Clinical Endoscopy

Case Report

A rare case of esophageal mucoepidermoid carcinoma successfully treated via endoscopic submucosal dissection: So Eun Jeun, Kyung Bin Kim, Bong Eun Lee, Gwang Ha Kim, Moon Won Lee, Dong Chan Joo; Received February 29, 2024 Accepted March 7, 2024 Published online June 18, 2024; DOI: https://doi.org/10.5946/ce.2024.051 [Epub ahead of print]

Abstract PDF PubReader ePub: Esophageal mucoepidermoid carcinoma (EMEC) is a special subtype of esophageal malignancy, accounting for less than 1% of all cases of primary esophageal carcinoma. Pathologically, it consists of a mixture of adenocarcinoma and squamous cell carcinoma with mucin-secreting cells. Special staining for mucicarmine helps to diagnose EMEC. We present a rare case of EMEC successfully treated via endoscopic submucosal dissection (ESD). A 63-year-old man was referred to our tertiary hospital. On esophagogastroduodenoscopy, a 6-mm-sized subtle reddish depressed lesion was identified in the mid-esophagus. Diagnostic ESD was performed with a high suspicion of carcinoma. Histopathologic findings were consistent with EMEC which was confined to the lamina propria without lymphatic invasion. We plan to do a careful follow-up without administering adjuvant chemotherapy or radiotherapy. Due to the small volume of the lesion, establishing a diagnosis was difficult through forceps biopsy alone. However, by using ESD, we could confirm and successfully treat a rare case of early-stage EMEC.

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Image of Issue

Aortoduodenal fistula bleeding caused by an aortic stent graft: Seunghyun Hong, Gwang Ha Kim; Clin Endosc 2024;57(3):407-408. Published online February 2, 2024; DOI: https://doi.org/10.5946/ce.2023.281

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Video of Issue

A remnant cystic duct presenting as a duodenal subepithelial tumor: Gwang Ha Kim, Dong Chan Joo; Clin Endosc 2024;57(2):268-269. Published online February 2, 2024; DOI: https://doi.org/10.5946/ce.2023.275

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Editorial

Clinicians should be aware of proton pump inhibitor–related changes in the gastric mucosa: Gwang Ha Kim; Clin Endosc 2024;57(1):51-52. Published online January 10, 2024; DOI: https://doi.org/10.5946/ce.2023.188

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Whitish gastric mucosa on upper gastrointestinal endoscopy
Eun Jeong Gong, Chang Seok Bang
Clinical Endoscopy.2024; 57(2): 277. CrossRef

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Original Article

Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study: Younghee Choe, Yu Kyung Cho, Gwang Ha Kim, Jun-Ho Choi, Eun Soo Kim, Ji Hyun Kim, Eun Kwang Choi, Tae Hyeon Kim, Seong-Hun Kim, Do Hoon Kim, The Research Group for Endoscopic Ultrasound in Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2023;56(6):744-753. Published online August 25, 2023; DOI: https://doi.org/10.5946/ce.2023.005

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: This study aimed to evaluate the prevalence and natural progression of subepithelial lesions (SELs) in the upper gastrointestinal (UGI) tract.
Methods
The medical records of patients with UGI SELs who underwent endoscopic screening at eight university hospitals between January and December 2010 were retrospectively investigated. The follow-up evaluations were performed until December 2016.
Results
UGI SELs were found in 1,044 of the 65,233 participants screened (endoscopic prevalence, 1.60%; the total number of lesions, 1,062; mean age, 55.1±11.2 years; men, 53.6%). The median follow-up period was 48 (range, 8–74) months. SELs were most frequently found in the stomach (63.8%) and had a mean size of 9.9±6.1 mm. Endoscopic ultrasonography (EUS) was performed in 293 patients (28.1%). The most common lesions were leiomyomas, followed by gastrointestinal stromal tumors (GISTs), and ectopic pancreas. The proportions of SELs with malignant potential according to size were 3% (<1 cm), 22% (1–2 cm), 27% (2–3 cm), and 38% (≥3 cm). In gastric SELs larger than 1 cm, resections were performed in 20 patients because of an increase in size, of which 12 were found to be GISTs.
Conclusions
The prevalence of UGI SELs was 1.60%. Further, 23% of gastric SELs ≥1 cm were precancerous lesions, most followed by EUS and clinical decisions without initial pathological confirmation.

