Endoscopic Submucosal Dissection for Resolution of a Symptomatic Pancreatic Rest in a Pediatric Patient: A Case Report and Literature Review

The pancreatic rest, aberrant, or heterotopic pancreas is a normal function pancreas found in the submucosal layer of the greater curvature of the gastric antrum and occasionally in the duodenum. Most of the patients are asymptomatic and the finding is usually incidental. We describe the case of a child with abdominal pain and history of recurrent ulcers that necessitated esophagogastroduodenoscopy and further evaluation with endoscopic ultrasound that confirmed a submucosal lesion consistent with a pancreatic rest. Endoscopic submucosal dissection was performed without complication, and complete symptom resolution was achieved after dissection of the pancreatic rest.

Diagnostic challenge in silent metastatic invasive breast carcinoma: dysphagia as the only symptom

Metastatic cancer to the oesophagus is rare. Most cases are diagnosed at autopsy or surgery. The breast is the most common organ bearing a primary tumour. Metastatic oesophageal tumours are nearly always located in the submucosal layer with normal benign-looking mucosa, rendering tissue diagnosis difficult. In the absence of breast-related symptoms, the diagnosis of oesophageal metastasis from breast primary would be very challenging. We report a case of a 50 year-old woman, who was referred to our centre for a second opinion after she was offered an esophagectomy for a suspected oesophageal carcinoma. She presented solely with dysphagia and weight loss. Multiple investigations were performed to investigate her dysphagia which eventually led to the diagnosis of metastatic breast cancer with oesophageal involvement. She underwent excision of right breast invasive lobular carcinoma with axillary dissection. She completed her adjuvant chemoradiotherapy and currently on daily dose of tamoxifen, whereby her dysphagia has dramatically improved.

A Newly Designed Polyvinyl Alcohol Hydrogel-Based Gastric ESD Simulator for Trainees: A Pilot Study

Background Endoscopic submucosal dissection (ESD) is a useful option for the treatment of a variety of digestive diseases but has the disadvantage of difficulty in acquiring skills. We developed a new polyvinyl alcohol hydrogel (PVA-H)-based gastric ESD simulator and evaluated its usefulness for training with a group of experts. Methods A new gastric ESD simulator was constructed with three modules (esophagus, gastric wall, and electric). The expert group tested ten ESD sessions and evaluated the simulator with questionnaires on eight items related to ESD procedures using a 7-point Likert scale. Results Compared with the real human stomach, the new ESD simulator showed no inferior success rate in lifting of the submucosal layer (5.00 [4.00–6.00]), cutting of the submucosal layer (6.00 [5.00–6.00]), visibility by bubble (4.00 [4.00–6.00]), thickness of the muscle layer (4.00 [4.00–5.00]), combination of the three layers (6.00 [6.00–7.00]), size of the ESD sheet (6.00 [5.00–6.00]), and connectivity of the electrode (6.00 [6.00–7.00]). Conclusion A new PVA-H-based gastric ESD simulator can be helpful for training before performing real human gastric ESD.

Low-Frequency Intravesical Electrical Stimulation for the Treatment of Acute Urinary Retention: A Promising Therapeutic Approach

Acute urinary retention (AUR) is a troublesome urological disease, which causes various lower urinary tract symptoms. However, only few studies explored and evaluated the effective treatments to improve AUR. We aimed to find an effective approach to cure AUR through comparing the efficacy of existing classical low-frequency transcutaneous electrical nerve stimulation (TENS) and novel intravesical electrical stimulation (IVES). A total of 24 AUR female rats were divided into 3 groups as follows: control, TENS, and IVES groups. Rats in the control group had no fake stimulation. Rats in the TENS and IVES groups underwent transcutaneous or intravesical stimulation of a symmetrical biphasic rectangular current pulse with a frequency of 35 Hz, 30 min per day, for seven consecutive days. IVES significantly reduced the actin expression in the submucosal layer but increased its expression in the detrusor layer (p= 0.035,p= 0.001). The neovascularization in the submucosal layer in the IVES group was significantly increased than in the other 2 groups (p= 0.006). Low-frequency IVES performed better than TENS in terms of simultaneously relieving bladder hyperactivity, accelerating epithelial recovery, and strengthening detrusor muscle. IVES may be a promising therapeutic approach for bladder dysfunction, specifically for AUR and overactive bladder in clinical practice.

Endoscopic Submucosal Hydrodissection with Paradoxical Movement of the Colonoscope Using Hybrid Knife “Traction Mode” for Malignant Polyp in the Cecum

The water-jet hydro dissection technique has been shown to be effective for colorectal tumors. This case report illustrates type T hybrid knife for the elevation of the submucosal layer, cutting the mucosa and dissecting submucosal fibers. ESD was performed using ERBEJET 2 hydrodissection system and hybrid Knife. The resection was completed en bloc within 135 minutes without adverse events. Pathology examination revealed a well-differentiated adenocarcinoma confined to the shallow submucosal layer with free resection margins.

CLINICAL AND MORPHOLOGICAL CHANGES IN GUM DURING THE MODELING OF EXPERIMENTAL GINGIVITIS

Gingivitis is the most common disease of periodontal tissues in children. An experimental model of gingivitis is necessary to study the pathogenetic processes occurring in this disease, as well as to develop new dosage forms. Drugs based on phospholipase A are used to model gingivitis, its content in viper venom is 32—59.8 %. The aim of the work is to evaluate the clinical and morphological changes in the gum tissues in experimental gingivitis caused by the drug «Vipraxin». 20 animals were selected to simulate experimental gingivitis. They were injected once into the submucosal layer of the gum with the drug «Vipraxin», which is an aqueous solution (0,2 ml) of viper venom. All rats were biopsied for histological examination on the 6th day from the beginning of the experiment. Redness of the gingival margin, puffiness and smoothness of the contour were visually noted in all rats. Also bleeding was determined while probing. The histological preparations revealed disintegration of the cells of the spiny and granular layers of the epithelium, smoothness of the papillae of the connective tissue lamina proper, swelling and loosening of the fibrous structures, and vascular fullness. 3 groups of activity of the inflammatory process depending on the degree of severity of changes in the gum tissues: mild, moderate and severe. All clinical and morphological changes match to the inflammatory process in case of using the drug «Vipraxin». This drug can be used for modeling experimental gingivitis.