Splenic artery aneurysm is the most frequently encountered visceral artery aneurysm, predominantly affecting women, especially those with a history of multiplepregnancies. This condition, which is mostly asymptomatic, can lead to serious morbidity and mortality if it ruptures. Here, a splenic artery aneurysm detected onendoscopic ultrasonography performed as further examination in a female patient with a subepithelial-like lesion detected during upper endoscopy is presented.Cite this article as: Kırsoy F, Özercan M, Oral AÇ, Artaş H, Yıldırım M, Yalnız M, Bahçecioğlu İH. Splenic artery aneurysm: a jeopardous condition mimicking gastric subepithelial lesion – a case report. Diagn Interv Endosc, 2025; 4(1), 0129, DOI:10.5152/DiagnIntervEndosc.2025.25129.
Hemangioma of the large intestine is a rare condition. Although such lesions do not present a risk of malignant transformation, they are associated with a potential for massive hemorrhage. Therefore, it is imperative to maintain a high index of suspicion for such lesions and to be cognizant of any interventional procedure that may result in excessive bleeding. This report presents the case of a patient who was admitted to the medical facility, where a hemangioma in the transverse colon was identified and subsequently excised without complications.Cite this article as: Moral K, Kaymaz E, Kabaçam G. “A rare cause of colonic polipoid lesion–colonic hemangioma”, Diagn Interv Endosc, 4, 0115, 2025. doi: 10.5152/DiagnIntervEndosc.2025.25115.
Objective: Acute upper gastrointestinal bleeding is a life-threatening emergency situation. Gastroscopy has an important place in the diagnosis and treatment.This study aimed to examine the etiological, clinical, and gastroscopic data of patients with upper gastrointestinal bleeding.Materials and Methods: The outcomes of patients who underwent gastroscopy for upper gastrointestinal bleeding in the endoscopy unit between January 2016and December 2021 were retrospectively reviewed.Results: Of the 511 patients evaluated, 341 (66.7%) were male, 170 (33.3%) were female, and the mean age of the patients was 60.2 ± 19.05 years (range 16-88)years. The most common cause of the bleeding was peptic ulcer (51.2%), and its location was the duodenum (70.7%). The second most common cause wasesophageal variceal bleeding (23%). Band ligation was applied to 99 (82%) of 122 patients with bleeding esophageal varices at the same session or at a latersession, and sclerotherapy was applied to 120 (46%) of 262 patients with bleeding peptic ulcers at the same session. Fifteen patients (2.9%) underwent surgerydue to severe bleeding and hemodynamic instability. Intravenous iron therapy was administered to 101 patients (20%). Mortality occurred in 67 of 511 patients(13.1%), including 29 of 122 patients (24%) with varicose veins and 38 of 391 patients (10%) with non-variceal bleeding during hospitalization.Conclusion: It was found that the mortality rate during hospitalization in the gastroenterology unit was 13% overall for patients hospitalized for upper gastrointestinal bleeding, one-fourth for patients hospitalized for variceal bleeding, and one-tenth for patients hospitalized for non-variceal bleeding. These data revealthat upper gastrointestinal bleeding, especially variceal bleeding, is a clinical condition with high mortality that requires urgent intensive care admission andrapid intervention.Cite this article as: Dumak T, Ağan FZ, Cindoğlu Ç, Uyanıkoğlu A. Analysis of etiological and gastroscopic data of patients with uppergastrointestinal bleeding. Diagn Interv Endosc. 2025; 4(1), 0132. DOI:10.5152/DiagnIntervEndosc.2025.24132.
