Gastric Adenocarcinoma
Gastric Adenocarcinoma with gastric varices and atrophic gastritis.

Video Endoscopic Sequence 1 of 8.

Gastric Adenocarcinoma with gastric varices and atrophic gastritis.

A 95 year-old male was hospitalized because of pallor and melena with 8.0 mg/dl. of Hb.

 

Gastric Adenocarcinoma with gastric varices and atrophic gastritis.

For more endoscopic details download the video clips by
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the video in full screen.

All endoscopic images shown in this Atlas contain
video clips.


Gastric Adenocarcinoma

Video Endoscopic Sequence 2 of 8.

Gastric Adenocarcinoma

Several conditions may be precancerous and may increase the risk of stomach cancer. They include:

Atrophic gastritis, chronic gastritis (inflammation of the stomach lining), and infection by a certain type of bacteria.

Pernicious anemia: a chronic vitamin-B12 deficiency anemia that occurs in older adults characterized by numbness and tingling in the extremities.

Achlorhydria: low levels or absence of hydrochloric acid in gastric juice.

Gastric Adenocarcinoma

Video Endoscopic Sequence 3 of 8.

Gastric Adenocarcinoma

Another image and video clip of this advanced and ulcerated neoplasia.

Gastric Adenocarcinoma

Video Endoscopic Sequence 4 of 8.

Gastric Adenocarcinoma

This image and the video clip display chromoendoscopy with lugol´s stain.

Chromoendoscopy and vital staining are simple adjunct methods to improve the yield of endoscopic.


Gastric Adenocarcinoma

Video Endoscopic Sequence 5 of 8.

Gastric Adenocarcinoma and Gastric Varices

Some isolated gastric varices were found at the fundus.

 

Gastric Adenocarcinoma

Video Endoscopic Sequence 6 of 8.

Gastric Adenocarcinoma and Gastric Varices

Islated gastric varices are more common with adenocarcinoma of the pancreas due to splecnic thrombosis.


Gastric Adenocarcinoma

Video Endoscopic Sequence 7 of 8.

Gastric Adenocarcinoma and Gastric Varices


More images and video clips of this case of adenocarcinoma with gastric varices.

Gastric Adenocarcinoma

Video Endoscopic Sequence 8 of 8.

Gastric Adenocarcinoma and Gastric Varices

This image display the neoplasia in frontal view.


Early gastric cancer with signet ring cell

Video Endoscopic Sequence 1 of 8.

Small Early Gastric Cancer with signet ring cell

This is a 53 year-old, male with a small gastric cancer in early stage and acute calculous cholecystitis.

Due to acute calculous cholecystitis.The pre-surgical studies were completed, including an upper endoscopy, finding a small ulcerated lesion with a suspected to be an adenocarcinoma with signet ring cell, we offered an endoscopic submucosal dissection (ESD), but the patient and his family preferred, subtotal gastrectomy.


Ver video en YouTube

 

Adenocarcinoma Gástrico Ulcerado y Várices Gástricas del Fondo

Video Endoscopic Sequence 2 of 8.

Early gastric cancer with signet ring cell

There has been much controversy surrounding the biologic behavior and prognosis of early stage gastric signet ring cell carcinoma.

Early gastric cancer with signet ring cell histology has a more favorable prognosis than other undifferentiated gastric adenocarcinomas. The presence of lymph-node metastasis is the most important factor in treating early gastric cancer by endoscopic resection.

Early gastric cancer with signet ring cell histology can be treated by endoscopic mucosal resection, if it is smaller than 25 mm, limited within the sm2 layer, and does not involve the lymphatic-vascular structure. More extensive prospective data are required to confirm definitive guidelines for the endoscopic treatment of patients with Early gastric cancer with signet ring cell histology.


Early gastric cancer with signet ring cell

Video Endoscopic Sequence 3 of 8.

Early gastric cancer with signet ring cell

According to World Health Organization (WHO) classification, gastric signet ring cell carcinoma (SRC) is a histologic type, primarily based on the microscopic characteristics of the tumor but not on the
biologic behavior. SRC has been classified as “diffuse type” by Lauren, “infiltrative type” by Ming, and “undifferentiated type” by Sugano et al. To establish a scale of tumor aggressiveness related to prognosis, the WHO and the Union International Contra la Cancrum (UICC) adapted a grading system in which SRC has been classified as
high grade.

Early gastric cancer with signet ring cell

Video Endoscopic Sequence 4 of 8.

Endoscopy of early gastric cancer with signet ring cell

Early gastric carcinoma with SRC is a distinct type of gastric carcinoma in terms of clinicopathologic features and prognosis. The favorable prognosis and lower rate of lymph node metastasis in early SRC suggest that the patients with early gastric carcinoma with SRC could be candidates for less invasive surgeries for an improved quality of life.

Prognosis of patients with advanced signet ring cell carcinoma was poor compared with patients with other types of this disease. In multivariate analysis, the statistical significant prognostic factors were vascular microinvasion and tumor location. These findings suggest that signet ring cell carcinoma of the stomach should be regarded as a distinct type of gastric cancer.

Marked elevation of plasma CEA may be found in the absence of liver metastasis from signet ring or poorly differentiated gastric carcinoma. Patients with marked elevations of CEA also had lymphatic and peritoneal dissemination.


Early gastric cancer with signet ring cell

Video Endoscopic Sequence 5 of 8.

Early gastric cancer with signet ring cell



Early gastric cancer with signet ring cell

Video Endoscopic Sequence 6 of 8.

