Search

Heterotopic pancreatic tissue in the stomach is an uncommon gastric subepithelial lesion. Is usually an asymptomatic condition which is found incidentally. As with other gastric subepithelial lesions, diagnosis can be challenging. Endoscopic forceps biopsy specimens are of little value. Endoscopic ultrasound findings are helpful in characterize this lesions, but they cannot absolutely determine the type of lesion or whether a lesion is benign or malignant. The sequence endosonography- cap assisted endoscopic mucosal resection allows en bloc resection of small gastric subepithelial lesions with low complication rates. We report a case of an ectopic pancreas of the antrum in the stomach that arises from the second layer of the gastric wall (muscularis mucosa) at endoscopic ultrasound that was removed en bloc with cap-assisted endoscopic mucosal resection technique in one endoscopic session without complications.

Common bile duct (CBD) stones extraction is usually performed by endoscopic sphincterotomy followed by removal by either a Dormia basket or extraction balloon catheter. However, some stones due to their size are not amenable to these procedures and extracorporeal or mechanical lithotripsy devices need to be used. Mechanical lithotripsy involves usage of a basket that will be inevitably destroyed which increases cost to the patient and endoscopy unit. The use of extracorporeal wave shock lithotripsy is an alternative; however it is not available widely. Reports about the use of hydrostatic large caliber balloon dilator (HLCBD) aiding in the extraction of large caliber CBD stones have concluded that is a safe and feasible therapeutic alternative. We present the case of a 25 mm x 30 mm CBD stone that could not be extracted using conventional methods. CBD dilation using HLCBD was performed after endoscopic sphincterotomy in an attempt to avoid mechanical lithotripsy.

Ampullary adenomas can occur sporadically or as part of familial adenomatous polyposis syndrome. Most of them are asymptomatic. Current standard of management is complete surgical or endoscopic resection, depending on depth of invasion and/or biliary tract involvement. The last can be established by endoscopic ultrasound or endoscopic retrograde colangiopancreatography. Surgical resection has high morbidity (25% to 65%) and mortality (10%) in unexperienced hands compared to endoscopic therapy (12% and 1%, respectively). Complications of endoscopic therapy ranges from 7% to 10%. Recurrence of adenomatous lesions treated endoscopically is 30%. Endoscopic surveillance after resection is mandatory. We present the case of a patient with an ampulla of Vater s adenoma successfully resected endoscopically previous assessment of the lesion by endoscopic ultrasound.

The endoscopic therapy has been used in the treatment of early stage neoplastic esophageal lesions with great success. The endoscopic ultrasound is a useful tool for the correct staging of these lesions. The staging accuracy of esophageal cancer with endoscopic ultrasound reaches 80% for T stage and 77% for N stage. The endoscopic approach provides complete resection of lesions confined to the mucosal layer, is a safety procedure with complications reported to occur from 3% to 13%. The morbidity and mortality rates after an endoscopic mucosal resection have been reported to be less than those posterior to esophagectomy. We present a case of a patient with high surgical risk, who underwent an upper endoscopy because of long history of gastroesophageal reflux disease and uncontrollable hiccup with successful endoscopic mucosal resection with plastic cap and polipectomy loop of an early stage esophageal adenocarcinoma derived of Barrett s esophagus.