Gastric Miscellaneous ,El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Extrinsic compression due to malign ascites. This 34 year-old male that, two years previously was diagnosed as having colon cancer, now present a severe abdominal bulking due to a malign ascites.

Video Endoscopic Sequence 1 of 10.

Extrinsic compression due to malign ascites

 This 34 year-old male that, two years previously was
 diagnosed as having colon cancer, now present a severe
 abdominal bulking due to a malign ascites. 

 For more endoscopic details download the video clips by
 clicking on the endoscopic images, wait to be downloaded
 complete then press Alt and Enter; thus you can observe
 the video in full screen.

 All endoscopic images shown in this Atlas contain
 video clips.
At the gastric fundus is observed two extrinsic compression

Video Endoscopic Sequence 2 of 10.

 At the gastric fundus is observed two extrinsic compression
In order to relief the ascites a transgastric procedure was performed, first a pre-cut needle was used through an duodenoscope..

Video Endoscopic Sequence 3 of 10.

 In order to relief the ascites a transgastric procedure was
 performed, first a pre-cut needle was used through an
 duodenoscope.

After the gastric walls was opened a hydrostatic balloon was used to dilate the small hole.

Video Endoscopic Sequence 4 of 10.

 After the gastric walls was opened a hydrostatic balloon
 was used to dilate the small hole.

The gastric wall was open using a sphincterotome, the video clip shows the ascites draining across the gastric wall, the Intra-abdominal pressure was relief.

Video Endoscopic Sequence 5 of 10.

 The gastric wall was open using a sphincterotome, the video
 clip shows the ascites draining across the gastric wall, the
 Intra-abdominal pressure was overcome.
A pulsatile bleeding emerging from the gastric wall.

Video Endoscopic Sequence 6 of 10.

A pulsatile bleeding emerging from the gastric wall.

 
To perform the hemostasis the argon plasma coagulator was used combined with the absolute alcohol.

Video Endoscopic Sequence 7 of 10.

 To perform the hemostasis the argon plasma coagulator
 was used combined with the absolute alcohol.
Injection therapy with absolute alcohol.

Video Endoscopic Sequence 8 of 10.

 Injection therapy with absolute alcohol.
After the gastric wall is open, a transgastric endoscopic access of the peritoneal cavity is seen in the video clip.

Video Endoscopic Sequence 9 of 10.

 After the gastric wall is open, a transgastric endoscopic
 access of the peritoneal cavity is seen in the video clip.

 

 
A Tran gastric periteneoscopy, a part of the peritoneal cavity is observed. This transgastric periteneoscopy, is one of the first performed in a human beings.

Video Endoscopic Sequence 10 of 10.

A transgastric periteneoscopy, a part of the peritoneal
 cavity is observed.

 
Gastric Carcinoid Tumor. Carcinoids are the most common neuroendocrine tumors. The tumor is derived from primitive stem cells in the gut wall but can be seen in the liver, pancreas, bronchus, and ovaries. In children, most cases occur in the appendix, and most are benign and asymptomatic.

Video Endoscopic Sequence 1 of 8.

Gastric Carcinoid Tumor.

 Carcinoids are the most common neuroendocrine tumors.
 The tumor is derived from primitive stem cells in the gut
 wall but can be seen in the liver, pancreas, bronchus, and
 ovaries. In children, most cases occur in the appendix, and
 most are benign and asymptomatic.
Gastric Carcinoid Tumor. These tumors have a yellow, tan, or gray-brown appearance that can be observed through the intact mucosa. The yellow color is a result of cholesterol and lipid accumulation within the tumor. Tumors can have a polypoid appearance and occasionally can ulcerate.

Video Endoscopic Sequence 2 of 8.

Gastric Carcinoid Tumor.

 These tumors have a yellow, tan, or gray-brown appearance
 that can be observed through the intact mucosa. The yellow
 color is a result of cholesterol and lipid accumulation within
 the tumor. Tumors can have a polypoid appearance and
 occasionally can ulcerate.

 Similar images of Duodenal Carcinoid Tumor are found in
 duodenal miscellaneous chapter.

Gastric Carcinoid Tumor.

Video Endoscopic Sequence 3 of 8.

Gastric Carcinoid Tumor.
Gastric Carcinoid Tumor. Indigo Carmin Stain.

