Biliary-enteric communications caused by duodenal ulcers are uncommon, and choledochoduodenal fistula (CDF) is by far the most common type. Usually in this situation, food material does not enter the common bile duct because the duodenal lumen is intact. Here, we report a case in which cholangitis occurred due to food materials impacted through a CDF. Duodenal obstruction secondary to duodenal ulcer prevented food passage into the duodenum in this case. Surgical management was recommended; however, the patient refused surgery because of poor general condition. Consequently, the patient expired with sepsis secondary to ascending cholangitis.
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Endoscopic management of upper gastrointestinal obstruction is safe and feasible. However, its technical and clinical success rate is about 90%, which is primarily due to inability to pass a guide-wire through the stricture. The aim of this study was to evaluate the usefulness of an ultrathin endoscope for correct placement of guide wire to avoid technical failure in upper gastrointestinal obstruction.
Retrospective assessment of ultrathin endoscope to traverse the stenosis of the upper gastrointestinal tract in technically difficult cases was performed. Technical and clinical success rates and immediate complications were analyzed.
Nine cases were included in this study (eight cases of stent insertion and one case of balloon dilatation). Technical success was achieved in all of the patients (100%) and oral feeding was feasible in all of the cases (100%). Immediate complications, such as migration, perforation, and hemorrhage, did not develop in any of the cases.
Ultrathin endoscope-assisted method for upper gastrointestinal obstruction is potentially safe and useful to avoid technical failure.
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Alterations of the expression pattern of mucins and trefoil peptides have been described in gastric adenocarcinomas and in their precursor lesions. The aim of this study was to determine the progression patterns of intestinal metaplasia (IM) subtypes by analyzing the expression patterns of TFF1 and MUC5AC in different subtypes of IM of the stomach.
Endoscopic gastric biopsies of the antrum and body were obtained from patients with dyspepsia and endoscopic IM. Alcian blue/periodic acid-Schiff staining and the high iron diamine technique were used to classify the subtypes of IM. Immunoreactivity for MUC5AC and TFF1 was estimated in different types of IM.
IM was detected in 128 samples from 80 patients; type I was found in 48 samples, type II was found in 37 samples, and type III was found in 43 samples. There was a gradual decrease in MUC5AC and TFF1 expression during the progression of IM from type I to type III via the type II intermediate.
This downregulation of MUC5AC and TFF1 expression may challenge the sequential progression of IM from type I to type III via the type II intermediate, and it might be associated with gastric carcinogenesis.
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