Early gastric cancer with signet ring cell





Early gastric cancer with signet ring cell

Video Endoscopic Sequence 7 of 8.



Early gastric cancer with signet ring cell

Video Endoscopic Sequence 8 of 8.

Early gastric cancer with signet ring cell



Gastric Cancer

Video Endoscopic Sequence 1 of 3.

Esophago-gastric Adenocarcinoma and Duodenal Ulcer

An 80 year-old man, presented weight loss, abdominal pain and dysphagia, endoscopy displays a esophago-gastric adenocarcinoma and duodenal ulcer.

The relation between peptic ulcer and gastric carcinoma has long been a matter of controversy. A coexisting gastric cancer has been reported in 2 percent of patients given a diagnosis of gastric ulcers, but follow-up studies have failed to demonstrate any increased long-term risk of gastric cancer in patients with gastric ulcers.
By contrast, duodenal ulcer disease has often been inversely associated with gastric cancer, but the evidence comes largely from small studies or case series. Helicobacter pylori infection is now recognized as an important causative factor in both duodenal ulcers and gastric cancer, contrary to what might be inferred from a negative association between duodenal ulcers and gastric cancer. Determining the risk of gastric cancer in patients with duodenal or gastric ulcers may shed light on this puzzle and on important aspects of gastric carcinogenesis. We therefore investigated the risk of gastric cancer during long-term follow-up of a large, population-based cohort comprising patients hospitalized for gastric or duodenal ulcers who had not received surgical treatment.




 


Duodenal Ulcer

Video Endoscopic Sequence 2 of 3.

In the Duodenal bulb an ulcer and pseudodiverticulum is observed due to a scar of ulcer.

Helicobacter pylori infection, now considered to be a cause of gastric cancer, is also strongly associated with gastric and duodenal ulcer disease. The discovery of these relations has brought the long-controversial connection between peptic ulcers and gastric cancer into focus.

Gastric ulcer disease and gastric cancer have etiologic factors in common. A likely cause of both is atrophic gastritis induced by H. pylori. By contrast, there appear to be factors associated with duodenal ulcer disease that protect against gastric cancer.

Study urges clinicians to confirm H. pylori infection and to start eradication therapy to prevent GC development in patients with peptic ulcers.

H. pylori is a bacterium found in the stomach. It is linked to the development of gastritis, peptic ulcers and stomach cancer. To prevent recurrence in patients with these diseases, it is necessary to eradicate bacterial infections with H. pylori.


Gastric Adenocarcinoma of the fundus

Video Endoscopic Sequence 3 of 3.

Gastric Adenocarcinoma of the fundus



Recurrent Gastric Adenocarcinoma

Video Endoscopic Sequence 1 of 4.

Recurrent Gastric Adenocarcinoma

This 75 year-old female, 3 months previous, in another country underwent a subtotal gastrectomy due to a gastric adenocarcinoma.



Recurrent Gastric Adenocarcinoma

Video Endoscopic Sequence 2 of 4.

Endoscopy of Recurent Gastric Adenocarcinoma.


 

 

Recurrent Gastric Adenocarcinoma

Video Endoscopic Sequence 3 of 4.

Endoscopy appearance of a Gastric Adenocarcinoma



Recurrent Gastric Adenocarcinoma

Video Endoscopic Sequence 4 of 4.

Endoscopy of Recurent Gastric Adenocarcinoma


Endoscopy of Gastric Adenocarcinoma with signet ring cell

Video Endoscopic Sequence 1 of 4.

Endoscopy of Gastric Adenocarcinoma with signet ring cells

A 73 year-old female with obstructing ulcerated gastric neoplasia that made pseudo piloro and infiltrated the posterior wall of the antrum.

 

Video Endoscopic Sequence 2 of 4.

Endoscopy Gastric Adenocarcinoma.

Status post Surgery of the case above displayed
Jejuno-Jejuno anastomosis.

The image and the video display the Jejuno-jejuno
anastomosis.


Video Endoscopic Sequence 3 of 4.

Endoscopy Gastric Adenocarcinoma.

Status post Surgery of the case above displayed
Jejunum-jejunum anastomosis.



Video Endoscopic Sequence 4 of 4.

Status post surgery of gastric carcinoma.


Four months after the surgery a new endoscopy was
performed, the image and the video display the
gastro-jejunostomy. 

Video Endoscopic Sequence 1 of 21.

Endoscopy of Early Gastric Cancer.

This 60 year-old male with vague abdominal discomfort.


Video Endoscopic Sequence 2 of 21.

Endoscopy of Early Gastric Cancer.

Early disease has no associated symptoms; however, some
patients with incidental complaints are diagnosed with early gastric cancer. Most symptoms of gastric cancer reflect advanced disease. Patients may complain of indigestion,
Nausea or vomiting, dysphagia, postprandial fullness, loss
of appetite, and weight loss.

Late complications include pathologic peritoneal and pleural effusions; obstruction of the gastric outlet, gastroesophageal junction, or small bowel; bleeding in the stomach from esophageal varices or at the anastomosis after surgery; intrahepatic jaundice caused by hepatomegaly; extrahepatic jaundice; and inanition resulting from starvation or cachexia of tumor origin.

 

 

Video Endoscopic Sequence 3 of 21.

Endoscopy of Early Gastric Cancer.