Video Endoscopic Sequence 4 of 8.

Gastric Carcinoid Tumor.

Indigo Carmin Stain.
Cromogranina.

Video Endoscopic Sequence 5 of 8.

  Cromogranina.

 
Gastric Carcinoid Tumor. At low power there is an intramucosal neoplasia.

Video Endoscopic Sequence 6 of 8.

4x.

 Gastric Carcinoid Tumor.

 At low power there is an intramucosal neoplasia.

 
Carcinoid Tumor. At medium power the organoid neoplasia replace the gastric glands. carcinoid tumor.

Video Endoscopic Sequence 7 of 8.

  10x.

Carcinoid Tumor.

 At medium power the organoid neoplasia replace the
 gastric glands. carcinoid tumor.

 
40x. The appendix is the most common site of gut carcinoid tumor, followed by the small intestine, rectum, stomach and ileum. Carcinoid tumor are potentially malignant and the tendency of malignant behavior correlate with the site of origin, the depth of local penetration and the size of the tumor.

Video Endoscopic Sequence 8 of 8.

40x.

 The appendix is the most common site of gut carcinoid
 tumor, followed by the small intestine, rectum, stomach and
 ileum.
 Carcinoid tumor are potentially malignant and the tendency
 of malignant behavior correlate with the site of origin, the
 depth of local penetration and the size of the tumor.

Gastric Angiodysplasia. This 91-year old lady had medical history of has multiple hospitalizations due to upper gastrointestinal bleeding.

Video Endoscopic Sequence 1 of 2.

Gastric Angiodysplasia

 This 91-year old lady had medical history of has multiple
 hospitalizations due to upper gastrointestinal bleeding

 Angiodysplasia is ectasia of intestinal submucosal veins
 and overlying mucosal capillaries. Lesions occur most often
 in the stomach, followed by the duodenum. Most lesions
 are less than 10mm in size, and multiple lesions are
 frequent. Concomitant lesions in the colon occur in 1/3 of
 cases. Anatomic clustering of acquired or sporatic
 angiodysplasia is a well described observation.

 
Gastric angiodysplasia is associated with several systemic diseases, most notably hereditary hemorrhagic telangiectasia (HHT), or Rendu-Osler-Weber syndrome.

Video Endoscopic Sequence 2 of 2.

 The endoscopic image as well as the video clip show
 multiple angiodysplasias

 Gastric angiodysplasia is associated with several systemic
 diseases, most notably hereditary hemorrhagic
 telangiectasia (HHT), or Rendu-Osler-Weber syndrome.

 The first approach to therapy should be to replace and
 maintain iron. Endoscopic control of bleeding lesions
 (sclerotherapy, contact probes, and lasers) is well
 described but the recurrent bleeding rate is high.

 

 
.Gastric Angiodysplastic lesions and argon plasma coagulation treatment. Gastric Angiodysplastic lesions may be encountered at any location, but they tend to occur primarily within the corpus. The tree images and video display ablative therapy with argon plasma coagulation APC.

Video Endoscopic Sequence 1 of 3.

 Gastric Angiodysplastic lesions and argon plasma
 coagulation treatment.

 Gastric Angiodysplastic lesions may be encountered at
 any location, but they tend to occur primarily within the
 corpus. The tree images and video display ablative
 therapy with argon plasma coagulation APC.

Gastric Angiodysplastic lesions with argon plasma coagulation treatment. Argon plasma coagulation (APC) is a method ofcauterizing the vascular abnormality using a non-contact probe.

Video Endoscopic Sequence 2 of 3.

 Gastric Angiodysplastic lesions with argon plasma
 coagulation treatment.
 Argon plasma coagulation (APC) is a method ofcauterizing
 the vascular abnormality using a non-contact probe.

.Gastric Angiodysplastic lesions with argon plasma coagulation treatment. Argon Plasma Coagulation has been used for more than 10 years in open surgery, laparoscopy and Thoracoscopy, especially for hemostasis of large surface bleeding. It conducts monopolar electrosurgical current to tissue via an ionized argon gas stream (argon plasma).

Video Endoscopic Sequence 3 of 3.

