The July issue of Clinical Endoscopy deals with selected articles covering the state-of-the-art lectures delivered during the 50th seminar of the Korean Society of Gastrointestinal Endoscopy (KSGE) on March 30, 2014, highlighting educational contents pertaining to either diagnostic or therapeutic gastrointestinal (GI) endoscopy, which contain fundamental and essential points in GI endoscopy. KSGE is very proud of its seminar, which has been presented twice a year for the last 25 years, and hosted more than 3,500 participants at the current meeting. KSGE seminar is positioned as one of premier state-of-the-art seminars for endoscopy, covering topics for novice endoscopists and advanced experts, as well as diagnostic and therapeutic endoscopy. The 50th KSGE seminar consists of more than 20 sessions, including a single special lecture, concurrent sessions for GI endoscopy nurses, and sessions exploring new technologies. Nine articles were selected from these prestigious lectures, and invited for publication in this special issue. This introductory review, prepared by the editors of Clinical Endoscopy, highlights core contents divided into four sessions: upper GI tract, lower GI tract, pancreatobiliary system, and other specialized topic sessions, including live demonstrations and hands-on courses.

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• Cost of Endoscopic Submucosal Dissection Versus Endoscopic Piecemeal Mucosal Resection in the Colorectum
  Nam Seok Ham, Jeongseok Kim, Eun Hye Oh, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon
  Digestive Diseases and Sciences.2020; 65(4): 969.     CrossRef
• Nationwide estimate of emergency department visits in the United States related to caustic ingestion
  Yiting Li, James Langworthy, Lan Xu, Haifeng Cai, Yingwei Yang, Yuanyuan Lu, Sara L Wallach, Frank K Friedenberg
  Diseases of the Esophagus.2020;[Epub]     CrossRef
• Upper GIS Endoscopy Indications of Patients Consulted at Internal Medicine Outpatient Clinics and Data Obtained According to These Indications
  Muhammed Tunc, Banu Boyuk, Osman Mavis
  Open Journal of Gastroenterology.2016; 06(04): 111.     CrossRef

Endoscopic stent placement is a well-accepted and effective alternative treatment modality for complex and refractory esophageal strictures. Among the currently available types of stents, the partially covered self-expanding metal stent (SEMS) has a firm anchoring effect, preventing stent migration and ensuring effective covering of a narrowed segment. However, hyperplastic tissue reaction driven by the uncovered mesh may prevent easy and safe stent removal. As an alternative, a fully covered SEMS decreases the recurrence of dysphagia caused by hyperplastic tissue ingrowth; however, it has a high migration rate. Likewise, although a self-expanding plastic stent (SEPS) reduces reactive hyperplasia, the long-term outcome is disappointing because of the high rate of stent migration. A biodegradable stent has the main benefit of not requiring stent removal in comparison with SEMS and SEPS. However, it still has a somewhat high rate of hyperplastic reaction, and the long-term outcome does not satisfy expectations. Up to now, the question of which type of stent should be recommended for the effective treatment of complex and refractory benign strictures has no clear answer. Therefore, the selection of stent type for endoscopic treatment should be individualized, taking into consideration the endoscopist's experience as well as patient and stricture characteristics.

