Chia-Wei Yang

Successful Double Balloon Enteroscopy Treatment for Bleeding Jejunal Diverticulum: A Case Report and Review of the Literature

In this article, we report a case study of a 54-year old man who presented with massive gastrointestinal bleeding. Esophagogastroduodenoscopy and colonoscopy had been performed in another hospital, but the location of the bleeding could not be identified, and the patient was transferred to our hospital. An initial abdominal computed tomography scan showed only a large blood clot in the small bowel and colon, with duodenojejunal diverticulosis. Emergent angiography was performed due to persistent active bleeding. Active bleeding from the jejunum was found, and the patient received a double balloon enteroscopy, which disclosed active bleeding in one of the jejunal diverticula. Two hemoclips were applied to treat the Dieulafoys lesion within the diverticulum. The patient had no bleeding during the month following treatment. Bleeding of the jejunal diverticulum is a rare clinical condition, and only a few cases have been reported in the literature with successful endoscopic treatment. A short review of the current methods of diagnosis and treatment of this rare disorder is provided.

Clinical impact of multidetector computed tomography before double-balloon enteroscopy for obscure gastrointestinal bleeding

AIM To evaluate the clinical impact of multidetector computed tomography (MDCT) before double-balloon endoscopy (DBE) for patients with obscure gastrointestinal bleeding (OGIB). METHODS A retrospective analysis of prospectively collected cases with DBE and MDCT for overt OGIB was conducted from April 2004 to April 2010 at Changhua Christian Hospital. We evaluated the clinical impact of MDCT on the subsequent DBE examinations and the diagnostic yields of both MDCT and DBE respectively. RESULTS From April 2004 to April 2010, a total of 75 patients underwent DBE for overt OGIB. Thirty one cases received MDCT followed by DBE for OGIB. The overall diagnostic yields of DBE and MDCT was 93.5% and 45.2%. The MDCT had a high diagnostic yield of tumor vs non-tumor etiology of OGIB (85.7% vs 33.3%, P = 0.014). Additionally, the choice of initial route of DBE was correct in those with a positive MDCT vs negative MDCT (100% vs 52.9%, P = 0.003). CONCLUSION This study suggests MDCT as a triage tool may identify patients who will benefit from DBE and aid the endoscopist in choosing the most efficient route.

Profound transient thrombocytopenia associated with 90Yttrium microsphere therapy for inoperable hepatoma.

The use of 90Yttrium microspheres to treat unresectable hepatoma is increasing worldwide. Therapeutically, 90Yttrium microspheres show promising increases in survival and tumor response, as well as acceptable toxicities. Here, we report on a 67-year-old man with hepatitis C-related advanced-stage hepatoma. This patient received selective internal radiation therapy (SIRT) using 90Yttrium microspheres (SIR-Spheres®). The patient displayed bone marrow suppression that resulted in a transient yet profound thrombocytopenia. To our knowledge, this is the first case of a hematologic complication as a consequence of the use of commercially available 90Yttrium microsphere devices.

The clinical significance of jejunal diverticular disease diagnosed by double-balloon enteroscopy for obscure gastrointestinal bleeding.

BackgroundJejunal diverticular disease is a rare cause of gastrointestinal bleeding. The reported incidence of this disease is low in the studies of double-balloon enteroscopy.AimThe aim of this study was to evaluate the clinical features and management of jejunal diverticular disease, diagnosed by double-balloon enteroscopy, at our institution.MethodThis was a retrospective study of patients with jejunal diverticular disease conducted from April 2004 to September 2009 at Changhua Christian Hospital. We evaluated the clinical significance of jejunal diverticular disease and the outcome of endoscopic treatment for jejunal diverticular bleeding.ResultsFrom April 2004 to September 2009, a total of 55 patients underwent double-balloon enteroscopy due to obscure gastrointestinal bleeding. Fifteen of these patients were diagnosed with jejunal diverticular disease (8 men and 7 women, mean age 71 years). Four patients were found to have a single diverticulum. Gastrointestinal bleeding was attributed to jejunal diverticular disease in 12 patients. Six patients received endoscopic treatment in order to achieve hemostasis. One patient received emergency surgery due to uncontrolled bleeding.ConclusionsTo our knowledge, this is the first study reporting the clinical significance of jejunal diverticular disease diagnosed by double-balloon enteroscopy. We found that obscure GI bleeding was attributed significantly to jejunal diverticular disease.

