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Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 43 year old male patient has a barium swallow and meal study. You are asked to review the images by a junior colleague. There is swift passage of contrast to the stomach with normal oesophageal outline and no gastro-oesophageal reflux. The stomach distends well. Gastric folds at the fundus measure 15 mm in thickness and 6 mm in the prepyloric region of the stomach. No gastric wall irregularity is identified and there is evidence of rapid gastric emptying.
Lymphoma
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Sarah J Vinnicombe, Rodney J Hicks
Primary lymphoma of the stomach accounts for about 2%–5% of gastric tumours (93) and the incidence appears to be rising. Pathologically, the commonest subtypes are DLBCL and MALT type lymphomas. In DLCBL, the radiological appearances reflect the gross pathological findings: common appearances are multiple large nodules, some with central ulceration, seen readily at endoscopy or barium meal, or a large fungating lesion. About 30% of cases present with diffuse infiltration and marked mural thickening, occasionally with luminal narrowing, sometimes extending into the duodenum (Figure 25.24). It may be indistinguishable from scirrhous carcinoma. Localized polypoid forms have also been described (94). In only around 10% does diffuse enlargement of the gastric folds occur (Figure 25.25), similar to that seen in hypertrophic gastritis. As the disease originates in the submucosa, these features are best demonstrated endoscopically or on barium studies, but these fail to show the extent of the disease. CT often shows extensive gastric mural thickening and locoregional nodal enlargement. Unlike gastric carcinoma, perigastric fat planes generally remain intact (Figure 25.26) (95). Demonstration of retroperitoneal nodal enlargement below the renal hila also favours a diagnosis of lymphoma rather than carcinoma.
Techniques of UGI endoscopy and normal anatomy
Published in Mohammad Ibrarullah, Atlas of Diagnostic Endoscopy, 2019
Z line represents the junction of pale squamous epithelium of the esophagus with the pink columnar epithelium of the stomach. This also marks the most proximal extent of the gastric folds. The junction may not be quite apparent when it lies at the level of diaphragmatic indentation (arrow in Figure 1.10a). In most cases, however, the junction can be made out clearly.
Endoscopic measurement of hiatal hernias: is it reliable and does it have a clinical impact? Results from a large prospective database
Published in Postgraduate Medicine, 2023
Charles Christian Adarkwah, Oliver Hirsch, Merlissa Menzel, Joachim Labenz
Hiatal hernias were measured both endoscopically and manometrically. Endoscopy and HRM were performed by different investigators unaware of the result of the other method. During endoscopy, the longitudinal extent of a hiatal hernia was measured at the end of the procedure after deflation of the stomach as the distance between the top of gastric folds and the diaphragmatic impression. Data collected during EGD include the presence of erosive esophagitis (ERD) according to the Los Angeles Classification [18,19], presence and extent of metaplasia in the distal esophagus according to the Prague classification system [20], hernia size in centimeters, and any focal abnormalities. Routine biopsy samples obtained from the duodenum, the stomach, the Z-line, and the tubular esophagus were analyzed by an experienced pathologist as were biopsies from suspected Barrett’s metaplasia and other focal findings. Due to the use of pH impedance measurement, the percentage of time (%) with pH < 4 (AET, acid exposure time) in both upright and supine positions, as well as the symptom-associated probability (SAP), was examined and noted. In addition, the DeMeester score and the number of acid and nonacid reflux events were determined. Resting pressure, lower esophageal sphincter relaxation, hernia size (in cm), and esophageal motility disorders were measured by high-resolution manometry (HRM) according to the Chicago classification [21,22].
Diagnostic performance of endoscopy for subsquamous extension of superficial adenocarcinoma of the esophagogastric junction
Published in Scandinavian Journal of Gastroenterology, 2023
Kazunori Takada, Yohei Yabuuchi, Tatsunori Minamide, Yoichi Yamamoto, Masao Yoshida, Yuki Maeda, Noboru Kawata, Kohei Takizawa, Yoshihiro Kishida, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Hiroyuki Ono
All white-light endoscopic images, chromoendoscopy images following dyeing with indigo carmine, and narrow-band images with and without magnifying endoscopy were reviewed. Gastric atrophy (no atrophy, closed type or open type), longitudinal location (tumor center above, on or below the EGJ), circumferential location (anterior wall, right wall, posterior wall, left wall or circumferential), tumor size, macroscopic type (flat type, 0-IIa and 0-IIb; depressed type, 0-IIc and 0-IIa + IIc; and protruded type, 0-I and 0-I + IIa), and the presence of Barrett’s esophagus were evaluated. Gastric atrophy was diagnosed as the presence of a pale color, increased visibility of the mucosal vessels and a loss of the gastric folds [23] and subclassified according to the Kimura-Takemoto classification system [24]. The Helicobacter pylori (H. pylori) infection status was evaluated using H. pylori IgG antibody testing (cut-off value: 10 U/mL). Data on medication with proton pump inhibitor (PPI) were collected. Barrett’s esophagus was defined as an endoscopically-confirmed columnar epithelial metaplasia continuously extending from the stomach to the esophagus [25].
Upper gastrointestinal bleeding as the initial manifestation of gastroenteropancreatic neuroendocrine tumors
Published in Baylor University Medical Center Proceedings, 2021
Thanita Thongtan, Anasua Deb, Sameer Islam, Kenneth Nugent
GEP-NETs have been rarely implicated in upper GI bleeding, accounting for only 0.18% in one study,6 including NETs of pancreatic,7–9 gastric,10 and small intestine origin.11 Gastric and ileal NETs have led to massive hematemesis and melena, respectively. Pancreatic NETs have contributed to upper GI bleeding from either gastric metastasis in the form of an ulcerative mass7 or from gastric varices resulting from local invasion of the splenic vein by the infiltrating tumor.8,9 Gastric metastases from pancreatic NETs have resulted in large ulcerative masses in the cardia of the stomach infiltrating into the muscularis propria along with diffuse thickening and congestion of gastric folds.8 Our patient likely developed GI bleeding from an infiltrating ulcerated mass in the gastric antrum and pylorus.