 Gastric Angiodysplastic lesions with argon plasma
 coagulation treatment.
 Argon Plasma Coagulation has been used for more than 10
 years in open surgery, laparoscopy and Thoracoscopy,
 especially for hemostasis of large surface bleeding. It
 conducts monopolar electrosurgical current to tissue via an
 ionized argon gas stream (argon plasma).
 
Foreign body of the stomach that resemble a snake. from time to time the endoscopist get some surprise performing a gastrointestinal endoscopy. 30 year-old woman that had been complaining of severe halitosis that is worse in the morning. The endoscopy was performed in 1990 with the old fiber optics endoscopes (Olympus pre-oes 1T). Therefore the video clips are dark.

Video Endoscopic Sequence 1 of 3.

 Foreign body of the stomach that resemble a snake.
 from time to time the endoscopist get some surprise
 performing a gastrointestinal endoscopy.
 30 year-old woman that had been complaining of severe
 halitosis that is worse in the morning.
 The endoscopy was performed in 1990 with the old
 fiber optics endoscopes (Olympus pre-oes 1T).
 Therefore the video clips are dark.
 
  
We observed the shape that resemble a snake?s head. Most swallowed foreign bodies pass harmlessly through the gastrointestinal (GI) tract. Foreign bodies that damage the GI tract, become lodged, or have associated toxicity must be identified and removed.

Video Endoscopic Sequence 2 of 3.

 We observed the shape that resemble a snake’s head.

 Most swallowed foreign bodies pass harmlessly through
 the gastrointestinal (GI) tract. Foreign bodies that damage
 the GI tract, become lodged, or have associated toxicity
 must be identified and removed.
 

A tooth brush that was found in her stomach. Impacted foreign bodies . A foreign body lodged in the GI tract may cause local inflammation leading to pain, bleeding, scarring, and obstruction, or it may erode through the GI tract. Migration from the esophagus most often leads to mediastinitis but may involve the lower respiratory tract or aorta and create an aortoenteric fistula. Migration through the lower GI tract may cause peritonitis.

Video Endoscopic Sequence 3 of 3.

 A tooth brush that was found in her stomach.

 Impacted foreign bodies.

 A foreign body lodged in the GI tract may cause local
 inflammation leading to pain, bleeding, scarring, and
 obstruction, or it may erode through the GI tract.
 Migration from the esophagus most often leads to
 mediastinitis but may involve the lower respiratory tract or
 aorta and create an aortoenteric fistula. Migration through
 the lower GI tract may cause peritonitis.

Heterotopic Pancreas with large central hole. Heterotopic Pancreas, due to the hole, as the diameter is not usual in the heterotopic pancreas, some biopsies were obtain from the submucosa which was demonstrated by histology that is a pancreas tissue.

Video Endoscopic Sequence 1 of 6.

Heterotopic Pancreas with large central hole.

 Heterotopic Pancreas, due to the hole, as the diameter is
 not usual in the heterotopic pancreas, some biopsies were
 obtain from the submucosa which was demonstrated by
 histology that is a pancreas tissue.
Heterotopic pancreas is an uncommon but not an exceedingly rare finding. Most of the time, the heterotopic pancreas is usually small (1 cm to 3 cm in size) and located in the antrum. Pancreatic rests are often discovered incidentally . Despite the observation that most cases of heterotopic pancreas do not cause problems, the condition has been reported to lead to symptoms from inflammation, obstruction, or even malignant transformation. Smaller rests have been removed using endoscopic techniques, primarily to secure a diagnosis, as the smaller tumors are often asymptomatic.

Video Endoscopic Sequence 2 of 6.

 Heterotopic pancreas is an uncommon but not an
 exceedingly rare finding. Most of the time, the heterotopic
 pancreas is usually small (1 cm to 3 cm in size) and located
 in the antrum. Pancreatic rests are often discovered
 incidentally.

 Despite the observation that most cases of heterotopic
 pancreas do not cause problems, the condition has been
 reported to lead to symptoms from inflammation,
 obstruction, or even malignant transformation. Smaller
 rests have been removed using endoscopic techniques,
 primarily to secure a diagnosis, as the smaller tumors are
 often asymptomatic.

The biopsies were obtain from the submucosa , Although malignant transformation has been reported, this appears to be uncommon enough that recommendations on follow up probably should be based on symptoms. With the abuse of alcohol has been reported "gastric pancreatitis."