As proposed by the Japanese Society of
Gastroenterological Endoscopy in 1962, early gastric
cancer (EGC, also called superficial spreading carcinoma)
is defined as adenocarcinoma limited to the gastric mucosa
and submucosa regardless of whether regional lymph nodes
are involved or not. This definition reflected an
appreciation that EGC represented a subset of gastric
cancers that had a favorable prognosis. Survival rates of 85
to more than 90 percent five years after resection have
been reported in Japan and the West . In one series from
Europe, for example, survival was similar for EGC and
benign gastric ulcer and no patients died of disseminated
disease. In comparison, five-year survival without surgery
was only 64.5 percent in one series from Japan due to
progression to invasive disease . These values are still
better than the 15 to 44 percent five-year survival with
advanced gastric cancer, indicating the EGC may be an
earlier stage of disease with a long latent period.

Video Endoscopic Sequence 4 of 21.

Endoscopy of Early Gastric Cancer.

Five days after a follow up endoscopy was performed.

Video Endoscopic Sequence 5 of 21.

Endoscopy of Early Gastric Cancer.

Surgical resection of early gastric cancers offers an
excellent (90-100%) chance of cure based on several
Japanese series.

Early gastric cancers, where tumor cells are confined to the mucosa (the most superficial layer of the stomach), have been identified in Japan where there is active
screening of patients at high-risk for gastric cancer. In these patients, early gastric cancer may appear as a subtle lesion, usually less than 2 cm in diameter. The
identification of early gastric cancer is important because it is potentially amenable to endoscopic therapy and accompanied by an excellent prognosis.

Video Endoscopic Sequence 6 of 21.

Endoscopy of Early Gastric Cancer.

Tumor biology and carcinogenesis are active areas of
research investigation. The management of gastric cancer
requires a thorough understanding of gastric anatomy.




Video Endoscopic Sequence 7 of 21.

Gastric Adenocarcinoma

Lugol Chromoendoscopy


Video Endoscopic Sequence 8 of 21.

Gastric Adenocarcinoma

Panoramic view of the gastric fundus with the tumor.


Video Endoscopic Sequence 9 of 21.

Gastric Adenocarcinoma

 

Video Endoscopic Sequence 10 of 21.

Gastric Adenocarcinoma

Video Endoscopic Sequence 11 of 21.

Gastric Adenocarcinoma

 

Video Endoscopic Sequence 12 of 21.

Gastric Adenocarcinoma

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Gastric Adenocarcinoma

Lymphatic nodules of the lesser curvature.

 

 

 

Video Endoscopic Sequence 14 of 21.

Gastric Adenocarcinoma

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Gastric Adenocarcinoma

 

Video Endoscopic Sequence 16 of 21.

Gastric Adenocarcinoma

 

Video Endoscopic Sequence 17 of 21.

Gastric Adenocarcinoma

 

Video Endoscopic Sequence 18 of 21.

Gastric Adenocarcinoma

Microscopic pictures of the malignant neoplasia with invasion of the submucosa.

 

Video Endoscopic Sequence 19 of 21.

Microscopic pictures of the malignant neoplasia with invasion of the submucosa.



Video Endoscopic Sequence 20 of 21.

Gastric Adenocarcinoma

 

Video Endoscopic Sequence 21 of 21.

Gastric Adenocarcinoma


Obstructed Adenocarcinoma of the Gastric Antrum.

A 62 year-old female with anemia and weight loss of more
than 20 pounds.
Gastric Adenocarcinoma, ulcerated, with elevated margins
that infiltrates the antrum and gastric angle.



Ulcerated and obstructed Adenocarcinoma.

A 67 year-old female with gastric adenocarcinoma that
obstructed the gastric antrum, infiltrated the gastric angle.
Central necrosis and ulceration are appreciated.

 

Obstructed Adenocarcinoma.

Gastric Adenocarcinoma

Gastric Carcinoma that produces antrum and distal body
obstruction.

 

Gastric Adenocarcinoma

Gastric Adenocarcinoma

Ulcerated Gastric Adenocarcinoma of the incisura angularis.

An 81 year old female with abdominal pain and weight loss
of 20 pounds.

 

 

Gastric Adenocarcinoma

 

 

Endoscopy of Gastric Adenocarcinoma

Gastric Adeno-Carcinoma that produces obstruction of the
gastric body.

 

Video Endoscopic Sequence 1 of 2.

A 51 year-old male, brother of a well known pediatric
surgeon, who asked us to perform an upper endoscopy, due
to obstructive symptoms. We found an antrum adenocarcinoma.
The image displayed above is one year after initial
diagnosis.
The carcinoma proved to be inoperable.
The image and video shown is after chemotherapy and
radiation used palliatively.

Video Endoscopic Sequence 2 of 2.

The antrum is deformed, the margin of the tumor are
elevated.


Gastric Adenocarcinoma of the Fundus.

An 84 year-old female with abdominal pain and weigh loss.
An ulcerated neoplasia in the fundus with hemorrhage is
observed. 

 

Video Endoscopic Sequence 1 of 3.

A 62 year-old female with multinodular goiter present with
nausea, vomiting and abdominal pain. She came to our
office with her family physician who asked to perform her
an upper endoscopy.
The endoscopic image displays a radial nodularity with
smooth tissue of the gastric antrum, There are some
retraction of the antrum with a pseudo diverticula.

 

Gastric Cancer

 Video Endoscopic Sequence 2 of 3.

The image displays obtaining some biopsies of the
neoplasia.

 

Video Endoscopic Sequence 3 of 3.

Gastric Adenocarcinoma

The image and the video clip display a ulcerated deforming
antrum.


Gastric Adenocarcinoma

Gastric Adenocarcinoma

A 75 year-old woman with ulcerated and infiltrating gastric
 carcinoma.

