This lesion was then fully removed via endoscopic mucosal resection (EMR) on a subsequent endoscopy, again ... This lesion was removed with a cold snare.
Am J Gastroenterol 2018;113:S1377–S1442; doi:10.1038/ajg.2018.318
ACCEPTED: CLINICAL VIGNETTES/CASE REPORTS—SMALL INTESTINE
Figure l. A. Semi-pedunculated duodenal mass visualized using a duodenoscope, measuring about 5cm and showing ulceration. B. Easily friable a_nd oozing upon
and oozing upon contact (Figure 1). The major papilla was visualized to be adjacent, but separate from this mass (Figure 2). Biopsies revealed features identical to a HP without malignancy or Helicobacter pylori. This lesion was then fully removed via endoscopic mucosal resection (EMR) on a subsequent endoscopy, again demonstrating HP features on pathology (Figure 3A). A surveillance EGO performed 3 months later revealed a small round mucosal abnormality at the prior EMR site (Figure 3B). This lesion was removed with a cold snare. Histology demonstrated no residual hyperplastic or malignant changes. The patient has not had aity recurrence of melena. HP are extremely rare lesions in the duodenum. \Vhile they are benign, there is at least one reported case of adenocarcinoma arising from a pedunculated HP at the duodenal bulb. Therefore complete excision of such polyps is recommended. It is critical to fully evaluate any duodenal lesion with duodenoscope and echoendoscope prior to endoscopic intervention. The_imponant factors include size, location, depth of invasion and relationship to major or minor papil lae. EMR can be safely performed by a skilled endoscopist with a rate of perforation reported from 0% to 1.9% and acute or delayed bleeding occurred in 0% to 14% of the cases. Polyps larger than 2cm will likely require piecemeal resection. A follow up endoscopy is recommended in 3-6 months for surveillance of the residual site in a piecemeal resection given the inherent limitations of determining histological nega tive margins in this setting. This case highlights a unique manifestation of a duodenal hyperplastic polyp and its successful EMR that resulted in the resolution of bleeding.
2588 When Gastroenteritis Is too Mainstream: Eosinophilic Gastroenteritis Virwd Nqgabhairu MD Manbeer S. Sarao, MD, Aswani Nagabhairu, MD, Vinad Naakala, MD. University ofPittsburgh Medical Center Pinnacle, Harrisburg. PA
2587_B Figure 2. Major papilla is shown at the left of the photo with bile flowing. Mass is at the top right of the image.
Eosinophilic gastroenteritis (EGE) represents one member within the spectrum. of diseases collec tively referred to as eosinophilic gastrointestinal disorders (EGIDs), which includes eosinophilic esophagitis (EoE), gastritis (EG), duodenitis (ED), enteritis, and colitis. To our knowledge, this is the only case in literature with such as extensive involvement of the GI tract. A 46-year-old obese Caucasian male presented with three weeks of right upper quadrant (RUQ) pain, radiating to the back. which began in the mid-epigastric region, episodes of bilious vomiting, diarrhea, and fever. His
2587_C Figure 3. A. Post endoscopic mucosaI resection site shown after submucosal lift with methylene blue. B. Endoscopic mucosaI resection site shown at three months surveillance endoscopy.
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