Constantine Soulellis

Use of the endoscopically applied hemostatic powder TC-325 in cancer-related upper GI hemorrhage: preliminary experience (with video)

o p h a p 4 Upper GI hemorrhage is a common complication of gastroduodenal tumors. Bleeding from these neoplasms s generally difficult to control and is associated with high ebleeding rates. Current modalities for management inlude endoscopy, radiotherapy, interventional angiograhy, and surgery. Hemospray (Cook Medical, Winston-Salem, NC) is an merging endoscopic hemostatic technology that was reently introduced in the management of upper GI bleedng.2 It is composed of a proprietary inorganic powder that, when put in contact with moisture in the GI tract, becomes coherent and adhesive, thus serving as a mechanical barrier for hemostasis. Given its malleable nature, its ability to cover large areas, and especially the lack of direct contact with target tissue as it is sprayed onto the lesion, its use in bleeding gastroduodenal tumors has been suggested.2 Animal studies have demonstrated its safety nd its lack of absorption by the GI tract; it is also elimiated within 48 hours of application with no reported owel obstruction.3 Recently, a prospective, pilot study involving 20 patients with nonmalignant upper GI bleeding showed that the application of Hemospray was associated with a 95% initial hemostasis with no active bleeding seen on repeat EGD at 72 hours, followed by total elimination of the inorganic substance without complications such as intestinal obstruction or embolization.2 To our knowledge, the following describes the first 5 reported cases of upper GI hemorrhage secondary to gas-

The Use of Balloon-assisted Enteroscopy at a Large Volume Centre: A Retrospective Analysis

Abstract Objectives Balloon-assisted enteroscopy (BAE) is increasingly used for the evaluation of small bowel disorders. We quantified local diagnostic and therapeutic yields of BAE in patients with suspected small bowel diseases. Methods Adult patients undergoing BAE between January 2010 and July 2015 at McGill University Health Centre were included. Procedures were identified using a prospectively maintained database. Patients were excluded if procedure report was unavailable. Electronic medical records were reviewed. Analyses were restricted to patients who did not have a previous BAE. Results BAE was performed in 453 patients, including 421 anterograde cases. Patients had a mean age of 61.0 ± 17.5 years. Most common indications for referral were obscure gastrointestinal bleeding (OGIB) (n=207, 45.7%), abnormal imaging (n=88, 19.4%), suspected small bowel neoplasia (SBN) (n=39, 8.6%) and Crohn’s disease (CD) (n=31, 6.8%). A diagnosis was established in 216 procedures (47.7%). A pre-endoscopic indication of CD (odds ratio [OR]: 3.78; 95% Confidence Interval [CI], 1.60–8.90), OGIB (OR: 3.69, 95% CI, 2.03–6.71), suspected SBN (OR: 2.45; 95% CI, 1.06–5.65) and previous VCE (OR: 9.33; 95% CI, 3.24–26.90) were associated with abnormal findings. A therapeutic procedure was performed in 126 cases (28.3%). OGIB (OR: 7.00; 95% CI, 3.83–12.81), previous video capsule endoscopy (VCE) (OR: 7.86; 95% CI, 2.93–21.04) and suspected SBN (OR: 6.30; 95% CI, 2.58–21.04) were associated with performance of a therapeutic intervention. Complication rate was 1.6%, with bleeding in seven cases and one perforation. Conclusions In carefully selected patients, such as those with OGIB, Crohn’s disease and previous VCE, BAE was a safe procedure that led to the identification of abnormal findings and therapeutic interventions.

Enteropathy-associated T cell lymphoma as a complication of longstanding celiac disease

Abstract is not required for Clinical Imagesis not required for Clinical Images (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 8 No. 10, October 2017. ISSN: 0976-3198 Int J Case Rep Images 2017;8(10):681–683. www.ijcasereportsandimages.com Hosseina et al. 681 CASE REPORT OPEN ACCESS Enteropathy-associated T cell lymphoma as a complication of longstanding celiac disease Melika Hosseina, Constantine Soulellis, Alan N. Barkun

Histoplasmosis of the Small Bowel Acquired While Camping

A 21-year-old woman with a history of juvenile idiopathic arthritis and Crohn’s disease on adalimumab for the past 5 years presented to our emergency department with a 3-week history of fevers, fatigue, nausea, vomiting, diffuse abdominal pain, and peripheral adenopathy following a camping trip. Computed tomography of the abdomen showed multiple regions of small-bowel thickening and balloon-assisted enteroscopy revealed multiple severely ulcerated and hard circumferential skip lesions causing luminal narrowing. The most severe ulcer caused a pinpoint lumen at around 80 cm beyond the ligament of Treitz (left and center). Grocott silver stain at 40× highlighting the presence of fungal organisms (arrows) consistent with a clinical diagnosis of disseminated histoplasmosis (right). In addition, the histological evaluation of the biopsied lesions revealed severe jejunitis with ulceration and multinucleated cells.