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Clinical Journal of Gastroenterology

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https://www.readbyqxmd.com/read/30414073/serum-and-histological-igg4-negative-type-1-autoimmune-pancreatitis
#1
Yuichi Takano, Takahiro Kobayashi, Fumitaka Niiya, Eiichi Yamamura, Naotaka Maruoka, Kazuaki Yokomizo, Hiroki Mizukami, Jun-Ichi Tanaka, Tomoko Norose, Nobuyuki Ohike, Masatsugu Nagahama
A 66-year-old man who was on oral medication for type 2 diabetes experienced a rapid decline in glycemic control (increase in glycosylated hemoglobin level from 7.7 to 10.2% over 3 months). Abdominal ultrasonography revealed a 20-mm hypoechoic mass in the pancreatic tail. Serum tumor marker carbohydrate antigen 19-9 and DUPAN2 levels were within the respective normal ranges; serum IgG4 level was also normal at 21.8 mg/dL. Abdominal contrast computed tomography revealed a 26-mm tumor in the pancreatic tail...
November 10, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30374884/combined-hepatocellular-cholangiocarcinoma-successfully-treated-with-sorafenib-case-report-and-review-of-the-literature
#2
Yuka Futsukaichi, Kazuto Tajiri, Saito Kobayashi, Kohei Nagata, Satoshi Yasumura, Terumi Takahara, Masami Minemura, Ichiro Yasuda
Sorafenib, a multiple kinase inhibitor, has been established as first-line standard systemic chemotherapy for patients with advanced hepatocellular carcinoma (HCC). We encountered a patient with combined hepatocellular and cholangiocarcinoma (CHC) who achieved complete remission in response to sorafenib treatment. A 58-year old man with hepatitis C virus (HCV)-induced liver cirrhosis was diagnosed with CHC in segments 6th and 7th of the liver and underwent partial surgical resection. Three months later, CHC recurred as metastases at multiple intrahepatic sites, lymph nodes, and bones, making surgery impossible...
October 29, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30343465/caroli-syndrome-a-clinical-case-with-detailed-histopathological-analysis
#3
Mikhail Mavlikeev, Angelina Titova, Renata Saitburkhanova, Maria Abyzova, Ilyas Sayfutdinov, Nasima Gizzatullina, Ilya Kotov, Igor Plaksa, Artur Isaev, Sayar Abdulkhakov, Andrey Kiyasov, Roman Deev
Herein we present a clinical case of the Caroli syndrome caused by the compound heterozygous mutation in the PKHD1 gene. Histopathological assessment of liver detected biliary cirrhosis, numerous dilated bile ducts of various sizes, hyperplastic cholangiocytes containing a large amount of acid mucopolysaccharides, decreased ß-tubulin expression and increased proliferation of cholangiocytes. A significant proportion of hepatic tissue was composed of giant cysts lined with a single layer of cholangiocytes, containing pus and bile in its lumen and surrounded by granulation tissue...
October 20, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30343464/acute-hemiparesis-and-status-epilepticus-following-endoscopic-esophageal-balloon-dilation-is-it-really-a-stroke
#4
Nicholas Di Mascio, Padraic MacMathuna, Sean Murphy, Eoin Carl Kavanagh
A 68-year-old gentleman was referred for elective upper gastrointestinal endoscopy on a background of dysphagia and esophageal candidiasis. A benign peptic stricture was noted, managed with balloon dilation without apparent immediate complication. At completion, however, the patient became confused and agitated, with no improvement despite the reversal of sedation. Two hours later, with all investigations for suspected complications including perforation, negative, he developed acute left-sided hemiparesis...
October 20, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30341715/occurrence-of-hepatocellular-carcinoma-24-years-after-successful-interferon-therapy-in-a-patient-with-chronic-hepatitis-c-a-case-report
#5
Yuichi Yoshida, Miki Yonezawa, Takuya Okamoto, Yudai Fujiwara, Akiko Suzuki, Yuji Suzuki, Kei Endo, Keisuke Kakisaka, Takayoshi Oikawa, Hidekatsu Kuroda, Akio Miyasaka, Yasuhiro Takikawa
An 82-year-old man presented with hepatocellular carcinomas (HCCs) 24 years after achieving a sustained virological response (SVR) to an interferon for hepatitis C. His hepatic fibrosis stage was F1 when he was treated at 58 years. He was followed-up by annual blood tests and abdominal ultrasonography or computed tomography. After the IFN treatment, he had drunk approximately 100 g of ethanol. Serum aspartate aminotransferase and gamma-glutamyl transpeptidase levels had been elevated since 2012. To investigate the possible factors that affect hepatocarcinogenesis over 10 years after achieving an SVR, we reviewed the literature...