Video Endoscopic Sequence 3 of 6.

The biopsies were obtain from the submucosa

 Although malignant transformation has been reported, this
 appears to be uncommon enough that recommendations on
 follow up probably should be based on symptoms.

 With the abuse of alcohol has been reported "gastric pancreatitis."

Low power view of gastric heterotopic pancreas.

Video Endoscopic Sequence 4 of 6.

Low power view of gastric heterotopic pancreas
( Acinar pancratic tissue at the left.

Video Endoscopic Sequence 5 of 6.

 Acinar pancratic tissue at the left
High power detail of the heterotopic pancreas.

Video Endoscopic Sequence 6 of 6.

High power detail of the heterotopic pancreas
PancreasAbarrarnte. The majority of the patients are asymptomatic and the lesion is diagnosed incidentally. Heterotopic pancreas is defined as pancreatic tissue outside the boundaries of the pancreas that lacks anatomic and vascular continuity to this organ. Heterotopic pancreas is a relatively infrequent lesion. The pathogenesis of this lesion is unknown; it is believed to arise during embryonic development of the gastrointestinal tract. The normal pancreas is derived from several evaginations originating from the wall of the primitive duodenum. During embryogenesis, if one or more evaginations remain in the wall of the bowel, then it may be carried away from the remainder of the gland by the developing gastrointestinal tract and may give rise to heterotopic pancreas.

Heterotopic Pancreas

 The majority of the patients are asymptomatic and the
 lesion is diagnosed incidentally.

 Heterotopic pancreas is defined as pancreatic tissue
 outside the boundaries of the pancreas that lacks anatomic
 and vascular continuity to this organ. Heterotopic pancreas
 is a relatively infrequent lesion.

 The pathogenesis of this lesion is unknown; it is believed to
 arise during embryonic development of the gastrointestinal
 tract. The normal pancreas is derived from several
 evaginations originating from the wall of the primitive
 duodenum. During embryogenesis, if one or more
 evaginations remain in the wall of the bowel, then it may be
 carried away from the remainder of the gland by the
 developing gastrointestinal tract and may give rise to
 heterotopic pancreas.
Pancreatic Heterotopia. Antral nodule with typically central depression and intact overlying, antral mucosa, the submucosa is the most frequent location, both exocrine and endocrine pancreatic tissue may comprise the lesion. The most distinctive heterotopic lesions occurs in the antrum. Ectopic pancreas generally has a typical apical dimple characteristic of this lesion. A rudimentary ductal system may empty into this depression.

Pancreatic Heterotopia.

 Antral nodule with typically central depression and intact
 overlying, antral mucosa, the submucosa is the most
 frequent location, both exocrine and endocrine pancreatic
 tissue may comprise the lesion.
 The most distinctive heterotopic lesions occurs in the
 antrum. 
 Ectopic pancreas generally has a typical apical dimple
 characteristic of this lesion. A rudimentary
 ductal system may empty into this depression.
Watermelon Stomach, longitudinal erythymatous stripes that formed lines within the antrum radiating towards the pylorus resembling the stripes of a watermelon and hence the name gastric antral vascular ectasias (GAVE), or watermelon stomach.

Video Endoscopic Sequence 1 of 7.

Watermelon Stomach

 longitudinal erythymatous stripes that formed lines within
 the antrum radiating towards the pylorus resembling the
 stripes of a watermelon and hence the name gastric antral
 vascular ectasias (GAVE), or watermelon stomach.

 
Treatment of watermelon stomach (GAVE syndrome) with endoscopic argon plasma coagulation (APC). The diagnosis is based on the endoscopic findings. The typical lesions have longitudinal rugal folds traversing the antrum and converging on the pylorus, each containing a visible convoluted column of vessels, the aggregate resembling the stripes of a watermelon. Although these lesions are confined to the antrum in the majority of cases, up to 33% of the patients have proximal gastric involvement typically in the presence of a diaphragmatic hernia. It is important to emphasize, however, that these lesions might be misdiagnosed as gastritis or portal gastropathy and thus delay in treatment could result.

Video Endoscopic Sequence 2 of 7.

 Treatment of watermelon stomach (GAVE syndrome) with
 endoscopic argon plasma coagulation (APC).

