Duodenojejunal Intussuspection Caused by a Solitary Peutz Jeghers Type Hamartomatous Polyp

Background: Peutz Jeghers syndrome is a rare autosomal dominant disorder characterized by hamartomatous polyps and characteristic mucocutaneous pigmentation. Solitary hamartomatous polyp has been considered a variant or separate disease entity without the features Peutz Jeghers syndrome. Such hamartomatous polyps occur predominantly in the small bowel, colon and stomach and the rarely arise from the appendix. These polyps are characterized by hyperplastic epithelia and by the proliferation of smooth muscle bundles around the mucosal glands. As compared with Peutz Jeghers syndrome, Peutz Jeghers type hamartomatous polyps are diagnosed with a lower risk of cancer. Methods: We report an experience of a solitary hamartomatous polyp in distal part of duodenum, that led to bowel intussusception. Results: A 24 yearold woman presented of long term epigastric pain and abdominal dyscomfort. On physical examination the abdomen was nontender and without palpable masses, vital signs of patient were normal. Mucocutaneous pigmentaion of the perioral region, buccal mucosa, hands and feet was absent. Patient had no family history of Peutz Jeghers syndrome. Standart laboratory tests were unremarkable. Abdominal computed tomography revealed a intussusception of distal part duodenum into the jejunum with suspicion of intraluminal expansion. We perform esophagogastroduodenoscopy. Examination demonstrated pedunculated polyp, measuring 50 mm in diameter. We performed endoscopic polypectomy, our procedure was without complications. Histological examination showed hamartomatous polyp. The patient underwent colonoscopy and examination of small bowel with no evidence other polyps. Conclusions: We described a patient wit a large Peutz Jeghers polyp, that obstructed small bowel. The incidence of sporadic Peutz Jeghers polyps is low. We miss more facts about a lifelong risk of cancer in patients with Peutz Jeghers polyps, but is necessary to perform consistent screening for excluding possible malignancies. PS 0218 Gastroenterology


Case Report : Infl ammatory Fibroid Polyp Invading Proper Muscle Layer
Background: Infl ammatory fi broid polyp (IPF) is localized proliferation disease in gastrointestinal tract. Recently, IPF has been detected more frequently as the use of endoscopy is increased. The histologic feature is mostly limited submucosa, no invasion of muscle layer. We report case of IPF invading proper muscle layer.

Case:
A 62 year old male without specific medical history, complained epigastric pain during 3 monthes. His blood laboratory test result is normal except Hb 7.5mg/ dL. His physical examination presents palpable epigastric mass and pale conjunctiva. His endoscopy remarks 10cm sized polypoid mass has stalk originating posterior wall of mid antrum. Initial Biopsy pathology reported necrotic infl ammatory exudate with granulation tissue formation and spindle cells proliferation. And CT stomach reported Stomach origin subcutaneous mass to stomach antum herniation. So we initially suggested gastrointestinal stromal tumor (GIST). We performed laparoscopic resection of stomach and fi nal pathologic diagnosis is infl ammatory fi broid polyp, invading proper muscle layer.

Conclusions:
We don't know exactly why IPF in stomach is limited submucosa. IPF in other GI tract often invading muscle layer. Stomach IPF has more symptoms and frequent endoscopy increase diagnosis rate. So huge sized stomach IPF is rare. We suggest stomach IPF is mostly limited submucosa, because it was related mass size.

Endoscopic Mucosal Resection in the Treatment of High Grade Dysplasia's and T1 Tumours of the Oesophagus
Harshadkumar RAJGOR 1 , Jeff BUTTERWORTH 1

Royal Shrewsbury Hospital, UK 1
Background: Barretts oesophagus increases the risk of developing oesophageal adenocarcinoma. Over the last 40 years there has been a 6 fold increase in the incidence of oesophageal adenocarcinoma and the incidence rates are increasing at a greater rate than cancers of the colon, breast and lung. Endoscopic mucosal resection is a relatively new technique being used by 2 centres in the greater midlands cancer network. EMR can be used for curative or staging purposes, for high grade dysplasia's and T1 tumours of the oesophagus. EMR is also suitable for those who are deemed high risk for oesophagectomy EMR has a recurrence rate of 21%. Methods: A retrospective study of prospectively collected data was carried out involving 24 patients who had EMR for curative or staging purposes. Data was collected on effective communication with patients regarding diagnosis and treatment, continuity of care and the use of multidisciplinary teams in managing these patients. The long term effi cacy, cost and complication rates of EMR were considered. Complications included suspicion of residual or recurrent disease that required further treatment with radio frequency ablation. Results: 92% of patients had a confirmed pathological diagnosis prior to endoscopic therapy or oesophagectomy. In 54% of cases residual or recurrent disease was suspected. Conclusions: EMR is a safe and effective treatment for patients who have high grade dysplasia and T1NO tumours. In 54% of cases residual or recurrent disease was suspected. These fi gures are most likely due to the technical skills of the endoscopist and the variability of results depending on endoscopist experience. Initially multiple resection attempts were carried out to reduce the risk of complications such as oesophageal perforation. As familiarity with the EMR increased the recurrence rate of disease was signifi cantly reduced. Background: Endoscopic submucosal dissection (ESD) is one of the therapeutic modalities for early gastric cancer. After the ESD, synchronous or metachronous lesions occur in some cases. Agent Orange (AO) is an herbicide used in the Vietnam War to defoliate forest areas. Many Korean veterans who participated in the war were exposed to it. But the infl uence of the material to stomach cancer remained uncertain. So, we investigate the infl uence of AO to the synchronous or metachronous gastric cancer in patients treated by ESD. Methods: From January 2008 to December 2012, 87 male early gastric cancer patients, including 38 AO exposure veterans, treated by ESD and followed up more than 12 months were enrolled, retrospectively. All patients were checked by gastrofi berscope and CT scan regularly for recurrence. Synchronous and metachronous lesion were defi ned as a new lesion found within 1 year and a new lesion found after 1 year of primary ESD treatment. We analyzed the relationship between the synchronous and metachronous lesion occurrence and the clinical characteristics including AO exposure. Results: The median age was 70 (52-85) and the medial follow-up duration was 25 months (12-63). Overall, synchronous lesion incidence rate was 4.6% (4 cases) and metachronous lesion incidence rate was 11.5% (10 cases). In analysis, the metachronous lesion incidence rate was higher in old age group (=65), statistically (0% vs. 14.5%, p <0.05). Otherwise, there was no relationship between the synchronous or metachronous gastric cancer occurrence and other clinical characteristics such as AO exposure, the tumor size, location, histologic and tumor type. Conclusions: Old age is suggested as a risk factor of the metachronous early gastric cancer. It is suggested that there was no infl uence of AO exposure to the synchronous and metachronous gastric cancer.