Objective: Rectal neuroendocrine tumors (rNETs) are a rare type of tumor that belong to a larger group called neuroendocrine neoplasms. These tumors aredivided into two main categories: well-differentiated neuroendocrine tumors (NET G1 and G2) and poorly differentiated neuroendocrine carcinomas (NEC G3).rNETs are often not noticed because they do not show symptoms, but they can sometimes cause bowel problems or hormone-related symptoms. Small rNETs areusually treated with endoscopic resection, while larger tumors may need surgery or other treatments.Materials and Methods: The aim of this study is to look at the clinical and histopathological features of rNETs treated with endoscopic submucosal dissection(ESD). The focus was on factors like tumor size, location, and the Ki-67 index, and how they affect patient outcomes.Results: In this study, the average age of patients was 52.6 years, and half of them were women. Most of the tumors were located between 5 and 10 cm fromthe rectum (56.3%). The majority of tumors were smaller than 10 mm (81.3%), and 56.3% of them were Grade 1. There was no significant correlation betweentumor size and the Ki-67 index (r=0.215, P=.424).Conclusion: Endoscopic submucosal dissection is a good treatment for rNETs that are smaller than 10 mm, with a high success rate in removing the tumorcompletely. For larger tumors or those with higher Ki-67 indices, careful monitoring is needed because they may have a higher risk of spreading.Cite this article as: Aktaş L, Vatansever S. Evaluation of rectal neuroendocrine tumors treated with endoscopic resection. Diagn IntervEndosc, 2025, 4(1), 0133, DOI:10.5152/DiagnIntervEndosc.2025.24133.
Esophageal anatomic deformities are difficult to manage and usually develop after malignancy, surgical complications, or radiotherapy. This case is rarely seen inthe literature due to the esophageal deformities, including refractory fistula and distal dilatation, that develop after multiple thoracotomies. A 77-year-old femalepatient with a history of 8 thoracotomies (4 right, 4 left) and radiotherapy was admitted with complaints of chronic dysphagia. The patient had previously undergone 3 endoscopic balloon dilations owing to complaints of dysphagia and esophageal stricture following an iatrogenic esophageal perforation. An endoscopywas performed and revealed marked dilation in the proximal esophagus and a fistula in the distal. Oral contrast-enhanced computed tomography revealed dilationof the esophagus to 75 × 66 millimeters (mm). This case highlights the importance of a multidisciplinary approach and shows that even complex anatomicalchanges may be managed conservatively in clinically stable patients.Cite this article as: Şahin H, Akpınar MY. Chronic dysphagia and esophageal deformities following multiple thoracotomies: a case report.Diagn Interv Endosc, 2025; 4(1), 0150, DOI:10.5152/DiagnIntervEndosc.2025.25150.
Cite this article as: Bozkına AÇ, Tekin F. IgG4-related inflammatory pseudotumor of the bile duct mimicking cholangiocarcinoma. Diagn Interv Endosc. 2025; 4(1), 0157, DOI:10.5152/DiagnIntervEndosc.2025.25157.
OBJECTIVE Gastric adenocarcinoma is one of the most common malignancies worldwide, typically presenting as ulcerated or infiltrative lesions during endoscopy. On the other hand, its manifestation as a subepithelial lesion (SEL) is exceptionally rare making diagnosis difficult. Recognizing malignant potential in SELs with atypical clinical or endoscopic features is crucial to avoid delays in diagnosis and treatment. We present an uncommon case of gastric adenocarcinoma manifesting as a SEL in the gastric corpus. This case emphasizes the importance of considering malignant etiologies in the differential diagnosis of SELs, particularly in patients with atypical clinical or endoscopic features. METHODS Fujinon EG580-UR radial ultrasonic endoscopy 12 MHz (Fujifilm Corporation, Tokyo, Japan), Fujinon EG-760R gastroscope (Fujifilm Corporation,Tokyo, Japan), DualKnife (Olympus Medical Systems, Tokyo, Japan), Adrenalin, hydroxyethyl starch (HES), and Indigo carmine solution. RESULTS A 59-year-old female patient was referred to our center after presenting with stool occult blood positivity at an external clinic center. Written informed consent was obtained from patient who participated in this study. Endoscopic examination revealed a SEL (measuring 2 × 2 cm) with a superficial clear ulcer in the gastric corpus (Figure 1A and B). An evaluation with 12 MHz radial EUS Fujinon EG580-12 MHz (Fujifilm Corporation, Tokyo, Japan), performed with water infusion, demonstrated a SEL originating from the muscularis mucosa (second layer) and submucosa (third layer). The lesion measured 20 mm. It was with welldefined but irregular borders. It exhibited a hypoechoic and heterogeneous structure. Disruptions in mucosal integrity were observed at the level of the lesion. The muscularis propria layer appeared intact in the region of interest. Based on these findings, a preliminary diagnosis of high-grade neuroendocrine tumor (NET) or gastrointestinal stromal tumor (GIST) was considered, and endoscopic resection was planned. For endoscopic submucosal dissection, a