 The diagnosis is based on the endoscopic findings. The
 typical lesions have longitudinal rugal folds traversing the
 antrum and converging on the pylorus, each containing a
 visible convoluted column of vessels, the aggregate
 resembling the stripes of a watermelon. Although these
 lesions are confined to the antrum in the majority of cases,
 up to 33% of the patients have proximal gastric
 involvement typically in the presence of a diaphragmatic
 hernia. It is important to emphasize, however, that these
 lesions might be misdiagnosed as gastritis or portal
 gastropathy and thus delay in treatment could result.
Watermelon stomach is an increasingly recognizable cause of persistent acute or occult gastrointestinal bleeding, especially in elderly women. The chief presentation is severe iron deficiency anemia and occult or overt gastrointestinal bleeding. Diagnosis is made on endoscopy by the characteristic appearance of visible watermelon linear stripes in the antrum. Histology is rarely needed to confirm the diagnosis. The importance of this lesion lies in the proper recognition since it is amenable to successful therapeutic interventions, leading to endoscopic healing of the lesion, significant improvement in the anemia and a reduction in the need for blood transfusions.

Video Endoscopic Sequence 3 of 7.

 Watermelon stomach is an increasingly recognizable cause
 of persistent acute or occult gastrointestinal bleeding,
 especially in elderly women. The chief presentation is
 severe iron deficiency anemia and occult or overt
 gastrointestinal bleeding. Diagnosis is made on endoscopy
 by the characteristic appearance of visible watermelon
 linear stripes in the antrum. Histology is rarely needed to
 confirm the diagnosis. The importance of this lesion lies in
 the proper recognition since it is amenable to successful
 therapeutic interventions, leading to endoscopic healing of
 the lesion, significant improvement in the anemia and a
 reduction in the need for blood transfusions.
The argon-plasma-coagulation uses instead of laser energy conduction of electric energy by ionized argon gas (plasma), which produces coagulation necrosis of tissues. The potential advantages of the argon-plasma-coagulation lie in the limited deep penetration, which reduces the risk of perforation and the symmetric spread of the coagulation effects in the surrounding mucosa. These properties make the argon plasma-coagulation a promising tool for the endoscopic therapy of mucosal lesions of the GI-tract. Further attractive is the low cost of the argon-plasma-coagulation equipment compared with laser devices.

Video Endoscopic Sequence 4 of 7.

 The argon-plasma-coagulation uses instead of laser energy
 conduction of electric energy by ionized argon gas (plasma),
 which produces coagulation necrosis of tissues. The
 potential advantages of the argon-plasma-coagulation lie in
 the limited deep penetration, which reduces the risk of
 perforation and the symmetric spread of the coagulation
 effects in the surrounding mucosa. These properties make
 the argon plasma-coagulation a promising tool for the
 endoscopic therapy of mucosal lesions of the GI-tract.
 Further attractive is the low cost of the argon-plasma
 -coagulation equipment compared with laser devices.
The therapeutic options are numerous for this condition and needs to be individualized. The simplest form of therapy is iron supplementation and occasional blood transfusions. When these measures fail, other approaches are warranted, including endoscopic, pharmacologic or surgical therapies.

Video Endoscopic Sequence 5 of 7.

 The therapeutic options are numerous for this condition and
 needs to be individualized. The simplest form of therapy is
 iron supplementation and occasional blood transfusions.
 When these measures fail, other approaches are warranted,
 including endoscopic, pharmacologic or surgical therapies.
 

 
Argon Plasma Coagulator is a new device that allows for non-contact monopolar coagulation of bleeding surfaces, and devitalization of tissue in the gastrointestinal tract. It is safer and much less expensive than lasers, more effective than bipolar cauterization techniques.

Video Endoscopic Sequence 6 of 7.

