Joseph W. Griffin

Gastrointestinal autonomic nerve tumor: immunohistochemical and molecular identity with gastrointestinal stromal tumor.

Gastrointestinal autonomic nerve tumor (GANT) is a gastrointestinal neoplasm that ultrastructurally recapitulates the enteric neural plexus. This study identifies and defines the features of 10 cases of this rare mesenchymal tumor and compares its clinicopathologic and molecular genetic features with the data on gastrointestinal stromal tumor (GIST). The majority of patients in this series presented at an older age (mean 64 years). Tumors arose from the stomach (6), small intestine (2), and retroperitoneum (2). Mean tumor size was 14 cm; however, four neoplasms were <6 cm. Histologically, tumors were spindled or epithelioid; one epithelioid tumor demonstrated a previously undescribed rhabdoid histologic phenotype. All tumors were positive for CD117 (KIT), while eight of 10 were positive for CD34. In contrast, only two were positive for S-100, and all were negative for actin and desmin. Five GANTs demonstrated GIST-specific gain-of-function mutations in the juxtamembrane domain of the c-kit gene (50%). Three of 10 patients died of disease in 22–30 months, one patient died in the postoperative period, and one patient died of complications of CML. The clinicopathologic, histologic, immunohistologic, and molecular features of GANT are similar to GIST, indicating that GANT merely represents a phenotypic variant of GIST.

Vascular Ectasia of the Colon: Clinical, Colonoscopic, and Radiographic Features

We report a retrospective review of the pertinent clinical, endoscopic, and radiologic findings of 15 patients with vascular ectasia of the colon. Although the majority of the patients were over 60 years old, 40% were older than 50 but younger than 60. Vascular ectasia can occur without associated aortic stenosis or chronic obstructing pulmonary disease. Twenty-seven percent of the patients had multiple lesions involving the transverse or descending colon or both, as well as the cecal-ascending colon area. Colonoscopy and angiography were able to detect the vascular ectasia, but both diagnostic methods missing some lesions. Watchful waiting appears to offer a reasonable approach toward patients with vascular ectasia of the colon unless the lesions cause significant or recurrent bleeding.

Role of colonoscopy in patients with unexplained melena: analysis of 53 patients

Colonoscopy revealed significant pathologic conditions in 16 (30%) of 53 patients who presented with melena and had negative or nondiagnostic upper and lower gastrointestinal x-ray studies and negative upper endoscopy.

“Skinny” Upper Gastrointestinal Endoscopy—The Initial Diagnostic Tool: A Prospective Comparison of Upper Gastrointestinal Endoscopy and Radiology

One hundred twenty-five patients were prospectively evaluated with upper gastrointestinal “skinny” endoscopy and radiology. Seventy-five patients underwent endoscopic examination before barium studies, whereas 50 patients underwent radiologic examination before endoscopy. If superficial mucosal erosions are eliminated, the areas of greatest disagreement occurred in the postoperative stomach, the deformed antrum, and the deformed duodenal bulb. We conclude that 1) a barium meal is not a prerequisite to a complete endoscopic examination by a trained endoscopist, 2) a barium meal following an adequate endoscopic examination usually adds little new information, and 3) “skinny” endoscopic examination can be utilized as the initial and usually the only diagnostic test in most patients with upper gastrointestinal symptoms.

Prolonged relief of intractable pruritus in primary sclerosing cholangitis by plasmapheresis.

We report a patient with intense pruritus in primary sclerosing cholangitis (PSC) who had long symptomatic remissions of pruritus after plasmapheresis therapy. The successful therapy may be related to removal of immune complexes as there was no lasting effect on the patients liver function tests.

The use of the 130-cm colonoscope for screening flexible sigmoidoscopy

The 130-cm colonoscope was utilized to determine whether a deeper insertion could be accomplished after the usual enema preparation for routine flexible sigmoidoscopy and, if so, to what extent that would enhance the yield of neoplastic findings. Sixty-four patients were examined, and intubation was accomplished to the level of 69 cm compared with 48.1 cm for a matched control group that had flexible sigmoidoscopy with the 60-cm endoscope. Another 24 patients who had a barium enema prep had a significantly greater depth of insertion (81.4 cm). Only two polyps were found proximal to 60 cm. The 130-cm colonoscope does not offer any substantial advantage over the standard 60-cm sigmoidoscope unless a bowel preparation more thorough than enemas is given and then it would probably only be worthwhile using the colonoscope in patients who are above average risk for colorectal neoplasia.

Hydropneumothorax Following Peritoneoscopy

Peritoneoscopy is recognized as a safe and effective procedure, even though numerous complications have been reported. We have seen a patient in whom left hydropneumothorax developed after laparoscopy, a complication not previously reported.