Fujinon EG-760R gastroscope was used. A cap-assisted technique was applied. There was an approximately 2 cm clean ulcer in the area. Loss of pit pattern was seen. The lesion was marked circumferentially, and a submucosal injection was performed to lift the area. After an initial mucosal incision, submucosal dissection was performed using a DualKnife (Olympus Medical Systems, Tokyo, Japan). Hemostasis was maintained throughout the procedure. The lesion, including the fibrotic ulcerated base with irregular microvasculature, was completely resected (Figure 1C). The defect was managed to support healing. During dissection, no significant vascularity was noted. The base had a fibrotic ulcer with irregular microvasculature. No signs of invasion were observed at the base. The resected specimen measured 3 × 2 cm, with a 2 cm elevated lesion and a partially ulcerated area (Figure 1D). Histopathological examination revealed intestinal-type adenocarcinoma with positive surgical margins at the base. The base of the lesion showed fibrosis and irregular microvasculature. Immunohistochemical analysis showed CD10 (+), CDX2 (+), and focal CK20 (+), confirming the diagnosis. Further evaluation with FDG-PET (Fluorodeoxyglucose Positron Emission Tomography) imaging showed no evidence of metastasis. Subsequently, the patient underwent laparoscopic total gastrectomy with Roux-en-Y esophagojejunostomy and D2 lymph node dissection. No tumoral lesions were observed. Microscopic evaluation revealed reactive changes and mild fibrosis in the described ESD scar area, with no evidence of malignancy. Dissection of lymph nodes from perigastric, D2, and 11D stations revealed reactive lymphoid hyperplasia without metastatic involvement (0/14). Immunohistochemical analysis confirmed epithelial markers (pancytokeratin) positivity in the ESD scar area. The final diagnosis excluded malignancy. The patient is now under close follow-up. CONCLUSION Subepithelial lesions in the gastric tract are benign in nature, with common diagnoses including GISTs, lipomas, and leiomyomas. Although rare, SELs can occasionally contain malignant pathologies, including adenocarcinoma. While these lesions are generally asymptomatic, larger SELs or those with specific characteristics such as rapid growth, irregular borders, or ulceration may raise suspicion for malignancy such as lymphoma, GIST, metastasis, and NETs.1 Gastric adenocarcinoma is among the most common malignancies worldwide, typically presenting as ulcerated or infiltrative lesions visible during endoscopy. However, its presentation as a SEL is exceptionally rare. This uncommon presentation may lead to delays in diagnosis and treatment, as the lesion can mimic benign subepithelial tumors, both in endoscopic appearance and clinical behavior.2 EUS (Endoscopic Ultrasonography) is the most important tool for evaluating SELs. EUS is mandatory to nonınvasively collect the target’s information and opt candidates for further evaluation.3,4 It helps determine the size, echogenicity, relationship with layers, and border of the lesion. Biopsies taken from the surface epithelium are often insufficient.4 ESD is used as both a diagnostic and therapeutic method. It allows for complete resection and facilitates histopathological analysis of the lesion.5 This case emphasizes the importance of EUS in evaluating the malignant potential of SELs and the effectiveness of ESD as both a diagnos tic and therapeutic method.
Objective: Minor biliary injuries make up about 50% of cholecystectomy-related biliary injuries. In this study, an evaluation of the technical features, technical efficacy, and clinical outcomes of endoscopic treatment for patients with minor biliary injuries due to cholecystectomy was aimed. Methods: Patients with biliary tract injuries who were treated endoscopically between April 2015 and May 2022 were identified by analyzing medical records. The Strasberg classification was used to categorize biliary injuries, and the Huang classification was used to categorize bile duct variations. Patients with minor biliary tract injuries were included in the study. Results: Of the 173 patients who underwent endoscopic treatment for biliary injury, 92 (53.2%) with minor biliary tract injuries were included in the study. Among these 92 patients, 83 (90.2%) had cystic stump leakage, and 9 (9.8%) presented with Luschka leakage. Three of the patients with cystic stump leakage also exhibited a right posterior aberrant duct draining into the cystic duct (Huang type A5 variation). Additionally, 7 patients had concurrent Strasberg E1 injuries. Across all patients, the average number of endoscopic procedures was 2.38 (range: 2-6). Endoscopic therapy was deemed technically and clinically successful in all patients (100%) and achieved stent-free follow-up. Conclusion: Endoscopic procedures should serve as the first-line treatment for minor biliary tract injuries following cholecystectomy due to their high success rate. However, it is important to note that these patients may present with complications such as Strasberg E1 injuries or Huang A5 biliary tract anomalies, which may necessitate tailored therapeutic approaches.