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• Lumen‐apposing metal stents provide early and late clinical benefits for the management of benign gastrointestinal strictures: Is there a role for definitive therapy?
  Ethan Pollack, Dalton Norwood, Hector Caceres, Babusai Rapaka, Isaac E. Perry, Usman Barlass, Rachel Mitchell, Jessica McCreight, Shajan Peter, Ramzi Mulki, Ali Ahmed, Kondal Kyanam, Sergio A. Sánchez‐Luna
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• Innovative Design of a 3D Printed Esophageal Stent Inspired by Nature: Mitigating Migration Challenges in Palliative Esophageal Cancer Therapy
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  Biomimetics.2024; 9(6): 359.     CrossRef
• Lumen-apposing metal stents for the treatment of benign gastrointestinal tract strictures: a single-center experience and proposed treatment algorithm
  Tala Mahmoud, Azizullah Beran, Fateh Bazerbachi, Reem Matar, Veeravich Jaruvongvanich, Farah Abdul Razzak, Donna Maria Abboud, Eric J. Vargas, John A. Martin, Todd A. Kellogg, Omar M. Ghanem, Bret T. Petersen, Michael J. Levy, Ryan J. Law, Vinay Chandrase
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• Caustic esophageal stenosis: A case report of endoscopic dilatation with nasogastric tubes
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• Comprehensive review of materials, applications, and future innovations in biodegradable esophageal stents
  Yaochen Yang, Yuanyuan Yang, Zhipeng Hou, Tingting Wang, Peng Wu, Lufan Shen, Peng Li, Kai Zhang, Liqun Yang, Siyu Sun
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• Palliative Endoskopie
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• Safety and efficacy of esophageal stents for esophageal anastomotic strictures: A 10-year single-center experience
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• Benign Esophageal Stricture
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  The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2022; 22(3): 197.     CrossRef
• Mechanical properties and degradation process of biliary self‐expandable biodegradable stents
  Chang‐Il Kwon, Jun Sik Son, Kyu Seok Kim, Jong Pil Moon, Sehwan Park, Jinkyung Jeon, Gwangil Kim, Sung Hoon Choi, Kwang Hyun Ko, Seok Jeong, Don Haeng Lee
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• Managing esophageal strictures following endoscopic resection of superficial neoplastic lesions
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• Biodegradable Stent/Tube for Pancreatic and Biliary Disease
  Chang-Il Kwon
  The Korean Journal of Pancreas and Biliary Tract.2020; 25(1): 18.     CrossRef
• An Overview of the Design, Development and Applications of Biodegradable Stents
  Keerthana Nakka, Sri D. Nagarajan, Balamayilsamy Sundaravadivel, Subramanian Shankaravel, Christopher Vimalson
  Drug Delivery Letters.2020; 10(1): 2.     CrossRef
• Alternative uses of lumen apposing metal stents
  Prabin Sharma, Thomas R McCarty, Ankit Chhoda, Antonio Costantino, Caroline Loeser, Thiruvengadam Muniraj, Marvin Ryou, Christopher C Thompson
  World Journal of Gastroenterology.2020; 26(21): 2715.     CrossRef
• Corrosive injury of the upper gastrointestinal tract: the evolving role of a radiologist
  Ayushi Agarwal, Deep Narayan Srivastava, Kumble Seetharama Madhusudhan
  The British Journal of Radiology.2020;[Epub]     CrossRef
• Improving stent efficiency by understanding stent-related adverse events
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• Management of tracheo-oesophageal fistula in adults
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  European Respiratory Review.2020; 29(158): 200094.     CrossRef
• 3D-printed flexible polymer stents for potential applications in inoperable esophageal malignancies
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• A Review of Self-Expanding Esophageal Stents for the Palliation Therapy of Inoperable Esophageal Malignancies
  Yunqing Kang
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• Clinical outcomes of lumen-apposing metal stent in the management of benign gastrointestinal strictures: a systematic review and meta-analysis
