Case Presentation

A 58-year-old woman with chronic, progressive anemia was referred to our hospital by a local physician. Capsule endoscopy revealed a bleeding polyp-like lesion around the jejunoileal junction. Double-balloon endoscopy performed through the mouth showed an erythematous subpedunculated polyp 5 mm in diameter near the upper ileum (Fig. 11.3.1a). After saline injection, EMR was performed. The polyp was resected without considerable bleeding or other complications, and the site was marked with India ink (Fig. 11.3.1b) [3].

Jejunoileal Junction

Fig. 11.3.1. Case 1 a Polyp 5 mm in diameter b After resection, a tattoo was placed rostral to the lesion

Fig. 11.3.1. Case 1 a Polyp 5 mm in diameter b After resection, a tattoo was placed rostral to the lesion

A 69-year-old man with previous Roux-en-Y reconstruction for gastric cancer was referred for investigation of eosinophilia and chronic diarrhea. The double-balloon endoscope advanced through the Roux-en-Y anastomosis to the blind end of the afferent loop. In addition to the papilla of Vater, a protruding lesion was found at the blind end of the afferent loop (Fig. 11.3.2a,b). Biopsy findings suggested adenocarcinoma. Thus, double-balloon endoscopy was repeated for EMR. A 70-cm short overtube was advanced to the lesion of interest and secured in place (Fig. 11.3.2d-1,2d-2). The endoscope was removed with the overtube left in place, and a thin upper endoscope with a larger forceps channel was inserted (Fig. 11.3.2d-3,2d-4). After saline injection, EMR was performed (Fig. 11.3.2c). The pathology examination led to a diagnosis of well-differentiated adenocarcinoma (IIa, sm1) with clear margins [4]. The patient was treated with the EN-450P5 before development of the EN-450T5; the use of the EN-450T5 obviates switching endoscopes.

Colonoscopy Looping Perforation

a Protruding lesion in the blind end of the afferent loop b Close-up of the lesion in a c Endoscopic mucosal resection of the entire lesion d Technical procedure

a Protruding lesion in the blind end of the afferent loop b Close-up of the lesion in a c Endoscopic mucosal resection of the entire lesion d Technical procedure b a c d

â–  References

1. Ono H (2002) Treatment of perforation occurring during EMR for gastroduodenal disease. Endosc Dig 2:187-192

2. Yamamoto H (2002) Complications of endoscopic treatment—perforations during therapeutic colonoscopy. Early Colorectal Cancer 6:129-134

3. Kita H, Yamamoto H, Nakamura T, et al (2005) Bleeding polyp in the mid small intestine identified by capsule endoscopy and treated by double-balloon endoscopy. Gastrointest Endosc 61:628-629

4. Kuno A, Yamamoto H, Kita H, et al (2004) Application of double-balloon enteroscopy through Roux-en-Y anastomosis for the endoscopic mucosal resection of an early carcinoma in the duodenal afferent limb. Gastrointest Endosc 60:1032-1034

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