Effect of gastric filling degree on thickness of advanced gastric carcinoma / 中国医学影像技术

Objective To investigate the effect of gastric filling degree on the thickness of advanced gastric carcinoma and the clinical value of the thickness measured by CT.Methods Totally 38 patients with advanced gastric carcinoma were enrolled and 21 patients were newly diagnosed,17 patients were reexamination after non surgical treatments.The stomach cavity was filled with oral gas-producing powder.The plain scanning (before filling) and enhanced scanning in venous phase (after filling) were performed.The thickness of the normal gastric wall and gastric carcinoma before and after filling were measured on axial images,and the differences were compared.The patients were measured again one month later by the same investigator,and the consistency between the twice measurements was evaluated.Results Before and after filling,the normal gastric wall thickness of each regions was significantly different (all P＜0.001),and the change was greatest at the region of greater curvature.Carcinoma thickness was similar in newly diagnosed patients (P＜0.05),but significantly different in patients for reexamination (P＜0.05).The twice measurements had a good consistency.Conclusion The thickness of gastric carcinoma can be considered as a baseline measurement indicator in newly diagnosed patients.It is critical to maintaining a similar gastric filling degree during reexamination,which is helpful to evaluate the efficacy of treatment accurately.

EUS-guided aspiration biopsy for gastric lesions with thickened gastric wall / 中华消化内镜杂志

Objective To explore the diagnostic value of EUS-guided aspiration biopsy for wall-thickened gastric lesions. Methods A retrospective study was performed in 45 patients who were diagnosed as having thickened gastric wall by EUS examination.Pathological and follow-up results of routine endoscopy and EUS-guided aspiration biopsy were analyzed,with the surgical results and follow-up outcome as the golden standard.The positive rate of routine endoscopy and EUS-guided aspiration biopsy were compared. Results In routine biopsy,gastric cancer was confirmed in 6,lymphoma in 3,dysplasia in 6,Menetrier′s disease in 2 and inflammatory changes in 28.EUS-guided aspiration biopsy was conducted in 45 patients,and gastric cancer was confirmed in 18,lymphoma in 5,dysplasia in 4,Menetrier′s disease in 2 and inflammatory changes in 16.The final pathological and follow-up results confirmed 21 gastric cancer,6 lymphoma,2 dys-plasia,2 Menetrier′s disease,other tumors in 4 and inflammatory changes in 10. The accuracy rate of routine biopsy and EUS-guided aspiration biopsy was 51. 11%( 23/ 45 ) and 82. 22%( 37/ 45 )respectively. Conclusion EUS-guided aspiration biopsy can yield a higher positive rate than endoscopic biopsy.

A Case of Eosinophilic Gastroenteritis with Rapid Deterioration Mimicking Borrmann Type 4 Advanced Gastric Cancer

Eosinophilic gastroenteritis is an uncommon disease of unknown etiology that is characterized by massive tissue infiltration of eosinophils in the tissue layers of various areas of the gastrointestinal tract. An accurate diagnosis is difficult as clinical presentations, symptoms, endoscopic and radiologic findings are nonspecific. A 51-year-old man visited our hospital presenting with abdominal pain. Esophagogastroduodenoscopy revealed diffuse hyperemic mucosal lesions at the stomach, duodenum. Symptoms and endoscopic findings deteriorated rapidly after three days. Small amounts of eosinophilic infiltration without malignant cells was confirmed from biopsy. However, we could not exclude malignancy and performed a subtotal gastrectomy. Stomach specimen showed eosinophilic infiltrations, and the patient was finally diagnosed as eosinophilic gastroenteritis. We report a case of atypical eosinophilic gastritis with rapid deterioration mimicking Borrmann type 4 advanced gastric cancer.

Medición histológica micrométrica de capa muscular gástrica de pacientes obesos / Histologic micrometer measuring of gastric muscle in obesity patients

Background: The measurement of gastric wall thickness is useful during cutting, suturing and stapling surgical procedures. Aim: To measure gastric wall thickness in stomachs excised during bariatric surgery. Material and Methods: Stomachs excised during gastric bypass and sleeve gastrectomy as treatment for obesity was analyzed. The surgical piece was prepared for pathological study in the usual way and the wall thickness was measured in the fundus, body, proximal and distal antrum, using a photographic camera and Scope Photo Software. Results: A sample of 110 stomachs, 45 coming from gastric bypass and 65 from sleeve gastrectomy, was analyzed. Fundus, body, proximal and distal antrum thicknesses were 1.551 more or less 514, 2.072 more or less 568, 2.348 more or less 637 and 3.742 more or less 967 respectively (p < 0.0001). Conclusions: The distal antrum had the higher gastric wall thickness in this series of excised stomachs.

