ACG Case Reports Journal最新文献

Endoscopic submucosal dissection (ESD) for pharyngeal squamous cell carcinoma (SCC) has predominantly been performed in Asia but interest in this procedure is growing in the West. This report details the first known Western application of ESD for oropharyngeal SCC. A Caucasian female with superficial oropharyngeal SCC detected during endoscopic surveillance post-ESD for esophageal SCC underwent successful en-bloc resection without complications. Pathology confirmed SCC in situ with tumor-free margins. This case underscores the importance of mindset to include the pharynx in upper gastrointestinal endoscopy during surveillance within the gastroenterologist's domain and the potential for broader application of ESD in the West.

Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms that commonly originate from the kidney, uterus, or lung, with gastrointestinal involvement being exceptionally uncommon. This case highlights the first known use of endoscopic ultrasound and endoscopic tunnel biopsy technique in diagnosing rectal PEComa. A 66-year-old woman presented with acute rectal bleeding. Imaging revealed a distal rectal mass 7.4 cm in diameter that was initially suspected to be a gastrointestinal stromal tumor. Endoscopic ultrasound with fine-needle aspiration and subsequent endoscopic tunnel biopsies confirmed the diagnosis of PEComa preoperatively. She was treated with neoadjuvant sirolimus, surgical resection, and later underwent partial hepatectomy for a solitary liver metastasis identified 3 years postoperatively. Radiologic findings in rectal PEComas often mimic gastrointestinal stromal tumor. Preoperative diagnosis is rarely achieved, but this case showed how advanced endoscopic biopsy techniques can enable early diagnosis and targeted therapy.

A 60-year-old woman with acute severe Crohn's colitis had a rapid initial response to off-label, high-intensity upadacitinib; however, she subsequently demonstrated clinical deterioration ultimately undergoing colectomy for suspected refractory Crohn's disease. Surgical pathology unexpectedly revealed quiescent Crohn's disease with cytomegalovirus colitis, despite no initial endoscopic evidence of infection.

Double-balloon enteroscopy assisted endoscopic retrograde cholangiopancreatography allows for the treatment of biliary and pancreatic diseases in patients with altered anatomy after gastrointestinal reconstruction. The percutaneous-endoscopic rendezvous technique is a well-described method that combines interventional radiology and interventional endoscopy, allowing for the cannulation of complex hepatobiliary systems through a combined endoscopic and percutaneous approach. The pancreatic transplant patient poses unique challenges in navigating the post-transplant ductal anatomy via an endoscopic approach. We describe a pancreas transplant recipient and the first report of a retrograde (scope passed through the rectum) double-balloon enteroscopy endoscopic retrograde cholangiopancreatography rendezvous to treat chronic pancreatitis.

Metastatic tumors of the pancreas are a rare occurrence, comprising 0.5%-5% of all pancreatic malignancies. Colorectal cancer (CRC) often metastasizes to the liver, lung, and/or local lymph nodes but rarely to the pancreas. In addition, patients with pancreatic metastasis from CRC ranged in age from 60 to 70 years. We present an intriguing case of a 42-year-old man with previously resected stage III rectal adenocarcinoma who developed a pancreatic head mass 6 months later. This case report demonstrates atypical metastatic spread of CRC in a younger patient.

We describe a variation of the rendezvous technique for choledocholithiasis using a peripherally inserted central catheter (PICC) instead of a guidewire. Three patients (aged 47-84 years) with bile duct stones underwent this approach during laparoscopic cholecystectomy at a tertiary center. Biliary cannulation and complete stone removal were successful in all cases, with no intraoperative or postoperative complications. The average hospital stay was 3 days. This technique appears feasible, although larger studies are needed to confirm its efficacy, safety, and potential cost-effectiveness.

Intrahepatic lymphedema is a rare condition usually associated with hepatobiliary diseases, cardiogenic factors, pancreatic disorders, or malignant lymph node lesions. This report describes a unique case of intrahepatic lymphedema presenting with abnormal bilirubin metabolism as the initial manifestation, with no identical cases identified in the China National Knowledge Infrastructure (CNKI), Wanfang Database, or PubMed. The patient was a 30-year-old Chinese man admitted due to fatigue, anorexia, and yellowish urine for 3 days. Physical examination revealed mild generalized jaundice without hepatosplenomegaly or signs of chronic liver disease. Laboratory tests showed marked elevation of total bilirubin (347.1 μmol/L), direct bilirubin (241.7 μmol/L), and indirect bilirubin (105.4 μmol/L), while viral hepatitis markers (Hepatitis B Virus DNA, Hepatitis C Virus RNA, Human Immunodeficiency Virus RNA) and autoimmune antibody panels were negative. Abdominal computed tomography (CT) demonstrated dilated lymphatic vessels around the intrahepatic portal vein without extrahepatic biliary obstruction or cardiac dysfunction. Intravenous methylprednisolone sodium succinate (40 mg/d) was initiated as exploratory treatment since autoimmune hepatitis could not be excluded. Jaundice improved significantly after 4 days, with the dose reduced to 20 mg/d. By day 8 of treatment, total bilirubin decreased to 112 μmol/L and liver CT showed regression of lymphatic dilation. At the 14-day follow-up, all biochemical indicators had normalized and CT abnormalities resolved; liver biopsy was not performed due to the patient's refusal and rapid clinical response to glucocorticoids. This case suggests that exploratory treatment with glucocorticoids (e.g., methylprednisolone sodium succinate) may be effective for patients with unexplained intrahepatic lymphedema and abnormal bilirubin metabolism, especially when an immune-mediated etiology is suspected.

Intestinal ultrasound is a noninvasive, cost-effective tool to assess disease activity in ulcerative colitis (UC). Although upadacitinib, a selective Janus kinase 1 inhibitor, has demonstrated efficacy for induction therapy in patients with moderately to severely active UC, data in acute severe UC remain limited. We report on the use of intestinal ultrasound to assess treatment response after induction with upadacitinib in 3 patients hospitalized with acute severe UC.