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A Case of Esophageal MALT Lymphoma Mimicking a Subepithelial Tumor
Ha Eun Lee, Gwang Ha Kim, Min Ji Kim, Kyung Bin Kim, Dong Chan Joo, Hye Kyung Jeon, Moon Won Lee, Bong Eun Lee
The Korean Journal of Gastroenterology.2024; 83(4): 157. CrossRef
Small gastric subepithelial lesions: A sand in the eye
Tanyaporn Chantarojanasiri, Nikhil Sonthalia, Rashid N. Lui
Journal of Gastroenterology and Hepatology.2024; 39(7): 1207. CrossRef
Endoscopic treatment of a large Brunner’s gland hamartoma in the duodenum
Ha Eun Lee, Gwang Ha Kim, Kyungbin Kim
Endoscopy.2024; 56(S 01): E546. CrossRef
Artificial Intelligence-Based Diagnosis of Gastric Mesenchymal Tumors Using Digital Endosonography Image Analysis
Dong Chan Joo, Gwang Ha Kim, Moon Won Lee, Bong Eun Lee, Ji Woo Kim, Kwang Baek Kim
Journal of Clinical Medicine.2024; 13(13): 3725. CrossRef
An Esophageal Leiomyoma with Cystic Degeneration Mimicking a Malignant Neoplasm
Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
The Ewha Medical Journal.2023;[Epub] CrossRef

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A Rare Cause of Subepithelial Tumor in the Gastric Fundus: Da Mi Kim, Gwang Ha Kim, Kyungbin Kim; Clin Endosc 2022;55(2):313-314. Published online February 25, 2022; DOI: https://doi.org/10.5946/ce.2022.039

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Special Article: Celebrating the 10th Anniversary of Clinical Endoscopy

Editors' Choice of Noteworthy Clinical Endoscopy Publications in the First Decade: Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han; Clin Endosc 2021;54(5):633-640. Published online September 13, 2021; DOI: https://doi.org/10.5946/ce.2021.216

Abstract PDF PubReader ePub: This is a special review to celebrate the 10^th anniversary of Clinical Endoscopy. Each deputy editor has selected articles from one’s subspecialty that are significant in terms of the number of downloads, citations, and clinical importance. The articles included original articles, review articles, systematic reviews, and meta-analyses.

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Brief Reports

Oral hyperpigmented macules observed during endoscopy intubation: Da Mi Kim, Gwang Ha Kim, Moon-Bum Kim; Clin Endosc 2022;55(4):574-575. Published online January 19, 2021; DOI: https://doi.org/10.5946/ce.2020.286

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Metastasis of breast cancer presenting as enlarged folds in the stomach: So Eun Jeun, Gwang Ha Kim, Moon Won Lee, Sojeong Lee; Clin Endosc 2022;55(3):463-464. Published online November 6, 2020; DOI: https://doi.org/10.5946/ce.2020.239

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Large Jejunal Phytobezoar with Small Bowel Obstruction Treated by Single-Balloon Enteroscopy: Eun Young Park, Dong Hoon Baek, Bong Eun Lee, Gwang Ha Kim, Geun Am Song; Clin Endosc 2022;55(2):310-312. Published online November 6, 2020; DOI: https://doi.org/10.5946/ce.2020.215

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Endoscopic Submucosal Dissection of an Inverted Pyloric Gland Adenoma Using Dental Floss and Clip Traction: Gwang Ha Kim, Moon Won Lee, Bong Eun Lee, Do Youn Park; Clin Endosc 2021;54(6):935-936. Published online August 31, 2020; DOI: https://doi.org/10.5946/ce.2020.164

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Citations

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Synchronous gastric MALT lymphoma and gastric adenocarcinoma of fundic gland type arising from a hamartomatous inverted polyp in a Helicobacter pylori naive patient
Ryo Miyamoto, Hidehiko Takigawa, Takahiro Kotachi, Hiroki Kadota, Ryo Yuge, Ryohei Hayashi, Yuji Urabe, Akira Ishikawa, Kazuhiro Sentani, Shiro Oka
Clinical Journal of Gastroenterology.2023; 16(4): 521. CrossRef
The Many Faces of Gastric Inverted Polyps: a case report
S.I. Kim, M.Y. Agapov, T.F. Savostyanov, A.A. Paratovskaya, I.A. Sokolova
Dokazatel'naya gastroenterologiya.2023; 12(2): 88. CrossRef
Pyloric Gastric Adenoma: Endoscopic Detection, Removal, and Echoendosonographic Characterization
Anabel Liyen Cartelle, Erik A. Holzwanger, Samuel Igbinedion, Sultan Mahmood, Harry J. Rosenberg, Tyler M. Berzin, Mandeep S. Sawhney, Moamen Gabr, Douglas K. Pleskow
ACG Case Reports Journal.2023; 10(12): e01229. CrossRef

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Gastric Oxyntic Mucosa Pseudopolyps: Dong Chan Joo, Gwang Ha Kim; Clin Endosc 2021;54(4):621-622. Published online August 11, 2020; DOI: https://doi.org/10.5946/ce.2020.157

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Citations

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Occurrence and characteristics of endoscopic gastric polyps in patients with autoimmune gastritis (AGAPE study): A multicentric cross-sectional study
Sara Massironi, Camilla Gallo, Edith Lahner, Valentina Sciola, Federica Cavalcoli, Marco Vincenzo Lenti, Alessandra Zilli, Ludovica Dottori, Gaia De Rossi, Emanuela Miceli, Bruno Annibale, Maurizio Vecchi, Paolo Cantù, Antonio Di Sabatino, Pietro Inverniz
Digestive and Liver Disease.2024;[Epub] CrossRef