 

Gastric Adenocarcinoma

Gastric Adenocarcinoma

A 62 year-old male with diffuse gastric carcinoma with
superficial mucosal necrosis.

Gastric Adenocarcinoma

62 year old male with obstructing Gastric Adenocarcinoma.

 

Gastric Adenocarcinoma

Gastric Adenocarcinoma of the fundus.

 An 84 year-old male with weight loss of 40 pounds.



Gastric Cancer

Ulcerated Adenocarcinoma.

A 36 year-old male with ulcerated adenocarcinoma of the
posterior wall of the corpus.

 



Gastric Cancer

Video Endoscopic Sequence 1 of 2.

Gastric Cancer

74 year-old man, with weight loss and vomiting abdominal
ultrasonography revealed that the stomach wall were
thickened.
Endoscopically a gastric carcinoma of the corpus is seen.
A cardial polyp is appreciated in the video clip.

There is a malignat gastric glandular neoplasia, tubular

 Video Endoscopic Sequence 2 of 2.
There is a malignat gastric glandular neoplasia, tubular  (Intestinal Type).

There is a malignat gastric glandular neoplasia, tubular
 (Intestinal Type).

Adenocarcinoma of the Gastric Antrum.

Adenocarcinoma of the Gastric Antrum.

A 73 years old man, with weight loss more than 25 pounds,
abdominal pain and vomiting.
Obstructing Adenocarcinoma of the antrum. 


Adenocarcinoma of the Gastric Antrum.

Adenocarcinoma of the Gastric Antrum.

A 60 year-old dumb deaf woman with ulcerated carcinoma at the pre-pyloric antrum.

Adenocarcinoma of the Gastric Antrum

Adenocarcinoma of the Gastric Antrum.

Ulcerated Gastric Carcinoma of the antrum with signet ring
cells.

 

Gastric Adenocarcinoma

Gastric Adenocarcinoma

A 70 year-old male, with abdominal pain, weight loss of
more than 40 pounds and vomiting.
Gastric Adenocarcinoma that invaded antrum, corpus and
fundus was found.

 

 

 

Gastric Adenocarcinoma

Gastric Adenocarcinoma

A 60 year-old male with Gastric Adenocarcinoma of the
 fundus
.

Gastric Adenocarcinoma

Gastric Adenocarcinoma

A 69 year-old male with Gastric Adeno Carcinoma of the
 cardias. 

Gastric Cancer

Ulcerated Adenocarcinoma of the fundus and the cardias.

A 56 year-old male from the republic of Spain.
He had disphagia and epigastric pain.


Gastric Adenoarcinoma of the fundus.

Gastric Adenoarcinoma of the fundus.

A 66 year-old male with weight loss of 22 pounds and
disphagia anorexia and vomiting.

 

Gastric Cancer

Endoscopy of Gastric Cancer

A 48 year-old female with weight loss of 20 pounds and
epigastric pain

Signet-ring adenocarcinoma of the gastric body and
fundus.





Gastric Adenocarcinoma of the Antrun

Video Endoscopic Sequence 1 of 2.

Gastric Adenocarcinoma of the Antrun

A 59 year-old male who came from the republic of
Honduras, to be evaluated for abdominal pain and weight
loss of 20 pounds.

Gastric Adenocarcinoma of the Antrun

Video Endoscopic Sequence 2 of 2.

Gastric Adenocarcinoma of the Antrun

The antrum is deformed, the margin of the tumor are
elevated.

 

Gastric Adenocarcinoma of the Fundus.

Gastric Adenocarcinoma of the Fundus.

An 84 year-old female with abdominal pain and weigh loss.
An ulcerated neoplasia in the fundus with hemorrhage is
observed.



Gastric Adenocarcinoma of the fundus.

Gastric Adenocarcinoma of the fundus.

An 84 year-old male with weight loss of 40 pounds.


Stomach Cancer

Video Endoscopic Sequence 1 of 3.

A 62 year-old female with multinodular goiter present with
nausea, vomiting and abdominal pain. She came to our
office with her family physician who asked to perform her
an upper endoscopy.
The endoscopic image displays a radial nodularity with
smooth tissue of the gastric antrum, There are some
retraction of the antrum with a pseudo diverticula.

Gastric Adenocarcinoma

Video Endoscopic Sequence 2 of 3.

Endoscopy of Gastric Adenocarcinoma

The image displays obtaining some biopsies of the
neoplasia.



Bronchoscopyxz1

Video Endoscopic Sequence 3 of 3.

Endoscopy of Gastric Adenocarcinoma

The image and the video clip display a ulcerated deforming
antrum.


Gastric Cancer

Ulcerated Adenocarcinoma.

A 36 year-old male with ulcerated adenocarcinoma of the
posterior wall of the corpus.



 

Gastric Cancer

Adenocarcinoma of the fornix

A 64 year-old male with adenocarcinoma of the fundus.

 

 

Gastric Cancer

Endoscopy of Gastric Cancer

Gastric AdenoCarcinoma that has been manifested with
hiccups.

This 77 year old man with persistent hiccups.
An infiltrating and ulcerated carcinoma of the body that
invades the cardias is observed.

 

Gastric Cancer

Video Endoscopic Sequence 1 of 5.

Endoscopy of Gastric Adenocarcinoma

This 72 year-old male smoker, has been suffering of
intractable hiccups weight loss of 40 pounds, nausea and
vomiting the biopsies display gastric adenocarcinoma of
the intestinal type. The incidence of persistent hiccup in
patients with advanced cancer is unknown but considered
to be small.

v
Gastric Cancer

Video Endoscopic Sequence 2 of 5.

