Case report: fatal bleeding from a duodenal ulcer—Dieulafoy’s lesion?

A 46-year-old man was admitted to the hospital by ambulance due to syncope. A standard blood screening showed a normal Hb value. The man had known hemorrhoids and a single fresh rectal bleeding earlier at home. On the following morning, the patient suddenly required resuscitation within a few minutes and subsequently died. Autopsy revealed a fatal hemorrhage with blood loss in the stomach and small and large intestines and a mucosal defect of the duodenum. After autopsy, the question arose whether the cause of death might have been a rare Dieulafoy’s lesion—aim of this case report was to clarify the diagnosis.

EP.FRI.874 Laparoscopic Assisted Submucosal Excision of an Intussuscepted Colonic Lipoma through a Colotomy; A New Technique

Lipomas are the most common non-epithelial tumours of the colon. Nevertheless, symptomatic colonic lipomas are a rare entity in adults. Intussusception is the commonest complication of submucosal lipomas and often presents with absent, non-specific or intermittent symptoms, hence the diagnosis is challenging. In non-emergency situations, most patients undergo computed tomography scan as well as endoscopic evaluation of the colon prior to any surgical intervention. While successful endoscopic excision of lipomas has been reported, segmental resection of the colon is most commonly practiced. To the best of our knowledge, this is the first report of laparoscopic assisted submucosal excision of an intussuscepting colonic lipoma through a colotomy. We present the case of a young female patient with few weeks history of intermittent abdominal pain associated with nausea. She had previously undergone various investigations including colonoscopy and was awaiting an elective left hemicolectomy. She presented to our Emergency department with subacute large bowel obstruction. A CT scan confirmed the diagnosis of colo-colic intussusception due to a large descending colon lipoma. The patient underwent a laparoscopic assisted procedure - following laparoscopic colonic mobilisation, submucosal excision of the large lipoma was performed through a colotomy placed through the taenia on the opposite wall. The mucosal defect and colotomy were closed following the excision. The patient recovery was uneventful and histopathology of the specimen confirmed the diagnosis.

What’s New with Endoscopic Treatments for Early Gastric Cancer in the “Post-ESD Era”?

<b><i>Background:</i></b> Endoscopic treatments for gastric cancers have still been progressing even after the great success of endoscopic submucosal dissection (ESD). <b><i>Summary:</i></b> In further advancements of ESD, safe and less-invasive procedures are challenged by managing postoperative bleeding, one of the major adverse events in ESD. Covering the mucosal defect after removal of lesions appears reasonable and effective for preventing delayed bleeding from the post-ESD ulcers. Shielding with biodegradable sheets is attempted on clinical trials, which show equivocal results. Although suturing of the mucosal rims is technically challenging, pilot studies demonstrate favorable outcomes for avoiding post-ESD bleeding even in cases at high risk. In cases after noncurative resection of ESD, the selection of patients who truly require additional gastrectomy with lymph node dissection is important to provide necessary surgery. Risk stratification of lymph node metastases and surgery has been developed, which offers tailor-made management to each patient considering the risks and benefits. In surgery, function-preserving gastrectomy to minimize the resection area in both lymphadenectomy and the primary site is clinically introduced. The sentinel node navigation surgery is promising to realize the minimally invasive gastrectomy, and it should strongly fit ESD as well as laparoscopic endoscopic cooperative surgery or endoscopic full-thickness resection, although nonexposure approaches are desirable. <b><i>Key Message:</i></b> Development for less-invasive managements on gastric cancer will be continued in step with the advancement of endoscopic treatments.

Prevalence of gastric ulcer syndrome in horses with different exercise intensity

Gastric ulcers or equine gastric ulcer syndrome (EGUS) is a common pathology in horses of different breeds. The objective of our research work was to investigate and determine the prevalence and severity of equine gastric ulcer syndrome (EGUS) in population of n = 28 riding horses with periods of physical activity and training intensity. Two breeds were presented in this study: English Thoroughbred (n = 15) and Ukrainian riding horse (n = 13). Horses were two age groups 3–7 and 8–16 years, including 17 mares and 11 geldings. Gastric endoscopy was performed as a diagnostic tool using a 3m video endoscope. Mucosal defects was evaluated using grading system proposed by (Equine Gastric Ulcer Council 0–4 grading system) ranging from 0 (normal mucosa with no lesions) to 4 (diffuse ulceration of mucosa with deep lesions). The study was conducted in two periods. Each period is related to different workload with mixed intensity in exercise during training program. The results of gastroscopic examination of the stomach indicate the prevalence of EGUS in 35.7 % during the first stage in horses with mild training. The severity of mucosal defect during this period which were related to grade 1 was shown in 10.7 % of horses, 2 – 21.4 %, 3 – 10.7 % and 4 – 0 %. Difference in results was found in the presence and severity of gastric ulcers between two periods in this study. During period of intermediate training the prevalence of EGUS was 46.4 % with severity of mucosal defect grade 1 presented in 14.2 % of affected horses, 2 – 28.5 %, 3 – 14.2 % and 4 – 3.5 %. Ulcerations on squamous gastric mucosa was diagnosed more often during each period (35.7 – 50 %) compare to glandular (7.1 – 10.7 %). The study confirms association between training intensity and gastric ulceration in two breed of horses. The prevalence and severity is dependent of the training intensity.

Endoscopic resection combined with the Cryoballoon focal ablation system in the porcine normal esophagus: a preclinical study

Background The Cryoballoon focal ablation system (CbFAS) for dysplastic Barrett’s esophagus is simple, time-saving and has high therapeutic efficacy. This study aimed to evaluate the technical feasibility and tissue damage with combination therapy of endoscopic resection (ER) and CbFAS in porcine models. Methods Three pigs (A, B, and C) were included, and all ER procedures were performed by endoscopic mucosal resection using the Cap method (EMR). Combination therapy for each pig was performed as follows: (a) CbFAS was performed for a post-EMR mucosal defect for Pig A; (b) CbFAS for post-EMR scar for Pig B, and (c) EMR for post-CbFAS scar for Pig C. All pigs were euthanized at 32 days after the initial procedure, and the tissue damage was evaluated. Results All endoscopic procedures were followed as scheduled. None of the subjects experienced anorexia, rapid weight loss, bleeding, and perforation during the observation period. They were euthanized at 32 days after the initial endoscopic procedure. On histological assessment, there was little difference between the tissue that was treated with CbFAS alone and that treated with CbFAS in combination with ER. Conclusion Combination therapy with ER and CbFAS can be technically feasible, and its outcome was not significantly different from CbFAS alone in terms of tissue damage.