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Video Endoscopic Sequence 1 of 16.
Gastric adenocarcinoma with infiltration to colon, splenic angle-transverse.
A 57 year-old, female, who lives in France when visiting her country of origin, El Salvador she consulted with a colleague of family medicine, palpating a mass on the left side of the mesogastrium, indicating an abdominal ultrasonography, which was indicative of neoplasia of the colon, was referred to our endoscopic unit for its respective colonoscopy finding a stenosis with an atypical infiltration, which gave us at first the suspicion of being a lymphoma or granulomatous disease such as TB, Histoplasmosis or even amoeboma.
See colonoscopy in Sequence 10 to 16 below.
For more endoscopic details download the video clips by
clicking on the endoscopic images, wait to be downloaded
complete then press Alt and Enter that you can appreciate
the video in full screen.
All endoscopic images shown in this Atlas contain
video clips.
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Video Endoscopic Sequence 2 of 16.
Gastric adenocarcinoma with infiltration to colon, splenic angle-transverse.
Signet ring cell carcinoma of the colorectum very rare; most cases are detected at an advanced stage. Therefore, its prognosis is poorer than that of ordinary colorectal cancer. tenemos un caso en este atlas
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Video Endoscopic Sequence 3 of 16.
Another image and video
There is thickening of folds and ulcers
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Video Endoscopic Sequence 4 of 16.
Gastric adenocarcinoma with infiltration to colon, splenic-transverse angle.
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Video Endoscopic Sequence 5 of 16.
Retroflexed image, cronic gastritis and a pseudo-follicular gastritis is displayed.
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Video Endoscopic Sequence 6 of 16.
Retroflexed image
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Video Endoscopic Sequence 7 of 16.
A close up to to the largest ulcer
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Video Endoscopic Sequence 8 of 16.
Adenocarcinoma Gástrico con infiltración a colon, angulo esplecnico-transverso.
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Video Endoscopic Sequence 9 of 16.
Se obtienen sus respectivas biopsias
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Video Endoscopic Sequence 10 of 16.
Colonoscopy
Splenic angle stenosis due to infiltration of gastric adenocarcinoma with signet ring cells, this study had been performed first due to the mass presented in the abdomen and what the ultrasonography displays.
There is a certain invagination of the mucosa
Colonoscopy finding a stenosis with an atypical infiltration, which gave us at first the suspicion of being or a lymphoma or granulomatous disease such as TB, Histoplasmosis or even a amoeboma.
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Video Endoscopic Sequence 11 of 16.
Splenic angle stenosis due to infiltration of gastric adenocarcinoma with signet ring cells.
Signet ring cell carcinoma of the colorectum very rare; most cases are detected at an advanced stage. Therefore, its prognosis is poorer than that of ordinary colorectal cancer. We have a case in colon_carcinoma_ii
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Video Endoscopic Sequence 12 of 16.
Splenic angle stenosis due to infiltration of gastric adenocarcinoma with signet ring cells.
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Video Endoscopic Sequence 13 of 16.
Colonoscopy
Splenic angle stenosis due to infiltration of gastric adenocarcinoma with signet ring cells.
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Video Endoscopic Sequence 14 of 16.
Splenic angle stenosis due to infiltration of gastric adenocarcinoma with signet ring cells.
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Video Endoscopic Sequence 15 of 16.
Splenic angle stenosis due to infiltration of gastric adenocarcinoma with signet ring cells
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Video Endoscopic Sequence 16 of 16.
Infiltration of gastric adenocarcinoma to the colon
Splenic angle stenosis due to infiltration of gastric adenocarcinoma with signet ring cells
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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.
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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.
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Video Endoscopic Sequence 3 of 8.
Gastric Adenocarcinoma
Another image and video clip of this advanced and ulcerated neoplasia.
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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.
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Video Endoscopic Sequence 5 of 8.
Gastric Adenocarcinoma and Gastric Varices
Some isolated gastric varices were found at the fundus.
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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.
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Video Endoscopic Sequence 7 of 8.
Gastric Adenocarcinoma and Gastric Varices
More images and video clips of this case of adenocarcinoma with gastric varices.
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Video Endoscopic Sequence 8 of 8.
