Shee-Chan Lin

Large‐volume endoscopic injection of epinephrine plus normal saline for peptic ulcer bleeding

Background and Aim:  Large‐volume endoscopic injection of epinephrine has been proven to significantly reduce rates of recurrent peptic ulcer bleeding. Injection of normal saline may be equally effective for the similar hemostatic effect of local tamponade. The aim of our study was to compare the therapeutic effects of large‐volume (40 mL) endoscopic injections of epinephrine, normal saline and a combination of the two in patients with active bleeding ulcers.

Proposed Scoring System to Determine Small Bowel Mass Lesions Using Capsule Endoscopy

BACKGROUND/PURPOSE Capsule endoscopy is a highly sensitive method for the detection of small bowel lesions. False-positive findings are important confounding factors. This study reports on a scoring system for evaluating the role of capsule endoscopy in small bowel tumors. METHODS Ten men and two women (age, 23-79 years) with suspected small bowel tumors were included from 120 patients referred for capsule endoscopy between March 2004 and March 2008. The indications were gastrointestinal bleeding (n = 9), melanoma workup (n = 1), physical checkup (n = 1), and iron deficiency anemia (n = 1). The proposed tumor score was composed of five components: bleeding, mucosal disruption, an irregular surface, color, and white villi. These can be scored for probability of mass lesions seen at capsule endoscopy. Small bowel mass lesions were probably present in those with a score of >or= 4, and a score of <or= 2 indicated a low probability of a small bowel mass lesion. RESULTS Capsule endoscopy showed probable small bowel mass lesions in six patients, and a low lesion probability in the other six. Capsule endoscopy showed that new lesions were not detected by esophagogastroduodenoscopy or colonoscopy. All six patients with probable small bowel tumors were found to have pathological findings upon capsule endoscopy: two with lymphangioma, and one each with ileal ectopic pancreas, with melanoma metastasis, gastrointestinal lymphoma, and gastrointestinal stromal tumor. CONCLUSION Capsule endoscopy may detect small bowel tumors more reliably by using the scoring system outlined. It should be considered in suspected cases of small bowel tumor.

Findings and Risk Factors of Early Mortality of Endoscopic Retrograde Cholangiopancreatography in Different Cohorts of Elderly Patients

OBJECTIVES: To analyze experience of endoscopic retrograde cholangiopancreatography (ERCP) in patients with of different age cohorts and discuss the risk factors of early mortality after ERCP.

Identification of Ectopic Pancreas in the Ileum by Capsule Endoscopy

Ectopic pancreas, an uncommon submucosal tumor in the gastrointestinal (GI) tract, is histologically similar to normal pancreatic tissue. We present a case of ectopic pancreas in the ileum. A 35-year-old man had intermittent dark bloody stool for 2 months accompanied by epigastric pain and postprandial abdominal fullness. Esophagogastroduodenoscopy and colonoscopy did not reveal any abnormalities. Capsule endoscopy revealed a small red polyp in the ileum. Abdominal computed tomography scan and small bowel barium follow-through study were not of any help. GI bleeding and abdominal discomfort were resolved after the lesion was surgically removed. Pathologic examination demonstrated pancreatic acinar cells and a secretory duct in the ileal submucosa, consistent with ectopic pancreas. Ectopic pancreas in the small intestine may be a rare cause of obscure GI bleeding. Capsule endoscopy seems to be a good, noninvasive tool for identification in the small bowel, particularly when other imaging modalities fail to detect any abnormalities.

Capsule endoscopy in elderly patients with obscure gastrointestinal bleeding: retrospective analysis of 152 cases.

SUMMARY Background: Capsule endoscopy (CE) is a highly sensitive examination for the detection of small bowel lesions. However, there are few clinical studies on obscure gastrointestinal bleeding (OGIB) among elderly patients. This study reports the risk factors of angiodysplasia with CE in the elderly. Methods: To ascertain the predictive clinical associations for angiodysplastic lesions as a cause of OGIB in the elderly, we retrospectively analyzed CE results in consecutive cases over a period of 4 years and 9 months (March 2004 to November 2008). Data were collected regarding patient demographics and potential risk factors. Risk factors were analyzed by the χ 2 test and binary logistic regression analyses. Results: From March 2004 to November 2008, a total of 121 consecutive patients (71 male and 50 female; mean age and standard deviation, 57.9 ± 17.9 years) were referred to our department for CE evaluation of OGIB. All cases had undergone standard investigation with negative results within the 3 months prior to CE. Angiodysplastic lesions of the small bowel, the most common cause of OGIB in the elderly, were found in 52% of cases. Clinical associations with angiodysplastic lesions as a cause of OGIB were examined. One risk factor was increased age (≥ 65 years) (odds ratio, 2.76; 95% confidence interval, 1.20–6.35; p = 0.02). Conclusion: The use of CE in the elderly is a simple and safe diagnostic tool in the evaluation of OGIB. CE affords great precision while avoiding radiation, and should thus be the preferred method of investigation in