  Shali Tan, Chunyu Zhong, Shu Huang, Xujuan Luo, Jin Xu, Xiangsheng Fu, Yan Peng, Xiaowei Tang
  Scandinavian Journal of Gastroenterology.2019; 54(7): 811.     CrossRef
• Novel Uses of Lumen-Apposing Metal Stents
  Monica Saumoy, Clark Yarber, Michel Kahaleh
  Gastrointestinal Endoscopy Clinics of North America.2018; 28(2): 197.     CrossRef
• Biodegradable Stents in Resistant Peptic Oesophageal Stricture: Is It the Right Way to Go?
  Tom Richardson, Gerlin Naidoo, Namal Rupasinghe, Howard Smart, Sayantan Bhattacharya
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• Current trends in the diagnosis and treatment of gastroesophageal reflux disease
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• Technical feasibility and tissue reaction after silicone-covered biodegradable magnesium stent insertion in the oesophagus: a primary study in vitro and in vivo
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• Use of a lumen-apposing metal stent to treat GI strictures (with videos)
  Shayan Irani, Sujai Jalaj, Andrew Ross, Michael Larsen, Ian S. Grimm, Todd H. Baron
  Gastrointestinal Endoscopy.2017; 85(6): 1285.     CrossRef
• Use of self-expandable plastic stents (SEPS) in management of refractory benign esophageal strictures: a single center experience
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  Esophagus.2017; 14(2): 159.     CrossRef
• Endoscopic treatment of benign esophageal strictures: a literature review
  Laurent Poincloux, Olivier Rouquette, Armand Abergel
  Expert Review of Gastroenterology & Hepatology.2017; 11(1): 53.     CrossRef
• Silicone-covered biodegradable magnesium-stent insertion in the esophagus: a comparison with plastic stents
  Yue-Qi Zhu, Kai Yang, Laura Edmonds, Li-Ming Wei, Reila Zheng, Ruo-Yu Cheng, Wen-Guo Cui, Ying-Sheng Cheng
  Therapeutic Advances in Gastroenterology.2017; 10(1): 11.     CrossRef
• Management of esophageal caustic injury
  Mark Anthony A De Lusong, Aeden Bernice G Timbol, Danny Joseph S Tuazon
  World Journal of Gastrointestinal Pharmacology and Therapeutics.2017; 8(2): 90.     CrossRef
• Stent-in-stent technique for removal of embedded partially covered self-expanding metal stents
  Tomas DaVee, Shayan Irani, Cadman L. Leggett, Manuel Berzosa Corella, Karina V. Grooteman, Louis-Michel Wong Kee Song, Michael B. Wallace, Richard A. Kozarek, Todd H. Baron
  Surgical Endoscopy.2016; 30(6): 2332.     CrossRef
• Caustic Esophageal Stenosis: A Case Report of Endoscopic Dilation With a Dynamic Stent
  Marlene Abreu, Isabel Nunes, Susana Corujeira, Marta Tavares, Eunice Trindade, Jorge Amil Dias
  GE Portuguese Journal of Gastroenterology.2016; 23(4): 218.     CrossRef
• A Comparison of a Fully Covered and an Uncovered Segmented Biodegradable Esophageal Stent in a Porcine Model: Preclinical Evaluation of Degradation, Complications, and Tissue Reactions
  Yadong Feng, Chunhua Jiao, Yang Cao, Ye Zhao, Yanfang Chen, Lin Fang, Ruihua Shi
  Gastroenterology Research and Practice.2016; 2016: 1.     CrossRef
• Therapy of caustic ingestion
  Mitchell D. Shub
  Current Opinion in Pediatrics.2015; 27(5): 609.     CrossRef
• Refractory Esophageal Strictures: What To Do When Dilation Fails
  Petra G. A. van Boeckel, Peter D. Siersema
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• Foregut caustic injuries: results of the world society of emergency surgery consensus conference
  Luigi Bonavina, Mircea Chirica, Ognjan Skrobic, Yoram Kluger, Nelson A. Andreollo, Sandro Contini, Aleksander Simic, Luca Ansaloni, Fausto Catena, Gustavo P. Fraga, Carlo Locatelli, Osvaldo Chiara, Jeffry Kashuk, Federico Coccolini, Yuri Macchitella, Mass
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• Caustic injury of the oesophagus
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• Efficacy and histopathological esophageal wall damage of biodegradable esophageal stents for treatment of severe refractory esophageal anastomotic stricture in a child with long gap esophageal atresia
  Yuichi Okata, Chieko Hisamatsu, Yuko Bitoh, Akiko Yokoi, Eiji Nishijima, Kosaku Maeda, Makiko Yoshida, Tsukasa Ishida, Takeshi Azuma, Hiromu Kutsumi
  Clinical Journal of Gastroenterology.2014; 7(6): 496.     CrossRef

