from gastritis and peptic ulcers to more severe complications such as gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. While pharmacological eradication therapies have been successful in managing H. pylori-associated diseases, the implications of this bacterium on surgical interventions remain a topic of ongoing research and clinical consideration. This comprehensive review aims to elucidate the intricate surgical implications of H. pylori infection. Recent data on the well-known relationship between and the development of gastroduodenal diseases, including peptic ulcers and gastric cancer, is analyzed. Concurrently, Helicobacter pylori infection may have a role in promoting colonic carcinogenesis and, more interestingly, it has also been linked to biliary tract cancers. The review highlights the evolving landscape of H. pylori management in the context of surgical interventions, accentuating the need for further research to delineate optimal strategies for preoperative screening, eradication therapies, and their impact on surgical outcomes and long-term patient prognosis. Comprehending the surgical ramifications of H. pylori infection remains crucial, emphasizing the significance of interdisciplinary approaches and ongoing research effort aimed at enhancing patient care.
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Yang J, Trivedi A, Nyirenda T, Shi M, Petit R, Talishinskiy T. Histopathologic findings in laparoscopic sleeve gastrectomy: is routine full pathologic evaluation indicated? Surg Obes Relat Dis 2023; 19:283-288. [PMID: 36372693 DOI: 10.1016/j.soard.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/07/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (SG) is the most commonly performed bariatric surgery. The resected gastric segment is routinely sent for pathology evaluation. No formal national recommendation exists that mandates pathology review. We proposed to study the largest histopathologic series in SG patients yet reported. OBJECTIVE The primary objective of our study was to determine whether a subgroup of patients who underwent bariatric surgery in the northeastern Unites States is more susceptible to having clinically significant pathologic findings that may benefit from routine histopathologic evaluation of the gastric sleeve specimen. SETTING University hospital. METHODS A retrospective electronic chart review of patients who underwent SG at a single large academic institution was performed. Patient demographics, body mass index, and histopathologic reports of the gastric specimens obtained during SG were analyzed. RESULTS The records of 3543 patients were reviewed. A total of 1076 patients had abnormal pathologies, including gastritis (938), follicular gastritis (98), intestinal metaplasia (25), gastrointestinal stromal tumor (12), leiomyoma (1), lymphoma (1), and other malignancy (1). Black and Hispanic patients had a higher incidence of developing gastrointestinal stromal tumor and intestinal metaplasia. A higher incidence of Helicobacter pylori infection among specimens with abnormal pathologies was noted. CONCLUSIONS The findings of this study call into question the routine use of pathology workup in gastric specimens after SG. Our data suggest that such analysis may be warranted in certain subtypes of patients such as older Black and Hispanic patients in the northeastern United States.
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Affiliation(s)
- James Yang
- St. Joseph's University Medical Center, Paterson, New Jersey.
| | - Aakash Trivedi
- St. Joseph's University Medical Center, Paterson, New Jersey
| | - Themba Nyirenda
- Hackensack University Medical Center, Hackensack, New Jersey
| | - Meiyi Shi
- Hackensack University Medical Center, Hackensack, New Jersey
| | - Ryan Petit
- Hackensack University Medical Center, Hackensack, New Jersey
| | - Toghrul Talishinskiy
- St. Joseph's University Medical Center, Paterson, New Jersey; Hackensack University Medical Center, Hackensack, New Jersey
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Hou JZ, Dong NN, Yue B, Meng FD, Wang YJ. Autoimmune gastritis with a gastric hamartomatous inverted polyp and two hyperplastic polyps: a case report. J Int Med Res 2023; 51:3000605231162451. [PMID: 36967703 PMCID: PMC10052490 DOI: 10.1177/03000605231162451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
We report an unusual case of autoimmune gastritis (AIG) complicated with a submucosal tumor (SMT) and two pedunculated polyps in a 60-year-old man. The patient was admitted for epigastric distention, heartburn, and anorexia. Endoscopy showed an SMT in the fundus, two pedunculated polyps in the body, and markedly atrophic mucosa of the body and fundus. The SMT, measuring 20 mm in diameter, was resected by endoscopic submucosal dissection and histologically diagnosed as a gastric hamartomatous inverted polyp (GHIP), which is characterized by submucosal glandular proliferation, cystic dilatation, and calcification. The gland structures consisted of foveolar cells and pseudopyloric or mucous-neck cell types. The two pedunculated polyps that were resected by endoscopic mucosal resection were histologically diagnosed as hyperplastic polyps, which are characterized by hyperplastic foveolar glands with pseudopyloric or mucous-neck glands in the inflamed stroma in the mucosa, which consisted of almost the same types of lining cells as the GHIP in the fundus. Findings may indicate the relationship between GHIP, hyperplastic polyp, and AIG. We highlight considering GHIP as a differential diagnosis for an SMT in patients with AIG.
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Affiliation(s)
- Jun-Zhen Hou
- Department of Gastroenterology, Shijingshan teaching hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China
| | - Ning-Ning Dong
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Bing Yue
- Department of Pathology, Beijing Friendship Hospital of Capital Medical University, Beijing, China
| | - Fan-Dong Meng
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
| | - Yong-Jun Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China
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de Lima Piña GP, Larrea Ramírez A, Fuertes Jiménez C, Cevallos Abad MI. Total gastrectomy due to emphysematous and necrotizing gastritis associated with Sarcina ventriculi in an 18-year-old patient. Rev Esp Enferm Dig 2023; 115:133-135. [PMID: 35360912 DOI: 10.17235/reed.2022.8767/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An 18-year-old woman with no pathological history, admitted to Emergency Department with abdominal pain and vomiting after consuming alcohol and cannabis in the last 36 hours. On physical examination, she presented with abdominal distention, signs of peritoneal irritation and sepsis. Abdominal computed tomography showed gastric, esophageal and duodenal distension, gastric and portal pneumatosis and the presence of free intra-abdominal fluid. An exploratory laparotomy was performed revealing extensive gastric necrosis. Then, total gastrectomy with stapled Roux-en-Y anastomosis was required. Histopathology of the gastric tissue confirmed extensive images of transmural emphysematous and necrotizing gastritis, and allowed to identify established Sarcina ventriculi infection.
