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Context.--Sessile serrated adenomas/polyps (SSA/Ps) have been increasingly studied during the last 10 years. However, their detailed anatomic distribution pattern has not been studied, especially given newer (broader) criteria for the diagnosis. Objectives.--To characterize the anatomic distribution of SSA/P with and without cytologic dysplasia and to assess the demographics of these patients in a nationwide database. Design.--We retrospectively analyzed the database of Miraca Life Sciences Research Institute for a 1-year period. Patients with a diagnosis of SSA/P, SSA/P with low-grade cytologic dysplasia (SSA/P-LGD), SSA/P with high-grade cytologic dysplasia (SSA/P-HGd), or SSA/P with adenocarcinoma (SSa/P-ACA) were retrieved, and patients' age, sex, and specific anatomic location were analyzed. Results.--A total of 11 201 patients were identified, of which 10 646 (95.0%) had SSA/P, 514 (4.6%) had SSA/P-LGD, 39 (0.35%) had SSA/P-HGD, and 2 (0.018%) had SSA/P-ACA. All SSA/Ps and more advanced lesions were significantly more common in the proximal colon--SSA/P (61.2%), SSA/P-LGD (61.2%), SSA/P-HGD (80%), and SSA/P-ACA (100%)--than in either the transverse (18.8%, 17.8%, 10.0%, and 0%, respectively) or the distal (19.9%, 21.0%, 10.0%, and 0%, respectively) colon, P Conclusions.--Sessile serrated adenomas/polyps with and without cytologic dysplasia and carcinoma are predominantly found in the cecum and ascending colon, whereas there is low prevalence in both the transverse and distal colon. Confirmation of previously published data regarding demographics of advanced lesions among a different cohort and including newer (broader) criteria suggests these criteria are valid. (Arch Pathol Lab Med. 2015; 139:388-393; doi: 10.5858/arpa.2013-0523-OA), Colorectal cancer (CRC) is the third most common cancer diagnosed in men and women and is the third leading cause of cancer death in the United States. (1-3) About 80% [...]

The article presents a case study of a 37-year-old man who had undergone laparoscopic cholecystectomy and discusses the endoscopic removal of a migrated and embedded biliary metallic stent using rat-tooth forceps successfully.

Background: The aim of this study was to assess the operating characteristics of using the confocal endomicroscopy miniprobe (pCLE) compared to cholangioscopic targeted biopsies for the detection of malignancy in biliary tract strictures., Methods: We conducted a retrospective analysis of data of patients who underwent evaluation of indeterminate biliary strictures after inconclusive brush cytology. Only those patients with a final pathologic diagnosis or a conclusive >12 months follow-up were included. Patients were divided into 2 groups: those who underwent pCLE assessment (pCLE) and those who underwent cholangioscopic targeted biopsies (SB) of biliary strictures. Cholangioscopic biopsies were considered positive for malignancy when adenocarcinoma cells were identified. pCLE was considered positive for malignancy according to the Miami and Paris criteria., Results: A total of 195 patients (median age, 66 years; 54.9% male) were included; 61 underwent C-pCLE and 134 underwent SB. Patient and biliary stricture characteristics were similar in the 2 groups. Final diagnoses were cholangiocarcinoma (N.=93), pancreatic adenocarcinoma (N.=6); and benign strictures (N.=96). The overall sensitivity of pCLE and SB for the detection of malignancy were 76.4% and 78.4% respectively (P=0.7). Similarly, there was no difference in the specificity of pCLE and CB for the diagnosis of malignancy (97.7% and 98.5% respectively; P=1). The diagnostic accuracy of pCLE was 83.6% versus 88.8% in SB (P=0.8). However, the specificity to detect a malignancy was higher for CB compared to pCLE (98.5 vs. 86.3%; P=0.04)., Conclusions: In patients with indeterminate bile duct strictures, cytology combined with pCLE has a similar sensitivity, and diagnostic accuracy when compared to cholangioscopic biopsies for the diagnosis of malignant strictures. pCLE may be beneficial for in vivo, real-time histopathologic examination of biliary strictures and help in the instantaneous characterization of biliary strictures.

Syphilitic proctitis is a rare disease that usually presents as proctitis, ulcer, and neoplasm but lacks pathognomonic clinical symptoms. It is thus difficult to diagnose and may be treated inappropriately. We report a 31-year-old man who had a hard, ulcerated mass that occupied the rectal and sigmoid colon wall and mimicked a tumor. Fortunately, a biopsy of the mass demonstrated Treponema pallidum organisms consistent with syphilitic proctitis. The patient was successfully treated with intravenous benzyl penicillin, resulting in improvement in his proctitis.

The management of pancreaticobiliary disease in patients with surgically altered anatomy is a growing problem for gastroenterologists today. Over the years, endoscopic ultrasound (EUS) has emerged as an important diagnostic and therapeutic modality in the treatment of pancreaticobiliary disease. Patient anatomy has become increasingly complex due to advances in surgical resection of pancreaticobiliary disease and EUS has emerged as the therapy of choice when endoscopic retrograde cholangiopancreatography failed cannulation or when the papilla is inaccessible such as in gastric obstruction or duodenal obstruction. The current article gives a comprehensive review of the current literature for EUS-guided intervention of the pancreaticobiliary tract in patients with altered surgical anatomy.