Novel Use of the Tip of a Standard Diathermic Snare for Endoscopic Submucosal Dissection of a Large Gastric Adenomatous Polyp

This case report describes a 63-year-old man initially diagnosed as having a 2.5-cm gastric adenomatous polyp with low-grade dysplasia. In contrast to using conventional knives for endoscopic submucosal dissection, the standard diathermic snare tip was used as an alternative knife for endoscopic submucosal dissection of the lesion with successful en bloc resection. The procedure was performed without complications. The polyp was finally confirmed as a tubulovillous adenoma with focal high-grade dysplasia.

Use of hemostatic forceps as a preoperative rescue therapy for bleeding peptic ulcers.

Standard endoscopic management of bleeding peptic ulcers includes injection, thermal coagulation, or mechanical clipping. The use of hemostatic forceps has increased with the widespread use of endoscopic submucosal dissection to control bleeding. However, there are few reports on the use of hemostatic forceps to control bleeding peptic ulcers. From January to October 2010, four hundred twenty-seven patients received endoscopic therapy at our institution for bleeding peptic ulcers. In 5 patients hemostasis was achieved with hemostatic forceps as a rescue therapy after standard endoscopic therapy had failed. In 4 patients successful hemostasis was achieved, whereas 1 patient had to undergo emergency surgery. We found that hemostatic forceps are a useful alternative for the control of bleeding peptic ulcers after standard endoscopic treatment has failed. This treatment may help in avoiding the necessity of surgery. Further large-scale studies are required to confirm our observations.

Short-term outcomes of endoscopic submucosal dissection for colorectal neoplasms in a single medical center

Endoscopic submucosal dissection (ESD) is an emerging technique for treating superficial neoplasms of the gastrointestinal tract. Clinical experience of ESD for superficial colorectal neoplasms remains limited in Taiwan. The aim of this study was to assess ESD performed in a series of patients at our hospital and report the results.

Use of dual knife for large pedunculated colorectal polyps.

Background: Endoscopic resection of large pedunculated colorectal polyps is technically difficult, especially when the polyps are so large that it is either not possible or too difficult to resect them using a conventional polypectomy snare. Aim: To facilitate the removal of pedunculated colorectal polyps, we developed a new technique using a combination of a dual knife and preventive hemostatic procedures. Methods: Nine patients (5 men and 4 women; mean age, 59.8 y; range, 49 to 79 y) with pedunculated polyps >2 cm in diameter were treated with this technique. A dual knife and endoclips or an endoloop were used as needed. Results: All lesions, except for 1 polyp, were resected endoscopically. The mean time for complete resection was 8.5 minutes (range, 1.5 to 16 min). The procedure time decreased significantly after the fifth case (168 vs. 746 s, P=0.0009). No hemorrhage, perforation, or other complications occurred during follow-up among the endoscopically resected cases. Conclusions: Combined use of a dual knife and prophylactic hemostatic procedures is a feasible alternative technique for removing large pedunculated colorectal polyps when conventional snare resection is impossible or difficult.

Direct cholangioscopy using an ultrathin endoscope for the diagnosis of hemobilia

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Synchronous Metastasis to the Oral Cavity and Proximal Upper Small Intestine as an Initial Presentation of Hepatocellular Carcinoma: Report of a Case

Hepatocellular carcinoma (HCC) usually metastasizes to the lungs, regional lymph nodes, bone tissue, and the adrenal gland. Metastasis to the gastrointestinal tract is rare and is usually associated with a poor prognosis. We describe a patient with a double metastasis of HCC to the oral cavity and proximal jejunum who presented with halitosis, abdominal pain, and melena. We emphasize the imaging of the HCC lesions because they may easily be mistaken for various types of benign lesions and because they may be the first sign of an undiscovered malignancy.