Endoscopy of Gastric Adenocarcinoma

Retroflexed image, observing the neoplasia that infiltrates the gastric cardias.

 

 

 
gastric Cancer

Video Endoscopic Sequence 3 of 5.

Endoscopy of Gastric Adenocarcinoma

More images of the gastric cardias.

 

Endoscopy of Gastric Cancer

Video Endoscopic Sequence 4 of 5.

Endoscopy of Gastric Cancer

Persistent or intractable hiccups are commonly associated
with an underlying disease. Hiccups are caused by
irritation of visceral afferent fibres of the vagus nerve or
by direct irritation of the diaphragm. Various definitions of
hiccups can be found in the literature. A consensus is 'the
repeated, involuntary, spasmodic contraction of the
diaphragm and inspiratory muscles followed by sudden
closure of the glottis' The medical term for hiccup –
singultus – stems from the Latin word singult, which means
catching one's breath while sobbing.

Gastric Cancer

Video Endoscopic Sequence 5 of 5.

Hiccupping is a characteristic noise caused by a sudden
closure of the glottis after repeated, involuntary,
spasmodic contraction of the respiratory muscles.
Hiccupping caused by gastric distention, spicy foods, and
neural dysfunction often resolves itself without any
treatment. Some hiccups are associated with certain
diseases or occur postsurgically, and life-restricting
intractable hiccups should be treated. The cause of hiccups
should be expressly stated for treatment.

Gastric Adenocarcinoma

Video Endoscopic Sequence 1 of 3.

Gastric Adenocarcinoma of the antrum that infiltrates the lesser curvature until near the fundus.

This 47 year-old male, presented with weight loss of 40 pounds.


Gastric Cancer

Video Endoscopic Sequence 2 of 3.

Endoscopy of a Gastric Cancer

The images and video clips show a large ulcerated tumor.


Gastric Cancer

Video Endoscopic Sequence 3 of 3.

More images and video clips.


Gastric Adenocarcinoma

 Video Endoscopic Sequence 1 of 6.

Gastric Adenocarcinoma

Recurrent Gastric Cancer after Gastrectomy Billroth II

This 65 year-old female, 3 years previously underwent a
gastrectomy Billroth II due to a gastric adenocarcinoma of
the antrum, one month previously of this endoscopy began
with dysphagia, patient was referred to our endoscopic unit
for evaluation.

Extensive neoplastic infiltration of the fundus and cardias,
retroflexed image.

Recurrent Gastric Cancer after Gastrectomy Billroth II

Video Endoscopic Sequence 2 of 6.

Post surgical appearance observing three suture granulomas.

Suture granulomas can occur after gastric surgery with
nonabsorbable suture material. They are usually an
asymptomatic, incidental finding on post-surgical x-ray
studies, but have to be recognized because their
radiological appearance may mimic gastric neoplasms and
therefore may lead to unnecessary reoperations.



Recurrent Gastric Cancer after Gastrectomy Billroth II

Video Endoscopic Sequence 3 of 6.

Recurrent Gastric Cancer after Gastrectomy Billroth II

Retroflexed image, the video clip shows the gastric fundus totally infiltrated with this cancer.

Patients with recurrent gastric cancer have cancer that has returned after primary treatment. Patients with refractory gastric cancer have cancer that has stopped responding to primary or secondary treatments.

Old age and peritoneal recurrence negatively influenced
on survival from recurrence for patients who had
underwent curative gastrectomy for gastric cancer.



Recurrent Gastric Cancer after Gastrectomy Billroth II

 Video Endoscopic Sequence 4 of 6.

Recurrent Gastric Cancer after Gastrectomy Billroth II


The video clip shows suture granulomas magnyfing image.

Chemotherapy is the main treatment for patients who have residual cancer after surgery or experience a cancer recurrence after surgery. Single chemotherapy agents such as Platinol®, 5-FU, Mutamycin®, doxorubicin and Ellence® have been used for the treatment of gastric cancer for several years. However, these drugs result in clinical responses in less than half of patients with recurrent gastric cancer and virtually no complete responses are seen following single agent chemotherapy. The survival of patients treated with 5-FU-based chemotherapy combinations is less than one year. Recent clinical trials indicate that newer chemotherapy agents such as Camptosar®, Gemzar®, Taxotere® and paclitaxel may be the most active single agents for the treatment of gastric cancer, with complete disappearance of cancer occurring in up to 15% of patients. Current clinical trials are evaluating various combinations of these newer drugs often in combination with Platinol® and 5-FU.

 

Recurrent Gastric Cancer after Gastrectomy Billroth II

Video Endoscopic Sequence 5 of 6.

Due to the manipulation with the endoscope, the neoplasia
initiates a slight bleeding that was controlled successfully
with argon plasma APC.

Patients who experience a cancer recurrence following
surgery can sometimes benefit from treatment with
radiation therapy with or without chemotherapy. Radiation
therapy can be extremely effective in temporarily
controlling local symptoms from gastric cancer. In one
clinical trial, 27 patients with inoperable gastric cancer
were treated with chemotherapy and concurrent radiation
therapy. The overall response rate was 56%, including
11 % with a complete response. Two years following
treatment, 29% of patients were alive without progression
of their cancer. It was concluded from this clinical trial that
combined chemotherapy and radiation therapy has
substantial activity for the local control of advanced gastric
cancer. Future clinical trials will continue to evaluate
combinations of newer chemotherapy drugs and radiation
with other local-regional and systemic treatments.



Recurrent Gastric Cancer after Gastrectomy Billroth II

Video Endoscopic Sequence 6 of 6.