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Abstract
INTRODUCTION Serious caustic burns of the stomach that present with no clinico-biological severity criteria (CBSC) can be treated conservatively. However, even if there are no CBSC at admission, 20% of patients still require delayed emergency surgery for peritonitis due to gastric perforation thus showing the limitations of this strategy in the diagnosis of irreversible gastric necrosis lesions. The aim of this study was to identify reliable computed tomography (CT) signs of irreversible gastric necrosis in patients with stage 3 endoscopic lesions. PATIENTS AND METHODS In a prospective study from March 2014 to January 2017, thoraco-abdomino-pelvic CT scan was performed in 30 consecutive patients with stage 3 endoscopic gastric lesions. The CT results were concealed from the clinicians and compared to CBSC results. RESULTS Twenty patients were treated conservatively and ten patients were operated on. Seventy percent of the patients underwent urgent delayed surgery for symptoms that developed late but before alterations in the CBSC. The CT scan showed a perfusion defect (PD) of gastric mucosal enhancement in all patients operated on for gastrointestinal distress, and could have provided an early diagnosis of irreversible gastric necrosis. CONCLUSION CT was a more effective diagnostic tool for the diagnosis of irreversible gastric necrosis following caustic ingestion than a strategy based on digestive endoscopy and the use of CBSC. CT could eventually replace gastrointestinal endoscopy in the emergency evaluation of gastroesophageal caustic burns.
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Affiliation(s)
- A Mensier
- Service de chirurgie digestive et transplantation, université Lille Nord de France, hôpital Claude-Huriez, CHU de Lille, rue Michel-Polonovski, 59037 Lille, France
| | - T Onimus
- Pôle anesthésie et réanimation, université Lille Nord de France, hôpital Roger-Salengro, CHU de Lille, 59037 Lille, France
| | - O Ernst
- Radiologie digestive, université Lille Nord de France, hôpital Hopital Claude-Huriez, CHU de Lille, 59037 Lille, France
| | - C Leroy
- Radiologie digestive, université Lille Nord de France, hôpital Hopital Claude-Huriez, CHU de Lille, 59037 Lille, France
| | - P Zerbib
- Service de chirurgie digestive et transplantation, université Lille Nord de France, hôpital Claude-Huriez, CHU de Lille, rue Michel-Polonovski, 59037 Lille, France.
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Kwon MJ, Kang HS, Kim HT, Choo JW, Lee BH, Hong SE, Park KH, Jung DM, Lim H, Soh JS, Moon SH, Kim JH, Park HR, Min SK, Seo JW, Choe JY. Treatment for gastric ‘indefinite for neoplasm/dysplasia’ lesions based on predictive factors. World J Gastroenterol 2019; 25:469-484. [PMID: 30700943 PMCID: PMC6350171 DOI: 10.3748/wjg.v25.i4.469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/31/2018] [Accepted: 01/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric ‘indefinite for neoplasm/dysplasia’ (IFND) is a borderline lesion that is difficult to diagnose as either regenerative or neoplastic. There is a need for guidance in the identification of a subset of patients, who have an IFND lesion with a higher risk of malignant potential, to enable risk stratification and optimal management.
AIM To determine the clinical and pathologic factors for the accurate diagnosis of gastric IFND lesions.
METHODS In total, 461 gastric lesions diagnosed via biopsy as IFND lesions were retrospectively evaluated. Endoscopic resection (n = 134), surgery (n = 22), and follow-up endoscopic biopsy (n = 305) were performed to confirm the diagnosis. The time interval from initial biopsy to cancer diagnosis was measured, and diagnostic delays were categorized as > 2 wk, > 2 mo, > 6 mo, and > 1 year. The IFND lesions presenting as regenerating atypia (60%) or atypical epithelia (40%) at initial biopsy were adenocarcinomas in 22.6%, adenomas in 8.9%, and gastritis in 68.5% of the cases.
RESULTS Four clinical factors [age ≥ 60 years (2.445, 95%CI: 1.305-4.580, P = 0.005), endoscopic size ≥ 10 mm (3.519, 95%CI: 1.891-6.548, P < 0.001), single lesion (5.702, 95%CI: 2.212-14.696, P < 0.001), and spontaneous bleeding (4.056, 95%CI: 1.792-9.180, P = 0.001)], and two pathologic factors [atypical epithelium (25.575, 95%CI: 11.537-56.695, P < 0.001], and repeated IFND diagnosis [6.022, 95%CI: 1.822-19.909, P = 0.003)] were independent risk factors for gastric cancer. With two or more clinical factors, the sensitivity and specificity for carcinoma were 91.3% and 54.9%, respectively. Ten undifferentiated carcinomas were initially diagnosed as IFND. In the subgroup analysis, fold change (5.594, 95%CI: 1.458-21.462, P = 0.012) predicted undifferentiated or invasive carcinoma in the submucosal layers or deeper. Diagnostic delays shorter than 1 year were not associated with worse prognoses. Extremely well-differentiated adenocarcinomas accounted for half of the repeated IFND cases and resulted in low diagnostic accuracy even on retrospective blinded review.
CONCLUSION More than two clinical and pathologic factors each had significant cut-off values for gastric carcinoma diagnosis; in such cases, endoscopic resection should be considered.
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Affiliation(s)
- Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, South Korea
| | - Ho Suk Kang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si 431-796, South Korea
| | - Hyeon Tae Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si 431-796, South Korea
| | - Jin Woo Choo
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si 431-796, South Korea
| | - Bo Hyun Lee
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si 431-796, South Korea
| | - Sung Eun Hong
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si 431-796, South Korea
| | - Kun Ha Park
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si 431-796, South Korea
| | - Dong Min Jung
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si 431-796, South Korea
| | - Hyun Lim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si 431-796, South Korea
| | - Jae Seung Soh
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si 431-796, South Korea
| | - Sung Hoon Moon
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si 431-796, South Korea
| | - Jong Hyeok Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si 431-796, South Korea
| | - Hye-Rim Park
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, South Korea
| | - Soo Kee Min
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, South Korea
| | - Jin won Seo
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, South Korea
| | - Ji-Young Choe
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, South Korea
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11
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Ramrakhiani NS, Shetler SA, Lombard C, Triadafilopoulos G. Gastritis Cystica Polyposa: A Rare Cause of Abdominal Pain and Early Satiety Treated with Endoscopic Resection. Dig Dis Sci 2018; 63:3220-3223. [PMID: 29987627 DOI: 10.1007/s10620-018-5195-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Nathan S Ramrakhiani
- Department of Gastroenterology, Palo Alto Medical Foundation, Mountain View, CA, USA.