 Argon Plasma Coagulator is a new device that allows for
 non-contact monopolar coagulation of bleeding surfaces,
 and devitalization of tissue in the gastrointestinal tract. It is
 safer and much less expensive than lasers, more effective
 than bipolar cauterization techniques.
The electrode in the argon channel of the probe is connected to an electrosurgical generator. The APC probe ionizes the argon gas where it remains ionized approximately 2-10mm distal to the tip of the probe. Ionized Argon gas is electrically conductive. This allows the current to flow between the probe and the tissue. Current density upon arrival at the tissue surface causes coagulation. The application of the energy to the tissue is uniform, and contact free. The Argon plasma beam acts not only in a straight line (axially) along the axis of the probe, but also laterally and radially and "around the corner" as it seeks conductive bleeding surfaces. Following physical principles, the plasma beam has a tendency to turn away from already coagulated (high impedance) areas toward bleeding or still inadequately coagulated receiving treatment. This automatically results in evenly applied , uniform surface coagulation.

Video Endoscopic Sequence 7 of 7.

 The electrode in the argon channel of the probe is
 connected to an electrosurgical generator.

 The APC probe ionizes the argon gas where it remains
 ionized approximately 2-10mm distal to the tip of the probe.
 Ionized Argon gas is electrically conductive. This allows the
 current to flow between the probe and the tissue. Current
 density upon arrival at the tissue surface causes
 coagulation. The application of the energy to the tissue is
 uniform, and contact free. The Argon plasma beam acts not
 only in a straight line (axially) along the axis of the probe,
 but also laterally and radially and "around the corner" as it
 seeks conductive bleeding surfaces. Following physical
 principles, the plasma beam has a tendency to turn away
 from already coagulated (high impedance) areas toward
 bleeding or still inadequately coagulated receiving
 treatment. This automatically results in evenly applied,
 uniform surface coagulation.
Watermelon-stomach is a rare cause of gastrointestinal bleeding. There has been an increasing number of reports on the association of this lesion with diseases of the scleroderma group. Gastric antral vascular ectasia (GAVE), also referred to as Watermelon stomach, is a severe haemorrhagic condition that leads to significant morbidity and transfusion dependence in some patients. Re-bleeding following treatment is common, and there are few treatment options. Until recent treatment modalities were developed, the only options available to patients were blood transfusions or the surgical removal of the stomach (antrectomy). The estimated prevalence of GAVE ranges from 0.3 per cent of cases in a large endoscopic series to 4 per cent in highly selected cohorts with severe gastrointestinal bleeding. Although some patients with diffuse GAVE may have portal hypertensive gastropathy, for the purpose of this application the indication is GAVE not related to portal hypertensive gastropathy.

Watermelon Stomach

 Watermelon-stomach is a rare cause of gastrointestinal
 bleeding. There has been an increasing number of reports
 on the association of this lesion with diseases of the
 scleroderma group.

 Gastric antral vascular ectasia (GAVE), also referred to as
 Watermelon stomach, is a severe haemorrhagic condition
 that leads to significant morbidity and transfusion
 dependence in some patients. Re-bleeding following
 treatment is common, and there are few treatment options.
 Until recent treatment modalities were developed, the only
 options available to patients were blood transfusions or the
 surgical removal of the stomach (antrectomy). The
 estimated prevalence of GAVE ranges from 0.3 per cent of
 cases in a large endoscopic series to 4 per cent in highly
 selected cohorts with severe gastrointestinal bleeding.
 Although some patients with diffuse GAVE may have portal
 hypertensive gastropathy, for the purpose of this
 application the indication is GAVE not related to portal
 hypertensive gastropathy.
Upside-down stomach, Gastric Rotation, The term "gastric volvulus" is reserved for cases in which the abnormal rotation has led to strangulation and obstruction Gastric volvulus is defined as an abnormal rotation of the stomach of more than 180°, creating a closed loop obstruction that can result in incarceration and strangulation. The stomach can rotate along an axis that is 90° to the longitudinal axis. Such rotation is called a mesenteroaxial rotation . This rotation may lead to an upside-down stomach. Mesenteroaxial rotation of an intrathoracic stomach is less common than organoaxial rotation. Mesenteroaxial rotation is more frequently seen in patients with progression of a type 2 paraesophageal hiatal hernia.

Video Endoscopic Sequence 1 of 3.

Upside-Down Stomach

 (Gastric Rotation)

 The term "gastric volvulus" is reserved for cases in which
 the abnormal rotation has led to strangulation and
 obstruction Gastric volvulus is defined as an abnormal
 rotation of the stomach of more than 180°, creating a
 closed loop obstruction that can result in incarceration and
 strangulation.

