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Upper gastrointestinal (GI) stents are increasingly being used to manage upper GI obstructions. Initially developed for palliative treatment of esophageal cancer, upper GI stents now play an emerging role in benign strictures of the upper GI tract. Because recurrent obstruction and stent-related complications are common, new modifications of stents have been implemented. Self-expandable metal stents (SEMS) have replaced older plastic stents. In addition, newly designed SEMS have been developed to prevent complications. This review provides an overview of the various types, indications, methods, complications, and clinical outcomes of upper GI stents in a number of malignant and benign disorders dividing the esophagus and gastroduodenum.

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A self-expandable metal stent (SEMS) is an effective and safe method for the decompression of colon obstruction. Based on recent evidence, colorectal SEMS is now recommended for the palliation of patients with colonic obstruction from incurable colorectal cancer or extracolonic malignancy and also as a bridge to surgery in those who are a high surgical risk. Prophylactic SEMS insertion in patients with no obstruction symptoms is not recommended. Most colorectal SEMS are inserted endoscopically under fluoroscopic guidance. The technical and clinical success rates of colorectal SEMS are high, and the complication rate is acceptable. Advances in this technology will make the insertion of colorectal SEMS better and may expand the indications of colorectal SEMS in the future.

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Palliative drainage is the main treatment option for inoperable hilar cholangiocarcinoma to improve symptoms, which include cholangitis, pruritus, high-grade jaundice, and abdominal pain. Although there is no consensus on the optimal method for biliary drainage due to the paucity of large-scale randomized control studies, several important aspects of any optimal method have been studied. In this review article, we discuss the liver volume to be drained, stent type, techniques to insert self-expanding metal stents, and approaches for proper and effective biliary drainage based on previous studies and personal experience.

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Applying proper coding is important for doctors practicing gastroenterology. The coding systems established by various organizations define tumors differently. As a result of changing concepts of tumor classification, there are coding and reimbursement issues following the confirmation of malignant lesions by nationwide cancer screening in patients with intramucosal carcinoma and neuroendocrine tumors of the colorectum. In addition, there have been discrepancies between the views of endoscopists and pathologists regarding tumor coding. The Korean Society of Gastrointestinal Endoscopy held an expert meeting and established a consensus for the coding of intramucosal carcinoma and neuroendocrine tumor of the colorectum.

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The Japanese Classification of Gastric Carcinoma histologically classifies endoscopically resected gastric cancer into differentiated and undifferentiated types according to the presence or absence of tubular structures on histology. The former includes papillary adenocarcinoma and tubular types, and the latter includes poorly differentiated adenocarcinoma, signet ring cell carcinoma and mucinous adenocarcinoma. However, gastric cancer sometimes contains a mixture of differentiated and undifferentiated components, and the clinical outcomes of the histological mixture are unknown, especially following endoscopic resection of early gastric cancer (EGC). This case was within the guideline indications for endoscopic submucosal resection (ESD), although it contained a partly signet ring cell carcinoma component; it recurred after 19 months with multiple lymph node and liver metastases. This case shows that additional surgical resection after ESD should be performed for patients with any mixed signet ring cell component, even in mild or moderately differentiated EGC.

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• Clinical significance of computed tomography-detected ascites in gastric cancer patients with peritoneal metastases
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Delayed perforation is a very rare complication of endoscopic submucosal dissection (ESD), with a reported incidence of 0.1% to 0.45%. Few reports exist on the clinical features and outcomes of delayed perforation after ESD, and it is unclear whether the optimal management strategy is emergency surgery or endoscopic closure with conservative treatment. Here, we report two cases of delayed perforation occurring after ESD for early gastric cancer. In both cases, lesions were located in the antrum, and tumor depths were confined to the mucosal layer. Total procedure times for ESD were 25 and 45 minutes, respectively. Because delayed perforation may be associated with excessive thermal damage and necrosis of the muscle layer, treatment with emergency surgery should be used instead of conservative management in cases of delayed perforation after ESD.

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• Delayed Perforation Occurring after Gastric Endoscopic Submucosal Dissection: Clinical Features and Management Strategy
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Syphilis is a chronic systemic infectious disease caused by the bacterium Treponema pallidum. Gastric involvement and nephrotic syndrome are uncommon but well documented complications of syphilis, but the co-occurrence of these two complications in the same patient is extremely rare. Thus, because of their nonspecific presentation, suspicion of gastric syphilis (GS) and nephrotic syndrome is essential for diagnosis. Patients should be investigated thoroughly and a diagnosis made based on clinical, endoscopic, and histological findings, in order to initiate appropriate therapy. We report of a 34-year-old male patient with a history of epigastric pain and a diagnosis of GS and syphilis-associated membranous glomerulonephritis confirmed by gastroscopy and kidney biopsy, who was treated successfully with penicillin G benzathine. This case report provides information on the typical features of GS that should help raise awareness of this rare disease entity among clinicians, resulting in earlier diagnosis and administration of appropriate therapy.