OBJECTIVE The aim of this study is to demonstrate the effectiveness and safety of endoscopic submucosal dissection (ESD) in the treatment of circumferential squamous cell carcinoma (SCC). It investigates the feasibility of an endoscopic approach in cases of circumferential SCC in the distal esophagus without the need for surgical intervention. METHODS Endoscopic submucosal dissection is used as a treatment method for early stage esophageal cancers. In this technique, the submucosal tissue surrounding the lesion is carefully dissected, and the tumor is removed en bloc. During the procedure, the “clip and line” traction method aids in the smooth lifting of the mucosa and facilitates proper tensioning of the operative area. Written informed consent was obtained from patients who participated in this study RESULTS A 62-year-old female patient presented to our clinic with a 1-year history of progressively worsening dysphagia. Esophagogastroduodenoscopy (EGD) revealed thickening of the mucosal layer surrounding the lumen in the distal esophagus and a B3 vascular pattern according to the Japanese Endoscopy Society classification. Chromoendoscopy using 1% Lugol’s solution to examine suspected SCC showed circumferential involvement in a 10 cm segment. No pathological lymph nodes were observed on endoscopic ultrasound, and the muscularis propria layer remained intact. The area, initially thought to be superficial SCC, was resected en bloc using the endoscopic submucosal dissection method through 2 tunnels in 156 minutes. The “clip and line” traction method was employed during the procedure. The histological diagnosis was SCC-T1b. Although surgical margins were intact, deep submucosal invasion (>200 microns) and lymphovascular invasion were observed. Therefore, adjuvant chemoradiotherapy was planned. The patient returned to our clinic in the first postoperative month due to dysphagia, and a narrowing of the ESD scar was noted during the control EGD examination. A covered metallic esophageal stent was placed. CONCLUSION Endoscopic submucosal dissection proves to be an effective and safe method in the treatment of early-stage circumferential SCC.
OBJECTIVE In this video report, the use and clinical outcomes of endoscopic ultrasound-guided gallbladder drainage are aimed to be presented. CASE A 95-year-old patient with a history of hypertension and coronary artery disease presented with abdominal pain and fever. Physical examination revealed tenderness in the right upper quadrant and a positive Murphy’s sign. General surgery was consulted, surgery was evaluated as high risk due to the patient’s age and comorbid diseases, and endoscopic intervention was planned after consultation with the patient and his relatives. The patient’s cholestasis tests were found to be high, and ultrasonography and Magnetic resonance (MR)/Magnetic resonance cholangiopancreatography (MRCP) revealed dilated intrahepatic and extrahepatic bile ducts, gallbladder stones, and findings consistent with calculous cholecystitis. The patient underwent Endoscopic Retrograde Cholangiopancreatography (ERCP), and the stones in the common bile duct were expelled into the intestine with a stone balloon, and then a Hot Spaxus metal stent was placed from the bulb to the gallbladder under the guidance of endosonography and the procedure was completed. An endoscopic ultrasound-guided gallbladder drainage procedure was performed. METHODS Visual The endoscopic ultrasound-guided drainage procedure was successfully completed. In this video, drainage of gallstones and sludge from the gallbladder into the duodenal lumen through the HOT SPAXUS™ stent placed in the gallbladder in the first segment of the duodenum under sonography guidance is seen (Video 1). A control endoscopic examination was performed a week later, and it was observed that the stent was in place and functioning. The baby scope was used to pass through the stent into the gallbladder (Video 2). Written informed consent was obtained from patients who participated in this study. RESULTS Post procedure, the patient showed significant improvement in symptoms. Follow-up confirmed the effectiveness of the drainage. In conclusion, endoscopic ultrasound-guided gallbladder drainage is a minimally invasive and effective treatment option, particularly for elderly patients with comorbidities.