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Review

Diagnosing Gastric Mesenchymal Tumors by Digital Endoscopic Ultrasonography Image Analysis: Moon Won Lee, Gwang Ha Kim; Clin Endosc 2021;54(3):324-328. Published online June 18, 2020; DOI: https://doi.org/10.5946/ce.2020.061

Abstract PDF PubReader ePub

Gastric mesenchymal tumors (GMTs) are incidentally discovered in national gastric screening programs in Korea. Endoscopic ultrasonography (EUS) is the most useful diagnostic modality for evaluating GMTs. The differentiation of gastrointestinal stromal tumors from benign mesenchymal tumors, such as schwannomas or leiomyomas, is important to ensure appropriate clinical management. However, this is difficult and operator dependent because of the subjective interpretation of EUS images. Digital image analysis computes the distribution and spatial variation of pixels using texture analysis to extract useful data, enabling the objective analysis of EUS images and decreasing interobserver and intraobserver agreement in EUS image interpretation. This review aimed to summarize the usefulness and future of digital EUS image analysis for GMTs based on published reports and our experience.

Citations

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Schwannoma gástrico. Reporte de un caso
Darío Montes N, Nixon Cevallos R, Rubén Montes N
Oncología (Ecuador).2024; 34(1): 52. CrossRef
Artificial Intelligence-Based Diagnosis of Gastric Mesenchymal Tumors Using Digital Endosonography Image Analysis
Dong Chan Joo, Gwang Ha Kim, Moon Won Lee, Bong Eun Lee, Ji Woo Kim, Kwang Baek Kim
Journal of Clinical Medicine.2024; 13(13): 3725. CrossRef
A combined radiomic model distinguishing GISTs from leiomyomas and schwannomas in the stomach based on endoscopic ultrasonography images
Xian‐Da Zhang, Ling Zhang, Ting‐Ting Gong, Zhuo‐Ran Wang, Kang‐Li Guo, Jun Li, Yuan Chen, Jian‐Tao Zhang, Ben‐Gong Ye, Jin Ding, Jian‐Wei Zhu, Feng Liu, Duan‐Min Hu, JianGang Chen, Chun‐Hua Zhou, Duo‐Wu Zou
Journal of Applied Clinical Medical Physics.2023;[Epub] CrossRef
An Esophageal Leiomyoma with Cystic Degeneration Mimicking a Malignant Neoplasm
Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
The Ewha Medical Journal.2023;[Epub] CrossRef
Advancements in the Diagnosis of Gastric Subepithelial Tumors
Osamu Goto, Mitsuru Kaise, Katsuhiko Iwakiri
Gut and Liver.2022; 16(3): 321. CrossRef
Schwannoma gástrico. Diagnóstico diferencial de tumores submucosos
M. Reyes Busta Nistal, Noelia Alcaide Suarez, Luis Fernández Salazar, Daniel Corrales Cruz
Gastroenterología y Hepatología.2021;[Epub] CrossRef
Scoring systems for differentiating gastrointestinal stromal tumors and schwannomas from leiomyomas in the stomach
Shotaro Okanoue, Masaya Iwamuro, Takehiro Tanaka, Takuya Satomi, Kenta Hamada, Hiroyuki Sakae, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada
Medicine.2021; 100(40): e27520. CrossRef

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Boost Your Learning with Quiz

A Rare Cause of Gastric Subepithelial Tumor: Gwang Ha Kim, Do Youn Park; Clin Endosc 2020;53(3):377-378. Published online May 29, 2020; DOI: https://doi.org/10.5946/ce.2020.134

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A Rare Cause of Subepithelial Tumor in the Gastric Fundus
Da Mi Kim, Gwang Ha Kim, Kyungbin Kim
Clinical Endoscopy.2022; 55(2): 313. CrossRef

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143 Download
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Brief Report

Unusual Rectal Foreign Body: A Golf Ball: Young Joo Park, Dong Hoon Baek, Eun Young Park, Gwang Ha Kim, Geun Am Song; Clin Endosc 2021;54(2):291-292. Published online May 25, 2020; DOI: https://doi.org/10.5946/ce.2020.097

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Successful Expulsion of a Golf Ball from the Sigmoid Colon Using Volume Laxatives
James P. Grantham, Amanda Hii, Tim Bright, David Liu, Neil Donald Merrett
Case Reports in Surgery.2023; 2023: 1. CrossRef

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Commentary

Diagnosis of Gastric Subepithelial Tumors Using Endoscopic Ultrasonography or Abdominopelvic Computed Tomography: Which is Better?: Eun Young Park, Gwang Ha Kim; Clin Endosc 2019;52(6):519-520. Published online November 14, 2019; DOI: https://doi.org/10.5946/ce.2019.188