 The stomach can rotate along an axis that is 90° to the
 longitudinal axis. Such rotation is called a mesenteroaxial
 rotation . This rotation may lead to an upside-down
 stomach.
 Mesenteroaxial rotation of an intrathoracic stomach is less
 common than organoaxial rotation. Mesenteroaxial
 rotation is more frequently seen in patients with
 progression of a type 2 paraesophageal hiatal hernia.

The most common cause of gastric volvulus in adults is diaphragmatic defects. In cases of paraesophageal hernias, the gastroesophageal junction remains in the abdomen while the stomach ascends adjacent to the esophagus, resulting in an upside-down stomach. Gastric volvulus is the most common complication of paraesophageal hernias. It has also been reported to complicate gastroesophageal surgery, neuromuscular disorders, and intra-abdominal tumors. Rarely, gastric volvulus may be a complication of liver transplant and may be related to ligation of the hepatogastric ligament during the hepatectomy.

Video Endoscopic Sequence 2 of 3.

 The most common cause of gastric volvulus in adults is
 diaphragmatic defects. In cases of paraesophageal hernias,
 the gastroesophageal junction remains in the abdomen
 while the stomach ascends adjacent to the esophagus,
 resulting in an upside-down stomach. Gastric volvulus is
 the most common complication of paraesophageal hernias.

 It has also been reported to complicate gastroesophageal
 surgery, neuromuscular disorders, and intra-abdominal
 tumors. Rarely, gastric volvulus may be a complication of
 liver transplant and may be related to ligation of the
 hepatogastric ligament during the hepatectomy.

 

Video Endoscopic Sequence 3 of 3.
Non-specific finding in the gastric fundus in a lupus patientīs This 54 year-old female with systemic lupus erythaematosus presenting with abdominal pain, physical Examination the abdomen soft, nontender, no masses, hernias or organomegaly, two months previously had discontinued her treatment with corticosteroids .

Video Endoscopic Sequence 1 of 7.

Non-specific finding in the gastric fundus in a lupus patientīs

 This 54 year-old female with systemic lupus
 erythaematosus presenting with abdominal pain, physical
 Examination the abdomen soft, nontender, no masses,
 hernias or organomegaly, two months previously had
 discontinued her treatment with corticosteroids.

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown cause that affects multiple organ systems. Immunologic abnormalities, especially the production of a number of antinuclear antibodies, are another prominent feature of this disease. The clinical course is marked by spontaneous remissions and relapses. Its multisystemic manifestations and the complications from the use of immunosuppressive agents make the diagnosis and management of this entity challenging.

Video Endoscopic Sequence 2 of 7.

 

 Systemic lupus erythematosus (SLE) is a chronic
 inflammatory disease of unknown cause that affects
 multiple organ systems. Immunologic abnormalities,
 especially the production of a number of antinuclear
 antibodies, are another prominent feature of this disease.
 The clinical course is marked by spontaneous remissions
 and relapses. Its multisystemic manifestations and the
 complications from the use of immunosuppressive agents
 make the diagnosis and management of this entity
 challenging.
Gastric Erosion is observed the biopsies were negative to malignancy. Gastrointestinal (GI) manifestations are common in patients with systemic lupus erythematosus (SLE). Virtually all patients with SLE require treatment with NSAID therapy and/or corticosteroids. The ulcerogenic effects of NSAIDs and corticosteroids used in combination are synergistic and put the patient at a high risk of serious ulcer disease. In addition, high-dose steroids may mask the early clinical signs of peptic ulcer perforation.

Video Endoscopic Sequence 3 of 7.

Gastric Erosion is observed the biopsies were negative to malignancy.

 Gastrointestinal (GI) manifestations are common in
 patients with systemic lupus erythematosus (SLE).
 Virtually all patients with SLE require treatment with
 NSAID therapy and/or corticosteroids

 The ulcerogenic effects of NSAIDs and corticosteroids
 used in combination are synergistic and put the patient at
 a high risk of serious ulcer disease. In addition, high-dose
 steroids may mask the early clinical signs of peptic ulcer
 perforation.

Impairment of blood supply to various parts of the gastrointestinal tract may result in abdominal pain, damage to the liver or pancreas (pancreatitis), or a blockage or tear (perforation) of the gastrointestinal tract.

Video Endoscopic Sequence 4 of 7.