Consideramos que la medición de la pared del estómago es importante en el desarrollo de la cirugía gástrica, no encontramos estudios histológicos previos en relación al grosor de ella. Considerando que la capa muscular ofrece la mayor resistencia durante los procedimientos de corte y sutura mecánica se plantea la medición histológica en micrones del músculo gástrico de estómagos sanos resecados por técnica bariátrica resectiva. Se realizó un protocolo para recolección de datos clínicos y de puntos de análisis de medición, tomando en cuenta las características de los pacientes y las distintas zonas gástricas: fondo, cuerpo y antro. Se realiza una revisión sistemática de la literatura publicada. Entre diciembre de 2008 y junio de 2009, se recolectaron 110 estómagos provenientes de cirugía bariátrica resectiva. La medida promedio del músculo en el fondo gástrico fue de 1.551, en el cuerpo de 2.072, en el antro, 2.348.

A Case of Focal Intramural Abscess Due to a Fish Bone Ingestion in a Healthy Middle Aged Woman / 대한소화기내시경학회지

Gastric wall abscess is a one form of phlegmonous gastritis and there are scare reports on this. Gastric wall abscess is a purulent inflammatory disease and it is commonly caused by a focal injury to the gastric mucosa such as a penetrating trauma from an ingested foreign body or an endoscopic biopsy where by bacterial infection occurs throughout all the layers of the gastric wall. With symptoms such as abdominal pain and fever, making the diagnosis after an operation was possible in the past, but it has recently become possible to make the diagnosis before the operation via esophagogastroduodenoscopy, endoscopic ultrasonography and/or abdominal computed tomography. We recently experienced a case of gastric wall abscess that was associated with a foreign body (presumably a fish bone) in a healthy middle aged woman. By performing generalized esophagogastroduodenoscopy and abdominal computed tomography at a primary medical institution, we made an early diagnosis and treated the patient. Herein, we report on this case and we review the relevant literature.

EUS on diagnosis of gastric lesions with thickened gastric wall and negative pathological findings / 中华消化内镜杂志

ObjectiveTo evaluate the accuracy of EUS,EUS-guided fine needle aspiration ( EUSFNA) and targeted biopsy in the diagnosis of wall-thickened gastric lesions with negative malignant results ofendoscopic biopsies.MethodsA retrospective study was carried out in 57 patients who were found with thickened gastric wall of negative malignant endoscopic biopsies and underwent EUS from January 2008 to December 2010 in our hospital.Compared the EUS findings with the surgical results and follow-up status.The diagnostic yield of EUS was characterized by the disappearance of the layers or the changes of thickness of gastric wall,the characteristics of echo imaging,and the results of EUS-FNA or EUS targeted biopsy were recorded to evaluate the value of EUS.ResultsOf 57 cases,gastric cancer was confirmed in 19,lymphoma in 10,dysplasia in 1,Menetrier's disease in 1 and inflammatory changes in 26.EUS could clearly demonstrate the changes of gastric wall including the thickness and the changes of layers,with the accuracy rate of 73.07％ ( 14/19 ) on gastric cancer.EUS diagnosed gastric cancer in 26 cases,in which 14 (53.8％) were confirmed by pathology.Gastric lymphoma was suspected by EUS in 20 cases,in which 10 (50.0％ ) were proved.EUS-FNA was conducted in 19 cases,with positive result in 9 (accuracy rate 50％ ).EUS-guided targeted deep biopsy or piece-meal biopsy were performed in 10 cases,with 8 malignant results.ConclusionEUS with/without EUS-FNA is not a golden standard for the diagnosis of gastric lesions in thickened gastric wall,yet it still has some significance.

A Case of Gastric Wall Hematoma and Ischemic Necrosis After Endoscopic Biopsy / 영남의대학술지

Hematoma of gastric wall is very rare, and occasionally associated with coagulopathy, trauma, peptic ulcer disease, and therapeutic endoscopy. Ischemic gastric necrosis is also rare because of the abundant anastomotic supply to the stomach, and it is usually associated with surgery and disruption of the major vessels. Endoscopic submucosal injection of hypertonic saline-epinephrine (HS-E) is a safe, cost-effective, and widely used therapy for hemostasis but it may cause tissue necrosis and perforation. We describe a case of gastric wall hematoma with oozing bleeding after endoscopic gastric mucosa biopsy in 71-year old woman with chronic renal failure and angina pectoris undergoing anti-platelet medication. We injected a small dose of HS-E (7ml) for controlling oozing bleeding. Two days later, endoscopy showed huge ulcer with necrotic tissue at the site of previously hematoma. Therefore we should pay particular attention for hematoma and mucosal necrosis when performing endoscopic procedure in a patients with high bleeding and atherosclerotic risk.