Gastric Adenocarcinoma and Gastric Varices
This image display the neoplasia in frontal view.
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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.
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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.
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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.
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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.
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Video Endoscopic Sequence 5 of 8.
Early gastric cancer with signet ring cell
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Video Endoscopic Sequence 6 of 8.
Early gastric cancer with signet ring cell
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Video Endoscopic Sequence 7 of 8.
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Video Endoscopic Sequence 8 of 8.
Early gastric cancer with signet ring cell
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Video Endoscopic Sequence 1 of 6.
Gastric Adenocarcinoma
A 73 year-old male, who in a previous endoscopy in his country found a mass in his stomach, who comes from the Republic of Honduras for a second opinion, since the previous biospies were inconclusive, the eyes with jaundice and axial tomography with multiple metastases.
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Video Endoscopic Sequence 2 of 6.
Pre-pyloric mass
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Video Endoscopic Sequence 3 of 6.
Ulcerated mass in the posterior wall of the antrum
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Secuencia Video Endoscópica 4 de 6.
Numerous ulcerated polyps are displayed, all positive to intestinal adenocarcinoma |
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Video Endoscopic Sequence 5 of 6.
A close-up to ulcerated polyps as part of this neoplasm. |
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Video Endoscopic Sequence 6 of 6.
More images and video clips of this case. |
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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.
But in this case the cancer occurs in the lower third of the esophagus and gastric fundus, possibly the etiology was, gastroesophageal reflux, sequence barrett to esophageal adenocarcinoma.
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.
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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.
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Video Endoscopic Sequence 3 of 3.
Gastric Adenocarcinoma of the fundus
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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.
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Video Endoscopic Sequence 2 of 4.
Endoscopy of Recurent Gastric Adenocarcinoma.
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Video Endoscopic Sequence 3 of 4.
Endoscopy appearance of a Gastric Adenocarcinoma
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Video Endoscopic Sequence 4 of 4.
Endoscopy of Recurent Gastric Adenocarcinoma
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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.
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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.
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Video Endoscopic Sequence 3 of 4.
Endoscopy Gastric Adenocarcinoma.
Status post Surgery of the case above displayed
Jejunum-jejunum anastomosis.
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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.
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Video Endoscopic Sequence 1 of 21.
Endoscopy of Early Gastric Cancer.
This 60 year-old male with vague abdominal discomfort.
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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.
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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.
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Video Endoscopic Sequence 4 of 21.
Endoscopy of Early Gastric Cancer.
Five days after a follow up endoscopy was performed.
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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.
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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.
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Video Endoscopic Sequence 7 of 21.
Gastric Adenocarcinoma
Lugol Chromoendoscopy
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Video Endoscopic Sequence 8 of 21.
Gastric Adenocarcinoma
Panoramic view of the gastric fundus with the tumor.
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Video Endoscopic Sequence 9 of 21.
Gastric Adenocarcinoma
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Video Endoscopic Sequence 10 of 21.
Gastric Adenocarcinoma |
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Video Endoscopic Sequence 11 of 21.
Gastric Adenocarcinoma
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Video Endoscopic Sequence 12 of 21.
Gastric Adenocarcinoma |
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Video Endoscopic Sequence 13 of 21.
Gastric Adenocarcinoma
Lymphatic nodules of the lesser curvature.
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Video Endoscopic Sequence 14 of 21.
Gastric Adenocarcinoma |
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Video Endoscopic Sequence 15 of 21.
Gastric Adenocarcinoma
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Video Endoscopic Sequence 16 of 21.
Gastric Adenocarcinoma
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Video Endoscopic Sequence 17 of 21.
Gastric Adenocarcinoma
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Video Endoscopic Sequence 18 of 21.
Gastric Adenocarcinoma
Microscopic pictures of the malignant neoplasia with invasion of the submucosa.
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Video Endoscopic Sequence 19 of 21.
Microscopic pictures of the malignant neoplasia with invasion of the submucosa.
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Video Endoscopic Sequence 20 of 21.
Gastric Adenocarcinoma
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Video Endoscopic Sequence 21 of 21.
Gastric Adenocarcinoma
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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.
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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.
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Obstructed Adenocarcinoma.
Gastric Adenocarcinoma
Gastric Carcinoma that produces antrum and distal body
obstruction.
