Acute duodenal ischemia and periampullary intramural hematoma are rare complications after endoscopic retrograde cholangiopancreatography (ERCP). A 77-year-old man with splenomegaly complained of abdominal pain caused by common bile duct (CBD) stone. After successful removal of the CBD stone without immediate complications, the patient developed intramural hematoma around the ampulla of Vater along with diffuse duodenal edema. The findings were compatible with acute intestinal ischemia, and further evaluation revealed that he had underlying primary myelofibrosis. Myeloproliferative diseases are known to be significantly associated with an increased risk of thrombohemorrhagic complications. Therefore, particular attention should be given to this group of patients when a high-risk procedure such as ERCP is performed.

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• Ischemic duodenitis after endoscopic retrograde cholangiopancreatography‐related procedure
  Yuki Tanisaka, Akashi Fujita, Shomei Ryozawa
  Digestive Endoscopy.2022; 34(6): 1264.     CrossRef
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Inflammatory fibroid polyps are rare benign tumors of the GI tract, that commonly present with intestinal obstruction as a result of intussusceptions in the small bowel. A 39-year old man visited our clinic with an asymptomatic polypoid mass in the distal ileum that was identified on abdominal computed tomography for postoperative surveillance after total gastrectomy due to previously diagnosed early gastric cancer. Retrograde double-balloon enteroscopy was performed to diagnose the ileal mass and a complete resection of the polyp was performed using snare for polypectomy without complications. The final histological finding was an ileal inflammatory polyp. Balloon-assisted enteroscopy is a valuable modality to diagnose and treat small bowel lesions in lieu of surgical procedures in selected cases.

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• Gel immersion EMR of small-bowel inflammatory fibroid polyp using double-balloon endoscopy
  Yuka Matsubara, Akiyoshi Tsuboi, Issei Hirata, Akihiko Sumioka, Hidenori Tanaka, Ken Yamashita, Yuji Urabe, Shiro Oka
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