| | - Sophia A Shetler
- Department of Gastroenterology, Palo Alto Medical Foundation, Mountain View, CA, USA
| | - Charles Lombard
- Department of Pathology, El Camino Hospital, Mountain View, CA, USA
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12
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Huang D, Zhan Q, Yang S, Sun Q, Zhou Z. Synchronous double superficial mixed gastrointestinal mucus phenotype gastric cancer with gastritis cystica profunda and submucosal lipoma: A case report. Medicine (Baltimore) 2018; 97:e10825. [PMID: 29851789 PMCID: PMC6392680 DOI: 10.1097/md.0000000000010825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Synchronous double superficial gastric cancer with gastritis cystica profunda (GCP) and submucosal lipoma is a rare disease and is difficult to diagnose and treat. CASE PRESENTATION A 61-year-old man was referred to our hospital with upper abdominal discomfort for the past 10 days. One year ago, the patient underwent surgery for duodenal ulcer and perforation. The diseases were diagnosed by magnifying endoscopy with narrowband imaging and pathological methods. Both mucosal lesions with a submucosal yellow-colored nodule were completely resected by endoscopic submucosal dissection and additional proximal gastrectomy was performed on the cancer embolus in the submucosal vena cava. The patient was finally diagnosed with synchronous double superficial well differentiated adenocarcinoma (mixed gastrointestinal mucus phenotype) with embolus in submucosal vena cava, coexisting with gastritis cystica profunda and submucosal lipoma. Final TNM classification was T1b (sm1) N0M0, and pathological stage was IA. The postoperative course was uneventful, and no recurrence or metastasis was observed during the 5-month follow-up period. CONCLUSION The diagnosis and treatment of synchronous double superficial gastric cancer with GCP and submucosal lipoma is challenging. In addition, elastic fiber staining and immune marker staining is effective and should be considered for diagnosis.
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Affiliation(s)
| | | | - Shudong Yang
- Department of Pathology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu
| | - Qi Sun
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zhiyi Zhou
- Department of Pathology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu
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13
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Baek IH, Kim KO, Choi MH, Jung SW, Jang HJ, Min KW. What Is Most Important to the Endoscopist for Therapeutic Plan? Morphology versus Pathology: A Nationwide Multicenter Retrospective Study in Korea. Am Surg 2018; 84:644-651. [PMID: 29966563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Histologic discrepancy may sometimes occur between biopsy and endoscopic resection. We investigated the discrepancy rate between the biopsy and the resection lesion in the Korean population. From January 2010 to October 2016, 268 patients with gastric endoscopic mucosal resection/endoscopic submucosal dissection history from nationwide hospitals were enrolled retrospectively. We compared the histologic discrepancy rates from the biopsy and the resection. The mean age was 63.2 years. Gastric adenomas occurred most frequently in the antrum. The pathology of the resected specimens classified 25 lesions (9.3%) as gastritis/hyperplasia, 146 lesions (54.5%) as low-grade dysplasia, 76 lesions (28.4%) as high-grade dysplasia (HGD), and 21 lesions (7.8%) as adenocarcinoma. The discrepancy rate between biopsy and resection was 23.1 per cent. Among the 44 cases of gastritis/hyperplasia, two cases (4.5%) were diagnosed as HGD and 11 cases (25.0%) were diagnosed as cancer after resection. Among the 182 cases of low-grade dysplasia, 33 cases (18.1%) were diagnosed as HGD and nine cases (5.0%) were diagnosed as cancer after resection. Gastritis/hyperplasia, ulceration, and lesions in the lower body location were significant factors related to the discrepancies. Especially, discrepancy occurred most frequently in gastritis/hyperplasia lesions with ulcer in the lower body. There was considerable histologic discrepancy between biopsy and resection. Ulcerative-type tumor morphology and biopsy diagnosis of gastritis/hyperplasia are suggestive factors predictive of discrepancy between biopsy and resection in terms of malignancy. Therefore, although the results of biopsy are gastritis/hyperplasia, suspicious tumorous lesions with ulcer should be indicative of active endoscopic resection for diagnosis and treatment.
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Affiliation(s)
- Il Hyun Baek
- Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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14
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Konstantinidis AO, Mylonakis ME, Psalla D, Soubasis N, Papadimitriou D, Rallis TS. Pyloric obstruction due to massive eosinophilic infiltration in a young adult dog. Can Vet J 2017; 58:1164-1166. [PMID: 29089651 PMCID: PMC5640296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 16-month-old dog was presented with chronic vomiting, anorexia, progressive weight loss, and melena. Exploratory laparotomy revealed a massive pyloric eosinophilic infiltration leading to pyloric obstruction that was treated successfully with pylorectomy. This is a novel clinical presentation of eosinophilic gastritis and highlights the need to consider it as a differential diagnosis for pyloric obstruction.