Although the numbers have decreased compared with in the past, cases of patients who ingest caustic substances and visit the emergency room are not rare. However, well-summarized data about caustic injuries are insufficient. Therefore, in this article, I will discuss the etiologic causative agents, injury mechanism, and clinical characteristics, as well as the endoscopic evaluation of the degree of injury and proper management of the patient, in gastrointestinal caustic injury.

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Acute variceal bleeding could be a fatal complication in patients with liver cirrhosis. In patients with decompensated liver cirrhosis accompanied by ascites or hepatic encephalopathy, acute variceal bleeding is associated with a high mortality rate. Therefore, timely endoscopic hemostasis and prevention of relapse of bleeding are most important. The treatment goals for acute variceal bleeding are to correct hypovolemia; achieve rapid hemostasis; and prevent early rebleeding, complications related to bleeding, and deterioration of liver function. If variceal bleeding is suspected, treatment with vasopressors and antibiotics should be initiated immediately on arrival to the hospital. Furthermore, to obtain hemodynamic stability, the hemoglobin level should be maintained at >8 g/dL, systolic blood pressure >90 to 100 mm Hg, heart rate <100/min, and the central venous pressure from 1 to 5 mm Hg. When the patient becomes hemodynamically stable, hemostasis should be achieved by performing endoscopy as soon as possible. For esophageal variceal bleeding, endoscopic variceal ligation is usually performed, and for gastric variceal bleeding, endoscopic variceal obturation is performed primarily. If it is considered difficult to achieve hemostasis through endoscopy, salvage therapy may be carried out while keeping the patient hemodynamically stable.

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Endoscopy for acute nonvariceal upper gastrointestinal bleeding plays an important role in primary diagnosis and management, particularly with respect to identification of high-risk stigmata lesions and to providing endoscopic hemostasis to reduce the risk of rebleeding and mortality. Early endoscopy, defined as endoscopy within the first 24 hours after presentation, improves patient outcome and reduces the length of hospitalization when compared with delayed endoscopy. Various endoscopic hemostatic methods are available, including injection therapy, mechanical therapy, and thermal coagulation. Either single treatment with mechanical or thermal therapy or a treatment that combines more than one type of therapy are effective and safe for peptic ulcer bleeding. Newly developed methods, such as Hemospray powder and over-the-scope clips, may provide additional options. Appropriate decisions and specific treatment are needed depending upon the conditions.

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Periprocedural management of antithrombotics for gastroenterological endoscopy is a common clinical issue. To decide how to manage the use of antithrombotics in patients undergoing endoscopy, the risk for hemorrhage and thromboembolism during the procedure must be considered. For low-risk procedures, no adjustments in antithrombotics are needed. For high-risk procedures with a low thromboembolic risk, discontinuation of warfarin at 5 days, and clopidogrel at 5 to 7 days before the procedure has been recommended. However, it is better to continue aspirin use even during high-risk procedures. A heparin bridging therapy may be considered before endoscopy in patients with a high thromboembolic risk. The management of patients taking antithrombotics remains complex, especially in high-risk settings.

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Colonoscopy is a widely accepted method for the evaluation of the colon and terminal ileum. Its diagnostic accuracy and therapeutic safety are influenced by prerequisites, including modulation of medication and bowel cleansing. Appropriate choices of sedative medication and bowel-cleansing regimen, together with diet modification, should be made based on the patient's underlying disease, age, and medication intake. Moreover, effective methods for patient education regarding bowel preparation should be considered.

