Endoscopic botulinum toxin injection in cricopharyngeal dysphagia

Botulinum toxin has been used to treat various gastrointestinal tract diseases such as achalasia, diabetic gastroparesis, sphincter of oddi dysfunction, and chronic anal fissures. Recently, it has also been used for the treatment of cricopharyngeal muscle dysfunction. Several studies have reported that botulinum toxin injections may be a safe and effective treatment. Previously, cricopharyngeal muscle dysfunction was treated by mechanical balloon dilation or cricopharyngeal myotomy. Here, we report a case of a 57-year-old man who presented with cricopharyngeal dysphagia due to cerebral infarction and who was successfully treated with endoscopic botulinum toxin injectionope

A Case of Abdominal Abscess Mimicking a Tumor Caused by a Perforated Gastric Ulcer

Gastric ulcer perforation usually results in panperitonitis, which requires surgical treatment. A peritoneal abscess also can occur with gastric ulcer perforation, but it is not a common complication of peptic ulcer disease. Here, we report a peritoneal abscess that mimicked a tumor and was caused by a gastric ulcer and provide a literature review. A 57-year-old woman was admitted to our hospital for evaluation of an abdominal mass found in another hospital, with no signs of infection. She underwent a left lobectomy of the liver due to choledocholithiasis. Abdominal computed tomography (CT) revealed a heterogeneous mass attached to the antrum of the stomach. At endoscopy, we confirmed that the gastric ulcer at the antrum of the stomach caused the abscess. After 4 weeks of antibiotics and proton pump inhibitor treatment, she was cured. In a patient with abdominal pain and a peritoneal abscess of unknown cause, the possibility of peptic ulcer perforation should be consideredope

Autoimmune Thyroiditis during Antiviral Therapy with Peginterferon

Combination treatment with pegylated interferon and ribavirin has been established as a standard therapy for chronic hepatitis C. Although interferon therapy is relatively safe, an important side effect is the induction of autoantibodies and autoimmune disease, especially autoimmune thyroid disease. Interferon associated autoimmune thyroid disease can consist of autoimmune hypothyroidism, Graves' disease, and destructive thyroiditis. Thyroid disease may lead to dose reduction or discontinuation of therapyope

The Relationship Between Gastric Myoelectric Activity and SCN5A Mutation Suggesting Sodium Channelopathy in Patients With Brugada Syndrome and Functional Dyspepsia - A Pilot Study

BACKGROUND/AIMS: SCN5A encodes the cardiac-specific Na(V)1.5 sodium channel, and Brugada syndrome is a cardiac conduction disorder associated with sodium channel α-subunit (SCN5A) mutation. The SCN5A-encoded Na(V)1.5 channel is also found on gastrointestinal smooth muscle and interstitial cells of Cajal. We investigated the relationship between functional dyspepsia (FD) and SCN5A mutation to evaluate sodium channelopathy in FD. METHODS: Patients with Brugada syndrome or FD were examined using upper endoscopy, electrogastrography (EGG), FD symptom questionnaire based on Rome III criteria and genetic testing for SCN5A mutation. Symptom scores of FD and EGG findings were analyzed according to SCN5A mutation. RESULTS: A total of 17 patients (4 Brugada syndrome and 13 FD) participated in the study. An SCN5A mutation was noted in 75.0% of the patients with Brugada syndrome and in 1 (7.7%) of the patients with FD. Of 4 patients with SCN5A mutation, 2 (50%) had FD. Postprandial tachygastria and bradygastria were noted in 2 (50%) and 1 (25%) of the patients with SCN5A mutation, respectively. The EGG findings were not significantly different between positive and negative mutation in 17 patients. CONCLUSIONS: Although we did not find statistically significant results, we suggest that it is meaningful to attempt to identify differences in symptoms and gastric myoelectric activity according to the presence of an SCN5A mutation by EGG analysis. The relationship between FD and sodium channelopathy should be elucidated in the future by a large-scale study.ope

Magnet Compression Anastomosis for Bilioenteric Anastomotic Stricture after Removal of a Choledochal Cyst: A Case Report

Magnet compression anastomosis is a nonsurgical method that uses two magnets to treat bilio-biliary and bilio-enteric anastomotic strictures after a living donor transplantation. The compression pressure of the two magnets induces ischemic necrosis at the anastomostic stricture and creates a fistula at the stricture site. A choledochal cyst is an uncommon congenital anomaly characterized by dilatation of the biliary tree and can cause obstructive jaundice, cholangitis, biliary stones, and cholangiocelluar carcinoma. Treatment for choledochal cyst is essentially surgical including total excision of the cyst with hepaticoenterostomy, but there can be complications such as postoperative intrahepatic stones and recurrent cholangitis due to a stricture at the site of the anastomosis. Endoscopic and fluoroscopy-guided radiologic interventions can be applied to resolve the anastomotic stricture, and re-operation is possible as the method of last resort. We report here a first case, trial magnet compression anastomosis in Korea of a bilioenteric anastomotic stricture after excision of a choledochal cyst and hepaticojejunostomy.ope

Factors Predictive of Adverse Events Following Endoscopic Papillary Large Balloon Dilation: Results from a Multicenter Series

BACKGROUND: Lack of established guidelines for endoscopic papillary large balloon dilation (EPLBD) may be a reason for aversion of its use in removal of large common bile duct (CBD) stones. AIMS: We sought to identify factors predictive of adverse events (AEs) following EPLBD. METHODS: This multicenter retrospective study investigated 946 consecutive patients who underwent attempted removal of CBD stones ≥10 mm in size using EPLBD (balloon size 12-20 mm) with or without endoscopic sphincterotomy (EST) at 12 academic medical centers in Korea and Japan. RESULTS: Ninety-five (10.0 %) patients exhibited AEs including bleeding in 56, pancreatitis in 24, perforation in nine, and cholangitis in six; 90 (94.7 %) of these were classified as mild or moderate in severity. There were four deaths, three as a result of perforation and one due to delayed massive bleeding. Causative factors identified in fatal cases were full-EST and continued balloon inflation despite a persistent waist seen fluoroscopically. Multivariate analyses showed that cirrhosis (OR 8.03, p = 0.003), length of EST (full-EST: OR 6.22, p < 0.001) and stone size (≥16 mm: OR 4.00, p < 0.001) were associated with increased bleeding, and distal CBD stricture (OR 17.08, p < 0.001) was an independent predictor for perforation. On the other hand, balloon size was associated with deceased pancreatitis (≥14 mm: OR 0.27, p = 0.015). CONCLUSIONS: EPLBD appears to be a safe and effective therapeutic approach for retrieval of large stones in patients without distal CBD strictures and when performed without full-EST.ope