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15
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Boyd K, Mukerji AN, Niazi M, Farkas DT. Eosinophilic Enteropathy Presenting as Small Bowel Obstruction. Am Surg 2017; 83:e430-e432. [PMID: 30454227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Katharine Boyd
- American University of the Carribbean, Cupecoy, St. Maarten
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16
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Palus K, Bulc M, Całka J. Changes in Somatostatin-Like Immunoreactivity in the Sympathetic Neurons Projecting to the Prepyloric Area of the Porcine Stomach Induced by Selected Pathological Conditions. Biomed Res Int 2017; 2017:9037476. [PMID: 29098163 PMCID: PMC5643105 DOI: 10.1155/2017/9037476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/10/2017] [Accepted: 08/22/2017] [Indexed: 12/16/2022]
Abstract
The aim of the present study was to define changes in the expression of somatostatin (SOM) in the sympathetic perikarya innervating the porcine stomach prepyloric area during acetylsalicylic-acid-induced gastritis (ASA) and experimentally induced hyperacidity (HCL) and following partial stomach resection (RES). On day 1, the stomachs were injected with neuronal retrograde tracer Fast Blue (FB). Animals in the ASA group were given acetylsalicylic acid orally for 21 days. On the 22nd day after FB injection, partial stomach resection was performed in RES animals. On day 23, HCL animals were intragastrically given 5 ml/kg of body weight of a 0.25 M aqueous solution of hydrochloric acid. On day 28, all pigs were euthanized. Then, 14-μm thick cryostat sections of the coeliac-superior mesenteric ganglion (CSMG) complexes were processed for routine double-labelling immunofluorescence. All pathological conditions studied resulted in upregulation of SOM-like (SOM-LI) immunoreactivity (from 14.97 ± 1.57% in control group to 33.72 ± 4.39% in the ASA group, to 39.02 ± 3.65% in the RES group, and to 29.63 ± 0.85% in the HCL group). The present studies showed that altered expression of SOM occurs in sympathetic neurons supplying the prepyloric area of the porcine stomach during adaptation to various pathological insults.
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Affiliation(s)
- Katarzyna Palus
- Department of Clinical Physiology, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Michał Bulc
- Department of Clinical Physiology, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Jarosław Całka
- Department of Clinical Physiology, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
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17
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Tsujio G, Aomatsu N, Wang E, Yamakoshi Y, Nagashima D, Hirakawa T, Iwauchi T, Nishii T, Morimoto J, Nakazawa K, Tei S, Uchima Y, Takeuchi K. [A Case of Eosinophilic Enteritis Needed to Distinguish from a Tumor of the Small Intestine]. Gan To Kagaku Ryoho 2016; 43:1863-1865. [PMID: 28133157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 75-year-old woman was diagnosed with aplastic anemia 6 months ago and was under follow-up at our hospital. She had originallypresented to our hospital because of ongoing diarrhea and abdominal pain. Her blood tests showed a rise in inflammatorymarkers (WBC count was 6,900/mL[eosinophil was 1.3%]and CRP was 8.60mg/dL). Her abdominal computed tomography(CT)scan showed gastric wall and small intestine edema as well as ascites. There was no evidence of free air. We diagnosed her with generalized peritonitis and performed an emergencyoperation . Intra-operatively, moderate amounts of yellowish ascitic fluid were noted, as was a diffuse reddening of the small intestine. We performed a partial resection of the small intestine. Histopathological examination showed transmural infiltration of inflammatorycells mainly comprising eosinophilic leukocytes. Eosinophils were also present in the ascitic fluid. Post-operative blood tests confirmed eosinophilic, and we diagnosed her with eosinophilic enteritis. She was started on corticosteroids and her symptoms improved immediately. We report a rare case of eosinophilic enteritis with a review of the pertinent literature.
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18
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Miller GC, Reid AS, Brown IS. The pathological findings seen in laparoscopic sleeve gastrectomies for weight loss. Pathology 2016; 48:228-32. [PMID: 27020497 DOI: 10.1016/j.pathol.2015.12.449] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 12/12/2022]
Abstract
Sleeve gastrectomy specimens are increasingly common surgical specimens received for examination following bariatric surgery for weight loss. The spectrum of pathological changes seen in these cases is not well documented. Retrospective examination was undertaken of 1463 consecutive sleeve gastrectomy specimens received at Envoi Specialist Pathologists. Most cases showed no pathological changes (80.2%). The most common changes seen were non-specific, non-Helicobacter associated chronic gastritis (7.2%), Helicobacter associated gastritis (6.8%) and benign fundic gland polyps (4.0%). Other, rarer changes were lymphocytic gastritis, autoimmune atrophic gastritis, chronic gastritis with intestinal metaplasia, hyperplastic polyps, pancreatic heterotopia, gastrointestinal stromal tumours (GISTs) and a leiomyoma. A wide range of pathological changes are seen in resection specimens following sleeve gastrectomies for weight loss. Many cases will require further treatment or ongoing investigation and surveillance.
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Affiliation(s)
- Gregory C Miller
- Envoi Specialist Pathologists, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia.
| | - Andrew S Reid
- Anatomical Pathology, Pathology Queensland, Brisbane, Qld, Australia
| | - Ian S Brown
- Envoi Specialist Pathologists, Brisbane, Qld, Australia; Anatomical Pathology, Pathology Queensland, Brisbane, Qld, Australia
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19
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Xu G, Peng C, Li X, Zhang W, Lv Y, Ling T, Zhou Z, Zhuge Y, Wang L, Zou X, Zhang X, Huang Q. Endoscopic resection of gastritis cystica profunda: preliminary experience with 34 patients from a single center in China. Gastrointest Endosc 2016; 81:1493-8. [PMID: 25686873 DOI: 10.1016/j.gie.2014.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 11/10/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Guifang Xu
- Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Chunyan Peng
- Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Xia Li
- Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Weijie Zhang
- Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Ying Lv
- Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Tingsheng Ling
- Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zhihua Zhou
- Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yuzheng Zhuge
- Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Lei Wang
- Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Xiaoping Zou
- Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Xiaoqi Zhang
- Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Qin Huang
- Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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20
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Joffe OY, Molnar IM, Tarasyuk TV, Tsyura YP, Stetsenko OP, Kryvopustov MS. [MORPHOLOGICAL CHANGES OF GASTRIC MUCOSA AFTER INSERTION OF INTRAGASTRIC BALLOON]. Klin Khir 2015:70-72. [PMID: 26946668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Morphological changes in gastric mucosa were studied, optimal terms of bariatric operations performance after intragastric balloon (IGB) insertion were determined. Before the IGB insertion in 10 (35.7%) patients, in accordance to histological investigations, the changes in gastric mucosa were not revealed, and in 18 (64.3%) - chronic gastritis was established. In accordance to endoscopic investigation results, immediately after the IGB removal in 23 (82.1%) patients a pronounced erythematous gastropathy was noted, and in 5 (17.9%) - erosive gastropathy. While investigating the gastric mucosa biopsies in all the patients a prominent inflammatory changes were revealed, including significant edema, pronounced lymphocytic infiltration. In accordance to esophagogastroduodenoscopy data on the 14-th day of endoscopic monitoring in 6 (21.4%) patients pathological changes of gastric mucosa were not revealed, in 22 (78.6 %) - erythematous gastropathy was noted, and in accordance to histological investigation - chronic gastritis. Persistence of IGB in gastric cavity during 6 mo caused a morphological changes in gastric mucosa - a significant inflammation, what was confirmed by endoscopic and histological investigations data. The gastric mucosa structure normalization was observed in 14 days after the IGB removal, that's why a radical bariatric intervention is recommended to perform not earlier the term established.