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The use of colonoscopy for the screening and surveillance of colorectal cancer has increased. However, the miss rate of advanced colorectal neoplasm is known to be 2% to 6%, which could be affected by the image intensity of colorectal lesions. Image-enhanced endoscopy (IEE) is capable of highlighting lesions, which can improve the colorectal adenoma detection rate and diagnostic accuracy. Equipment-based IEE methods, such as narrow band imaging (NBI), Fujinon intelligent color enhancement (FICE), and i-Scan, are used to observe the mucosal epithelium of the microstructure and capillaries of the lesion, and are helpful in the detection and differential diagnosis of colorectal tumors. Although NBI is similar to chromoendoscopy in terms of adenoma detection rates, NBI can be used to differentiate colorectal polyps and to predict the submucosal invasion of malignant tumors. It is also known that FICE and i-Scan are similar to NBI in their detection rates of colorectal lesions. Through more effective and advanced endoscopic equipment, diagnostic accuracy could be improved and new treatment paradigms developed.

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Endoscopic retrograde cholangiopancreatography (ERCP) is an essential technique for the diagnosis and treatment of pancreatobiliary diseases. However, ERCP-related complications such as pancreatitis, cholangitis, hemorrhage, and perforation may be problematic. For a successful and safe ERCP, preprocedural evaluations of the patients and intervention-related risk factors are needed. Furthermore, in light of the recent population aging and increase in chronic cardiopulmonary diseases in Korea, precautions including endoscopic sedation and prevention of cardiopulmonary complications should be considered. In this literature review, we describe these risk factors and the use of endoscopic sedation. In addition, we reviewed the commonly available guidewires, including their materials and options, used as a basic accessory for ERCP procedures.

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Uneventful duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is an uncommon but occasionally fatal complication. ERCP-related perforations may occur during sphincterotomy and improper manipulation of the equipment and scope. Traditionally, duodenal perforation has been treated with early surgical repair. Recently, nonoperative early endoscopic management techniques including clips or fibrin glue have been reported. In the present paper we review the literature pertaining to the treatment of perforations.

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• Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations
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• Unexpectedly Discovered Duodenal Perforation
  Hye Min Park, Min Young Do, Sei Myung Choi, Kyung Ho Yang, Chang Jae Hur, Kwang Bum Cho
  Korean Journal of Pancreas and Biliary Tract.2015; 20(4): 241.     CrossRef
• Duodenal perforation following esophagogastroduodenoscopy (EGD) with cautery and epinephrine injection for peptic ulcer disease: An interesting case of nonoperative management in the medical intensive care unit (MICU)
  Jason Chertoff, Vikas Khullar, Lucas Burke
  International Journal of Surgery Case Reports.2015; 10: 121.     CrossRef
• ERCP-induced duodenal perforation successfully treated with endoscopic purse-string suture: a case report
  Quanpeng Li, Jie Ji, Fei Wang, Xianxiu Ge, Junjie Nie, Boming Xu, Xiuhua Zhang, Guobing Jiang, Lin Miao
  Oncotarget.2015; 6(19): 17847.     CrossRef

Tuberculosis remains a serious infectious disease with primary features of pulmonary manifestation in Korea. However, duodenal tuberculosis is rare in gastrointestinal cases of extrapulmonary tuberculosis. Here, we report a case of primary duodenal tuberculosis mistaken as a malignant tumor and diagnosed with QuantiFERON-TB GOLD (Cellestis Ltd.) in an immunocompetent male patient.