October 19, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30284703/an-extremely-rare-case-who-underwent-total-remnant-pancreatectomy-due-to-recurrent-pancreatic-metastasis-of-intraductal-tubulopapillary-neoplasm
#6
Akira Umemura, Kazuyuki Ishida, Hiroyuki Nitta, Takeshi Takahara, Yasushi Hasegawa, Kenji Makabe, Tamotsu Sugai, Akira Sasaki
We describe a rare case of recurrent pancreatic metastasis of intraductal tubulopapillary neoplasm (ITPN). A 53-year-old woman diagnosed with an intraductal papillary mucinous neoplasm (IPMN) and a pancreatic ductal adenocarcinoma (PDAC) of the pancreatic body underwent a distal pancreatectomy. The tumor was composed of cuboidal, high-grade dysplastic cells proliferating in a tubulopapillary growth pattern without mucin production; hence, the final diagnosis was ITPN. A follow-up computed tomography scan revealed an enhanced 2 cm mass of the pancreatic head 3 years after the surgery...
October 4, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30284196/size-does-matter-when-a-large-plastic-biliary-stent-ends-up-in-the-root-of-the-mesentery
#7
Konstantinos Ekmektzoglou, Efstathios Nikou, Periklis Apostolopoulos, Despina Grigoraki, Konstantinos Manesis, Georgios Alexandrakis
Duodenal perforations due to biliary stenting migration, although rare, can occur. We report a unique case of duodenal perforation due to a large in length plastic stent with no (or marginal) migration, which ended up in the root of the mesentery, explaining the normal laboratory values and minimal imaging findings observed. Any clinical symptom during the postprocedural period should raise the suspicion of a major complication and prompt quick management decisions.
October 3, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30259299/superficial-non-ampullary-duodenal-cancer-identified-by-small-bowel-capsule-endoscopy-a-case-report-with-video
#8
Kazuhiro Ota, Satoshi Kikutani, Yuka Kawasaki, Noriaki Sugawara, Satoshi Harada, Yuichi Kojima, Sadaharu Nouda, Toshihisa Takeuchi, Hiroshi Akutagawa, Kazuhide Higuchi
Herein, we report for the first time a case of a surficial superficial non-ampullary duodenal cancer causing obscure intestinal bleeding that was identified by small-bowel capsule endoscopy and treated by endoscopic mucosal resection. A 73-year-old man underwent upper gastrointestinal endoscopy to identify the cause of anemia. Although conventional duodenoscopy revealed a flat, elevated 5-mm lesion with a central recess and "milk-white mucosa" at the inferior duodenal angulus, capsule endoscopy revealed a white nodular 5-mm lesion with central recess at the duodenum slightly to the anal side from the major duodenal papilla...
September 26, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30251013/proton-pump-inhibitor-induced-fundic-gland-polyps-with-hematemesis
#9
Mamoru Tanaka, Hiromi Kataoka, Takashi Yagi
Fundic gland polyps (FGPs) are generally considered benign. Proton-pump inhibitors (PPIs) are used worldwide as first-line therapy for gastroesophageal reflux disease and nonsteroidal anti-inflammatory drug-induced ulcer treatment. Long-term use of PPIs increases the risk of FGP development. We report an extremely rare case of PPI-induced FGPs with hematemesis. A 37-year-old woman taking daily rabeprazole presented to the hospital with a complaint of hematemesis and tarry stools. Esophagogastroduodenoscopy (EGD) revealed > 20 pedunculated polyps in the gastric body and fundus...
September 24, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30244310/a-case-of-unique-endoscopic-findings-of-intestinal-endometriosis-exposed-to-the-mucosa-aggregation-of-papillary-protruded-bulges-from-the-submucosal-elevation-of-the-rectum
#10
Shinsuke Kazama, Takeyuki Hiramatsu, Kenji Kuroda, Kumiko Hongo, Yukihiro Watanabe, Toshiaki Tanaka, Ken Kuriki
Intestinal endometriosis exposed to the mucosa is relatively rare. Therefore, its endoscopic findings with pit pattern and magnifying endoscopy with narrow-band imaging and clinicopathological features of intestinal endometriosis exposed to the mucosa have not been well documented until now. A 44-year-old woman was suspected to have gastrointestinal bleeding by positive fecal occult blood test. Colonoscopy revealed a hemicircular submucosal tumor whose surface was covered with easy-bleeding papillary bulges in the rectum...