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Citations

Citations to this article as recorded by

Single-incision needle-knife biopsy for the diagnosis of GI subepithelial tumors: a systematic review and meta-analysis
Yassin Shams Eldien Naga, Banreet Singh Dhindsa, Smit Deliwala, Kyaw Min Tun, Amaninder Dhaliwal, Daryl Ramai, Ishfaq Bhat, Shailender Singh, Saurabh Chandan, Douglas G. Adler
Gastrointestinal Endoscopy.2023; 97(4): 640. CrossRef
Feasibility of endoscopic resection and impact of endoscopic ultrasound-based surveillance on colorectal subepithelial tumors
Eun Young Park, Dong Hoon Baek, Seung Min Hong, Bong Eun Lee, Moon Won Lee, Gwang Ha Kim, Geun Am Song
Surgical Endoscopy.2023; 37(9): 6867. CrossRef
Endoscopic ultrasound artificial intelligence-assisted for prediction of gastrointestinal stromal tumors diagnosis: A systematic review and meta-analysis
Rômulo Sérgio Araújo Gomes, Guilherme Henrique Peixoto de Oliveira, Diogo Turiani Hourneaux de Moura, Ana Paula Samy Tanaka Kotinda, Carolina Ogawa Matsubayashi, Bruno Salomão Hirsch, Matheus Oliveira Veras, João Guilherme Ribeiro Jordão Sasso, Roberto Pa
World Journal of Gastrointestinal Endoscopy.2023; 15(8): 528. CrossRef
Características endosonográficas de las lesiones subepiteliales del tracto digestivo superior: experiencia de un centro de referencia en Colombia
Ileana Rocío Bautista Parada, Angel Rojas Espinosa, Lazaro Antonio Arango Molano, Andrés Sánchez Gil, Claudia Díaz Tobar
Revista colombiana de Gastroenterología.2023; 38(3): 264. CrossRef
Convolutional neural network‐based object detection model to identify gastrointestinal stromal tumors in endoscopic ultrasound images
Chang Kyo Oh, Taewan Kim, Yu Kyung Cho, Dae Young Cheung, Bo‐In Lee, Young‐Seok Cho, Jin Il Kim, Myung‐Gyu Choi, Han Hee Lee, Seungchul Lee
Journal of Gastroenterology and Hepatology.2021; 36(12): 3387. CrossRef

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Case Reports

A Rare Duodenal Subepithelial Tumor: Duodenal Schwannoma: Dong Hwahn Kahng, Gwang Ha Kim, Sang Gyu Park, So Jeong Lee, Do Youn Park; Clin Endosc 2018;51(6):587-590. Published online May 15, 2018; DOI: https://doi.org/10.5946/ce.2018.050

Abstract PDF PubReader ePub

Schwannomas are uncommon neoplasms that arise from Schwann cells of the neural sheath. Gastrointestinal schwannomas are rare among mesenchymal tumors of the gastrointestinal tract, and only a few cases have been reported to date. Duodenal schwannomas are usually discovered incidentally and achieving a preoperative diagnosis is difficult. Schwannomas can be distinguished from other subepithelial tumors on endoscopic ultrasonography; however, any typical endosonographic features of duodenal schwannomas have not been reported due to the rarity of these tumors. Immunohistochemistry is essential to distinguish schwannomas from gastrointestinal stromal tumors and leiomyomas. We report a case of duodenal schwannoma found incidentally during a health check-up endoscopy. On endoscopic ultrasonography, this tumor was suspected as a gastrointestinal stromal tumor; therefore, the patient underwent laparoscopic wedge resection of the tumor. Histopathology and immunohistochemistry confirmed that the duodenal lesion was a benign schwannoma.

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Ileal Schwannoma: A Rare Cause of Pelvic Mass
Martin Jezovit, Hasan Bakirli, Ifrat Bakirov, Khalid Hureibi, Gultakin Bakirova, Roman Okolicany, Pavol Janac, Iveta Meciarova, Nasser Alhwaymel, Ilkin Bakirli, Augustin Prochotsky, Muthukumaran Rangarajan
Case Reports in Surgery.2024; 2024: 1. CrossRef
Surgical approaches for subepithelial tumors in difficult locations of the gastrointestinal tract
Hoseok Seo
Foregut Surgery.2024; 4(2): 51. CrossRef
Periampullary duodenal schwannoma mimicking ampullary neoplasm
Marly Pierina Rubio Sierra, Aydamir Alrakawi, Ahmad Alduaij, Dana AlNuaimi, Numan Cem Balci
Radiology Case Reports.2020; 15(11): 2085. CrossRef

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Magnifying Endoscopy for Esophageal Ectopic Sebaceous Glands: Mu Song Jeon, Gwang Ha Kim, Dong Young Jeong, Byeong Kyu Park, Moon Won Lee, So-Jeong Lee, Do Youn Park; Clin Endosc 2018;51(5):495-497. Published online February 26, 2018; DOI: https://doi.org/10.5946/ce.2017.187

Abstract PDF PubReader ePub

Ectopic sebaceous glands are found very rarely in the esophagus; heretofore, several cases have been reported. The sebaceous gland is originally a source of an endodermal origin; however, there have been controversies regarding whether the origin of the esophageal ectopic sebaceous gland is ectodermal or endodermal. Ectopic sebaceous glands of the esophagus usually do not cause symptoms; thus, they are often found incidentally on endoscopy for routine health screening. Endoscopic findings are characterized by single or multiple yellow patches or nodular lesions of various sizes, sometimes with small central openings. We report two cases of esophageal ectopic sebaceous glands found incidentally during endoscopy with magnifying endoscopic findings. The lesions were in the mid-esophagus and lower esophagus, respectively, and both endoscopic findings were similar as multiple yellowish patches or plaques. Magnifying endoscopy revealed the openings of the excretory ducts surrounded by circular microvessels in both cases.