Objective: Endoscopic submucosal dissection (ESD) is an endoscopic treatment method that has been indicated as the preferred method for the treatment of early gastric cancer (EGC) and finds increased use in Western countries. This study analyzed the experience of a tertiary center in Türkiye using the ESD methodfor the treatment of gastric neoplastic lesions. Methods: Patients with gastric neoplastic lesions who underwent ESD between March 2019 and March 2023 were included in the study. The rates of en bloc and R0 resection were investigated. The curability of EGC was evaluated according to the current guidelines of the Japan Gastroenterological Endoscopy Society. Patients with a follow-up period of <1 year were excluded from the study. Results: In total, 42 gastric neoplastic lesions from 38 patients were included in the study. The mean tumor diameter was 26.39 mm (range: 10-75 mm). The success rates of en bloc and R0 resection were 97.6% and 90.4%, respectively. Curative resection was achieved in 8/13 (61.5%) patients diagnosed with EGC. The median length of hospital stay was 1 day (range: 1-3 days). Complications occurred postoperatively in 13.1% of the patients. Recurrence was observed in 1 patient (2%) at a median follow-up of 18 months (range: 12-57 months). Conclusion: Endoscopic submucosal dissection is an effective and safe method for treating gastric neoplastic lesions. The rate of curative treatment with the ESD method in EGC should be improved.
Objective: Anorectal manometry serves as a diagnostic tool, particularly in identifying chronic constipation associated with rectal evacuation disorders. We aimed to share the anal motility results of patients presenting with constipation complaints in our tertiary referral center’s motility laboratory. Methods: Between January 2018 and December 2022, a total of 87 patients presenting with constipation complaints underwent anal motility measurements at İzmir Tepecik Training and Research Hospital, Clinic of Gastroenterology. Eighty-nine patients without constipation complaints were included in the study. Results: It was determined that 87 patients presented with constipation complaints. The mean age of these patients was 45.42 ± 16.34 years. Of these patients, 61 were female and 26 were male. Regarding motility measurements, an increase in resting pressure, a higher volume at which they first felt the urge to defecate, a decrease in the maximum tolerable volume, and an increase in the incidence of dyssynergia, predominantly type I dyssynergia, were observed in constipated patients. However, no statistically significant relationship was found between patients’ resting pressures, initial sensation measurements, maximum tolerable volume, dyssynergia, average resting pressure, squeezing pressure, and constipation (respectively; P: .28, P: .39, P: .76, P: .41, P: .095). Conclusion: In our study, our anorectal motility results were not found to be associated with the presence of constipation. However, with a larger number of patients compared to many studies and the results obtained from anorectal manometry performed at very few centers, we believe that some of our findings will be instructive for constipation patients.
Objective: The diagnostic yield of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) can vary according to many factors. We aimed to determine the predictors that optimize the diagnostic yield of EUS-FNA, particularly the role of on-site cytopathologists. Methods: A total of 175 patients who underwent EUS-FNA were retrospectively enrolled in this study. Lesion localization, size, characteristics, and the presence of a cytopathologist during the examination were evaluated. A standard endoscope and a Cook Medical Echo Tip 22G needle were used to view, evaluate, and perform FNA on the lesions using the Standard Suction Technique. Results: The most common lesion location was the pancreas, accounting for 70% of cases. The average lesion size was 3.2 ± 1.7 cm. Rapid on-site pathological evaluations (ROSE) were performed for 64 patients (37%), significantly improving diagnostic rates to 78% compared to 63% without ROSE (OR 2.09, 95% CI 1-4.2, P=.039). The diagnostic yield was higher for solid lesions compared to cystic ones (OR 2.2, 95% CI 1-4.7, P=.03). A positive correlation was found between lesion size and diagnostic yield (R 0.18, P=.017). ROC analysis showed that lesions larger than 2.4 cm had a diagnostic specificity of 73% and sensitivity of 45% (AUC 0.61, P=.019). Conclusion: Our findings clearly revealed that ROSE enhances the diagnostic yield and procedural efficiency of EUS-FNA. This may be related to the high quality of smears prepared by the cytopathologist. Furthermore, larger lesion sizes were associated with higher diagnostic accuracy, particularly in pancreatic lesions.
