ABSTRACT
The escalating prevalence of gastrointestinal cancers underscores the urgency for transformative approaches. Current treatment costs amount to billions of dollars annually, combined with the risks and comorbidities associated with invasive surgery. This highlights the importance of less invasive alternatives with organ preservation being a central aspect of the treatment paradigm. The current standard of care typically involves neoadjuvant systemic therapy followed by surgical resection. There is a growing interest in organ preservation approaches by way of minimizing extensive surgical resections. Endoscopic ablation has proven to be useful in precursor lesions, as well as in palliative cases of unresectable disease. More recently, there has been an increase in reports on the utility of adjunct endoscopic ablative techniques for downstaging disease as well as contributing to non-surgical complete clinical response. This expansive field within endoscopic oncology holds great potential for advancing patient care. By addressing challenges, fostering collaboration, and embracing technological advancements, the gastrointestinal cancer treatment paradigm can shift towards a more sustainable and patient-centric future emphasizing organ and function preservation. This editorial examines the evolving landscape of endoscopic ablation strategies, emphasizing their potential to improve patient outcomes. We briefly review current applications of endoscopic ablation in the esophagus, stomach, duodenum, pancreas, bile ducts, and colon.
ABSTRACT
Sarcoidosis is a chronic inflammatory multisystem disease. The stomach is the most commonly involved gastrointestinal organ. Symptomatic appendicular sarcoidosis is extremely rare. We present a case of a 49-year-old woman with abdominal pain. An ultrasound of the abdomen was suggestive of acute appendicitis. Laparoscopic appendectomy was performed and the pathology revealed nonnecrotizing granulomas. Biopsy of the mediastinal lymph nodes suggested noncaseating granulomas. She was treated with steroid therapy followed by mycophenolate mofetil. Our case demonstrates the importance of considering appendiceal sarcoid among the differentials in a patient with systemic sarcoidosis presenting with an acute abdomen.
ABSTRACT
Stress cardiomyopathy or Takotsubo cardiomyopathy (TCM) is transient left ventricular apical akinesis in the absence of angiographic evidence of corresponding obstructive coronary artery disease. A classic presentation is of chest pain following intense emotional or physical stress. Reports of stress-inducing triggers include acute respiratory failure, sudden death of a loved one, sympathomimetic drugs, pheochromocytoma crisis, diabetic ketoacidosis, and even earthquakes. We report three cases of intra-abdominal etiologies precipitating Takotsubo cardiomyopathy: two with small bowel obstruction, and one with Clostridium difficile colitis.
ABSTRACT
Drug-induced pancreatitis can be caused by a wide array of medications. In fact, the diagnosis is likely commonly missed due to the difficulty in diagnosing one agent as the sole cause. We present a case of dapsone-induced pancreatitis in a 75-year-old male with history of celiac disease. He presented with abdominal pain and was found to have acute pancreatitis. Interestingly, he had been on dapsone for 5 years and had no other recent medication changes, significant alcohol use, or gallbladder disease. It was determined this was an episode of delayed acute pancreatitis due to dapsone. This is a rarely addressed entity in the literature and is the first case in which pancreatitis occurred so late in a patient's treatment course on dapsone.
ABSTRACT
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is the third highest cause of cancer mortality worldwide. Risk factors include chronic liver disease and cirrhosis of various causes including chronic hepatitis B and C. In cases of chronic hepatitis C virus (HCV), HCC usually does not manifest unless the liver has become cirrhotic. Fortunately, novel treatments for hepatitis C including ledipasvir/sofosbuvir can cure patients from their disease and as a result, may never develop cirrhosis and therefore, be at much lower risk of developing HCC. We present a patient with chronic HCV genotype 1a who was successfully treated with ledipasvir/sofosbuvir with documented sustained viral response, but 6 months later was found to have multifocal HCC with virus reactivation with no evidence of cirrhosis on imaging or biochemical testing. While novel antiviral agents for HCV lead to >90% cure rate, cure is defined as sustained viral response of only 12 weeks. This brings to light a new patient population who may require further follow-up than 3 months to ensure viral clearance. Furthermore, this patient developed HCC despite initial viral clearance and no evidence of cirrhosis, indicating possible oncogenic potential of HCV that is independent of cirrhosis that necessitates further investigation.