Citations

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Multiple heterotopic sebaceous glands in the oesophagus: A case report and literature review
Yuan Fang, Zhi Wang, Yong Qiang Yang, Bei Wen Song, Wen Bin Gou
Tropical Doctor.2024; 54(1): 49. CrossRef
Spectrum of Choristoma
Pranita Mohanty, Anima Hota, Rajashree Tripathy, Santosh K. Swain, Ajit S. Mohapatra, Pallak Batalia
Journal of Datta Meghe Institute of Medical Sciences University.2022; 17(2): 392. CrossRef
Clinicopathologic Characteristics of Esophageal Ectopic Sebaceous Glands: Chronological Changes and Immunohistochemical Analysis
Hirotsugu Hashimoto, Hajime Horiuchi, Sakiko Miura, Shunya Takayanagi, Toshiaki Gunji, Teppei Morikawa
International Journal of Surgical Pathology.2021; 29(4): 378. CrossRef
The clinical and endoscopic features of esophageal ectopic sebaceous glands
Hui‐Fen Chen, Hsi‐Chang Lee, Min‐Kai Liao, Ting‐An Chang, Chih‐Lin Lin, Li‐Ying Liao, Kuan‐Yang Chen
Advances in Digestive Medicine.2020; 7(4): 179. 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
Digestive Diseases and Sciences.2019; 64(7): 2049. CrossRef
Ectopic Sebaceous Gland in Esophagus Presenting as Subepithelial Tumor
Dong Han Yeom, Han Seung Ryu
Chonnam Medical Journal.2019; 55(3): 168. CrossRef

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Bile Duct Patency Maintained after Intraductal Radiofrequency Ablation in a Case of Hepatocellular Cholangiocarcinoma with Bile Duct Invasion: Sung Yong Han, Geun Am Song, Dong Uk Kim, Dong Hoon Baek, Moon Won Lee, Gwang Ha Kim; Clin Endosc 2018;51(2):201-205. Published online August 31, 2017; DOI: https://doi.org/10.5946/ce.2017.097

Abstract PDF PubReader ePub

Combined hepatocellular-cholangiocarcinoma (HCC-CC) with bile duct invasion (BDI) is rare. In unresectable cases, biliary stent placement and photodynamic therapy (PDT) are used for resolving obstructive jaundice. However, stent occlusion remains problematic, and PDT is expensive and time-consuming. Intraductal radiofrequency ablation (RFA) is an emerging procedure for palliation in these patients. It has potential benefits including less expense, lower rates of severe complication, longer maintenance of ductal patency, and easier technique compared with PDT or stenting alone. We report a 67-year-old man who underwent repeated intraductal RFA for HCC-CC and HCC with BDI (HCC-BDI), for whom bile duct patency was maintained without additional biliary procedures.

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Clinical and cost effectiveness of endoscopic bipolar radiofrequency ablation for the treatment of malignant biliary obstruction: a systematic review
Fiona Beyer, Stephen Rice, Giovany Orozco-Leal, Madeleine Still, Hannah O’Keefe, Nicole O’Connor, Akvile Stoniute, Dawn Craig, Stephen Pereira, Louise Carr, John Leeds
Health Technology Assessment.2023; : 1. CrossRef
Improving biliary stent patency for malignant obstructive jaundice using endobiliary radiofrequency ablation: experience in 150 patients
Ya-Lin Kong, Hong-Yi Zhang, Cheng-Li Liu, Xiao-Jun He, Gang Zhao, Cheng Wang, Ling-Hong Kong, Jing Zhao
Surgical Endoscopy.2022; 36(3): 1789. CrossRef

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A Rare Case of Early Gastric Cancer Combined with Underlying Heterotopic Pancreas: Jung Bin Yoon, Bong Eun Lee, Dae Hwan Kim, Do Youn Park, Hye Kyung Jeon, Dong Hoon Baek, Gwang Ha Kim, Geun Am Song; Clin Endosc 2018;51(2):192-195. Published online August 31, 2017; DOI: https://doi.org/10.5946/ce.2017.055

Abstract PDF PubReader ePub

Heterotopic pancreas in the stomach is usually asymptomatic and benign. Here, we presented a rare case of an early gastric cancer overlying a heterotopic pancreas. A 48-year-old woman underwent esophagogastroduodenoscopy, which revealed a subepithelial mass measuring 2.0×1.5 cm on the gastric antrum with a 1-cm erosive erythematous discoloration on the surface. A biopsy specimen showed moderately differentiated tubular adenocarcinoma. Endosonography showed a heterogeneous hypoechoic mass measuring 1.3×0.6 cm, with indistinct margins in the second and third layers of the gastric wall; anechoic tubular structures within the mass were suggestive of heterotopic pancreas. Distal gastrectomy was performed, which confirmed an early gastric cancer confined to the mucosa, and a separate underlying heterotopic pancreas. Although heterotopic pancreas is most likely benign, careful endoscopic observation of the mucosal surface is necessary to avoid overlooking a coincident early gastric cancer.