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21
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Kim SB, Oh MJ, Lee SH. Gastric subepithelial lesion complicated with abscess: Case report and literature review. World J Gastroenterol 2015; 21:6398-6403. [PMID: 26034377 PMCID: PMC4445119 DOI: 10.3748/wjg.v21.i20.6398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/10/2014] [Accepted: 01/30/2015] [Indexed: 02/06/2023] Open
Abstract
Gastric abscess is a localized pyogenic inflammation of the gastric wall, which is a rare form of suppurative gastritis. The rarity of gastric abscess may be associated with the difficulty of early diagnosis and high mortality as a result. In general, subepithelial lesions (SELs) of the stomach are incidentally detected during the course of upper endoscopy without specific clinical symptoms and signs. However, some gastric SELs present rarely as a form of hemorrhage, obstruction, perforation, and abscess. Here we report a 45-year-old man with gastric SEL presenting as a gastric abscess, which was diagnosed as an ectopic pancreas of the stomach, along with a review of the literature. Although gastric SEL presenting as an abscess is known as a serious and life-threatening lesion, the patient made a complete recovery through surgical resection as well as medical treatment.
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22
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Aguilar-Jiménez J, Jiménez-Ballester MÁ, Valero-Navarro G, Navarro-Martínez MN, Plasencia-Martínez JM, Aguayo-Albasini JL. Eosinophilic gastroenteritis and bowel obstruction. Can surgery be avoided? Rev Esp Enferm Dig 2015; 107:185-187. [PMID: 25733047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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23
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Archer DC, Costain DA, Sherlock C. Idiopathic focal eosinophilic enteritis (IFEE), an emerging cause of abdominal pain in horses: the effect of age, time and geographical location on risk. PLoS One 2014; 9:e112072. [PMID: 25463382 PMCID: PMC4251896 DOI: 10.1371/journal.pone.0112072] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/13/2014] [Indexed: 11/28/2022] Open
Abstract
Background Idiopathic focal eosinophilic enteritis (IFEE) is an emerging cause of abdominal pain (colic) in horses that frequently requires surgical intervention to prevent death. The epidemiology of IFEE is poorly understood and it is difficult to diagnose pre-operatively. The aetiology of this condition and methods of possible prevention are currently unknown. The aims of this study were to investigate temporal and spatial heterogeneity in IFEE risk and to ascertain the effect of horse age on risk. Methodology/Principal Findings A retrospective, nested case-control study was undertaken using data from 85 IFEE cases and 848 randomly selected controls admitted to a UK equine hospital for exploratory laparotomy to investigate the cause of colic over a 10-year period. Generalised additive models (GAMs) were used to quantify temporal and age effects on the odds of IFEE and to provide mapped estimates of ‘residual’ risk over the study region. The relative risk of IFEE increased over the study period (p = 0.001) and a seasonal pattern was evident (p<0.01) with greatest risk of IFEE being identified between the months of July and November. IFEE risk decreased with increasing age (p<0.001) with younger (0–5 years old) horses being at greatest risk. The mapped surface estimate exhibited significantly atypical sub-regions (p<0.001) with increased IFEE risk in horses residing in the North-West of the study region. Conclusions/Significance IFEE was found to exhibit both spatial and temporal variation in risk and is more likely to occur in younger horses. This information may help to identify horses at increased risk of IFEE, provide clues about the aetiology of this condition and to identify areas that require further research.
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Affiliation(s)
- Debra C. Archer
- Institute of Infection and Global Health/School of Veterinary Science, University of Liverpool, Leahurst Campus, Neston, United Kingdom
- * E-mail:
| | - Deborah A. Costain
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Chris Sherlock
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
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Abstract
Little information is available about long-term outcomes of major gastric surgery when performed very early in life and adverse consequences in growing children might be expected. In this case, gastrectomy with Roux-en-Y esophagojejunostomy was performed in early childhood. Despite stomach loss, growth velocity paralleled the third percentile for age during development. Maintained on a daily multivitamin and monthly B12 injections, no overt nutritional deficiencies were detected in adulthood. However, dual energy X-ray absorptiometry scan at age 31 revealed that the patient had abnormally low bone mineral density. This case study demonstrates that even after gastrectomy and reconstruction early in life, linear growth can be achieved. However, bone density can be adversely affected, even in the face of normal serum calcium and vitamin D levels.
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Affiliation(s)
- M A Stefater
- Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH, 45229-3039, USA,
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Makhoul E, Mana F, Vandermeulen L, Basile N. Emphysematous gastritis. Acta Gastroenterol Belg 2013; 76:445-446. [PMID: 24592553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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26
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Kang KS, Yang HR, Ko JS, Seo JK. Long-term outcomes of endoscopic variceal ligation to prevent rebleeding in children with esophageal varices. J Korean Med Sci 2013; 28:1657-60. [PMID: 24265531 PMCID: PMC3835510 DOI: 10.3346/jkms.2013.28.11.1657] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 09/11/2013] [Indexed: 01/06/2023] Open
Abstract
After an episode of acute bleeding from esophageal varices, patients are at a high risk for recurrent bleeding and death. However, there are few reports regarding the long-term results of secondary prophylaxis using endoscopic variceal ligation (EVL) against variceal rebleeding in pediatrics. Thirty-seven, who were followed for over 3 yr post-eradication, were included in the study. The mean duration of follow up after esophageal variceal eradication was 6.4±1.9 yr. The mean time required to achieve the eradication of varices was 3.25 months. The mean number of sessions and O-bands needed to eradicate varices was 1.9±1.2 and 3.8±1.5, respectively. During the period before the first EVL treatment, 145 episodes of bleedings developed in 37 children. Over the 3 yr of follow-up after variceal eradication, only 4 episodes of rebleeding developed in 4 of 37 patients. The four rebleeding episodes consisted of an esophageal variceal bleed, a gastric variceal bleed, a duodenal ulcer bleed, and a bleed caused by hemorrhagic gastritis. There was no mortality during long-term follow up after variceal eradication. During long-term follow up after esophageal variceal eradication using solely EVL in children with esophageal variceal bleeds, rebleeding episodes and recurrence of esophageal varices were rare. EVL is a safe and highly effective method for the long-term prophylaxis of variceal rebleeding in children with portal hypertension.