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• Rare case of duodenal tuberculosis causing gastric outlet obstruction, a case report
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• Disseminated tuberculosis mimicking abdominal metastatic carcinoma
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• The role of dual time point PET/CT for distinguishing malignant from benign focal 18F-FDG uptake duodenal lesions
  Ri Sa, Hong-Guang Zhao, Yu-Yin Dai, Feng Guan
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• Lymph node tuberculosis mimicking malignancy on 18F-FDG PET/CT in two patients: A case report
  Rui-Lin Ding, Hong-Ying Cao, Yue Hu, Chang-Ling Shang, Fang Xie, Zhen-Hua Zhang, Qing-Lian Wen
  Experimental and Therapeutic Medicine.2017; 13(6): 3369.     CrossRef

There is paucity in the literature on the use of endoscopic ultrasound (EUS) for evaluating the thyroid gland. We report the first case of primary papillary thyroid cancer diagnosed by using EUS and fine needle aspiration (FNA). A 66-year-old man underwent EUS for the evaluation of mediastinal lymphadenopathy. FNA of the lymph nodes showed benign findings. A hypoechoic mass was noted in the right lobe of the thyroid gland. Therefore, FNA was performed. The cytological results were consistent with primary papillary thyroid cancer.

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• EUS of the neck: A comprehensive anatomical reference for the staging of head and neck cancer (with videos)
  Malay Sharma, Amit Pathak, Abid Shoukat, ChittapuramSrinivasan Rameshbabu, Sumit Goyal, Raghav Bansal, Rooby Hamza, Kshitij Charaya
  Endoscopic Ultrasound.2019; 8(4): 227.     CrossRef

Gastric high-grade dysplasia is an important premalignant lesion in gastric epithelial cells and has a high possibility of transforming to adenocarcinoma. Therefore, biopsy-proven high-grade dysplasia should be treated with en bloc resection methods such as endoscopic mucosal resection or endoscopic submucosal dissection (ESD). We report the case of a 63-year-old male patient, diagnosed with gastric high-grade dysplasia at the angle and lesser curvature side of the lower body. The patient was initially treated with ESD, although histopathology subsequently showed horizontal margin involvement. Since the lesion was diffusely edematous and margins were uncertain because of the previous ESD treatment, we chose to treat the patient with laparoscopy-assisted endoscopic full-thickness resection (EFTR). EFTR is a recently developed procedure, which uses both endoscopic and laparoscopic techniques to resect the full-thickness of the tissue. The final pathologic report revealed high-grade dysplasia and a focal intramucosal carcinoma of 0.8×0.7 cm. We conclude that EFTR can be an effective alternative treatment in gastric high-grade dysplasia unsuitable for ESD.

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• Endoscopic diagnosis and treatment of gastric dysplasia and early cancer: Current evidence and what the future may hold
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• Identification and preparation of lesions suitable for endoscopic full-thickness resection
  Jeffrey Fiorenza, Pavlos Kaimakliotis
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Xanthoma is an uncommon nonneoplastic lesion resulting from the accumulation of histiocytes. It predominantly shows cutaneous manifestations associated with dyslipidemia. However, xanthoma of the esophagus is extremely rare. To the best of our knowledge, only 14 cases have been reported thus far. The clinical significance of this lesion has not been established. However, this lesion should be distinguished grossly from ectopic sebaceous glands and small subepithelial tumors such as carcinoid and granular cell tumor. Moreover, signet ring cell carcinoma, which contains round cells with abundant cytoplasm and has similar histologic features to xanthoma, should be distinguished microscopically.

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• Multiple heterotopic sebaceous glands in the oesophagus: A case report and literature review
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• Esophageal xanthoma with nearby coexistent squamous cell carcinoma observed using magnifying endoscopy with narrow-band imaging
  Tomohiko Mannami, Tsukasa Sakaki, Takehiro Tanaka, Yasushi Fukumoto, Toshiyuki Wakatsuki, Shinichi Furutachi, Shin’ichi Shimizu, Tsuyoshi Umekawa, Mayu Mitsumune, Hanako Nagahara, Genyo Ikeda, Nobukiyo Fujiwara
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• Diffuse xanthoma in early esophageal cancer: A case report
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  World Journal of Clinical Cases.2021; 9(19): 5259.     CrossRef
• Case Report of a Proposed, Novel, Endoscopic “Whitehead Pimple” Sign of Ectopic Esophageal Sebaceous Glands Based on Their Mimicking the Dermatologic and Histopathologic Characteristics of Cutaneous Whitehead Pimples/Closed Comedones
  Amy Le, Mitual Amin, Mitchell S. Cappell
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• A Yellowish Granular Lesion in the Esophagus
  Seong Keun Lee, Chul Hong Park, Min Hee Jung
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• Magnifying Endoscopy for Esophageal Ectopic Sebaceous Glands
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  Clinical Endoscopy.2018; 51(5): 495.     CrossRef
• Nodular Esophageal Xanthoma: A Case Report and Review of the Literature
  Ahmed Dirweesh, Muhammad Khan, Sumera Bukhari, Cheryl Rimmer, Robert Shmuts
  Case Reports in Gastrointestinal Medicine.2017; 2017: 1.     CrossRef