Citations

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Duodenal Heterotopic Pancreas with a Large Retention Cyst: A Case Report and Literature Review
Shinya Kawaguchi, Akinori Murakami, Masato Nishida
Internal Medicine.2023; 62(5): 723. CrossRef
Gastric ectopic pancreas combined with synchronous multiple early gastric cancer: A rare case report
Zhen-Ya Zhao, Yue-Xing Lai, Ping Xu
World Journal of Clinical Cases.2023; 11(7): 1569. CrossRef
A rare case of enlarged gastric heterotopic pancreas with retention cysts: A case report and literature review
Keiso Matsubara, Michihiro Ishida, Toshiaki Morito, Tetsushi Kubota, Yasuhiro Choda, Masao Harano, Hiroyoshi Matsukawa, Hitoshi Idani, Shigehiro Shiozaki, Masazumi Okajima
International Journal of Surgery Case Reports.2020; 74: 284. CrossRef
A case of gastric heterotopic pancreas with gastroduodenal invagination
Shoko Iwahashi, Masaaki Nishi, Toshiaki Yoshimoto, Hideya Kashihara, Chie Takasu, Takuya Tokunaga, Tomohiko Miyatani, Jun Higashijima, Kozo Yoshikawa, Yuma Wada, Yoshimi Bando, Mitsuo Shimada
Surgical Case Reports.2019;[Epub] CrossRef

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Commentary

Is a Cytopathologist Always Needed during Endoscopic Ultrasonography-Guided Tissue Acquisition?: Moon Won Lee, Gwang Ha Kim; Clin Endosc 2017;50(4):311-312. Published online July 17, 2017; DOI: https://doi.org/10.5946/ce.2017.103

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Review

Endoscopic Submucosal Dissection for Early Gastric Cancers with Uncommon Histology: Gwang Ha Kim; Clin Endosc 2016;49(5):434-437. Published online September 30, 2016; DOI: https://doi.org/10.5946/ce.2016.127

Abstract PDF PubReader ePub

Endoscopic submucosal dissection (ESD) enables en bloc curative resection of early gastric cancers (EGCs) with a negligible risk of lymph node metastasis (LNM). Although ESD for EGCs with absolute and expanded indications is safe, the results differ between EGCs with specialized and common histologies. EGC with papillary adenocarcinoma is a differentiated-type adenocarcinoma. At present, it is treated with ESD according to the same criteria as other differentiated-type adenocarcinomas. The LNM rate under the current indication criteria is high, and over half of the patients who undergo ESD as a primary treatment for EGC with papillary adenocarcinoma achieve an out-of-ESD result. Gastric carcinoma with lymphoid stroma in EGC has a low LNM rate and a favorable outcome, despite deep submucosal invasion. Patients with this gastric cancer subtype may be good candidates for ESD, even with deep submucosal invasion. Large-scale prospective multi-center studies with longer follow-up periods are needed to set proper ESD criteria for these tumors. Clinicians should be aware of these disease entities and ESD should be more carefully considered for EGCs with papillary adenocarcinoma and gastric carcinoma with lymphoid stroma.

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Gastric carcinoma with lymphoid stroma derived from hamartomatous inverted polyp with osteoclast-like giant cells: a case report
Shoko Yamashita, Masaaki Nishi, Kozo Yoshikawa, Toshihiro Nakao, Takuya Tokunaga, Chie Takasu, Hideya Kashihara, Yuma Wada, Toshiaki Yoshimoto, Yosuke Iwakawa, Takeshi Oya, Koichi Tsuneyama, Mitsuo Shimada
International Cancer Conference Journal.2022; 11(3): 196. CrossRef
Endoscopic Submucosal Dissection of Papillary Gastric Adenocarcinoma; Systematic Review
Chang Seok Bang, Jae Jun Lee, Gwang Ho Baik
Journal of Clinical Medicine.2020; 9(5): 1465. CrossRef
Pitfalls in the Interpretation of Publications about Endoscopic Submucosal Dissection of Early Gastric Cancer with Undifferentiated-Type Histology
Chang Seok Bang, Gwang Ho Baik
Clinical Endoscopy.2019; 52(1): 30. CrossRef
A new Schiff base coordinated copper(II) compound induces apoptosis and inhibits tumor growth in gastric cancer
Yan Xia, Xingkai Liu, Luping Zhang, Jinzhu Zhang, Chaoying Li, Nan Zhang, Hong Xu, Yan Li
Cancer Cell International.2019;[Epub] CrossRef