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• Case report of gastric syphilis in Korea
  Hyung-Joo Yu, Seong-Jung Kim, Hyung-Hoon Oh, Chan-Mook Im, Bora Han, Eun Myung, Sook-Jung Yun, Kyung-Hwa Lee, Young-Eun Joo
  Medicine.2021; 100(50): e28212.     CrossRef
• Secondary syphilis associated crescentic glomerulonephritis: A case report
  Marcelo Santos Sampaio, Grigoriy Alexander Shekhtman, Mandana Rastegar, Richard Michael Treger, Glenn Tetsu Nagami, Jonathan Eric Zuckerman
  Human Pathology Reports.2021; 26: 300563.     CrossRef
• Un homme, deux femmes : un trio à en perdre les cheveux !
  N. Girszyn, L. Hellouin, G. Sauvêtre, S. Ngo, H. Lévesque, A. Masseau
  La Revue de Médecine Interne.2017; 38(2): 147.     CrossRef
• Borrmann Type 4 Advanced Gastric Cancer: Focus on the Development of Scirrhous Gastric Cancer
  Kyoungwon Jung, Moo In Park, Sung Eun Kim, Seun Ja Park
  Clinical Endoscopy.2016; 49(4): 336.     CrossRef

An ectopic opening of the common bile duct (CBD) into the duodenal bulb is a very rare congenital anomaly of the biliary system, which may cause recurrent duodenal ulcer or biliary diseases such as choledocholithiasis and cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) plays a major role in the diagnosis of this anomaly. We report two such cases: one in a 61-year-old man and the other in a 57-year-old man. In the first case, this anomaly caused acute cholangitis with multiple CBD stones, which were successfully treated by ERCP. In the second case, abdominal computed tomography showed pneumobilia, which was further evaluated using ERCP. Besides, this patient was diagnosed with an ectopic opening of the CBD associated with gallbladder cancer. We report these unusual cases and review the relevant medical literature.

Citations

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• An operative case of gastric cancer with ectopic bile duct drainage in the lesser curvature of the stomach
  Kazuaki Hashimoto, Tsukasa Ihara, Yuichiro Maruyama, Shinichi Tomisaki, Hiroshi Harada
  Surgical Case Reports.2024;[Epub]     CrossRef
• Ectopic Opening of the Common Bile Duct Accompanied by Duodenal Ulcer
  Jin Hee Noh
  The Korean Journal of Gastroenterology.2024; 84(3): 138.     CrossRef
• Ectopic ampulla with cholangitis: A case report
  Kiran Shankar, Vikas Pemmada, Parvesh Kumar Jain
  International Journal of Gastrointestinal Intervention.2024; 13(4): 133.     CrossRef
• Ectopic Opening of the Bile Duct Into the Duodenal Bulb: Complications of Biliary Drainage
  James Yang, Rohit Agrawal, Constantine Melitas, Brian Boulay, Josi Herren, Ronald Gaba, Edward Villa
  ACG Case Reports Journal.2023; 10(2): e00973.     CrossRef
• Seltene anatomische Variante im hepatobiliären System
  Viliam Masaryk, Frank Meyer, Uwe Will
  Die Chirurgie.2023; 94(7): 635.     CrossRef
• Ectopic papilla of Vater in the pylorus presenting with cholangitis: A case report with literature review
  Taha Alkarboly, Dana T. Gharib, Karzan M. Salih, Shevan M. Mustafa, Abdulwahid M. Salih, Fahmi H. Kakamad
  International Journal of Surgery Case Reports.2022; 93: 106887.     CrossRef
• Efficacy and safety of therapeutic ERCP in patients with ectopic papilla of Vater
  Junbo Hong, Weiping Pan, Wei Zuo, Anjiang Wang, Liang Zhu, Xiaodong Zhou, Xiaojiang Zhou, Guohua Li, Zhijian Liu, Pi Liu, Hao Zhen, Yong Zhu, Jiuhong Ma, Jianhui Yuan, Xu Shu, Yin Zhu, Nonghua Lu, Youxiang Chen
  Medicine.2020; 99(1): e18536.     CrossRef
• A unique case of a double common bile duct with ectopic drainage into the gastric antrum: a case report and review of the literature on double duct variants
  Li Lian Kuan, John Isherwood, Cristina Pollard, Ashley Dennison
  Journal of Surgical Case Reports.2020;[Epub]     CrossRef
• Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: Diagnosis and Therapeutic Management and Considerations for Timing of Surgery and Duration of Follow-up After Initial Endoscopic Retrograde Cholangiopancreatography
  Bahtiyar Muhammedoğlu
  Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2019; 29(5): 399.     CrossRef
• Aberrant Opening of the Common Bile Duct with Precancerous Change
  Min Kyu Kang, Kook Hyun Kim, Tae Nyeun Kim
  The Korean Journal of Pancreas and Biliary Tract.2018; 23(1): 32.     CrossRef
• ERCP and Direct Cholangioscopy with Gastroscope in Patients with Ectopic Opening of the Bile Duct into the Duodenal Bulb: A Report of 3 Cases
  Ji Woong Jang, Sae Hee Kim, Sung Hee Jung, Anna Kim
  Korean Journal of Pancreas and Biliary Tract.2016; 21(2): 112.     CrossRef

Biliary-enteric communications caused by duodenal ulcers are uncommon, and choledochoduodenal fistula (CDF) is by far the most common type. Usually in this situation, food material does not enter the common bile duct because the duodenal lumen is intact. Here, we report a case in which cholangitis occurred due to food materials impacted through a CDF. Duodenal obstruction secondary to duodenal ulcer prevented food passage into the duodenum in this case. Surgical management was recommended; however, the patient refused surgery because of poor general condition. Consequently, the patient expired with sepsis secondary to ascending cholangitis.

Citations

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• Stone-Induced Purulent Choledocoduodenal Fistula Presenting with Ascending Cholangitis
  Christienne Shams, Michael Cannon, Jared Bortman, Seifeldin Hakim
  ACG Case Reports Journal.2018; 5(1): e60.     CrossRef
• Successful Conservative Treatment of a Cholecystoduodenal Fistula Caused by a Cytomegalovirus-associated Duodenal Ulcer
  Hideki Mori, Moriya Zakimi, Shin Kato, Koki Yamada, Kenji Chinen, Tomiaki Kubota, Masayuki Arashiro, Susumu Shinoura, Kaoru Kikuchi
  Internal Medicine.2016; 55(18): 2617.     CrossRef