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Gastric Polyps Leading to Occult Blood Loss

Nishant Aggarwal, Rabin Neupane, and Ketan Rana

Publication Date: 10-2022

Introduction

In patients presenting with iron deficiency anemia, blood loss must be considered as an etiology. This is especially important in patients who are planned to undergo invasive procedure or need to be on antiplatelets or anticoagulation.

Discussion

Gastric polyps are noted to be present in 6% of EGDs, and are mostly incidentally detected. Many gastric polyps have similar endoscopic appearances and some of them have malignant potential, hence histolopathology is important. Gastric hyperplastic polyps are strongly associated with inflammatory disorders such as chronic gastritis, H. pylori gastritis, and pernicious anemia.1 Other gastric polyps: – Fundic gland polyps – Adenomatous polyps: High malignant potential – Gastric neuroendocrine tumors – Inflammatory fibroid polyps

Conclusion

Occult blood loss must be considered in differential diagnosis for new onset iron deficiency anemia. Even though gastric polyps may be incidentally detected, histopathology is important to rule out malignancy.
Cap polyposis: an unusual cause of rectal bleeding in a young patient

Inayat Gill, Nishant Aggarwal, Mitual Amin, and Atulkumar Patel

Publication Date: 10-2022
Colonoscopy-Induced Transient Mobitz Type 1 Block

Inayat Gill, Samiksha Pandey, and Atulkumar Patel

Publication Date: 10-2022

• Propofol is a commonly used anesthetic in endoscopic procedures. • It can prolong the AV conduction through vagal stimulation leading to AV block. • We report a unique case of a healthy female undergoing a routine screening colonoscopy who developed a Mobitz type I block, in which propofol was the sole agent used for sedation.
Gangliocytic Paraganglioma: incidental presentation of a rare gastrointestinal stromal tumor

Claire Hamman and Mariquit Sendelbach

Publication Date: 5-2022

• Gangliocytic paraganglioma (GP) is an extremely rare gastrointestinal stromal tumor frequently found in the second portion of the duodenum1 . • GP can present as an obstructive process, in the setting of abdominal pain, gastrointestinal bleeding, or incidentally. • In this case, we describe an 80 year old female with finding of an incidental GP during endoscopic retrograde cholangiopancreatography
PEG Tube: Dealing With Transcolonic Misplacement

Marko Kozyk, Kateryna Strubchevska, and Mihaela Batke

Publication Date: 10-2022

Introduction

Percutaneous endoscopic gastrostomy (PEG) tube acts as the favorable route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition, generally beyond 4 weeks. As PEG tube provides direct percutaneous access to the stomach, another indication for PEG placement includes stomach decompression. PEG tube placement is a relatively safe procedure; however, complications sometimes occur.

Discussion

Complications of PEG: • Hemorrhage • Aspiration • Inflammation • Infections • Misplacement • Formation of fistulas Misplacement results from juxtaposition of the colon between the stomach and the skin during the PEG insertion, resulting in a feeding tube passing through the colon, usually the transverse colon, before being anchored in the stomach.

Prevention of PEG-tube misplacement: • Adequate air insufflation of the stomach can help prevent this complication by displacing the colon away from the path of the PEG tube

Management of PEG tube misplacement: • Surgical (in the presence of peritonitis) • Endoscopic (in the absence of peritonitis) • Percutaneous removal of the tube may result in stercoral peritonitis or colocutaneous fistula.
Endoscopic Management of Migrated Pancreatic Stent into Hepaticojejunostomy Causing Acute Pancreatitis

Samiksha Pandey, Andrew Aneese, Shailesh Niroula, and Laith H. Jamil

Publication Date: 10-2022

• Trans-anastomotic pancreatic stents after the pancreatoduodenectomy are placed to decrease the complications, maintain ductal patency and support healing of the anastomosis. • Complications of migration of trans-anastomotic stent from the pancreatojejunostomy (PJ) through the hepaticojejunostomy (HJ) is rare. • We present a case of acute pancreatitis in the setting of pancreatic duct (PD) stent migration into the biliary tree in a patient who had previously undergone pancreaticoduodenectomy.
Gastrointestinal Kaposi Sarcoma: A Case Report

Samiksha Pandey, Shailesh Niroula, Rabin Neupane, Gaurav Kakked, and Naveen Reddy

Publication Date: 10-2022

• Kaposi sarcoma (KS) in the gastrointestinal (GI) tract is an uncommon entity specially without any cutaneous manifestation since the introduction of HAART therapy in HIV patients. • Most of the gastrointestinal KS, remains undiagnosed as majority of KS is asymptomatic.(1) Here we present a case of GI- KS in a HIVAIDS patient.
Risk Factors of Clostridium Difficile Infection in Helicobacter Pylori Diagnosed Patients: A Multicenter Study

Samiksha Pandey, Tamera Tennant, Ashbina Pokharel, Andrew Aneese, and Alexandra Halalau

Publication Date: 10-2022

• Clostridium difficile infection (CDI) is one of the most common gastrointestinal illnesses. • There are conflicting studies regarding the association of CDI with Helicobacter Pylori (H. pylori) treatment regimens.1-3 • Our aim is to investigate the risk of CDI in those treated for H. pylori as well as characterize other risk factors for developing CDI.