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Commentary

Second-Look Endoscopy after Endoscopic Submucosal Dissection: Can We Obtain Valuable Information?: Hye Kyung Jeon, Gwang Ha Kim; Clin Endosc 2016;49(3):212-213. Published online May 9, 2016; DOI: https://doi.org/10.5946/ce.2016.062

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Bleeding Risk Factors after Endoscopic Submucosal Dissection in Early Gastric Cancer and the Necessity of “Second-Look” Endoscopic Examination on the following Day
Rika Kobayashi, Ken Kawaura, Tohru Ito, Sadafumi Azukisawa, Hiroaki Kunou, Junji Kamai, Kazu Hamada, Tsuyoshi Mukai, Hidekazu Kitakata, Yasuhito Ishigaki
Journal of Clinical Medicine.2022; 11(4): 914. CrossRef

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Original Article

Endosonographic Features of Gastric Schwannoma: A Single Center Experience: Jong Min Yoon, Gwang Ha Kim, Do Youn Park, Na Ri Shin, Sangjeong Ahn, Chul Hong Park, Jin Sung Lee, Key Jo Lee, Bong Eun Lee, Geun Am Song; Clin Endosc 2016;49(6):548-554. Published online March 15, 2016; DOI: https://doi.org/10.5946/ce.2015.115

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Background
/Aims: Gastric schwannomas are rare benign mesenchymal tumors that are difficult to differentiate from other mesenchymal tumors with malignant potential, such as gastrointestinal stromal tumors. This study aimed to evaluate the characteristic findings of gastric schwannomas via endoscopic ultrasonography (EUS).
Methods
We retrospectively reviewed the EUS findings of 27 gastric schwannoma cases that underwent surgical excision at Pusan National University Hospital during 2007 to 2014.
Results
Gastric schwannomas were mainly located in the middle third of the stomach with a mean tumor size of 32 mm. All lesions exhibited hypoechoic echogenicity, and 24 lesions (88.9%) exhibited heterogeneous echogenicity. Seventeen lesions (63.0%) exhibited decreased echogenicity compared to the normal proper muscle layer. Distinct borders were observed in 24 lesions (88.9%), lobulated margins were observed in six lesions (22.2%), and marginal haloes were observed in 24 lesions (88.9%). Hyperechogenic spots were observed in 21 lesions (77.8%), calcifications were observed in one lesion (3.7%), and cystic changes were observed in two lesions (7.4%).
Conclusions
During EUS, gastric schwannomas appear as heterogeneously hypoechoic lesions with decreased echogenicity compared to the normal proper muscle layer. These features may be helpful for differentiating gastric schwannomas from other mesenchymal tumors.

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Case Report

Immunoglobulin G4-Related Inflammatory Pseudotumor Presenting as a Solitary Mass in the Stomach: Hong Ryeol Cheong, Bong Eun Lee, Geun Am Song, Gwang Ha Kim, Sung Gyu An, Won Lim; Clin Endosc 2016;49(2):197-201. Published online February 12, 2016; DOI: https://doi.org/10.5946/ce.2015.074

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Immunoglobulin G4 (IgG4)-related disease (IgG4RD) is a relatively recently recognized entity that is histopathologically characterized by an extensive infiltration of lymphocytes and IgG4-positive plasma cells with dense fibrosis. IgG4RD is now known to affect any organ system, and a few cases of gastrointestinal lesions have also been reported. However, solitary IgG4RD of the stomach is still very rare. Furthermore, as it can mimic malignant conditions, it is important to recognize this disease to avoid unnecessary surgery. Herein, we present a case of IgG4RD presenting as an isolated subepithelial mass in the stomach.

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Focused Review Series: Endoscopic Management of Upper Gastrointestinal Bleeding

Endoscopic Management of Dieulafoy's Lesion: Hye Kyung Jeon, Gwang Ha Kim; Clin Endosc 2015;48(2):112-120. Published online March 27, 2015; DOI: https://doi.org/10.5946/ce.2015.48.2.112

Abstract PDF PubReader ePub

A Dieulafoy's lesion is a vascular abnormality consisting of a large caliber-persistent tortuous submucosal artery. A small mucosal defect with the eruption of this protruding vessel can cause bleeding. In fact, a Dieulafoy's lesion is a relatively rare but potentially life-threatening condition. It accounts for 1% to 2% of cases of acute gastrointestinal bleeding. Although there is no consensus on the treatment of Dieulafoy's lesions; treatment options depend on the mode of presentation, site of the lesion, and available expertise. Endoscopic therapy is usually successful in achieving primary hemostasis, with hemostasis success rates reaching 75% to 100%. Although various therapeutic endoscopic methods are used to control bleeding in Dieulafoy's lesions, the best method for endoscopic intervention is not clear. Combination endoscopic therapy is known to be superior to monotherapy because of a lower rate of recurrent bleeding. In addition, mechanical therapies including hemostatic clipping and endoscopic band ligation are more effective and successful in controlling bleeding than other endoscopic methods. Advances in endoscopic techniques have reduced mortality in patients with Dieulafoy's lesion-from 80% to 8%-and consequently, the need for surgical intervention has been reduced. Currently, surgical intervention is used for cases that fail therapeutic endoscopic or angiographic interventions.