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Affiliation(s)
- Ki Soo Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Kee Seo
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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27
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Martínez-Ubieto F, Bueno-Delgado A, Jiménez-Bernadó T, Santero Ramírez MP, Arribas-Del Amo D, Martínez-Ubieto J. [Acute abdomen caused by eosinophilic enteritis: six observations]. CIR CIR 2013; 81:237-241. [PMID: 23769255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Eosinophilic enteritis is a rather rare condition characterized by infiltration of the gastrointestinal tract by eosinophils; as a casue of acute abdomen it is really exceptional. The etiology is unclear and its description in the literature is sparse, but associations have been made with collagen vascular disease, inflammatory bowel disease, food allergy and parasitic infections as it was confirmed in one of our pathologic studies. CLINICAL CASES From 1997 to 2011 six cases of eosinophilic enteritis that involved a small bowel segment were diagnosed. A partial resection by an irreversible necrosis was necessary in three of them; in the other three only a biopsy was necessary due to the inflammatory aspect of the affected loop causing the acute abdomen. CONCLUSIONS Eosinophilic enteritis can originate acute abdomen processes where an urgent surgical treatment is necessary. The intraoperative aspect can be from a segment of small bowel with inflammatory signs up to a completely irrecoverable loop, where removing of the affected segment is the correct treatment, which can be done laparoscopically.
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Kuwahara N, Kitazawa R, Fujiishi K, Nagai Y, Haraguchi R, Kitazawa S. Gastric adenocarcinoma arising in gastritis cystica profunda presenting with selective loss of KCNE2 expression. World J Gastroenterol 2013; 19:1314-1317. [PMID: 23483772 PMCID: PMC3587490 DOI: 10.3748/wjg.v19.i8.1314] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 12/19/2012] [Accepted: 01/21/2013] [Indexed: 02/06/2023] Open
Abstract
Gastritis cystica profunda (GCP) is a rare condition caused by ectopic entrapment of gastric glands, probably secondary to the disruption of muscularis mucosae. GCP is often associated with gastric adenocarcinoma, and loss of the KCNE2 subunit from potassium channel complexes is considered a common primary target molecule leads to both GCP and malignancy. In this study, we, for the first time, analyzed the expression of KCNE2 in surgically excised tissue from human gastric cancer associated with GCP and confirmed that reduced KCNE2 expression correlates with disease formation.
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Deery S, Yates R, Hata J, Shi C, Parikh AA. Gastric adenocarcinoma associated with gastritis cystica profunda in an unoperated stomach. Am Surg 2012; 78:E379-E380. [PMID: 22856484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Sarah Deery
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Ferrada PA. Successful surgical treatment of emphysematous gastritis on a patient with poor cardiac function. Am Surg 2012; 78:66-67. [PMID: 22369797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Paula A Ferrada
- Virginia Commonwealth University Medical Center, Trauma, Critical Care and Emergency Surgery, Richmond, VA 23298, USA.
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31
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Hui CK. Resolution of eosinophilic gastroenteritis after resection of uterine leiomyomas. Singapore Med J 2011; 52:e217-e219. [PMID: 22009412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Eosinophilic gastrointestinal disorders (EGIDs) primarily affect the gastrointestinal tract. EGIDs have a broad spectrum of presentations, characterised by prominent eosinophilic infiltration through a variable depth in the gastrointestinal tract in the absence of a known cause for eosinophilia. EGIDs include eosinophilic oesophagitis, eosinophilic gastritis, eosinophilic gastroenteritis, eosinophilic enteritis and eosinophilic colitis. Here, we report EGID in a woman who had co-existing uterine leiomyomas. Her EGID resolved after resection of the leiomyomas. She remained asymptomatic on follow-up 13 months after the myomectomy, with resolution of the eosinophilic infiltrate in the gastrointestinal tract.
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Affiliation(s)
- C K Hui
- Centre for Alimentary Studies, 5/F Century Square, 1 D'Aguilar Street, Central, Hong Kong SAR, China.
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Bloomfield I, Rossaak J. Gastritis cystica polyposa mimicking gastric malignancy. N Z Med J 2011; 124:83-86. [PMID: 21475364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
Acute phlegmonous infection of the gastrointestinal tract is characterized by purulent inflammation of the submucosa and muscular layer with sparing of the mucosa. The authors report a rare case of acute diffuse phlegmonous esophagogastritis, which was well diagnosed based on the typical chest computed tomographic (CT) findings and was successfully treated. A 48-yr-old man presented with left chest pain and dyspnea for three days. Chest radiograph on admission showed mediastinal widening and bilateral pleural effusion. The patient became febrile and the amount of left pleural effusion is increased on follow-up chest radiograph. Left closed thoracostomy was performed with pus drainage. A CT diagnosis of acute phlegmonous esophagogastritis was suggested and a surgery was decided due to worsening of clinical condition of the patient and radiologic findings. Esophageal myotomies were performed and the submucosal layer was filled with thick, cheesy materials. The patient was successfully discharged with no postoperative complication.