Recurrent Gastric Cancer after Gastrectomy Billroth II

Therapeutic maneuver is being continued.

Prior to any surgical procedure, adequate preparation of
the patient is important to minimize complications. Many
patients with gastric cancer are malnourished at the time
of diagnosis. Aggressive nutritional support has not been
shown to improve long-term survival, but it has been
shown to improve survival in the immediate post-operative
period. Feeding intravenously and/or through a
naso-gastric tube can enhance nutrition before surgery.

Recurrent Gastric Cancer after Gastrectomy Billroth II

Video Endoscopic Sequence 1 of 3.

Recurrent Gastric Cancer after Gastrectomy Billroth II

This 67 year-old male, five year-previously underwent a
gastrectomy Billroth II due to a gastric adenocarcinoma of
the antrum in this follow up endoscopy founded a neoplasic
infiltration in the lesser curvature.

 

Recurrent Gastric Cancer after Gastrectomy Billroth II

Video Endoscopic Sequence 2 of 3.

Recurrent Gastric Cancer after Gastrectomy Billroth II

Gastro-jejuno-anastomosis.

 


Recurrent Gastric Cancer after Gastrectomy Billroth II

Video Endoscopic Sequence 3 of 3.

Recurrent Gastric Cancer after Gastrectomy Billroth II

More images and video clips.

Early Gastric Adenocarcinoma

Video Endoscopic Sequence 1 of 5.

Early Gastric Adenocarcinoma

This 52 year-old female, presented this lesion at the
antrum, the endoscopic ultrasound showed that lesion is
limited at the mucosa and submucosa.

Early Gastric Adenocarcinoma

Video Endoscopic Sequence 2 of 5.

This image shows irregular ulcerated adenocarcinoma.

 

Early Gastric Adenocarcinoma

Video Endoscopic Sequence 3 of 5.

Endoscopy of Gastric Adenocarcinoma in the Early Phase

More images and video clips.

 

Early Gastric Adenocarcinoma

Video Endoscopic Sequence 4 of 5.

Endoscopy of Gastric Adenocarcinoma in the Early Phase

 

Early Gastric Adenocarcinoma

Video Endoscopic Sequence 5 of 5.

Endoscopy of Gastric Adenocarcinoma in the Early Phase

 

Gastric Tubular Adenocarcinoma

Gastric Tubular Adenocarcinoma

Gastric AdenoCarcinoma that has been manifested with recurrent hiccups.

This 77 year old man with persistent hiccups.
An infiltrating and ulcerated carcinoma of the body that
invades the cardias is observed.

Hiccups are repeated involuntary spasms of the diaphragm followed by a quick closing of the vocal cords. The spasms occur between normal breaths and make a distinctive sound. The diaphragm is the thin muscle below the lungs and heart that separates the chest cavity from the abdomen. It is the main muscle used in breathing. Hiccups may also be called singultus or hiccough.

  • some brain tumours
  • esophageal cancer
  • stomach cancer
  • pancreatic cancer
  • tumours of the mediastinum, which is the space in the chest between the lungs, breastbone and spine
  • lung cancer
  • bowel obstruction
  • surgery to the abdomen
  • some medicines

    Hiccups may be due to irritation of the nerve that controls the diaphragm. This irritation can be caused by:

    • tumour growth
    • enlarged liver
    • buildup of fluid in the abdomen, or ascites
    • extra air in the stomach, or gastric distension
    • inflammation of the esophagus, or esophagitis


 


Histology: There is a malignant gastric tubular adenocarcinoma.

Gastric Adenocarcinoma of the cardias

Gastric Adenocarcinoma of the cardias.

A 74 year-old female, with dysphagia to solid food and
weight loss of 60 pounds. Gastric adenocarcinoma that
protrude into the esophagus. More details Download the
video clip.

 


Gastric Adenocarcinoma

Gastric Adenocarcinoma

Gastric Adenocarcinoma that has been extended upwards
into to the middle portion of the esophagus.

An 85 year-old male with progressive dysphagia and
weight loss.

The endoscopic procedure revealed a gastric carcinoma
with an unusual presentation, showing itself as a large mass
of the fundus which extended upwards into to the middle
portion of the esophagus.


Early Gastric Adenocarcinoma

Cauliflower-like Infiltrating Gastric Carcinoma.

A 94 year-old female with long history of epigastric
pain, nausea, vomiting, sialorrea and weight loss
.



Early Gastric Adenocarcinoma

Advanced Gastric Carcinoma of the body.

A 54 year-old male who had been on treatment for a
supposed gastritis by a general practitioner for more than
a year. Patient did not reported weight loss.
The Gastrointestinal Video Endoscopy reveled advanced
Gastric Carcinoma of the body.

 

Early Gastric Adenocarcinoma

 

Gastric Adenocarcinoma which exhibits a mass effect and
 displays multiple ulcers.

Early Gastric Adenocarcinoma

Ulcerated Gastric Carcinoma of the body.

Gastrointestinal cancer is a major medical and economic
burden worldwide. Oesophageal and gastric cancers are
most common in the non-industrialized countries, while
colorectal cancer is the predominant gastrointestinal
malignancy in westernized countries. Their aetiology is
mainly related to correctable and preventable lifestyle
habits; namely diet (including obesity), physical activity,
alcohol and tobacco intake, and sanitation. Prevention
and/or treatment of Helicobacter pylori infection would
significantly reduce the prevalence of gastric cancer.
Screening for cancer, its early detection and treatment
requires medical facilities, endoscopic expertise and a
major investment of national financial resources. This is
only feasible in affluent industrialized countries such as
Japan for gastric cancer, some western countries for
esophageal and colorectal cancer. Only population
screening for colorectal cancer has been proven feasible
and cost-beneficial.