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Gastric Adenocarcinoma
Ulcerated Gastric Adenocarcinoma of the incisura angularis.
An 81 year old female with abdominal pain and weight loss
of 20 pounds.
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Endoscopy of Gastric Adenocarcinoma
Gastric Adeno-Carcinoma that produces obstruction of the
gastric body.
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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.
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Video Endoscopic Sequence 2 of 2.
The antrum is deformed, the margin of the tumor are
elevated.
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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.
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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.
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Video Endoscopic Sequence 2 of 3.
The image displays obtaining some biopsies of the
neoplasia.
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Video Endoscopic Sequence 3 of 3.
Gastric Adenocarcinoma
The image and the video clip display a ulcerated deforming
antrum.
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Gastric Adenocarcinoma
A 75 year-old woman with ulcerated and infiltrating gastric
carcinoma.
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Gastric Adenocarcinoma
A 62 year-old male with diffuse gastric carcinoma with
superficial mucosal necrosis.
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62 year old male with obstructing Gastric Adenocarcinoma.
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Gastric Adenocarcinoma of the fundus.
An 84 year-old male with weight loss of 40 pounds.
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Ulcerated Adenocarcinoma.
A 36 year-old male with ulcerated adenocarcinoma of the
posterior wall of the corpus.
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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. |
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Video Endoscopic Sequence 2 of 2.
There is a malignat gastric glandular neoplasia, tubular
(Intestinal Type).
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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.
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Adenocarcinoma of the Gastric Antrum.
A 60 year-old dumb deaf woman with ulcerated
carcinoma at the pre-pyloric antrum. |
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Adenocarcinoma of the Gastric Antrum.
Ulcerated Gastric Carcinoma of the antrum with signet ring
cells.
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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.
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Gastric Adenocarcinoma
A 60 year-old male with Gastric Adenocarcinoma of the
fundus. |
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Gastric Adenocarcinoma
A 69 year-old male with Gastric Adeno Carcinoma of the
cardias.
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Ulcerated Adenocarcinoma of the fundus and the cardias.
A 56 year-old male from the republic of Spain.
He had disphagia and epigastric pain.
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Gastric Adenoarcinoma of the fundus.
A 66 year-old male with weight loss of 22 pounds and
disphagia anorexia and vomiting.
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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.
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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.
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Video Endoscopic Sequence 2 of 2.
Gastric Adenocarcinoma of the Antrun
The antrum is deformed, the margin of the tumor are
elevated.
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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.
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Gastric Adenocarcinoma of the fundus.
An 84 year-old male with weight loss of 40 pounds.
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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.
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Video Endoscopic Sequence 2 of 3.
Endoscopy of Gastric Adenocarcinoma
The image displays obtaining some biopsies of the
neoplasia.
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Video Endoscopic Sequence 3 of 3.
Endoscopy of Gastric Adenocarcinoma
The image and the video clip display a ulcerated deforming
antrum.
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Ulcerated Adenocarcinoma.
A 36 year-old male with ulcerated adenocarcinoma of the
posterior wall of the corpus.
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Adenocarcinoma of the fornix
A 64 year-old male with adenocarcinoma of the fundus.
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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.
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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. |
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Video Endoscopic Sequence 2 of 5.
Endoscopy of Gastric Adenocarcinoma
Retroflexed image, observing the neoplasia that infiltrates the gastric cardias.
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Video Endoscopic Sequence 3 of 5.
Endoscopy of Gastric Adenocarcinoma
More images of the gastric cardias.
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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.
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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.
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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.
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Video Endoscopic Sequence 2 of 3.
Endoscopy of a Gastric Cancer
The images and video clips show a large ulcerated tumor.
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Video Endoscopic Sequence 3 of 3.
More images and video clips.
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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. |
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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.
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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.
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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.
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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.
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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.
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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.
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Video Endoscopic Sequence 2 of 3.
Recurrent Gastric Cancer after Gastrectomy Billroth II
Gastro-jejuno-anastomosis.
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Video Endoscopic Sequence 3 of 3.
Recurrent Gastric Cancer after Gastrectomy Billroth II
More images and video clips.
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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.
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Video Endoscopic Sequence 2 of 5.
