Angelo Pezzullo

The Over-The-Scope-Clip (OTSC) System is Effective in the Treatment of Chronic Esophagojejunal Anastomotic Leakage

IntroductionManagement of postoperative esophagojejunal anastomotic leakage after total gastrectomy represents a very challenging event. Surgical repair is difficult, and conservative treatment can predispose to more severe complications. Endoclips and self-expanding stents are useful endoscopic therapeutic options but present some drawbacks. The Over-The-Scope-Clip (OTSC) system has been shown to be appropriate to close acute small gastrointestinal perforations, but its use in the treatment of chronic leakage remains controversial.Case SeriesThe present series reports three consecutive chronic esophagojejunal anastomotic leaks successfully treated with OTSC. In all cases, clip application was simple, safe and effective, without early and late complications.DiscussionThe OTSC system may represent a new therapeutic option in the management of postoperative esophagojejunal anastomotic leakage.

Foregut duplication of the stomach diagnosed by endoscopic ultrasound guided fine-needle aspiration cytology: case report and literature review

Gastric duplication cyst (GDC) with a pseudostratified columnar ciliatedepithelium is an uncommon malformation supposed to originate from a respiratorydiverticulum arising from the ventral foregut. Morphologic appearance of GDCs isvariable, depending on the density of their contents. GDCs are oftenmisdiagnosed as solid masses by imaging techniques, and as a consequence theymay be wrongly overtreated. We report our case of a 56-year-old man with a 5 cmhypoechoic mass of the gastroesophageal junction, incidentally detected bytransabdominal ultrasonography. Neither transabdominal ultrasonography normagnetic resonance clearly outlined the features of the lesion. The patientunderwent endoscopic ultrasound (EUS), which showed a hypoechoic mass arisingfrom the fourth layer of the anterior gastric wall, just below thegastroesophageal junction. According to EUS features, a diagnosis ofgastrointestinal stromal tumor was suggested. EUS-guided fine-needle aspirationcytology revealed a diagnosis of GDC with pseudostratified columnar ciliatedepithelium. We therefore performed an endoscopically-assisted laparoscopicexcision of the cyst.In conclusion, whenever a subepithelial gastric mass is found in the upper partof the gastric wall, a duplication cyst, although rare, should be considered. Inthis case, EUS-guided fine-needle aspiration cytology could provide acytological diagnosis useful to arrange in advance the more adequate surgicaltreatment.

Esophageal papilloma: Flexible endoscopic ablation by radiofrequency.

Squamous papilloma of the esophagus is a rare benign lesion of the esophagus. Radiofrequency ablation is an established endoscopic technique for the eradication of Barrett esophagus. No cases of endoscopic ablation of esophageal papilloma by radiofrequency ablation (RFA) have been reported. We report a case of esophageal papilloma successfully treated with a single session of radiofrequency ablation. Endoscopic ablation of the lesion was achieved by radiofrequency using a new catheter inserted through the working channel of endoscope. The esophageal ablated tissue was removed by a specifically designed cup. Complete ablation was confirmed at 3 mo by endoscopy with biopsies. This case supports feasibility and safety of as a new potential indication for Barrx(TM) RFA in patients with esophageal papilloma.