Bleeding gastric polyps# in a patient with bleeding
esophageal varices#
A 45-year-old man presented with upper GI bleeding was
admitted to the endoscopy unit. The patient underwent upper digestive
endoscopy. The scope revealed esophageal varices and 3 polyps in the stomach,
two of these polyps are bleeding.
What is your opinion?
google.com, pub-4485728567761794, DIRECT, f08c47fec0942fa0
Tokyo live, one endoscopy# is an interesting gastrointestinal endoscopy meeting, this year it was held online and also it is free. it is an amazing experience 3 days of lectures and workshops from experts of gastroenterology from all overthe world. every year at the same time, so if your are a GI endoscopist do not miss this opportuinity.
the meeting website:http://www.coac.jp/tokyolive/english/
google.com, pub-4485728567761794, DIRECT, f08c47fec0942fa0
Our original research article is published in theworld journal of gastroenterology#
World J Gastroenterol. Nov 21, 2020; 26(43): 6880-6890
Published online Nov 21, 2020. doi: 10.3748/wjg.v26.i43.6880
it is an important issue in the field of gastroenterology and hepatology during the era of COVID19#
Thanks to all the authors of this work
ORCID number: Omar Elshaarawy (0000-0002-6945-6204); Sameh Aldesoky Lashen (0000-0002-8599-1338); Nahed A Makhlouf (0000-0003-2949-4369); Doaa Abdeltawab (0000-0002-1150-1113); Mariam Salah Zaghloul (0000-0002-4244-5396); Rasha M Ahmed (0000-0002-5912-920X); Hayam Fathy (0000-0002-4218-7550); Shimaa Afifi (0000-0001-5937-4240); Muhammad Abdel-Gawad (0000-0002-0204-4715); Eman Abdelsameea (0000-0002-3225-7164); Sherief Abd-Elsalam (0000-0003-4366-2218); Salem Youssef Mohamed (0000-0003-2917-4293); Mohammed Tag-Adeen (0000-0001-9813-3191); Mina Tharwat (0000-0001-9834-1644); Ahmed Alzamzamy (0000-0002-3817-5370); Ahmed Nasr Bekhit (0000-0002-9689-3362); Alshaimaa M Eid (0000-0002-4753-9826); Abeer Awad (0000-0001-9945-9767); Mohammad Aamr (0000-0002-1871-4509); Waleed A Abd El Dayem (0000-0002-4897-2170); Mohamed-Naguib Wifi (0000-0002-3403-7106); Mohamed Alboraie (0000-0002-8490-9822).
the link to the full paper : https://www.wjgnet.com/1007-9327/full/v26/i43/6880.htm
What to do next
(The site of previously band ligated cardiac nodule in a
patient with bleeding esophageal varices)
13 days after the nodule was ligated, another upper
digestive endoscopy was done and revealed the scar of the previous band ligated
cardiac nodule
What is your opinion?
1-
Just a follow-up, after
what time
2-
Follow-up as scheduled for
the varices and each time examine the scar area
3-
More investigations
4-
Ignore
https://youtu.be/VDH3ocuAZcI
#Remnant gastric
carcinoma#
A 68-year-old man presented with dysphagia was admitted to
the gastroenterology unit. The patient gives a history of operated gastric
cancer 3 years ago (partial gastrectomy mostly involving the fundus, body, and
pylorus). The patient had received chemotherapy and radiotherapy. Also, the
patient received target therapy and immunotherapy but, without improvement. The
most recent pet CT showed an active tumor in the remaining gastric portion. The
patient was advised by his oncologist to undergo upper digestive endoscopy for
stent insertion to overcome the obstruction made by the tumor. The patient underwent
upper GI endoscopy. The scope showed about 8cm gastric mass that nearly
occupying the stomach lumen, besides, the mass easily bleeds on touch. This
mass extends to the lower esophagus with a remnant of food in the stomach and
lower esophagus. Also, lower esophagus inflammation was detected. Duodenal examination
revealed a common pathway extending from the stomach but, after 3 to 4 cm this
common pathway is divided into 2 pathways as shown in this video. A safari guidewire
was inserted and a partially covered esophageal stent (13 cm long) was deployed
into the duodenum (2 cm inside the duodenal lumen) all over the stomach lumen
and up to 3 cm inside the esophageal lumen (oral end of the stent).
N.B.
1-To make sure that the distal end of the stent is inserted appropriately
into the duodenum this step was done under direct visualization by the endoscope,
also the cephalad end of the stent with the help of the fluoroscopy.
2-you can notice that the introduction of the scope into the
duodenum is difficult due to the previous operation and the remnant gastric
cancer, the endoscopist make an upward movement to get into the duodenum
Questions
Do you think that the esophageal stent is the best option
for this patient? What about the gastric mega stent?
Is it dysphagia alone or dysphagia and gastroparesis?
What was the type of operation done 3 years ago?
Is the opening between the stomach and duodenum the true
pyloric ring or a postoperative one?
A 64-year-old man presented with recurrent attacks of upper
gastrointestinal bleeding was admitted to the GI unit. The patient gives a
history of advanced HCC (on supportive treatment) and a similar attack of upper
GI bleeding 7 months ago. In the previous attack, upper digestive endoscopy
revealed esophageal varices that were ligated at this time. The patient
underwent upper GI endoscopy. The scope revealed a nodule at the cardia and
large esophageal varices.
What is your opinion?
1-
Band ligation for both the
nodule and varices
2-
Band ligation for the
varices only, discard the nodule
3-
Band ligation for the
varices with biopsies from the nodule
4-
Others
A 26- year- old man presented with melena was admitted to the GI endoscopy unit. The patient gives a history of operated perforated peptic ulcer. The patient underwent endoscopy that revealed a large duodenal ulcer. Also, the scope showed two reddish lesions in the upper esophagus. The endoscopist cannot see these lesions during the introduction of the scope. With careful examination during withdrawal of the scope, the endoscopist meticulously examines the upper esophagus.
Is it esophageal inlet patches#
Should we classify the esophagus into 3 parts ( upper, middle, lower) and examine each part thoroughly and write in detail this description in the endoscopic report?
Should we recommendfor a withdrawal time (like that of colonoscopy with a shorter time duration) during the examination of the esophagus?