Calcifying Fibrous Tumor Mimicking a Foreign Body ofthe Stomach: A Case Report / 대한소아소화기영양학회지

Calcifying fibrous tumors (CFTs) are unusual benign tumors of childhood, located primarily in soft tissues, pleura, and peritoneum. The cause and pathogenesis are unclear. We report a rare case of a CFT in a 2-year-old boy who presented with vomiting and abdominal distension. An abdominal X-ray showed an elliptical, calcific shadow in the LUQ area mimicking a foreign body. An internally protruding mass along the lesser curvature of the gastric body was an incidental finding during upper endoscopy, biopsies of which were negative. Abdominal CT showed a 4.5x3.2 cm soft tissue mass of the gastric wall with calcifications. A diagnosis of gastric submucosal mass was suspected and a wedge resection of the stomach was performed. On microscopic examination, the tumor was composed of whorls of dense hyalinized collagen bundles with a few fibroblasts. There were also amorphous dystrophic calcifications and nodular aggregates of mononuclear inflammatory cells. Immunohistochemically, spindle cells did not stain for anaplastic lymphoma kinase-1 (ALK-1), CK, smooth muscle actin (SMA), or desmin. Taken together, the mass was compatible with a CFT of the gastric wall. This is the first reported case of CFT in a Korean child.

A Case of Gastric Wall Abscess Associated with Gastritis Cystica Profunda / 대한소화기내시경학회지

Gastric wall abscess is a form of phlegmonous gastritis and has been very rarely reported. The pathogenesis of gastric wall abscess is thought to involve a focal injury to the gastric mucosa such as a penetrating trauma from an ingested foreign body or an endoscopic biopsy, where by bacterial infection occurs. Gastritis cystica profunda is a rare disease in which hyperplasia of mature glandular epithelium extends into the tissues beneath the submucosa. It shows multiple small cysts in the mucosa and submucosa of the stomach. To our knowledge, the association of gastric wall abscess with gastritis cystica profunda has never been reported yet. We, recently, experienced a case of gastric wall abcess associated with gastritis cystica profunda. Herein, we report it with a brief review with literatures.

The Usefulness of the Endoscopic Ultrasonography in the Evaluation of the Thickened Gastric Wall / 대한소화기내시경학회지

BACKGROUND/AIMS: The thickened gastric wall are seen in a great number of benign and malignant conditions. Sometimes the differential diagnosis with either upper gastrointestinal X-ray or endoscopy of those lesions is difficult. We evaluated the usefulness of the endoscopic ultrasonogrphy (EUS) in the differential diagnosis for the thickened gastric wall of benign and malignant lesions. METHODS: Fifty Borrmann type 4 advanced gastric cancers, 7 gastric lymphomas, 4 hypertrophic gastropathies, 3 acute gastric mucosal lesions, and one anisakiasis were included. We measured the full thickness of the gastric wall, the thickness of each layer and the preservation of the five-layered structure of the gastric wall, and then compared them with the endosonographic findings of 11 healthy controls. RESULTS: Endosonographic findings of Borrmann type 4 advanced gastric cancers showed a diffuse thickening of all five layers, especially the third and fourth layers. Endosonographic findings of gastric lymphomas showed enlargement of the second, third, and fourth layers in 4 patients, the second and third layers in 1 patient, and only the second layer in 2 patients. The second layer was thickened in hypertrophic gastropathies, the second and third layers were thickened in acute gastric mucosal lesions, and the third layer was thickened in anisakiasis. The fourth ultrasound layer corresponding to the muscularis propria was significantly thickened only in malignant lesions. CONCLUSIONS: EUS can clearly visualize the wall architecture of the thickened gastric wall. EUS may be useful for the differential diagnosis of the thickened gastric wall and the differentiation of benign from malignant gastric lesions.

Results of Experimental Canine Gastric Wall Ligation using 0-shaped Rubber Band / 대한소화기내시경학회지

Objectives: Endoscopic variceal ligation is well established metbod of treatment for esophageal varices whereas for gastric varices there has not been any systematic report of its use as a method of treatment. To evaluated its possible clinical application, the band ligation(banding) and the method of band ligation in conjuction with submucosal ethanolamine injection(banding with sclero) were tested on canine stomach, and results were assessed.