Gastric Ulcer
Hourglass Stomach.

Video Endoscopic Sequence 1 of 14.

Hourglass Stomach.

This 62 year-old female, have been presented with severe abdominal pain since two months, in addition to the ulcer, she has choledocolitiasis and a big abdominal hernia.

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Endoscopic Image of Hourglass Stomach.

Video Endoscopic Sequence 2 of 14.

Endoscopic Image of Hourglass Stomach.

Hourglass Stomach a stomach more or less completely and permanently divided into two parts, so that it resembles an hourglass in shape; the deformity is due to scarring which complicates gastric ulcer or neoplasia.

A deformity of the stomach in which the ‘waist’ is constricted by fibrosis caused by a chronic peptic ulcer, producing an upper and a lower cavity separated by a narrow channel.


Endoscopy of of Hourglass Stomach

Video Endoscopic Sequence 3 of 14.

Endoscopy of of Hourglass Stomach.

Retraction of the gastric wall adjacent to lesser-curve ulcers may lead to the formation of smooth, symmetric folds that radiate from the ulcer crater. The opposite wall may also be retracted; this produces an incisura of the greater curvature and, ultimately, an hourglass stomach.


Endoscopy of of Hourglass Stomach

Video Endoscopic Sequence 4 of 14.

Endoscopy of of Hourglass Stomach

Hour-Glass Contraction

The image and the video clip show retraction of the gastric walls, therefore giving us the formation of an invagination. With little of resistance, the endoscope, it is advanced to the antrum.

 

Endoscopy of of Hourglass Stomach

Video Endoscopic Sequence 5 of 14.

Endoscopy of Hourglass Stomach.


 

Endoscopy of of Hourglass Stomach

Video Endoscopic Sequence 6 of 14.

Endoscopy of of Hourglass Stomach

Due to the retraction of the gastric wall, to overcome some difficulties, some maneuver to look the pylorus were achieved.


Endoscopy of of Hourglass Stomach

Video Endoscopic Sequence 7 of 14.

Follow up endoscopy.

After four days of treatment with lanzoprazol 30 mg twice a day, a follow up endoscopy was performed.


Endoscopy of of Hourglass Stomach

Video Endoscopic Sequence 8 of 14.

In spite of a short treatment of four days with PPI´s, there are generative epithelium and less resistance to the passage of the endoscope through narrowness.


Endoscopy of of Hourglass Stomach

Video Endoscopic Sequence 9 of 14.

Hourglass Stomach.

A close up of generative epithelium at the border of the ulcer, magnifying image.

 

Endoscopy of of Hourglass Stomach

Video Endoscopic Sequence 10 of 14.

Hourglass Stomach.

A close up of generative epithelium at the border of the ulcer, magnifying image.


Endoscopy of of Hourglass Stomach

Video Endoscopic Sequence 11 of 14.

Chromoendoscopy using indigo carmine.


Endoscopy of of Hourglass Stomach

Video Endoscopic Sequence 12 of 14.

High-resolution chromoendoscopy.

Chromoendoscopy, the intravital staining of gastrointestinal. epithelia, provides additional diagnostic information with respect to the epithelial morphology and pathophysiology. Based on experience gathered, chromoendoscopy is now in more widespread use, in particular to identify preneoplastic and neoplastic lesions.

 

Endoscopy of of Hourglass Stomach

Video Endoscopic Sequence 13 of 14.

More images and video clips of Hourglass Stomach with indigo carmin stain.





 

Endoscopy of of Hourglass Stomach

Video Endoscopic Sequence 14 of 14.

Chromoendoscopy.

Is a technique used to study the fine details of the mucosa throughout the gastrointestinal tract. Chromoendoscopy combines high resolution endoscopy with various methods of vital staining of epithelial structures. In these methods, during endoscopy, tissues are coloured by a stain introduced through a spray catheter. The staining techniques are technically simple, economical and easy to perform.

 


 

Hourglass Stomach.

Video Endoscopic Sequence 1 of 10.

Hourglass Stomach.

This 67 year-old woman, presented with abdominal pain, nausea and vomiting, endoscopy displays an image that divided the stomach into two parts due to retraction of the gastric wall.

Ulcers may lead to the formation of smooth, symmetric folds that radiate from the ulcer crater. The opposite wall may also be retracted; this produces an incisura of the greater curvature and, ultimately, an hourglass stomach.