Accidental diagnosis of Trichuris trichiura by colonoscopy

A 42-year-old man came to our hospital with a 6-month history of anorexia, upper abdominal fullness, and loose stools; he also had recently had one episode of bloody stools. Physical examination revealed only mild external inflammation without evidence of bleeding. Laboratory data were normal. Stool culture and ova and parasite examinations revealed no pathogens. Colonoscopy showed a squirming, whitish, thin form with a whitish silk tip in the cecum near the ileocecal valve (A). Microscopically, the specimen was revealed to be a female worm, including intestine and uterus, the latter containing some barrel-shaped, thick-shelled eggs with bipolar prominences compatible with Trichuris trichiura (B, H&E, orig. mag. 100, lower left panel, H&E, orig. mag. 400). A repeat stool examination for parasite or ova again showed negative results. Colonoscopy was a useful tool for the diagnosis, especially because the stool tests showed negative results. DISCLOSURE

Clinical implications of C-kit gene mutation in patients with large gastrointestinal stromal tumors

Background and Aim:  To evaluate the clinical implications of C‐kit gene mutation in patients with gastrointestinal stromal tumors (GIST) greater than 10 cm in size.

Changing Pattern of Ectopic Pancreas: 22 Years of Experience in a Medical Center

BACKGROUND/PURPOSE Ectopic pancreas is usually a silent gastrointestinal malformation. It may become clinically evident when complicated by chronic inflammation or by growth. More ileal ectopic pancreas has been found in recent years in our hospital. We report the clinical manifestation of ectopic pancreas over the past 22 years. METHODS We reviewed the medical records of patients seen between May 1984 and December 2005 at Mackay Memorial Hospital, with a diagnosis of ectopic pancreas, and extracted clinical and histopathology data from the records. RESULTS A total of 39 patients (18 male, 21 female; mean age, 46 years) were diagnosed with ectopic pancreas. Most patients were aged between 30 and 50 years. Only 15 (38%) had symptoms suggestive of ectopic pancreas. These included abdominal pain (n = 9), upper gastrointestinal bleeding (n = 5), and abdominal distension (n = 2). The diagnosis in the other 24 patients was made incidentally, usually during surgery for other conditions. While lesions in the stomach were more likely to be diagnosed because of symptoms (12 of 13), lesions in the small bowel were almost always diagnosed incidentally. Only one of eight in the duodenum, one of 10 in the jejunum, and one of eight in the ileum, were isolated findings. One case of ectopic pancreas was detected by capsule endoscopy. CONCLUSION Ectopic pancreas can be found in various parts of the gastrointestinal tract. The high proportion of ileal ectopic pancreas is unexpected and needs further study.

GALLSTONE ILEUS: A DISEASE EASILY IGNORED IN THE ELDERLY

Summary Gallstone ileus is an uncommon cause of small bowel obstruction, accounting for only 1–4% of all intestinal obstructions. In patients with cholelithiasis, only 0.3–0.5% reportedly develop gallstone ileus. However, the condition causes 25% of cases of non-strangulated small bowel obstruction in those over the age of 65 years. We report a patient with gallstone ileus who presented with small bowel obstruction that was initially misdiagnosed. The correct diagnosis was made based on finding an ectopic gallstone on plain abdominal radiography, a cholecystoduodenal fistula, and gallstone impaction in a small bowel follow-through study. [International Journal of Gerontology 2008; 2(1): 18–21]

Synergistic Effect of Hyperglycemia and Helicobacterpylori Infection Status on Colorectal Adenoma Risk

Context Both Helicobacter pylori and type 2 diabetes mellitus are possible risk factors for colon adenoma. Objective The purpose of this study was to assess the interaction between H. pylori and hyperglycemia status on the risk of colon adenoma. Design, Setting, and Participants This was a cross-sectional, retrospective study conducted at the MacKay Memorial Hospital, Taiwan. The study included 3943 subjects aged >40 years undergoing bidirectional gastrointestinal endoscopy on the same day between July 2006 and June 2015. All subjects had a gastric biopsy specimen tested for H. pylori. Main Outcome Measure Colon adenoma with and without H. pylori infection at different hemoglobin A1c (HbA1c) levels. Results The prevalence of colorectal adenomas in patients who were H. pylori-positive and H. pylori-negative was 37.3% and 27.29%, respectively. Multivariate logistic regression analysis identified male sex, age, body mass index, H. pylori infection, and HbA1c ≥6.5% as independent risk factors for adenoma; use of hypoglycemic agents decreased this risk. The prevalence of adenoma was increased with elevated HbA1c levels regardless of H. pylori status. The odds ratio (OR) for adenoma was 1.44 (95% confidence interval [CI], 1.20 to 1.73) if H. pylori was present or 1.68 (95% CI, 1.05 to 2.70) in patients who were H. pylori-negative but had HbA1c ≥7.0%. If both conditions were present, the OR was 4.79 (95% CI, 2.92 to 7.84). A 1% increase in HbA1c was associated with an increased prevalence of adenoma by 42.4% in H. pylori-positive subjects. Conclusions The combination of H. pylori infection and elevated HbA1c is associated with an increased risk of colon adenoma.