 

Bronchoscopyxz1

Large Gastric Adenocarcinoma of the body with central
 ulceration
.

Bronchoscopyxz1

Ulcerated Adenocarcinoma of the Body.

Bronchoscopyxz1

Endoscopic Image of Gastric Cancer

Gastric Adenocarcinoma presented as two ulcers at the
antrum and angle.

 

Bronchoscopyxz1

Video Endoscopic Sequence 1 of 2.

Adenocarcinoma of the cardias extending into the
esophagus.

 

Bronchoscopyxz1

Video Endoscopic Sequence 2 of 2.

Fundus Adenocarcinoma.

The endoscope is retroflexed, You can see a gastric
neoplasia that infiltrated the gastric cardias and the fornix.

 

Bronchoscopyxz1

Advanced Gastric Cancer.

 A large ulcerated mass is seen.
 




Bronchoscopyxz1

Infiltrating Adenocarcinoma.

Advanced adenocarcinoma of the corpus and fundus.

 

Bronchoscopyxz1

Ulcerated Adenocarcinoma of the body.



Bronchoscopyxz1

Adenocarcinoma of the Gastric Antrum.

A 45 year-old female with carcinoma of the antrum and with
obstructive signs. Nevertheless, the endoscopic diagnosis
was delayed, because the patient had multiple anti ulcer
treatment for over six months, having seen different
physicians and receiving diverse treatments without any
prior special diagnostic examinations, like an endoscopy,
etc.

This clinical history is repeated frequently, since many
people believe that they have an ulcer or gastritis; or
being told so by their doctor or any particular person,
without having any special exams (I.e. endoscopy).
One must always keep in mind that an ulcer or gastritis,
treated with modern prescription medicine, improves
greatly clinically, in as few as three or four days. Full
recovery is expected, within one month to six weeks after
the beginning of the treatment.
Any delay in clinical improvement is an important reason
for concern and cancer must be ruled out by endoscopy.


Bronchoscopyxz1

Adenocarcinoma of the antrum

A 77 year-old male with Ulcerated Gastric adenocarcinoma
with elevated margins in the area of the corpus and
antrum.

 

Bronchoscopyxz1

A 60 year-old male with extensive obstructing carcinoma.

 


Bronchoscopyxz1

Fornix gastric Adenocarcinoma.

Gastric ulcerated carcinoma of the fundus that causes
mild hemorrhage.

 


Bronchoscopyxz1

Extensive Gastric Carcinoma.

Ulcerated and Infiltrating Adenocarcinoma.

 


Bronchoscopyxz1

Ulcerated and infiltrating Gastric Adenocarcinoma.

Helicobacter pylori: Antral gastritis caused by H pylori
has been lined to the development of gastric cancer.
Patients with H pylori gastritis are 3-6 times more likely to
develop gastric cancer than individuals without the infection.

 

 

Bronchoscopyxz1

Infiltranting Adenocarcinoma of the Cardias.

A 76 year-old female with gastric adenocarcinoma of the
cardias.





Bronchoscopyxz1

Obstructing Gastric Adenocarcinoma.

A 63 year-old male with weight loss of more than 40 pounds
and vomiting. Obstructing gastric adenocarcinoma of the
cardias is observed.

 

 

Bronchoscopyxz1

Extensive infiltrating gastric adenocarcinoma.

A 50 year-old female with abdominal pain and weight loss
for a period of six months. Extensive infiltrating gastric
carcinoma is observed.

 

 

Bronchoscopyxz1

Extensive Infiltrating Gastric Adenocarcinoma.

A 75 year-old woman with ulcerated and infiltrating gastric
carcinoma of the corpus and fundus.

 

Bronchoscopyxz1

A 79 year-old male, weight loss more than 20 pounds
gastric adenocarcinoma of distal corpus and the antrum.

 

Bronchoscopyxz1

A 75 year-old female with ulcerated gastric carcinoma of
the antrum.

Infiltrating Adenocarcinoma of the Antrum.

Advanced Gastric Carcinoma that is observed as ulcerated
and infiltrating.

 



Infiltrating Adenocarcinoma of the Antrum.

Infiltrating Adenocarcinoma of the Antrum.

A 62 year-old with ulcerated and infiltrating
adenocarcinoma of the antrum of the diffuse type. 

 

 

Image of Gastric Polypoid Adenocarcinoma

Photography Sequence 1 of 9.

Image of Gastric Polypoid Adenocarcinoma

 

 

 

 

Press on the images to enlarge in a new window


Image of Gastric Polypoid Adenocarcinoma

Photography Sequence 2 of 9.

Image of Gastric Polypoid Adenocarcinoma

More images.


Image of Gastric Polypoid Adenocarcinoma

Photography Sequence 3 of 9.

Image of Gastric Polypoid Adenocarcinoma

 

Image of Gastric Polypoid Adenocarcinoma

Photography Sequence 4 of 9.

Image of Gastric Polypoid Adenocarcinoma

Image of Gastric Cancer

 

Image of Gastric Polypoid Adenocarcinoma

Photography Sequence 5 of 9.

Image of Gastric Polypoid Adenocarcinoma

Image of Polypoid Adenocarcinoma.

 

 

 


To enlarge the image in a new window press on it


 

Image of Gastric Polypoid Adenocarcinoma

Photography Sequence 6 of 9.