Rectal Dieulafoy's lesion (DL) is rare cause of lower gastrointestinal bleeding. Because of its rarity, there is no consensus on the optimal endoscopic hemostasis technique for rectal DL. We analyzed six patients who underwent endoscopic management for rectal DL after presenting with hematochezia at a single institute over 10 years. Of the six patients, three underwent endoscopic band ligation (EBL) and three underwent endoscopic hemoclip placement (EHP). Only one patient was treated with thermocoagulation. There were no immediate complications in any of the patients. None of the patients required a procedure or surgery for the treatment of rebleeding. Mean procedure times of EBL and EHP were 5.25 minutes and 7 minutes, respectively. Both EHP and EBL are shown to be effective in the treatment of bleeding rectal DL. We suggest that EBL may have potential as the preferred therapy owing to its superiority in technical and economic aspects, especially in elderly and high-risk patients.

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• Over-the-scope clip as a rescue treatment for massive bleeding due to Dieulafoy lesion at the colorectal anastomosis: A case report
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• Severe lower gastrointestinal bleeding caused by rectal Dieulafoy’s lesion: Case reports and literature review
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• Endoscopic management of massive rectal bleeding from a Dieulafoy's lesion: Case report
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• Georges-Paul Dieulafoy (1839–1911) de l’ulcération…
  V. de Parades, J. -D. Zeitoun, N. Fathallah, D. Bouchard, G. Rahmi, J. -F. Contou
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• Lower gastrointestinal bleeding due to rectal Dieulafoy’s lesion
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Afferent loop syndrome caused by an impacted enterolith is very rare, and endoscopic removal of the enterolith may be difficult if a stricture is present or the normal anatomy has been altered. Electrohydraulic lithotripsy is commonly used for endoscopic fragmentation of biliary and pancreatic duct stones. A 64-year-old man who had undergone subtotal gastrectomy and gastrojejunostomy presented with acute, severe abdominal pain for a duration of 2 hours. Initially, he was diagnosed with acute pancreatitis because of an elevated amylase level and pain, but was finally diagnosed with acute afferent loop syndrome when an impacted enterolith was identified by computed tomography. We successfully removed the enterolith using direct electrohydraulic lithotripsy conducted using a transparent cap-fitted endoscope without complications. We found that this procedure was therapeutically beneficial.

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• Cola Dissolution Therapy via Ileus Tube Was Effective for Ileus Secondary to Small Bowel Obstruction Induced by an Enterolith
  Yuga Komaki, Shuji Kanmura, Akihito Tanaka, Mari Nakashima, Fukiko Komaki, Hiromichi Iwaya, Shiho Arima, Fumisato Sasaki, Yuichiro Nasu, Shiroh Tanoue, Shinichi Hashimoto, Akio Ido
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• Intestinal stones: A rare cause of bowel obstruction
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• Afferent loop obstruction with obstructive jaundice and ileus due to an enterolith after distal gastrectomy: A case report
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• Afferent Loop Syndrome after Roux-en-Y Total Gastrectomy Caused by Volvulus of the Roux-Limb
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