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• W2891114298 abstract "Question: A 40-year-old man with history of hypertension, hyperlipidemia, and acid reflux was admitted for a 4-day history of melena. He had an episode of hemoglobin of 5 g/dL in the past on routine physical examination and the workup included an esophagogastroduodenoscopy, colonoscopy, capsule endoscopy, and an anterograde and retrograde double balloon with findings only of gastric polyps. He takes naproxen occasionally for body aches. On admission, he was tachycardic at 112 beats per minute but with a normal blood pressure. Physical examination was normal. Initial laboratory revealed hemoglobin of 8.3 g/dL, compared with 12 g/dL 4 days ago. Sera blood urea nitrogen and creatinine were 18 mg/dL and 1.3 mg/dL, respectively. The rest of his laboratory examinations were unremarkable. A push enteroscopy was done with advancement to the proximal jejunum revealing numerous gastric polyps ranging from 5 to 10 mm in the body and fundus of the stomach. A single 10-mm polyp that was bleeding in the fundus of the stomach was removed via hot snare polypectomy. Pathology later revealed fundic gland polyp. Because of the finding of numerous gastric polyps, a decision to proceed with a capsule endoscopy, which showed an abnormal-appearing ampulla of Vater (Figure A–C). A side viewing duodenoscope revealed a prominent looking ampulla (Figure D, E) and was subsequently biopsied (Figure F). What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. At 20× magnification, the biopsy showed closely packed glands with hyperchromatic stratified nucleus (arrows), consistent with an adenoma. Adenomas are the most common benign lesions of the ampulla, but have the potential to undergo malignant transformation to ampullary carcinomas. Ampullary adenomas can occur sporadically or in the setting of an adenomatous polyposis syndrome. Traditionally, a forward-viewing endoscopy or side-viewing endoscopies are recommended in patients with familial adenomatous polyposis for surveillance of periampullary and duodenal polyposis. Multiple studies have shown the limitation of capsule endoscopy to identify the ampulla of Vater with a diagnostic accuracy of 43.6% in a study by Kong et al.1Kong H. Kim Y.S. Hyun J.J. et al.Limited ability of capsule endoscopy to detect normally positioned duodenal papilla.Gastrointest Endosc. 2006; 64: 538-541Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar The reasons may be related to the speed at which the capsule passes through the fixed second part of the duodenum, active peristalsis at the second portion of the duodenum or because of the position of the ampulla that is difficult to identify.1Kong H. Kim Y.S. Hyun J.J. et al.Limited ability of capsule endoscopy to detect normally positioned duodenal papilla.Gastrointest Endosc. 2006; 64: 538-541Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar However, despite this limitation, if visualized, important pathologic processes can be identified and help in the treatment process, as in this case.2Badran A.M. Vahedi K. Berrebi D. et al.Pediatric ampullar and small bowel blue rubber bleb nevus syndrome diagnosed by wireless capsule endoscopy.J Pediatr Gastroenterol Nutr. 2007; 44: 283-286Crossref PubMed Scopus (7) Google Scholar, 3Sigounas D.E. Koulaouzidis A. Plevris J.N. Pyobilia seen during small-bowel capsule endoscopy (with video).Gastrointest Endosc. 2014; 80: 904-905Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar" @default.
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• W2891114298 date "2018-12-01" @default.
• W2891114298 modified "2023-10-06" @default.
• W2891114298 title "Unusual Pick Up by Capsule Endoscopy" @default.
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• W2891114298 doi "https://doi.org/10.1053/j.gastro.2018.08.051" @default.
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