Image of Gastric Polypoid Adenocarcinoma

Press on the image to enlarge in a new window

 

Image of Gastric Polypoid Adenocarcinoma

Photography Sequence 7 of 9.

Appearance of Gastric Carcinoma

Image of Gastric Polypoid Adenocarcinoma

 

Image of Gastric Polypoid Adenocarcinoma

Photography Sequence 8 of 9.

Appearance of Gastric Cancer

Image of Gastric Polypoid Adenocarcinoma

 

 


To enlarge the image in a new window press on it

 

 

Image of Gastric Polypoid Adenocarcinoma

Photography Sequence 9 of 9.

Image of Gastric Polypoid Adenocarcinoma.

 

Endoscopy of Advanced Gastric Cancer

Video Endoscopic Sequence 1 of 5.

Gastric Adenocarcinoma of the antrum.


Endoscopy of Advanced Gastric Cancer

Video Endoscopic Sequence 2 of 5.

Endoscopy of Advanced Gastric Cancer

There are a small foci of bleeding that may cause the anemia.


Endoscopy of Advanced Gastric Cancer

Video Endoscopic Sequence 3 of 5.

Endoscopy of Advanced Gastric Cancer

After the biopsies, there is a slight but continuous bleeding



Endoscopy of Advanced Gastric Cancer

Video Endoscopic Sequence 4 of 5.

Endoscopy of Advanced Gastric Cancer

 

Endoscopy of Advanced Gastric Cancer

Video Endoscopic Sequence 5 of 5.

Endoscopy of Advanced Gastric Cancer

Argon Plasma Coagulation for hemostatic Therapy.

Endoscopy of Advanced Gastric Cancer

Video Endoscopic Sequence 1 of 4.

Advanced Gastric Cancer

80 year-old female, who, underwent a
gastro-jejunal anastomosis due to an advanced gastric cancer.

Endoscopy of Advanced Gastric Cancer

Video Endoscopic Sequence 2 of 4.

Endoscopy of Advanced Gastric Cancer

The pylorus is observed that apparently the duodenal bulb is infiltrated by this neoplasia.

Gastrojejunostomy (GJ) is a surgical procedure in which an anastomosis is created between the stomach and the proximal loop of the jejunum. This is usually done either for the purpose of draining the contents of the stomach or to provide a bypass for the gastric contents. Gastrojejunostomy can be done either by open or laparoscopic approach. Percutaneous gastrojejunostomy may be performed, in which a tube is placed through the abdominal wall into the stomach and then through the duodenum into the jejunum.

The first successful gastroenterostomy
(gastroduodenostomy) was carried out by Theodor Billroth in 1881. It was performed in a patient with carcinoma of the stomach following partial gastrectomy.

 

 

Endoscopy of Advanced Gastric Cancer

Video Endoscopic Sequence 3 of 4.

Gastric Adenocarcinoma

Gastro-jejunal anastomosis

Later that year, while operating on a case of pyloric carcinoma, Wolfer noted extension of the growth into the pancreas. Because gastrectomy was not possible, he went on to perform the first successful palliative gastrojejunostomy.

When Billroth attempted the same procedure, his patient succumbed to symptoms and postmortem findings of what is today known as afferent loop syndrome. To avoid this complication, the technique of the Roux-en-Y anastomosis was introduced by Wolfer in 1883 and later popularized by Cesar Roux of Lausanne in 1887.

In 1885, when Billroth encountered a large pyloric tumor during laparotomy, instead of a gastroduodenostomy, he anastomosed a loop of jejunum to the stomach proximal to the growth because the patient was not fit for primary resection due to malnourishment secondary to gastric outlet obstruction. In the second stage, Billroth resected the tumor and closed the cut ends of stomach and duodenum, which was described by von Hacker as Billroth II partial gastrectomy.

In 1888, Kroenlein unsuccessfully attempted modification of Billroth II partial gastrectomy by anastomosing the side of jejunum directly to cut the end of the stomach. One year later, von Eiselsberg performed the same procedure successfully, which in the following years was modified by Mikulicz, Reichel, Polya, and Finsterer. The Polya gastrectomy is a commonly performed alternative to Billroth II procedure.



Endoscopy of Advanced Gastric Cancer

Video Endoscopic Sequence 4 of 4.

Endoscopy of Advanced Gastric Cancer

Based on his anatomic studies, Petersen recommended an anastomosis of the high jejunal loop to the posterior surface of the stomach to avoid the long looped Roux-en-Y anastomosis. This technique forms the basis of the posterior gastroenterostomy procedure done today.

Alongside new techniques, surgeons also began to study and describe the various complications encountered. In 1899, Braun described the first jejunal ulcer resulting from a gastroenterostomy. In 1913, a paper on the unfavorable effects of gastroenterostomy was presented by Hertz. Mix coined the term dumping syndrome and described its characteristics in 1922. The use of vagotomy by Dragdtedt and Owens in 1943 was a significant milestone in peptic ulcer therapeutics. This neurosection was soon accompanied by a gastrojejunostomy to overcome the gastric stasis. This procedure is practiced today.

The gastrojejunostomy procedure was slow to gain popularity as reports in 1884 showed that only 2 out of 7 patients had survived the procedure.[3] By 1900, Mayo-Robson reported a mortality of only 16.4% in 188 consecutive cases. By the end of the 20th century, advances such as laparoscopic , percutaneous, and endoscopic gastrojejunostomy and use of the technique in bariatric procedures had been popularized. Gastrojejunostomy is now a routine procedure performed by surgeons all over the world.


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