This image shows irregular ulcerated adenocarcinoma.
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Video Endoscopic Sequence 3 of 5.
Endoscopy of Gastric Adenocarcinoma in the Early Phase
More images and video clips.
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Video Endoscopic Sequence 4 of 5.
Endoscopy of Gastric Adenocarcinoma in the Early Phase
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Video Endoscopic Sequence 5 of 5.
Endoscopy of Gastric Adenocarcinoma in the Early Phase
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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.
Histology: There is a malignant gastric tubular adenocarcinoma.
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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.
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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.
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Cauliflower-like Infiltrating Gastric Carcinoma.
A 94 year-old female with long history of epigastric
pain, nausea, vomiting, sialorrea and weight loss.
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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.
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Gastric Adenocarcinoma which exhibits a mass effect and
displays multiple ulcers.
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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.
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Large Gastric Adenocarcinoma of the body with central
ulceration. |
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Ulcerated Adenocarcinoma of the Body.
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Endoscopic Image of Gastric Cancer
Gastric Adenocarcinoma presented as two ulcers at the
antrum and angle.
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Video Endoscopic Sequence 1 of 2.
Adenocarcinoma of the cardias extending into the
esophagus.
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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.
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Advanced Gastric Cancer.
A large ulcerated mass is seen.
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Infiltrating Adenocarcinoma.
Advanced adenocarcinoma of the corpus and fundus.
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Ulcerated Adenocarcinoma of the body.
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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.
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Adenocarcinoma of the antrum
A 77 year-old male with Ulcerated Gastric adenocarcinoma
with elevated margins in the area of the corpus and
antrum.
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A 60 year-old male with extensive obstructing carcinoma.
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Fornix gastric Adenocarcinoma.
Gastric ulcerated carcinoma of the fundus that causes
mild hemorrhage.
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Extensive Gastric Carcinoma.
Ulcerated and Infiltrating Adenocarcinoma.
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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.
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Infiltranting Adenocarcinoma of the Cardias.
A 76 year-old female with gastric adenocarcinoma of the
cardias.
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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.
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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.
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Extensive Infiltrating Gastric Adenocarcinoma.
A 75 year-old woman with ulcerated and infiltrating gastric
carcinoma of the corpus and fundus.
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A 79 year-old male, weight loss more than 20 pounds
gastric adenocarcinoma of distal corpus and the antrum.
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A 75 year-old female with ulcerated gastric carcinoma of
the antrum.
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Advanced Gastric Carcinoma that is observed as ulcerated
and infiltrating.
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Infiltrating Adenocarcinoma of the Antrum.
A 62 year-old with ulcerated and infiltrating
adenocarcinoma of the antrum of the diffuse type.
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Photography Sequence 1 of 9.
Image of Gastric Polypoid Adenocarcinoma
Press on the images to enlarge in a new window
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Photography Sequence 2 of 9.
Image of Gastric Polypoid Adenocarcinoma
More images.
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Photography Sequence 3 of 9.
Image of Gastric Polypoid Adenocarcinoma
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Photography Sequence 4 of 9.
Image of Gastric Polypoid Adenocarcinoma
Image of Gastric Cancer
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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
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Photography Sequence 6 of 9.
Image of Gastric Polypoid Adenocarcinoma
Press on the image to enlarge in a new window
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Photography Sequence 7 of 9.
Appearance of Gastric Carcinoma
Image of Gastric Polypoid Adenocarcinoma
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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
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Photography Sequence 9 of 9.
Image of Gastric Polypoid Adenocarcinoma.
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Video Endoscopic Sequence 1 of 5.
Gastric Adenocarcinoma of the antrum.
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Video Endoscopic Sequence 2 of 5.
Endoscopy of Advanced Gastric Cancer
There are a small foci of bleeding that may cause the anemia.
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Video Endoscopic Sequence 3 of 5.
Endoscopy of Advanced Gastric Cancer
After the biopsies, there is a slight but continuous bleeding
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Video Endoscopic Sequence 4 of 5.
Endoscopy of Advanced Gastric Cancer
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Video Endoscopic Sequence 5 of 5.
Endoscopy of Advanced Gastric Cancer
Argon Plasma Coagulation for hemostatic Therapy.
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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.
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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.
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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.
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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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