September 22, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30238285/solitary-extramedullary-plasmacytoma-of-the-rectum-complicating-ulcerative-colitis
#11
Wataru Miwa, Takashi Hiratsuka, Shutetsu Tei, Ken Sato, Kato Yo
Solitary extramedullary plasmacytoma (EMP) arising in the rectum is an extremely rare clinical entity. Only ten cases have been reported in the English-language literature. We experienced a case of an EMP in the rectum of a 55-year-old man with an 8-year history of proctitis-type ulcerative colitis (UC). The plasmacytoma appeared as an 8-mm semipedunculated polypoid lesion in the actively inflamed rectal mucosa when the remittent UC flared. The tumor was treated using endoscopic mucosal resection. This is the second case of rectal EMP associated with UC after a similar report was published in 2004...
September 20, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30232705/chronic-intestinal-pseudo-obstruction-due-to-al-amyloidosis-a-case-report-and-literature-review
#12
Tomoya Iida, Daisuke Hirayama, Gota Sudo, Kei Mitsuhashi, Hisayoshi Igarashi, Kentaro Yamashita, Hiroo Yamano, Hiroshi Nakase
A 59-year-old woman presented to our hospital with a 6-month history of nausea, weight loss, and abdominal distension. Physical examination revealed abdominal distension without tenderness, and edema, numbness, and multiple peripheral neuropathy in the limbs. Blood test results showed anemia, hypoproteinemia, and hypoalbuminemia. Immunoelectrophoresis detected kappa-type Bence-Jones protein in both the serum and urine. Bone marrow examination did not reveal an increase of plasma cells. Computed tomography showed intestinal distension and retention of intestinal contents...
September 19, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30232704/atypical-serious-hematochezia-and-rare-imaging-feature-in-gastrointestinal-tuberculosis
#13
Jing Liu, Ge Bai, Jianxing Qiu, Yan Chi, Xiaoyu Hu, Yong Huang, Xiaoying Wang, Huahong Wang
A young patient had serious hematochezia for nearly 2 months without obvious cause. Abdominal CT images showed rare features such as serious hemorrhage and multiple miliary nodules in the small bowel. The colonoscopy showed multiple lymphoid follicles in the terminal ileum. The laparotomy showed adverse adhesion in the abdominal cavity and multiple miliary noduli in the surfaces of small bowel wall. The pathology suggested tuberculosis. This patient received anti-TB therapy and the condition improved gradually...
September 19, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30218430/an-intensive-medical-care-network-led-to-successful-living-donor-liver-transplantation-in-late-onset-hepatic-failure-with-disseminated-staphylococcus-aureus-infection
#14
Rie Kure, Natsumi Uehara, Kazuaki Inoue, Tomomi Kogiso, Kazuhisa Kodama, Makiko Taniai, Katsutoshi Tokushige, Masayuki Nakano, Hiroto Egawa, Masakazu Yamamoto
Here, we describe a 42-year-old male patient with late-onset hepatic failure (LOHF) due to acute-onset autoimmune hepatitis. At first, his response to steroid therapy was good, but hepatitis relapsed during steroid pulse therapy. Deterioration of liver function caused LOHF, and LOHF has a poor prognosis, particularly when it is complicated by infection. Systemic infection by Staphylococcus aureus resulted in a skin rash and septic pulmonary embolism, and is an absolute contraindication for liver transplantation (LT)...
September 14, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30209730/importance-of-mediastinal-screening-based-observation-during-endoscopic-ultrasound-to-examine-gastrointestinal-pathologies
#15
Naohito Uchida, Yuko Bando, Sae Hamaya, Yukiko Koyama, Kazuhiro Kozuka, Rie Kawakita, Yuki Sawada, Akihiko Tatemoto, Toshiaki Nakatsu
In all endoscopic ultrasound (EUS) examinations performed at our hospital, the heart, vasculature, and mediastinal lymph nodes from the esophagus are observed after checking for gastrointestinal pathologies. Since the introduction of EUS using a convex linear-array echoendoscope at our hospital in April 2015, EUS examinations have been performed in 371 cases for examining pancreaticobiliary diseases, submucosal tumors, and other pathologies during the 3-year period, till March 2018. We diagnosed 2 patients with asymptomatic cardiovascular disease while observing the mediastinum during EUS examination to examine identified pancreaticobiliary disease...