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Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View: Jin Woong Cho, Suck Chei Choi, Jae Young Jang, Sung Kwan Shin, Kee Don Choi, Jun Haeng Lee, Sang Gyun Kim, Jae Kyu Sung, Seong Woo Jeon, Il Ju Choi, Gwang Ha Kim, Sam Ryong Jee, Wan Sik Lee, Hwoon-Yong Jung, Korean ESD Study Group; Clin Endosc 2014;47(6):523-529. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.523

Abstract PDF PubReader ePub

One of the most important prognostic factors in esophageal carcinoma is lymph node metastasis, and in particular, the number of affected lymph nodes, which influences long-term outcomes. The esophageal lymphatic system is connected longitudinally and transversally; thus, the pattern of lymph node metastases is very complex. Early esophageal cancer frequently exhibits skipped metastasis, and minimal surgery using sentinel node navigation cannot be performed. In Korea, most esophageal cancer cases are squamous cell carcinoma (SCC), although the incidence of adenocarcinoma has started to increase recently. Most previous reports have failed to differentiate between SCC and adenocarcinoma, despite the fact that the Union for International Cancer Control (7th edition) and American Joint Committee on Cancer staging systems both consider these separately because they differ in cause, biology, lymph node metastasis, and outcome. Endoscopic tumor resection is an effective and safe treatment for lesions with no associated lymph node metastasis. Esophageal mucosal cancer confined to the lamina propria is an absolute indication for endoscopic resection, and a lesion that has invaded the muscularis mucosae can be cured by local resection if invasion to the lymphatic system has not occurred.

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Stricture Occurring after Endoscopic Submucosal Dissection for Esophageal and Gastric Tumors: Gwang Ha Kim, Sam Ryong Jee, Jae Young Jang, Sung Kwan Shin, Kee Don Choi, Jun Haeng Lee, Sang Gyun Kim, Jae Kyu Sung, Suck Chei Choi, Seong Woo Jeon, Byung Ik Jang, Kyu Chan Huh, Dong Kyung Chang, Sung-Ae Jung, Bora Keum, Jin Woong Cho, Il Ju Choi, Hwoon-Yong Jung, Korean ESD Study Group; Clin Endosc 2014;47(6):516-522. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.516

Abstract PDF PubReader ePub

Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric and esophageal cancer. Compared to endoscopic mucosal resection, ESD has the advantage of enabling en bloc removal of tumors regardless of their size. However, ESD can result in a large artificial ulcer, which may lead to a considerable deformity. Circumferential mucosal defects of more than three-fourths the esophageal circumference, long longitudinal mucosal defects (>30 mm), and lesions in the upper esophagus are significant risk factors for the development of post-ESD strictures of the esophagus. In the stomach, a circumferential mucosal defects more than three-fourths in extent and longitudinal mucosal defects >5 cm are risk factors of post-ESD stricture. If scheduled early, regular endoscopic balloon dilation is effective in controlling and preventing post-ESD stricture. Moreover, intralesional steroid injections or oral steroids can achieve remission of dysphagia or reduce the need for repeated endoscopic balloon dilation. However, further study is needed to improve the prevention of stricture formation.

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Case Report

Acute Ectopic Pancreatitis Occurring after Endoscopic Biopsy in a Gastric Ectopic Pancreas: Seong Jun Lee, Gwang Ha Kim, Do Youn Park, Sang A Choi, Sang Hee Lee, Yu Yi Choi, Moo Song Jeon, Geun Am Song; Clin Endosc 2014;47(5):455-459. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.455

Abstract PDF PubReader ePub

Ectopic pancreas is a congenital anomaly and the most common type of ectopic tissue in the gastrointestinal tract. Most patients with an ectopic pancreas are asymptomatic and rarely have complications. Ectopic pancreatitis after an endoscopic biopsy has not been reported. We report a patient who developed acute ectopic pancreatitis in the stomach after an endoscopic biopsy. A 71-year-old male patient presented with a subepithelial tumor (SET) in the stomach and had no symptoms. Endoscopic ultrasonography demonstrated a 30-mm hypoechoic mural mass, lobulated margins, and anechoic duct-like lesions. To obtain proper tissue specimen, endoscopic biopsy was performed through the opening on the surface of the mass. The pathologic results confirmed an ectopic pancreas. One day after the endoscopic biopsy, he developed persistent epigastric pain. His serum amylase and lipase elevated. Computed tomography of the abdomen showed swelling of the SET and diffuse edema of the gastric wall. His condition was diagnosed as acute ectopic pancreatitis occurring after endoscopic biopsy.

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Review

Plastic and Biodegradable Stents for Complex and Refractory Benign Esophageal Strictures: Young Hee Ham, Gwang Ha Kim; Clin Endosc 2014;47(4):295-300. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.295

Abstract PDF PubReader ePub

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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