 Systemic lupus erythematosus: Gastrointestinal Tract
 Problems: Impairment of blood supply to various parts of
 the gastrointestinal tract may result in abdominal pain,
 damage to the liver or pancreas (pancreatitis), or a
 blockage or tear (perforation) of the gastrointestinal tract.

 
The inflammatory infiltrate from patients with SLE was found to contain higher levels of young and mature fibroblasts than those from patients with gastroduodenitis, and was associated with the progression of SLE. During disease exacerbation, immune complex deposition was observed in the arteriolar walls.

Video Endoscopic Sequence 5 of 7.

 The inflammatory infiltrate from patients with SLE was
 found to contain higher levels of young and mature
 fibroblasts than those from patients with gastroduodenitis,
 and was associated with the progression of SLE. During
 disease exacerbation, immune complex deposition was
 observed in the arteriolar walls

 The inflammatory changes in the gastric and duodenal
 mucosa were ascertained to be associated with the
 progression of SLE. In exacerbation of SLE, the walls of
 vessels (arterioles) exhibited immune complexes classified
 mainly as IgG and, to a lesser degree, as IgM.
 In remission, the luminescence of the vessels decreased.
 The serum level of immunoglobins did not correlate with
 their regional production in the gastric and duodenal
 mucosa.
Systemic lupus erythematosus (SLE) on the gastrointestinal (GI) tract from mouth to anus, attempting to distinguish the features that are most likely to be due to therapy. GI manifestations of SLE include mouth ulcers, dysphagia, anorexia, nausea, vomiting, haemorrhage and abdominal pain. GI vasculitis is usually accompanied by evidence of active disease in other organs. Early recognition of the significance of these symptoms offers the best opportunity.

Video Endoscopic Sequence 6 of 7.

 Systemic lupus erythematosus (SLE) on the
 gastrointestinal (GI) tract from mouth to anus, attempting
 to distinguish the features that are most likely to be due to
 therapy. GI manifestations of SLE include mouth ulcers,
 dysphagia, anorexia, nausea, vomiting, hemorrhage and
 abdominal pain. GI vasculitis is usually accompanied by
 evidence of active disease in other organs. Early
 recognition of the significance of these symptoms offers
 the best opportunity.
The inflammatory infiltrate from patients with SLE was found to contain higher levels of young and mature fibroblasts than those from patients with gastroduodenitis, and was associated with the progression of SLE. During disease exacerbation, immune complex deposition was observed in the arteriolar wall.

Video Endoscopic Sequence 7 of 7.

 The inflammatory infiltrate from patients with SLE was
 found to contain higher levels of young and mature
 fibroblasts than those from patients with gastroduodenitis,
 and was associated with the progression of SLE. During
 disease exacerbation, immune complex deposition was
 observed in the arteriolar walls
Foreign body. Chewed gum in the stomach. Patient swallowed the gum while in the waiting room.

Foreign body.

 Chewed gum in the stomach.
 Patient swallowed the gum while in the waiting room.
 

Phytobezoar. Bezoars are concretions in the GI tract that increase in size by the accumulation of nonabsorbable food or fibers. They are uncommon, but when present, they are usually found in patients with altered GI motility or with a history of gastric surgery. A phytobezoar is composed of indigested plant or vegetable fibres, plant skins and leaves. A phytobezoar may develop when foreign material accumulates in the stomach because of indigestibility, poor mastication or disturbances in the gastric emptying mechanism which can occur following surgical procedures such as vagotomy, pyloroplasty or antrectomy. A trichobezoar is secondary to hair ingestion, usually in mentally disturbed patients.

Phytobezoar.

 Bezoars are concretions in the GI tract that increase in size
 by the accumulation of nonabsorbable food or fibers. They
 are uncommon, but when present, they are usually found in
 patients with altered GI motility or with a history of gastric
 surgery.
 A phytobezoar is composed of indigested plant or vegetable
 fibres, plant skins and leaves. A phytobezoar may develop
 when foreign material accumulates in the stomach because
 of indigestibility, poor mastication or disturbances in the
 gastric emptying mechanism which can occur following
 surgical procedures such as vagotomy, pyloroplasty or
 antrectomy. A trichobezoar is secondary to hair ingestion,
 usually in mentally disturbed patients