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Affiliation(s)
- Hyoung Su Kim
- Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea
| | - Jung Hwa Hwang
- Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea
| | - Seong Sook Hong
- Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea
| | - Won Ho Chang
- Department of Thoracic Surgery, Soonchunhyang University Hospital, Seoul, Korea
| | - Hyun Jo Kim
- Department of Thoracic Surgery, Soonchunhyang University Hospital, Seoul, Korea
| | - Yun Woo Chang
- Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea
| | - Kui Hyang Kwon
- Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea
| | - Deuk Lin Choi
- Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea
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Staiano T, Grassia R, Iiritano E, Bianchi G, Dizioli P, Buffoli F. Treatment of radiation-induced hemorrhagic gastritis with endoscopic band ligation. Gastrointest Endosc 2010; 72:452-3. [PMID: 20226458 DOI: 10.1016/j.gie.2009.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 11/12/2009] [Indexed: 12/10/2022]
Affiliation(s)
- Teresa Staiano
- Digestive Endoscopy and Gastroenterology Unit, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy
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Sena MJ, Larson S, Piovesan N, Vercruysse G. Surgical application of kaolin-impregnated gauze (Combat Gauze) in severe hemorrhagic gastritis. Am Surg 2010; 76:774-775. [PMID: 20698390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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36
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Jabbour N, DiGiuseppe JA, Usmani S, Tannenbaum S. Copper deficiency as a cause of reversible anemia and neutropenia. Conn Med 2010; 74:261-263. [PMID: 20509415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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37
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Vieth M, Kuhnen C. [New and proven methods in gastric pathology]. Pathologe 2010; 31:169-70. [PMID: 20349064 DOI: 10.1007/s00292-009-1264-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Banerjee S, Shah S, Chandran BS, Pulimood A, Mathew G. Chronic perforation in isolated xanthogranulomatous gastritis. Trop Gastroenterol 2010; 31:45-47. [PMID: 20860227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Sudeep Banerjee
- Division of Gastrointestinal Surgery (Upper GI Unit), Christian Medical College, Vellore, Tamil Nadu, India
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39
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Tomlow B, Schweizer JJ. [A progressive vomiting pre-schooler]. Ned Tijdschr Geneeskd 2010; 154:A418. [PMID: 20298632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 4-year-old boy with persistent vomiting had a peptic stenosis of the oesophagus.
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Affiliation(s)
- Ben Tomlow
- Maasstad Ziekenhuis, afd. Kindergeneeskunde, Rotterdam, The Netherlands.
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40
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Aloia TA, Barakat O, Connelly J, Haykal N, Michel D, Gaber AO, Ghobrial RM. Gastric radiation enteritis after intra-arterial yttrium-90 microsphere therapy for early stage hepatocellular carcinoma. EXP CLIN TRANSPLANT 2009; 7:141-144. [PMID: 19715522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES As clinicians who treat hepatocellular carcinoma move yttrium-90 intra-arterial radiotherapy from the palliative setting to the treatment of patients with potentially curable early stage disease, more intense scrutiny of the safety of that procedure is warranted. To demonstrate the potential risks associated with this treatment, in the following case report, we describe a patient with early stage hepatocellular carcinoma who experienced severe toxicity from intra-arterial radiotherapy. MATERIALS AND METHODS Screening studies in a 64-year-old Asian woman with a history of hepatitis C virus infection and cirrhosis identified a 3.5-cm well-differentiated hepatocellular carcinoma with no vascular invasion. After initial evaluation, the patient received treatment with intra-arterial radiotherapy. Four weeks after the conclusion of that therapy, she experienced nausea, vomiting, and weight loss. Upper endoscopy with biopsy identified antral gastritis and embolic microspheres in the submucosal layer of the gastric antrum. RESULTS When she was subsequently referred for a liver transplant evaluation, her symptoms included failure to thrive and persistent weight loss. She was initially treated with feeding via a jejunostomy tube and ultimately received a liver transplant. However, 8 months after transplant she required an urgent gastrojejunostomy to bypass a progressive pyloric outlet obstruction. At the time of this writing, 1 year has elapsed since this patient received a liver transplant. No evidence of malignancy has been identified, but she remains partially dependent on tube feedings. CONCLUSIONS This case highlights the potential risks associated with radioactive microsphere embolization in patients with hepatocellular carcinoma. Given the paucity of data regarding the efficacy of this therapy in treating early stage disease, the use of radioactive microsphere therapy in that patient population should be prospectively studied. To minimize the risk of complications, internationally approved consensus guidelines for the delivery of yttrium-90 should be followed.
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Affiliation(s)
- Thomas A Aloia
- Department of Surgery, Division of Transplantation, The Methodist Hospital, Houston, Texas 77030, USA.
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Agarwal N, Kumar S, Sharma MS, Agrawal R, Joshi M. Emphysematous gastritis causing gastric and esophageal necrosis in a young boy. Acta Gastroenterol Belg 2009; 72:354-356. [PMID: 19902871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Emphysematous gastritis is a rapidly fatal and rare type of infectious gastritis. It may lead to involvement of esophagus, and organ necrosis, in its severe form. A 16-year-old, previously healthy, boy presenting with acute abdomen was diagnosed to have emphysematous gastritis on CT scan. During laparotomy, there was complete necrosis of the stomach, with patchy esophageal involvement. Aggressive management in the form of total gastrectomy, and later, transthoracic esophagectomy was done. However, it failed to alter the course of the illness, and the patient succumbed to the illness. Emphysematous gastritis is rare in young patients without known risk factors. Also, only two previous cases have been reported with esophageal involvement. We have presented this case with a brief review of literature.
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Affiliation(s)
- Nitin Agarwal
- Department of Surgery, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi-l 10095, India.
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Affiliation(s)
- D Nasr
- Service de chirurgie digestive, Hôpital des Chanaux - Mâcon, France.