Hourglass Stomach.

 




Hourglass Stomach.

Video Endoscopic Sequence 2 of 10.

Endoscopy of Hourglass Stomach.

Healing of antral ulcers is associated with narrowing and deformity that may mimic malignancy. The hourglass stomach results from the healing of a lesser-curve ulcer and marked retraction or deformity of the opposite wall.






Hourglass Stomach

Video Endoscopic Sequence 3 of 10.

Endoscopy of Hourglass Stomach.

Hourglass deformity caused by fibrosis. This ulcer is healing, with fibrosis dividing the body of the stomach into 2 compartments.

 

 

Endoscopy of Hourglass Stomach.

Video Endoscopic Sequence 4 of 10.

A follow up endoscopy was performed after two months of PPI treatment.

View from retroflexed image.

 

Endoscopy of Hourglass Stomach.

Video Endoscopic Sequence 5 of 10.

Endoscopy of Hourglass Stomach.

Video Endoscopic Sequence 6 of 10.

The biopsies ruled out malignancy, a follow up endoscopy was performed finding complete resolution of this process.



Endoscopy of Hourglass Stomach.

Video Endoscopic Sequence 7 of 10.

After two months of PPI treatment a follow up endoscopy was performed finding the images and videos presented here, (retroflexed image).


Endoscopy of Hourglass Stomach.

Video Endoscopic Sequence 8 of 10.

There are less retractable wall and multiple scars


Endoscopy of Hourglass Stomach.

Video Endoscopic Sequence 9 of 10.

More images and video clips

 

Endoscopy of Hourglass Stomach.

Video Endoscopic Sequence 10 of 10.

A stomach with an equatorial constriction usually caused by formation of scar tissue around an ulcer.

 

Hourglass Ulcers

Video Endoscopic Sequence 1 of 5.

Hourglass Ulcers constriction at the proximal gastric corpus.

A 42-year-old alcoholic man, with a history of vomiting and abdominal pain, presented hematemesis. A failed upper endoscopy was performed at a Public Hospital, which it was given diagnose of an obstructive stomach. We performed an upper endoscopy observing red blood remains and signs of Mallory Weiss Syndrome, which it was treated with Plasma Argon Coagulator. After maneuvering, we were able to overcome the obstruction at the gastric body. Hourglass ulcers constriction was observed which causes the obstruction.

 

Endoscopy of Hourglass Stomach.

Video Endoscopic Sequence 2 of 5.

Hourglass stricture of the proximal gastric corpus.

The image and the video display a proximal hourglass stricture of the gastric corpus.The video clip displays resistance to pass the endoscope through the stenosis.

Retraction of the gastric wall adjacent to lesser-curve ulcers may lead to the formation of smooth, symmetric folds that radiate from the ulcer crater. The opposite wall may also be retracted; this produces an incisura of the greater curvature and, ultimately, an hourglass stomach.


Video Endoscopic Sequence 3 of 5.

Another image and video of this endoscopic sequence.The antrum is observed with diffuse redness and rest of blood.

Occasionally, a gross horizontal fibrous contracture in association with long-standing ulceration can cause a permanent hourglass constriction, or the lesser curvature can shorten longitudinally.


Video Endoscopic Sequence 4 of 5.

The pre-pyloric antrum.

 

 

Endoscopy of Hourglass Stomach.

Video Endoscopic Sequence 5 of 5.

A Mallory Weiss tear was found, and argon plasma coagulator APC was used to the point of bleeding.


Endoscopy of Hourglass Stomach.

Video Endoscopic Sequence 1 of 4.

Hourglass Stomach.

This 72 year-old female, underwent this upper endoscopy due to abdominal pain, nauseas and vomiting.


Endoscopy of Hourglass Stomach.

Video Endoscopic Sequence 2 of 4.

Endoscopy of Hourglass Stomach.

Hourglass stricture or stenosis of stomach.

 

Endoscopy of Hourglass Stomach.

Video Endoscopic Sequence 3 of 4.

The retroflexed image show one of the ulcers

Endoscopy of Hourglass Stomach.

Video Endoscopic Sequence 4 of 4.

3 Ulcers are seen

In this Endoscopic image there are three ulcers which perhaps was at first a single ulcer healing and has caused extensive fibrosis retracting the tissue and dividing the stomach into two parts.

 

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