September 12, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30206777/a-case-of-gastric-cancer-with-delayed-onset-of-tumor-reduction-effect-by-nivolumab-therapy
#16
Rika Satoyoshi, Osamu Muto, Akio Masuda, Kei Kotanagi, Takuya Kichiraku, Kazuhiro Kudoh, Toshiya Sawada, Hideaki Miyazawa, Hitoshi Kotanagi
Immune checkpoint inhibitors may have different clinical effects compared with conventional anticancer drugs. An 85-year-old male received chemotherapy for recurrent gastric cancer. As liver metastasis progressed, nivolumab was introduced as a fourth line treatment. Progression of liver metastasis in size was observed in CT after 3 courses of nivolumab therapy. Nivolumab treatment was discontinued, because the general condition of the patient also worsened. However, his general condition improved as hepatobiliary enzyme levels, inflammatory response, and tumor markers improved...
September 11, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30206776/golimumab-in-inflammatory-bowel-diseases-present-and-future-scenarios
#17
REVIEW
Gabriele Dragoni, Marco Le Grazie, Beatrice Orlandini, Francesca Rogai
Golimumab is the third anti-TNF agent approved for the treatment of ulcerative colitis. Despite initial success demonstrated by PURSUIT trials, only few real-life studies have been published evaluating its efficacy and safety in clinical practice. Its subcutaneous route and monthly administration represent an advantage in patient compliance, respectively, vs infliximab (intravenous) and adalimumab (two doses per month). The most important weakness of the molecule which often leads clinicians to choose another anti-TNF is the impossibility to dose escalate or reduce the frequency of administrations in case of secondary failure; ongoing studies are trying to solve this problem by monitoring drug levels and the eventual presence of neutralizing anti-drug antibodies...
September 11, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30182162/a-case-of-chronic-pancreatitis-exacerbation-associated-with-pancreatic-arteriovenous-malformation-a-case-report-and-literature-review
#18
Takuya Seike, Takuya Komura, Yoshiaki Shimizu, Hitoshi Omura, Tatsuo Kumai, Takashi Kagaya, Hajime Ohta, Atsuhiro Kawashima, Kenichi Harada, Shuichi Kaneko, Masashi Unoura
A 60-year-old man with an unruptured cerebral aneurysm and family history of moyamoya disease was admitted to our hospital with epigastric pain since the previous day. Serum levels of pancreatic enzyme were elevated and abdominal contrast-enhanced computed tomography showed localized enlargement of the pancreatic tail in the arterial phase and revealed numerous areas of fine mesh-like vascular hyperplasia consistent with an enlarged pancreatic tail. We diagnosed pancreatic arteriovenous malformation (P-AVM) with acute pancreatitis...
September 4, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30171488/endoscopic-ultrasound-guided-treatment-of-pancreatic-fluid-collections-with-lumen-apposing-metallic-stents-lessons-learned
#19
Rodrigo Cañada Surjan, Tiago de Castro Basseres, Otavio Micelli, Eloy Taglieri, Daniel Bauab Puzzo, José Celso Ardengh
Pancreatic fluid collections are common pancreatitis complications that frequently require drainage. Endoscopic ultrasound-guided placement of expandable lumen apposing metallic stents has recently emerged as an effective and less invasive treatment option. It is associated with less morbidity, lower costs, and faster clinical recovery than other therapeutic modalities. Nevertheless, this procedure may result in severe complications such as bleeding, buried stent syndrome, and prosthesis dislodgement (with perforation and peritoneal leakage)...
August 31, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/30171487/successful-treatment-of-an-esophageal-perforation-that-occurred-during-endoscopic-submucosal-dissection-for-esophageal-cancer-using-polyglycolic-acid-sheets-and-fibrin-glue
#20
Umaporn Seehawong, Yoshinori Morita, Yoshiko Nakano, Takehiro Iwasaki, Chonlada Krutsri, Hiroya Sakaguchi, Tomoya Sako, Toshitatsu Takao, Shinwa Tanaka, Takashi Toyonaga, Eiji Umegaki, Yuzo Kodama
A 74-year-old female, who was diagnosed with superficial esophageal cancer, underwent endoscopic submucosal dissection (ESD) at another hospital, but a perforation occurred during the procedure. The perforation was closed with endoscopic clips, and the ESD was halted. The patient was referred to our hospital, and ESD was retried. There was severe fibrosis around the lesion, and injections into the submucosal layer were difficult. In addition, it was not possible to identify the submucosal layer, and making an oral-side incision caused a large perforation along the incision line...
August 31, 2018: Clinical Journal of Gastroenterology
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