ABSTRACT
Endosalpingiosis is a benign condition with unclear pathogenesis and clinical significance and is defined as the presence of ectopic fallopian tube-like epithelium. It can be found in multiple locations, most commonly in the pelvic peritoneum covering the ovaries, uterus, and fallopian tubes, and less commonly found in the lymph nodes, omentum, appendix, cervix, vulva, or vagina. It is difficult to distinguish from endometriosis by gross appearance or localization, and theories propose that tissues of the secondary Mullerian system may undergo a metaplastic transformation, for example, from endosalpingiosis to endometriosis, which contributes to the debated association of endosalpingiosis with chronic pelvic pain. Additionally, there is evidence demonstrating a close association with reproductive tract neoplasms. We report the clinical course, diagnosis including pathology, follow-up, and the treatment plan of vaginal endosalpingiosis in a 34-year-old woman presenting with a chronic painful right-sided vaginal mucosal ulceration, dyspareunia, and foul-smelling vaginal discharge. To our knowledge, this is the second reported case of vaginal endosalpingiosis and the first case with this presentation.
ABSTRACT
BACKGROUND: Suture and staple-based endoluminal devices for gastroesophageal reflux disease (GERD) and obesity have failed to demonstrate long-term efficacy. OBJECTIVE: To demonstrate the feasibility of mucosal excision and full-thickness suture apposition of the excision beds to create sufficient scar tissue formation at the gastroesophageal junction for the intraluminal treatment of GERD or obesity. DESIGN: Survival animal experiments. PATIENTS: Seven mongrel dogs. Interventions. Under general endotracheal anesthesia, a Barostat test was performed on 4 dogs. A mucosal excision device was introduced through the esophagus into the proximal stomach. Two to 4 mucosal excisions were performed on all dogs at or just below the gastroesophageal junction and the mucosal pieces were removed. After hemostasis, an intraluminal suturing instrument was introduced and either 2 or 4 sutures were placed through the excision beds to bring them into apposition. These were tied and the suture strands cut. All dogs were survived for 2 months. End-term endoscopies were performed, and a repeat Barostat procedure was performed on the animals undergoing an antireflux procedure. After euthanasia the stomachs were explanted, examined, photographed, and sectioned for histologic examination. RESULTS: All dogs survived without complication. In the 4 GERD dogs, the Barostat studies demonstrated a significant decrease in gastroesophageal junction compliance. In the 3 dogs undergoing the obesity procedure, the gastric outlet apposition to a 6-mm endoscope was satisfactory with full insufflation and the desired scarring was seen on histologic examination. CONCLUSION: It is possible to create adequate gastroesophageal junction scarring for the treatment of GERD and obesity. A clinical pilot study will be initiated.