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43
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Ang DKY, Brodnicki TC, Jordan MA, Wilson WE, Silveira P, Gliddon BL, Baxter AG, van Driel IR. Two genetic loci independently confer susceptibility to autoimmune gastritis. Int Immunol 2007; 19:1135-44. [PMID: 17698560 DOI: 10.1093/intimm/dxm087] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Autoimmune gastritis is a CD4+ T cell-mediated disease induced in genetically susceptible mice by thymectomy on the third day after birth. Previous linkage analysis indicated that Gasa1 and Gasa2, the major susceptibility loci for gastritis, are located on mouse chromosome 4. Here we verified these linkage data by showing that BALB.B6 congenic mice, in which the distal approximately 40 Mb of chromosome 4 was replaced by C57BL/6 DNA, were resistant to autoimmune gastritis. Analysis of further BALB.B6 congenic strains demonstrated that Gasa1 and Gasa2 can act independently to cause full expression of susceptibility to autoimmune disease. Gasa1 and Gasa2 are located between D4Mit352-D4Mit204 and D4Mit343-telomere, respectively. Numerical differences in Foxp3+ regulatory T cells were apparent between the BALB/c and congenic strains, but it is unlikely that this phenotype accounted for differences in autoimmune susceptibility. The positions of Gasa1 and Gasa2 correspond closely to the positions of Idd11 and Idd9, two autoimmune diabetes susceptibility loci in nonobese diabetic (NOD), mice and this prompted us to examine autoimmune gastritis in NOD mice. After neonatal thymectomy, NOD mice developed autoimmune gastritis, albeit at a slightly lower incidence and severity of disease than in BALB/c mice. Diabetes-resistant congenic NOD.B6 mice, harbouring a B6-derived interval encompassing the Gasa1/2-Idd9/11 loci, demonstrated a slight reduction in the incidence of autoimmune gastritis. This reduction was not significant compared with the reduction observed in BALB.B6 congenic mice, suggesting a difference in the genetic aetiology of autoimmune gastritis in NOD and BALB mice.
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Affiliation(s)
- Desmond K Y Ang
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, VIC 3010, Australia
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Abstract
Burill Crohn's convincing description of the disease that now carries his name conceived of the illness as arising exclusively from the terminal ileum, involving other sites only secondarily. As a result, he took the condition to be curable by an adequate operative resection. The current concept is that Crohn's disease may affect any segment of the gastrointestinal tract. The practical implication of this change in thinking is the need to conserve bowel when weighing medical and surgical options for each child. Operations should be used to treat complications of the disease. Absolute indications for the surgery are uncommon and include perforation, bleeding, and refractory obstruction. The margins of resection need only include a short amount of grossly normal intestine. Strictureplasty to relieve obstruction without resection should be done when applicable. Maintenance medication after an operation to limit recurrence or recrudescence is frequently advocated.
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Affiliation(s)
- Stephen E Dolgin
- Department of Pediatric Surgery, Schneider Children's Hospital, NS-LIJ Health System, New Hyde Park, New York, USA.
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Abstract
HISTORY AND ADMISSION FINDINGS A 44-year-old woman was on long-term immunosuppressive therapy with leflunomide and adalimumab for rheumatoid arthritis. She was admitted to the emergency room with diffuse abdominal pain of sudden onset. On physical examination she had rebound tenderness in all four abdominal quadrants. INVESTIGATIONS The white blood cell count was 3300/l, C-reactive protein 25 mg/dl and serum lactate 10 mmol/l. Abdominal computed tomography revealed a diffusely thickened gastric wall and ascites. At explorative laparotomy 1000 ml of a cloudy peritoneal fluid were aspirated and found to be negative for bacteria. But a culture of a mesenterial smear grew streptococci group A. Intra-operative endoscopy showed extensive hemorrhagic gastritis. Because there was no perforation or transmural necrosis gastric resection was not performed. DIAGNOSIS, TREATMENT AND COURSE Diffuse thickening of the gastric wall, extended mucosal necrosis and the peritoneal finding of streptococci in an immunocompromised patient suggested the diagnosis of phlegmonous gastritis. On treatment with antibiotics and proton pump inhibitor the patient made a slow recovery over the following eight weeks. Nine months after the event an asymptomatic antral stricture was noticed at follow-up gastroscopy. CONCLUSION Phlegmonous gastritis is a rare but life-threatening complication in immunosuppressed patients.
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Affiliation(s)
- W Scheppach
- Medizinische Klinik mit Schwerpunkt Gastroenterologie/Rheumatologie, Juliusspital Würzburg, Würzburg, Germany.
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Affiliation(s)
- D Béchade
- Department of Gastroenterology, Val de Grâce Hospital, Paris, France.
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Abstract
Radiation-induced gastritis is a serious complication of radiation therapy for pancreatic cancer which is difficult to manage. A 79-year-old man had been diagnosed as having inoperable pancreatic cancer (stage IVa). We encountered this patient with hemorrhagic gastritis induced by external radiotherapy for pancreatic cancer that was well-treated using argon plasma coagulation (APC). After endoscopic treatment using APC, anemia associated with hemorrhagic radiation gastritis improved and required no further blood transfusion.
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Affiliation(s)
- Kazutaka Shukuwa
- Department of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, Shool of Medicine, Kitakyushu
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Maàmouri N, Cheikh I, Belkahla N, Bouaziz S, Ouerghi H, Rahal K, Ben Romdhane K, Ben Ammar A. [Case report of isolated Crohn's disease of the stomach presenting as plastica linitis]. Tunis Med 2006; 84:513-6. [PMID: 17175696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Crohn's disease of the stomach is rare. There is nearly always concomitant disease in the small bowel or colon. Gastric involvement occurs rarely as an isolated entity. Upper endoscopy is sensitive for detecting subtle disease but more extended lesions can mimic neoplasms such us linitis. Exégèse: A 74-year old female was admitted to hospital with abdominal pain, vomiting and weight loss. Upper endoscopy and radiology aspects was suspicious of gastric linitis. Multiple endoscopic biopsies of the stomach showed one granuloma, chronic inflammation and Helicobacter Pylori. Because of the importance of obstructive syndrome, the patient underwent surgery. The resected stomach concluded to a Crohn's disease. CONCLUSION Through this observation, we review clinical characteristics, diagnostic difficulties and treatment options of Crohn's disease of the stomach.
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Abstract
For much of the twentieth century, surgery was frequently the solution for peptic ulcer disease. Our understanding of the pathophysiology of ulcers paralleled the development of potent pharmaceutical therapy. As the surgical world developed parietal cell vagotomy which would minimize the complications of surgery, patients failing medical therapy became rare. Emergent surgery for complicated peptic ulcers has not declined however. The development of proton pump inhibitors and the full understanding of the impact of H pylori has led to a trend towards minimalism in surgical therapy for complicated peptic ulcer disease. In addition to the changes in patient care, these developments have had an impact on the training of surgeons. This article outlines these trends and developments.
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Affiliation(s)
- Tamar Lipof
- Department of Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, MC 3955 Farmington, CT 06030-3955, USA
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